Working with out-of-school youth in Belize and Peru.

Urban youth in Belize and Peru face a number of common concerns, including high pregnancy rates, lack of knowledge and negative attitudes about sexual and reproductive health, low self-esteem, poor decision-making skills, and limited economic opportunities.

For example, teen pregnancy rates in Belize have been as high as 20 percent. Out-of-school youth are particularly vulnerable to such difficulties, but reaching these youth can be challenging.

FINDING WAYS TO PROVIDE SERVICES

Family planning associations must find creative ways to attract out-of-school youth to services and to provide them with the information and skills they need for improved sexual and reproductive health and quality of life.

Successful strategies have included, in the case of iBelize, using arts and entertainment to communicate important sexual and reproductive health information, and, in the case of Peru, linking out-of-school youth's economic concerns with sexual and reproductive health.

In 1995, the Belize Family Life Association (BFLA) initiated a series of discussions with its youth groups throughout the country and with the Society for the Promotion of Education and Research (SPEAR), a local organization that had successfully worked with inner-city youth, to identify ways to effectively work with out-of-school adolescents.

As a result of these consultations, BFLA developed a project that combined both education and entertainment in targeting urban youth in Belize City. The drama/dance peer-counseling project, which received funding from the Hewlett Foundation for a two-year period (1996-98), was intended to serve as a model for reaching out-of-school youth with information and education on sexual and reproductive health issues.

The Peruvian Institute for Responsible Parenthood (INPPARES) focused on enhancing urban youth's opportunities for income generation while improving their knowledge and attitudes related to sexual and reproductive health. The two-and-a-half-year project (May 1997 through October 1999) was based on the premise that when young people lack opportunities to become productive members of society, their self-esteem, relationships, and health suffer.

With local funds and contributions from International Planned Parenthood Federation (IPPF)/Western Hemisphere Region and UNICEF, INPPARES teamed with the Center for Integral Development (CID), a local nongovernmental organization (NGO) specializing in income generation and micro-enterprise development. Together, we provided "Quality of Life" training, integrating sexual and reproductive health education and the development of income-generating strategies and skills for primarily out-of-school youth 16 to 28 years of age in three Peruvian cities (Lima, Huancayo, and Cusco).

PROJECT GOALS, OBJECTIVES

The overall goal of the drama/dance peer-counseling project in Belize was to equip out-of-school youth with the skills and knowledge needed to better manage their sexuality, leading to improved relationships and sexual and reproductive health.

The specific objectives of the project were to increase the ability of adolescents to negotiate safer sexual practices, including the use of condoms, and to improve attitudes among out-of-school youth regarding gender equity.

The goal of the "Quality of Life" program in Peru was to improve the situation of youth in poor urban areas by means of sexual and reproductive health education and skills development for income generation.

The main objectives were to improve adolescents' knowledge and attitudes related to sexual and reproductive health, to increase their capacity to implement income-generating activities, and to build their self-esteem and leadership skills.

PROJECT ACTIVITIES

Youth involvement in project design was a key strategy in working with out-of-school youth in both Belize and Peru. In Belize, members of BFLA's Youth Advocacy Movement provided input during the design phase of the project, and in Peru, project staff conducted needs assessments and involved youth in the design of project activities.

The drama/dance peer-counseling project in Belize successfully recruited and trained 28 out-of-school youth volunteers to serve as peer counselors and members of the Astrals Entertainment Group. The youth received training in drama and dance as well as sexual and reproductive health and life skills. Twenty-one of these youth remained for the life of the project, resulting in a retention rate of 75 percent.

The comprehensive training program for these peer counselors focused on building their personal value system and self-esteem. Improving the peer counselors' own decision-making skills related to sexuality and sexual relations and increasing their understanding of the responsibilities of parenthood and employment were also key components of the training.

Most of the training was based on a "life skills" curriculum called Life Planning Education developed by the Center for Population Options. After this preparation, the youth were able to provide sexual and reproductive health information and counseling in communication/negotiation skills to their peers through drama and dance performances, rap sessions, and counseling sessions.

The drama and dance performances relied on out-of-school youth's attraction to crowds and loud music in the streets, while the rap sessions utilized a "talk show" format and encouraged sharing and discussion among youth who might not do so in a more formal setting.

The peer educators also provided individual counseling and used a referral card system to direct out-of-school youth to clinical and other reproductive health services at BFLA's Teen Center.

The "Quality of Life" training course consisted of 20 hours of instruction over the course of a week, split between sexual and reproductive health and skills for income generation. Specific topics that were covered included skills assessment, small business planning, entrepreneurial culture, self-esteem, sexuality, human anatomy and physiology, sexually transmitted infections, family and personal relationships, and family planning. After course facilitators found that many of the young men had machista attitudes, additional time was spent covering gender issues.

Workshops and talks were also held at high schools and youth groups, and individual counseling was made available to address participants' vocational and sexual and reproductive health needs. The project sponsored two nationwide small business competitions, with winners receiving small grants to implement and evaluate their business plans. Other project outputs included a manual called "Sexual and Reproductive Health," which was developed and distributed to all course participants, as well as a pamphlet series on a variety of SRH topics.

EVALUATION STRATEGIES 

The projects used a variety of methods to monitor and evaluate their efforts.

In Belize, project staff designed a plan for monitoring and evaluation, which included pre- and post-test examinations of peer counselor trainees. Peer counselors were also asked to provide feedback on their perceptions of the training sessions.

In Peru, project staff employed both quantitative and qualitative methods to evaluate the effectiveness of the intervention. Pre- and post-test questionnaires were administered to 360 youth participating in the "Quality of Life" courses, and a series of focus groups were held with other youth.

KEY RESULTS

The drama/dance peer-counseling model in Belize and the Peruvian model, which combined sexual and reproductive health and small business training, both proved to be effective in reaching out-of-school youth. The projects brought positive changes in youth's knowledge and attitudes as well as an increase in their use of sexual and reproductive health clinical services.

In Belize, not surprisingly, the project had the greatest effect on those young people who participated directly in the project as peer counselors. Training session evaluations revealed that youth were satisfied with the level of their training.

Furthermore, pre- and post-test results revealed that before the training, 45 percent of youth had correct knowledge of sexual and reproductive health and appropriate communication/negotiation skills. Following the training, the percentage increased to 91 percent.

Another project success was an increase in youth's use of clinical services. Fifteen sexually active peer counselors became family planning users following their involvement in the project, and 176 out-of-school youth utilized the clinical services of BFLA's Teen Center, an increase of more than 10 percent from the period before the project was initiated.

In addition to the 28 youth who received training as peer counselors and another 24 drop-in youth who received training on an informal basis, the project reached nearly 3,000 young people through various activities. There were 24 community presentations, involving 729 out-of-school youth, 21 rap sessions with 394 out-of-school youth, and six peer education/outreach sessions involving 198 out-of-school youth. Through 32 school presentations held at five high schools in Belize City, more than 1,500 in-school youth were also reached.

In Peru, the "Quality of Life" training project touched the lives of thousands of youth. More than 15,000 were reached through 213 talks, 32 workshops, and 22 "Quality of Life" trainings in the three project cities. In addition, 1,681 youth received individual counseling, the majority for inter-personal problems such as communicating with a partner or parent. Based on the project evaluation results, participating youth's self-esteem improved by 89 percent on the Stanley Cooper Smith Scale for Self-Esteem, a self-administered test consisting of 58 yes/no questions. There were also increases in knowledge about sexual and reproductive health themes covered in the courses, and improved attitudes related to sexuality. Furthermore, many participants said that prior to participating in the course, they lacked the skills to resolve interpersonal conflicts. During the project period, there was also an increase in youth seeking sexual and reproductive health services and counseling at INPPARES clinics.

More than 2,000 youth registered for the project's small-business project design competitions, with more than 400 projects submitted. Many youth were able to develop successful businesses, such as bakeries, tailor shops, or agricultural projects, which in some cases became the principal source of income for the family, according to project staff.

The project also had a positive effect on INPPARES as an organization. Vocational issues were successfully integrated into the topics covered in counseling sessions with young people at INPPARES' Youth Center in Lima, including skills assessment and help in creating a personal plan for finding employment or starting an income-generating project.

LESSONS LEARNED

Reaching out-of-school youth is particularly challenging for sexual and reproductive health care providers. Developing successful strategies often requires targeting other important youth needs, such as generating income, or finding innovative ways--such as drama and dance--to present information.

IPPF of the Western Hemisphere Region has identified a number of key lessons to consider when designing programs for out-of-school youth:

* Work with other organizations to address topics not usually in the scope of sexual and reproductive health to expand the association's reach and contribute to an improvement in adolescents' overall quality of life.

* Include a component in programs targeting out-of-school youth that involves income generation. These young people consider their economic situation to be more pressing than the risk of HIV/STIs and pregnancy.

* Develop a flexible program with a realistic pace so that out-of-school youth can fit it into their work schedules. Peru's "Quality of Life" program offered classes at flexible times to make attendance easier for participants.

* Discuss sexual and reproductive health concerns in the context of other pressing concerns, such as jobs, or in informal settings such as the "rap sessions" utilized in Belize.

* Include practical issues--such as decision-making, self- esteem, and development of life goals--in programs so that young people will find them more useful. This was true of Peru's "Quality of Life" project.

RELATED ARTICLE: DEVELOPING GUIDELINES FOR COMPREHENSIVE SEXUALITY EDUCATION

SIECUS has worked with organizations in Brazil, India, Nigeria, and Russia since 1995 to develop a consensus on the components of comprehensive sexuality education.

During that time, participants have learned that simply translating the SIECUS Guidelines is not appropriate because of the culturally specific aspects of sexuality.

SIECUS' International Department has therefore published a booklet titled Developing Guidelines for Comprehensive Sexuality Education that answers questions educators, service providers, and policymakers worldwide have about the development of guidelines in their own countries.

Specifically, the booklet outlines a 14-step approach to developing country-specific guidelines based on SIECUS' work in the United States and internationally.

The booklet is available for $10 by writing to SIECUS Publications, SIECUS, 130 West 42nd Street, Suite 350, New York, NY 10036-7802. All orders must be accompanied by a check made payable to SIECUS and drawn on a U.S. bank.