Increasing Contraceptive Use and HIV Testing Among Youth: New Evidence from Liberia
By Rena Greifinger, Technical Advisor, Youth & Girls, PSI
Rebecca Firestone, Senior Technical Advisor, Strategic Research & Evaluation, PSI
Reid Moorsmith, Former Country Representative, Liberia and current Technical Director, Asia, PSI
HealthyActions is delivered over five days for learners attending math and literacy classes through EDC’s Alternative Basic Education programs. The program uses engaging participatory methods such as trivia, games, role-play, music, and small group discussions to help young people think critically about their health and the actions they can take to improve it. The program ends with a Clinic Celebration Day, a “pop-up” clinic staffed by government health workers and open to the entire community. Learners, as well as their neighbors, family, and friends are invited to access HIV testing and counseling and family planning services, as well as enjoy music, food, and health talks.
Even before the Ebola crisis, the West African country of Liberia was in development turmoil. Fourteen years of civil conflict, infamous for the exploitation of children as soldiers, left a badly frayed social fabric, collapsed infrastructure, failed healthcare system and a generation of young people forced to drop out of school and take on adult responsibilities before they were ready. Ten years after the end of the conflict, despite enormous development assistance, bright spots are still rare. One of these, though, was HealthyActions, an innovative program combining education and health for young people across Liberia.
In Liberia, 60 percent of girls and young women are mothers or pregnant by age 19. A mere 13 percent have fertility awareness. While nearly all Liberians have heard of HIV/AIDS, and the majority knows where to get tested, only 37 percent of 15-24 year old women and 11 percent of 15-24 year old men have ever been tested.
Low education levels exacerbate this situation. In 2013, one-third of women reported they had never been to school, and even those with some education suffer from poor quality of teaching and inhospitable learning environments. Far fewer women than men are able to receive an education while many young women engage in transactional sex to secure school fees, clothing and other commodities.
In 2012, PSI and the Education Development Center (EDC) teamed up in Liberia to design and implement HealthyActions, which was delivered in two phases between 2012 and 2014. The program was designed to align with the recommendations in USAID’s 2012 Youth in Development Policy:
a) use an assets-based approach;
b) involve communities;
c) create opportunities for youth participation; and
d) work cross-sectorally (e.g. health and education).
In 2014, we built an evaluation around the program’s second phase to learn if HealthyActions could positively affect young people’s sexual and reproductive health. As it turns out, the program did just that, and the results of the evaluation have just been published in the journal Global Health: Science and Practice.
With Healthy Actions PSI and EDC learned that bringing together an intensive group learning experience with on-site health services led to increased contraceptive use and HIV testing among participants in the program. Young women participating in HealthyActions were 13 percent more likely to report using a modern contraceptive method than women in the control group. HealthyActions demonstrated a 45 percent increase in the probability that an individual had ever been tested for HIV and knew the result. We were especially excited to see a major increase (by nine percentage points) in adoption of contraceptive implants, a critical long-acting reversible contraceptive that has only recently been promoted to younger women.
PSI’s deepest levels of excitement stem from seeing a truly cross-sectoral program work for young people, particularly young women. The program aimed to create a successful intervention that takes advantage of an existing group setting with trusted peer networks; to infuse that space with health education and female and community empowerment; and to make access to health services easy for communities with low levels of trust in institutions, including the health system. As PSI works toward its ambitious FP2020 pledge to reach 10 million young people with contraception by December 2020, HealthyActions is a promising program that can be adapted and delivered in any number of settings, for various populations, and in different ways. We hope that others will partner with us, or use it in their own programs, to improve the sexual and reproductive health of young people worldwide.