Real-world solutions for adolescent girls: sexual and reproductive health and rights – Jordan

Improving Adolescent Sexual and Reproductive Health: Lessons from Implementation Research

Authors:

• Chaitali Sinha – Senior program specialist, IDRC
• Marie-Gloriose Ingabire – Team leader, IDRC

According to UNICEF, 90 percent of adolescents (10 to 19 years) live in low- and middle-income countries. Girls and boys within this group are navigating a critical journey towards adulthood, marked by physical, emotional and psychological changes. The ability to exercise their sexual and reproductive rights, and to access tailored information and services, will pave the trajectory of their lives and the lives of those around them.

Dedicated strategies needed to improve health outcomes for adolescent girls

Adolescent girls in low-resource settings face multiple challenges, the impacts of which are tangible and can be long lasting. Menstruation is a case in point. This natural occurrence may force decisions upon adolescent girls that can include dropping out of school, early sexual debut and forced marriage.

The price for these decisions — often made by others — is paid by adolescent girls in the form of sexual or gender-based violence, unintended pregnancies and sexually transmitted infections. This can and lead to shame and psychological hardship for girls.

In these situations, adolescent girls’ agency and actions are hamstrung by deeply rooted structural barriers such as weak protective laws, restrictive policies, as well as sociocultural barriers such as harmful traditional practices and regressive social and gender norms.

Evidence has shown that investing in improving sexual and reproductive health and rights (SRHR) is an effective strategy to transform adolescent girls’ lives. It can equip them with skills and supports to seize opportunities and exercise agency — and make informed decisions about their bodies, relationships and futures.

When such strategies are scaled in ways that are localized, ethical, inclusive and sustainable, the resulting transformative change can be far reaching and long lasting. Addressing the root drivers — or structural barriers — of SRHR can set a positive and protective foundation for adolescent girls in low- and middle-income countries to be healthy and thrive. Failure to do so challenges progress against the Sustainable Development Goals (SDGs), notably SDG 3 (Good Health and Well-Being) and SDG 5 (Gender Equality).

The gap between what we know and the “real world”

Despite a growing body of evidence that supports interventions for improving SRHR for adolescents, effective implementation across the globe, including in low- and middle-income countries, remains a challenge. The space between what is known about SRHR interventions and operationalizing that knowledge in a “real world” context can be referred to as the “know-do gap.”

Implementation research provides an integrated approach designed specifically to bridge this gap by focusing on outcomes such as the extent of adoption, acceptability, appropriateness, scale, coverage and cost-effectiveness of a given health policy or program. It studies real-world solutions that concretely tackle root drivers of SRHR — such as legal and policy environments, social and gender norms, intergenerational dynamics, peer influences, cultural and religious beliefs, and the influence of media and digital technology — in a manner that is solution oriented.

Implementation research’s real-world relevance is central to IDRC’s work on adolescent SRHR. The responsive and grounded approach of implementation research is well-suited to inform the transformative processes and changes needed in different contexts.

Implementation research with impact — lessons from IDRC experience

In funding implementation research studies on adolescent SRHR across different regions, IDRC adopts some key features. These include using action-oriented research questions, and engaging with communities, policymakers and adolescents in creating spaces for adolescents to voice their ideas, assume leadership roles and act as change agents. These studies recognize that supporting gender transformative change requires careful consideration of young boys and masculinities.

For example, in Kenya, implementation research highlighted boys’ vulnerabilities and risks, including drugs, substance abuse, violence and more. Embedding an inclusive and participatory approach across contexts — including humanitarian crises — reduces the “know-do gap” and can contribute to acceptable, appropriate, sustainable and scalable responses.

Meaningful measures of change across different contexts benefit from considering implementation outcomes and health outcomes. These two types of outcomes are distinct but interrelated: health outcomes measure the ultimate impact on health, while implementation outcomes focus on the extent of adoption, acceptability, appropriateness, scale, coverage and cost-effectiveness of a given health policy or program.

Examples of implementation outcomes from IDRC-funded adolescent SRHR projects include:

1. Scale and adoption: Addressing a high rate of teenage pregnancy in Togo, this project worked across the education, health and legal systems and engaged community, traditional and local elected leaders. The project resulted in an 80% decrease in teenage pregnancy from 2018 to 2021. In 2022, the project was scaled to 250 schools in 50 communities with the goal of reducing the prevalence of teenage pregnancy by at least 50 percent. Resulting health outcomes include delayed pregnancy, enhanced bodily autonomy and healthy sexual behaviours.
2. Acceptability and appropriateness: Among the more than 1.5 million Syrian refugees in Lebanon, adolescent refugee girls carry a heavy combined burden of poverty, displacement and patriarchy. Rates of early marriage are high. This

   SDGs, Targets, and Indicators in the Article

   1. Which SDGs are addressed or connected to the issues highlighted in the article?

   • SDG 3: Good Health and Well-Being
   • SDG 5: Gender Equality

   The article discusses the importance of improving sexual and reproductive health and rights (SRHR) for adolescent girls in low- and middle-income countries. This is directly connected to SDG 3, which aims to ensure healthy lives and promote well-being for all at all ages. It is also linked to SDG 5, which focuses on achieving gender equality and empowering all women and girls.

   2. What specific targets under those SDGs can be identified based on the article’s content?

   • SDG 3.7: By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programs.
   • SDG 5.6: Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Program of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences.

   The article emphasizes the need to improve sexual and reproductive health and rights for adolescent girls, which aligns with the targets under SDG 3.7 and SDG 5.6.

   3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

   • Adolescent pregnancy rates
   • Prevalence of early marriage
   • Knowledge about puberty and menstruation
   • Awareness about sexual health, contraception, and family planning
   • Adolescent access to comprehensive sexuality education
   • Adolescent access to youth-friendly sexual and reproductive health services
   • Reduction in teenage pregnancy rates
   • Enhanced bodily autonomy
   • Improved decision-making regarding relationships and sexual health
   • Improved menstrual health

   These indicators can be used to measure progress towards the targets of SDG 3.7 and SDG 5.6. They reflect the outcomes and impacts of interventions aimed at improving sexual and reproductive health and rights for adolescent girls.

   Table: SDGs, Targets, and Indicators

   SDGs	Targets	Indicators
   SDG 3: Good Health and Well-Being	Target 3.7: By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programs.	– Adolescent pregnancy rates – Knowledge about puberty and menstruation – Awareness about sexual health, contraception, and family planning – Adolescent access to comprehensive sexuality education – Adolescent access to youth-friendly sexual and reproductive health services – Reduction in teenage pregnancy rates – Enhanced bodily autonomy – Improved decision-making regarding relationships and sexual health – Improved menstrual health
   SDG 5: Gender Equality	Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Program of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences.	– Prevalence of early marriage – Knowledge about puberty and menstruation – Awareness about sexual health, contraception, and family planning – Adolescent access to comprehensive sexuality education – Adolescent access to youth-friendly sexual and reproductive health services – Enhanced bodily autonomy – Improved decision-making regarding relationships and sexual health – Improved menstrual health

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   Source: reliefweb.int

    

   

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