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Elizabeth Futrell is an associate technical officer at FHI, where she works on activities related to community-based family planning and youth sexual and reproductive health.

A study published nearly 10 years ago in Family Planning Perspectives noted an interesting trend: the modern contraceptive methods most relied upon among sexually active American teens ages 18-19 were the least effective methods for this age group. Almost nine percent of teens using highly popular oral contraceptive pills got pregnant within the first year. Male condoms yielded a 17.7 percent pregnancy rate in the same time period. Failure rates are particularly high among teens because they are less likely than adults to use these methods consistently and correctly. To make matters worse, half of condom users and one-third of pill users discontinue use within a year. Meanwhile, teen users of long-acting reversible contraceptives (LARCs)—the injectable contraceptive Depo-Provera, the intrauterine device (IUD), and the contraceptive implant—only experienced a 4.3 percent pregnancy rate within the first year. In general, among people who correctly and consistently use these LARCs, the pregnancy rate is less than one percent. However, far fewer teens rely on these methods than on pills and condoms. As a result, the U.S., with one of the worst family planning records in the developed world, experiences 800,000 annual teen pregnancies, 80 percent of which are unintended.

These trends ring true in many parts of the world, and not much has changed in the 10 years since the study described above was published. Globally, young people use less effective contraception and use contraception less consistently than adults, although unintended pregnancy often poses far more negative consequences for adolescents than adults. Adolescent girls ages 15-19 are twice as likely to die during pregnancy as women in their 20s, and the risks are much higher for girls younger than 15. In fact, pregnancy and childbirth-related complications are the leading cause of death of girls ages 15-19 worldwide, killing 70,000 girls annually and leaving millions more with lifelong disabilities or chronic ailments. Yet each year, 16 million girls ages 15-19 give birth, and up to 4 million more adolescent pregnancies end in unsafe abortion.

LARCs have been proven to be highly effective, acceptable, convenient, and cost-effective, and the World Health Organization has deemed them appropriate for youth. So why aren’t more young people using LARCs? Among the barriers are:

  • Misinformation and lack of information among providers. Many providers avoid presenting IUDs as an option for young clients due to unsubstantiated concerns about risks related to STIs, infertility, postpartum use, side effects, and patient acceptability. Concerns about the negative effect of Depo-Provera on bone mineral density in adolescents are also common, although the Society of Adolescent Medicine issued a position paper in 2006 stating that the pregnancy posed greater health risks to adolescents than Depo-Provera and recommending that physicians continue to prescribe it with proper counseling to adolescents who wish to prevent pregnancy.
  • Inadequate training. Though many providers are trained to insert and remove IUDs and implants, some report a low level of comfort or experience with these tasks.
  • Low demand due to misinformation and lack of information among patients. Recent studies have shown that many women have little or no knowledge about LARCs and that unfounded concerns about their safety, effect on fertility, and side effects are widespread.
  • High up-front cost. While these methods are cost-effective in the long-term, their up-front cost is often significantly higher than that of condoms or pills.

To increase access to LARCs for young people who wish to prevent pregnancy, the public health community must conduct research to understand provider biases and youth barriers, including policies dictating access to contraception for youth. We must use these findings to develop and implement strategies to better serve the contraceptive needs of youth. We must continue to publish and promote clear, medically accurate information and training materials to bridge knowledge gaps and dispel misinformation among both providers and patients. To embrace LARCs, young people need to understand what they are and how they work. They must be able to access them and afford them. Expanding access to long-acting reversible methods for young people will drastically reduce the rate of unintended pregnancies, unsafe abortions, and maternal and infant morbidity and mortality across the world. The benefits of offering these options to young people far outweigh the risks.

At the IYWG, one of our major activities is producing and disseminating publications and tools that advance the sexual and reproductive health of youth. That is why we are always happy to hear from organizations that are using our materials!

Recently, we sent a shipment of our Muslim family life education curriculum to the Kenya Muslim Youth Foundation. After receiving the copies, they graciously shared with us quotes of their colleagues’ reactions and photos from the dissemination. We were so excited, we thought; “why not share this with our blog readers as well?”

“The book is very interesting, particularly to the Muslim youth. The book has specified the roles both male and female youth could play to avoid idleness; this prepares them for the responsibilities ahead of them when they will marry and have children.”

“Indeed, it is a good book that will be used by our facilitators during our workshops.”

Thanks again to Kenya Muslim Youth Foundation for sharing these photos!

To view the Muslim family life education curriculum, click here.

To learn more about faith-based programming for youth sexual and reproductive health, visit our faith-based program area page.

Karyn Fulcher is a peer educator at Scarleteen.

A couple of weeks ago, I had the chance to attend sex::tech 2011, a conference in San Francisco about the intersection of sex education and technology. Over those two days, there was a lot of discussion centered around peer education—what it is, whether it works or doesn’t work, how it should or shouldn’t be done, and the major pros and cons. And then I was handed a copy of the IYWG’s Evidence-Based Guidelines for Youth Peer Education, written to provide a framework and some basic concepts for organizations wanting to start their own peer education program.

Being a peer educator myself, albeit online at, I was asked to take a look at how realistic these guidelines are from my perspective―the perspective of a peer educator who works in an organization that’s pretty unique in a lot of ways as far as peer education goes.

To make clear how unique Scarleteen really is, think about how we work: there is no set curriculum (pretty much impossible in an online format where participants come and go as they please). We peer educators have got the chance to contribute to any part of the site, whether that be writing an article, answering one of the longer-format “sexpert” advice questions, or doing a piece for the blog. We’re flexible in how we work and do our best to make sure that all the users get exactly what they need, and we always, always put the young people we serve at the forefront. If they voice concerns or problems with the way we do things, we make changes. And we get feedback about everything, all the time; our message boards act basically as one giant ongoing evaluation form, letting us know what’s working and what isn’t for our users.

Even though Scarleteen’s format and structure are clearly different from a lot of peer education programs, it turns out that a lot of the guidelines fit what we do very well. The concept of youth-adult partnerships is key to how Scarleteen functions as a whole. Our executive director is always asking us for our input on things like new content, changes to the message boards, or who we think would be a good fit when we’re in need of new volunteers. I’ve always had the feeling that my opinions and knowledge are valued and appreciated, and that any feedback I give about any topic will be listened to and taken into consideration. (Even our new logo was chosen with input from me and the other volunteers.) I’m a peer not just in the sense of being similar in age to the people Scarleteen serves, but in the sense that I am treated as an equal to our executive director, our assistant director, and any adult doing work for the site.

The idea that youth should be involved in program planning is also important to the way Scarleteen functions. Our director is a former Montessori teacher, and the concept of teaching to what young people say they need and want is a model we all follow. There’s no set curriculum, although we do have thousands of pages of static content we can refer users to, and we do our best to get a good picture of what it is they’re looking for before referring them to that information. I don’t think I’ve ever answered a question with the mindset “this is what you should know.” Rather, I always start off by asking what a given user feels they need and how I can help them. Information doesn’t just go one way at Scarleteen: we learn as much from the people we’re educating about their lives and their needs as they learn from us about contraception and healthy relationships. I would never presume to know what one of our users is looking for without asking them.

While some of these guidelines mesh very well with the work I do as an online peer educator, some of them don’t hold up as well. Two things in particular jumped out at me: the idea that “simple and consistent messages” are the best at helping young people make long-term changes in behavior, and the recommendation that there be a “chain of command”—that peer educators report to a program coordinator who then reports to a program supervisor, and so on. (And, tied into this, the fact that the program participants themselves—the population to be served—seems to be missing in the list of stakeholders.)

First off, the simple messaging. Even though Scarleteen serves people from around the world (one of the many benefits of being an online organization), I can’t remember any instance of someone asking us to make our information simpler—not even someone whose first language isn’t English. Actually, the reverse seems to be true: often our users take offense when we ask if they need the information to be simpler. They’re tired of older people assuming that just because they’re young, they can’t handle complex ideas. Who hasn’t had the experience of hearing “you’re too young to understand” or “maybe when you’re older you’ll get it”? Speaking from experience, if it’s something we’re interested in, something that’s relevant to our lives, young people can handle all sorts of information, and the more there is available, the better.

The second thing that really struck me in these guidelines is the placement of peer educators in the hierarchy of an organization. The participation of peer educators and young people in general is critical in many programs serving youth—young people are, after all, the entire reason these programs exist in the first place. Why, then, are they so far down the totem pole? And why is there a totem pole at all? It might be obvious that Scarleteen is not big on hierarchies. Everyone involved, whether executive director or new volunteer, is important. We’re all part of what makes Scarleteen work, and while we have different roles, there isn’t one that’s seen as better than any other. Each of us—along with the young people we serve—is a stakeholder, and if I had to show the structure of Scarleteen as a hierarchy, I’d put those young people at the top.

I realize that most organizations don’t work the way Scarleteen does. Some might not think it’s possible to get youth involved in every aspect or to be ultimately accountable to the participants of their programs rather than to funders or parents or community leaders. But ultimately, I think it can be done, and it needs to be done. These guidelines are a great starting point, but they need to go further. In the end, young people are people, and we can handle a lot more than you might think. Give us the chance to prove it.


Tell us what you think of our peer education guidelines. Check them out here and leave us a comment.

Robyn Dayton is a Technical Officer at FHI where she works on the research utilization portfolio of youth reproductive and sexual health activities.

I had the opportunity to present at Sex Tech 2011 in San Francisco, CA a few weeks ago. It was a great conference, and it was awesome to be surrounded by the energy of so many people who care about youth sexual and reproductive health and have ideas on how to harness technology to promote that health.

There are some really interesting initiatives that use technology to promote adolescent sexual and reproductive health. For example, texting is being used by peer educators to answer questions and make referrals, by clinic workers to give information on contraceptive options after abortion, and by organizations seeking to help women use family planning more effectively. Facebook is also being used all over the world to promote contraception. Some organizations are using Facebook campaigns to promote male condoms, the female condom, and long-acting methods for youth. Twitter is also widely used. Finally, there are some innovative campaigns designed to start conversations among youth on topics such as HIV.

More traditional media was also represented at the conference. The producers of MTV’s “16 and Pregnant,” along with their partners at the National Campaign to Prevent Teen and Unplanned Pregnancy, joined the conference to talk about the impact of their incredibly popular show and the work they are doing to increase awareness of unplanned pregnancy.

For more information on the conference, check out their Web site,

Sarah Forde is the executive director of Moving the Goalposts, a girls’ football (soccer) and development program in coastal Kenya. She is a development professional with experience in sports and development programming, gender, and social justice. She is also a trained radio journalist: she worked with the BBC for six years and is currently engaged in communication work on sexual and reproductive health issues affecting young women in Africa.

I’m sad to say I probably wouldn’t be described as “young” any more. I turn 40 at the end of the year but I still play football every week and have done so since I was about five years old. As a feminist with a love of football, I set up Moving the Goalposts (MTG) 10 years ago. Moving the Goalposts is a girls’ football and development initiative in one of the poorest districts, Kilifi, in coastal Kenya. The aim was to get girls out playing football, challenging gender inequalities, and giving them opportunities to fulfill their potential. In the early days, we had fewer than 100 girls playing football. Now, in 2011, there are close to 3,000 rural girls participating in MTG’s football leagues and tournaments. They organize their own field activities as the coaches, referees, and first aiders, and they have access to information and social support from peer educators and peer counselors.

So in 10 years, MTG has grown quite substantially, but so what? With more girls taking part, is there more impact and more social change? Not necessarily, but we’ve tried to measure change over time with a survey developed by the Laureus Sport for Good Foundation. We piloted the survey in 2009 and administered it again in 2010 to track the same girls 12 months on. We interviewed 167 girls in both years and have some interesting findings. We used the strictest statistical procedures, in which we only claimed that a change could be attributed to MTG if the probability of the change in scores was less than 0.002. In other words, there was only a 0.2% possibility that the change could have happened by chance. The girls reported better-developed life skills in 2010 than in 2009. The life skills questions that made up this score covered being able to identify your own strengths and weaknesses, deciding on short- and long-term plans, taking advice from those with experience, being well-prepared, enjoying challenges, and showing perseverance and self-control. Working well with others was another area that girls reported had improved; this is often a benefit that is attributed to playing team sports such as football. There was a significant difference in the scores regarding speaking; questions about this indicator asked about knowing when to speak, when to be silent, and what to say; explaining to others one’s goals and ambitions; adjusting how one speaks to different people; and presenting information to others.

Another important feature of MTG’s work is peer-educator led sexual health education, which includes learning new ways of thinking about people with HIV/AIDS as well as encouraging members to be more empowered in their sexual relationships. The impact of MTG on beliefs about HIV/AIDS was measured with five items: understanding how people are infected, talking about HIV/AIDS to others, increased confidence to refuse sex, treating those infected with respect, and knowing how to protect oneself from becoming infected. The score increased significantly from 2009 to 2010.

Our monitoring and evaluation efforts are not just to prove we are doing well or to show that our program has significant benefits for girls. They are to let us know where we could improve and where we should direct more of our efforts to achieve our aims in the coming years. I’ll blog again soon about our findings that showed where we’re having least impact and where we need to up our game. Oh, and by the way, we’ve documented more qualitative work in a book called, Playing by Their Rules: Coastal Teenage Girls in Kenya on Life, Love and Football, which is a journey into the teenage world of rural East African girls, whose voices are rarely heard beyond their own small world. It’s available here.

To learn more about how participation in sports can help girls build social networks, challenge gender norms, and enhance their physical and mental well-being, also see the latest IYWG YouthLens: Sports for Adolescent Girls (233 KB).

Last week, and The New York Times posted an alarming story of a fourteen-year-old girl named Hena Akhter, from Bangladesh. Hena was accused of having an affair with a married man and died after being lashed in public as punishment.

According to Hena’s Sister, Hena was being pursued by her cousin, a man three times her age. Hena dismissed her cousin’s advances. But one evening while she was walking to an outdoor toilet, the cousin allegedly “gagged her with cloth, forced her behind nearby shrubbery and beat and raped her.” ( Rather than being treated as a victim of a crime, Hena was accused of adultery. She was sentenced to 110 lashes, and her cousin was to receive 201 lashes and pay the family $1,000. The cousin escaped after a few whippings; Hena dropped to the ground after receiving 70. She was taken to the hospital, where she died a week later. Doctors reported that Hena committed suicide, a common occurrence among girls who have brought “shame to their family.” A public outcry spurred authorities to exhume her body and conduct a second autopsy, which found that Hena had died of internal bleeding that resulted from her injuries. The doctors who conducted the first autopsy will stand trial for submitting a false report.

This story is atrocious and shocking, and it illustrates the injustices that women and girls face as a result of harmful gender norms. For females, gender norms in many cultures include submissiveness, deference to male authority, dependence, virginity until marriage, and faithfulness during marriage. Norms for men, in contrast, are built around power and control, independence, not showing emotions, risk-taking, early sexual activity, and having multiple sexual partners. Such inequality limits young people’s control over their sexual and reproductive lives. That the perpetrator in this story might only have to pay $1,000 while Hena paid with her life is a tragic demonstration of how young women suffer as a result of deeply held gender norms.

To read more about this story see:

Only 14, Bangladeshi girl charged with adultery was lashed to death

When a Girl Is Executed… for Being Raped

To learn about programming to challenge harmful gender norms, visit the IYWG program area page: Gender Norms.

Current events such as the unrest in the Middle East, the crisis in Japan, and the continued recovery efforts in Haiti remind us of the many needs of adolescents in humanitarian settings. Adolescents are a special population, and they require tailored programming to meet their unique needs in crisis situations. Nearly 85 percent of the world’s young people live in developing countries, where most humanitarian emergencies occur. Humanitarian emergencies disrupt family and social structures; in crisis situations, adolescents are often separated from their families, and educational programs are discontinued.

“The loss of livelihood, security and the protection provided by family and community places adolescents at risk of poverty, violence, and sexual exploitation and abuse.” -ASRH Toolkit for Humanitarian Settings (Save the Children and UNFPA)

To learn more about working with adolescents in Humanitarian settings, participate in the upcoming IYWG e-forum, Untapped potential—Working with youth to meet their SRH needs in humanitarian emergencies, April 19th through April 22nd.  Facilitated by experts in the field, the forum will give participants an opportunity to discuss this topic and to ask questions about the Adolescent Sexual and Reproductive Health Toolkit for Humanitarian Settings (Save the Children and UNFPA), a companion to the Inter-agency Field Manual on Reproductive Health in Humanitarian Settings (Inter-Agency Working Group on Reproductive Health in Crises). An e-learning course on this subject has also been released by UNFPA and Save the Children.

Click here to register for the forum and read more about the facilitators. We look forward to hearing from you on the 19th!


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This blog is brought to you by the Interagency Youth Working Group (IYWG) with financial assistance from the U.S. Agency for International Development and the U.S. President's Emergency Plan for AIDS Relief. The content is managed by FHI, which functions as the secretariat for the IYWG.
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