School-Based Projects INHL 681 Outline and Execution of Conceptive Wellbeing Programs

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In formal classes or as after-school exercises. One time sessions versus longer-term ... 3) Clear message on sexual action and condom or preventative use and ...

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School-Based Programs INHL 681 Design and Implementation of Reproductive Health Programs Ilene S. Speizer November 26, 2001

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Demographic Trends Today, 30% of the total populace is between the ages of 10-24 years; 83.5% of the world's youngsters live in creating nations; In various nations in sub-Saharan Africa there are 5 times the quantity of individuals <15 years than more than 55; In numerous creating nations youngsters make up 20-25% of the populace; in Japan and France it is 13% and 14%, in China, 16%.

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Education and Marriage by and large, there is a 30% spread in adolescent marriage when young ladies with more years of tutoring are contrasted and less Education Region > 6 years < 6 years Sub-Saharan Africa 38.4 71.4 Near East/North Africa 18.5 49.8 Asia 19.8 56.0 Latin America/Caribbean 30.0 62.1

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Education, Age and Birth Education Region > 6 years < 6 years Sub-Saharan Africa 37.0 63.8 Near East/North Africa 8.6 35.0 Asia 17.1 45.7 Latin America/Caribbean 21.3 53.1 Percentage of ladies matured 20-24 who conceived an offspring before age 20, by district, as indicated by habitation and years of training, 1980s-90s.

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Consequences of Education Delay in period of marriage; Rise in fatherless births; Rise in undercover premature births; Rise in number of sexual accomplices with related dangers of AIDs and different STDs.

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Secondary School enlistment rates in optional school, by district and year, ages 12-17 East Asia/Pacific Near East/North Africa Latin America/Caribbean South Asia Sub-Saharan Africa

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Adolescent Risk-Taking: Early Age of Sexual Debut Adolescent young men and young ladies having intercourse mid: 56% of guys, 32% of females 15-19 ever had intercourse in Paraguay (76% and 29% for Brazil age 11-19; About portion of youngsters age 10-24 are sexually experienced in sub-Saharan Africa (Togo, Ghana, Zambia, South Africa), exemption Zimbabwe. Center results

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51-60% Burkina Faso 54.1% Ghana 59.0% <20% Philippines 8.1% Rwanda 14.2% Peru 18.4% 31-40% Paraguay 30.1% Senegal 35.4% 61-70% Zambia 60.5% Niger 60.9% Uganda 61.6% Central African Republic 62.0% Mali 66.0% Cote d'Ivorie 68.1% Cameroon 68.5% 21-30% Kazakstan 20.5% Brazil (NE) 22.5% Bolivia 22.9% Guatemala 25.0% Dominican Republic 26.9% Colombia 29.6% Haiti 29.0% Zimbabwe 29.7% 41-half Namia 42.4% Kenya 46.1% Tanzania 49.9% Adolescent Sexual Activity % of youths who have ever engaged in sexual relations

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11-20% Kenya 12.5% Madagascar 13.7% Senegal 15.8% Tanzania 16.5% Uganda 16.9% Bolivia 14.8% Dominican Republic 14.2% Haiti 14.3% 21-30% Peru 22.7% Columbia 25.6% Brazil (NE) 22.5% Zimbabwe 20.5% Namibia 22.5% Mali 25.6% Ghana 22.4% C. African Republic 20.4% Burkina Faso 21.3% <10% Malawi 7.9% Niger 8.4% Rwanda 7.5% Zambia 3.5% Guatemala 6.1% Paraguay 9.2% 31-40% Nigeria 30.7% Cote d'Ivoire 34.9% Kazakstan 39.0% 40% + Cameroon 52.7% Adolescent Risk-Taking: Contraceptive Use Percent of sexually dynamic 15-19 year olds utilizing any technique for contraception Low use at first sex

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Adolescent Risk-Taking: Other Outcomes Multiple sexual accomplices Exchange of sex for cash - "business sex", sugar daddies Non-RH hazard taking practices - liquor, sedate utilize (degenerate practices) Multitude of predecessors identified with RH results

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Antecedents - components connected with hazard taking Three Broad Groups: Biological - age, sex, testosterone - coordinate Attitudes and convictions identified with sexual action usually tended to by sexuality programs Social complication - fierce wrongdoing, destitution, unemployment, and so on youth improvement programs

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Why Are School Based Programs Attractive? Where instruction is obligatory, get high presentation to program Provide data ahead of schedule, before young people turn out to be sexually dynamic. Mindful group of onlookers in an organized situation

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Why Are School Based Programs Controversial? We are discussing SEX here, and that is disputable Fear that giving data in the schools will energize early sex Discomfort of instructors and executives to discuss sex Role of school medical caretaker in educating and arrangement of administrations misty

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Who ought to choose what is educated? Government (national or nearby) School organization Teachers: assume a part since they execute Parents School nurture Based on expressed needs of teenagers Unclear what ought to be shown Family life training (code word for something?) General science or life structures STD/HIV data (realities, or counteractive action messages?) address homosexuality, masturbation, premarital sexual action, fetus removal Decisions About Implementation Are Unclear

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Decisions About Implementation, proceeded with Who ought to be instructed? What is the right age to start projects Should children be required to have authorization slips Should young men and young ladies be part up for sessions? In formal classes or as after-school exercises One time sessions versus longer-term programs Only the 'high – hazard' kids? I wager we have difference in the room on these issues

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What Works? Sorts of S-B Programs (U.S. Certainties First) Abstinence just instruction Impacts on deferring sex uncertain, however not empowering; sexually experienced not influenced Abstinence based sexuality and HIV educ. Forbearance not worried as ONLY satisfactory conduct, likewise portrays advantages of cont. No effect on expanding sex Out of 28 studies: 9 postponed start; 18 no effect; 1 rushed start Some effects on expanding prophylactic utilize Condom impacts with AIDS instruction (esp. high-chance guys)

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Common Characteristics of Effective Curricula (Kirby) 1) Focus on lessening at least one sexual practices that prompt to unintended pregnancy or HIV/STD disease 2) Use hypothetical methodologies that impact wellbeing related hazardous practices – social psychological hypothesis, social impact, contemplated activity, or hypothesis of arranged conduct. 3) Clear message on sexual movement and condom or prophylactic utilize and fortify the message. 4) Provide fundamental, exact data on dangers of high schooler sexual action and strategies to maintain a strategic distance from intercourse or utilize security. 5) Include exercises to address social weights that impact sexual conduct

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Characteristics of Effective Curricula (Kirby), cont. 6) Provide displaying and routine of correspondence, transaction, and refusal aptitudes (e.g., pretending) 7) Employ an assortment of instructing techniques to include understudies and encourage them to customize information. 8) Use age suitable and socially fitting objectives, showing techniques and materials. 9) Last an adequate timeframe – at least 14 hours, or a littler number of hours yet youth who volunteered and worked in little gatherings. 10) Train and select instructors and companion pioneers who are inspired.

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School-Based or School-Linked Clinics Most school centers give insignificant RH administrations Few really give medicines or apportion contraception or condoms. Perfect, in principle (if well run and very much staffed): area helpful achieve both guys and females give complete wellbeing administrations secret staff chose and prepared to work with youth simple to give catch up administrations are free effortlessly incorporate instruction, advising and benefits Exception – don't connect of school or more established youth

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School Condom Availability Programs Importance of HIV/AIDS Making condoms accessible in schools - by school attendant, advisor, or candy machines Results uncertain because of changing outlines and tests

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What Do We Know About S-B Programs in Developing Countries? Overpowering number of the effect thinks about found were on school based projects (22 out of 39) Most projects had impacts on information and demeanors, less had impacts on behavs. Little is known on long haul impacts on KASB

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AIDS Education in Nigeria - Fawole et al. Complete wellbeing ed. educational programs - six week after week AIDS/HIV ed sessions (2-6 hrs each) - addresses, film, pretend, stories, tunes, talks about, papers. 2 trial schools, and 2 control Baseline and follow-up information from an arbitrary example of classes in every school. Follow-up 6 months after the fact

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Baseline: No distinctions in demographics No distinctions in learning and demeanors No distinctions in sexual practices Follow-up: information more noteworthy in exploratory gathering dispositions more positive in trial bunch practices of test gathering less hazardous at development (no control for demog refinements between) Nigeria Results

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Sexuality Education in Jamaica The Grade 7 Project Sexuality and FLE for advertisements. 11-14 (review 7) Abstinence advancement and hazard diminishment/more secure sex program Nine month educational modules, coeducational sessions once every week (45 min every) Lectures, visual guides, and little gathering circles. 5 mediation, 5 coordinated examination schools, longitudinal outline - 9 mo (92%) and 21 mo (76%) development

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9-month follow-up Improved information (4/7 things) More moderate dispositions (sex action and juvenile parenthood) No effect on sexual start Slight effect on use at first sex 21-month follow-up Knowledge impacts not maintained Attitudinal effects not supported No effect on sexual start No distinction being used among the individuals who started sex in f.u. Jamaica Results

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FOCUS Results on S-B Programs Effective in affecting sexual-regenerative wellbeing information and states of mind Roughly half have affected transient practices. Degree to which they impact long haul practices is less sure Research is expected to distinguish/confirm the key components of successful sexual-regenerative wellbeing instruction programs in school settings in creating nations

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FOCUS Results on S-B Programs

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What Do We Know About Peer Education Programs? Peer impacts have vital effect on RTB of youth (both positive and negative). Prepare youth who serve as guides and part