Listening to Youth

In Liberia, youth are taking action to improve their health

“Some family planning methods treat people badly and it makes others scared to take family planning. A lady living near me has a big stomach. I was surprised to learn that her stomach was that big as a result of the family planning method she was taking.”

“We are girls and when you as a girl don’t know anything, men will bluff you.”

“It is good for young people to prevent pregnancy until they finish school and get married. In Liberia, if you have children and the father is not working, you will worry as to how to take care of the children.” 

Over and over again, we heard statements like those during interviews and focus group discussions with youth in Liberia. The research uncovered low levels of knowledge about family planning and many myths about side effects from contraceptives. Girls spoke about transactional sex – sex in exchange for material goods or small bits of money — and a general perception that transactional sex is normal and unavoidable.

Following a fourteen-year civil war and resulting pervasive poverty, Liberian youth face significant challenges related to their sexual and reproductive health and education is a critical factor. Nearly 50 percent of young women 15-24 cannot read at all and a majority of youth leave school before beginning high school. These are the young people in the country with the highest rates of unintended pregnancy and lowest rates of contraceptive use and HIV testing.

But along with grim outcomes, we found that Liberian youth want to be educated and generally understand the impact that a pregnancy can have on education and well-being. Many do see a bright and hopeful future ahead of them.

These discussions led to the development of HealthyActions – a collaborative project launched in 2012 by PSI Liberia and USAID’s Advancing Youth Project, implemented by the Education Development Center (EDC).

HealthyActions’ aim is to:

  • Improve knowledge: of HIV and other sexually transmitted infections, and contraceptives and how they work.

  • Build skills: in negotiating condom use, communicating in relationships, talking to children (for teen parents) about healthy sexuality.

  • Change attitudes: toward oft-marginalized groups such as girls and young women, and young people living with HIV.

  • Increase uptake of modern contraceptive methods and HIV counseling and testing.

HealthyActions was designed to align with USAID’s recently released Youth in Development Policy, with particular attention to four key elements:

  • Creating opportunities for youth participation – youth play a central role in HealthyAction’s design, implementation and evaluation.

  • Using an assets-based approach – the program focuses on building internal assets such as self-efficacy, communication and assertiveness skills, and gender transformational attitudes, as well as external assets for youth such as access to education and social cohesion.

  • Involving communities –a key component of HealthyActions is engaging the wider community and bringing information and access to services to the communities where young people live.

  • Pursuing cross-sectoral programs – the Youth in Development Policy emphasizes “de-siloing” the development community and promoting programs and interventions that are multi-and-cross-sectoral. HealthyActions does that by integrating sexual and reproductive health education and services within a formalized (albeit non-traditional) education program.

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.

Now in its second phase, HealthyActions has reached over 4,300 learners, 75 percent of whom are female, in six counties across Liberia. Over half of female participants have received family planning counseling and have chosen a modern contraceptive method after completing the program—far above the 20 percent contraceptive prevalence rate for Liberia (CPR is six percent in women without children and 15 percent among those with no secondary education). Over 60 percent have gotten tested for HIV (nationally, less than ten percent of the Liberian population has ever tested for HIV and only one percent of those people with no education have ever tested).

Want to learn more about PSI’s other great programs for youth? PSI’s Sexual and Reproductive Health Programs for Youth is a new Program Brief that provides an inside look at how PSI is integrating and aligning international best practices for youth programming into its existing services and programs.

For more on youth and peer pressure as a life-saving force, read this article from The New York Times’ Fixes blog, which featured PSI’s work on sexual and reproductive health education for youth in Liberia.

Photo: At a Clinic Celebration Day for HIV testing and contraceptives education and distribution – the capstone of the HealthyActions curriculum for youth developed with PSI’s support in Liberia.