International article
West African youth initiative: outcome of a reproductive health education program

https://doi.org/10.1016/S1054-139X(01)00264-6Get rights and content

Abstract

Purpose: To describe the implementation and evaluation of an adolescent reproductive health peer education program in West Africa. The program, known as the West African Youth Initiative (WAYI), was developed to improve knowledge of sexuality and reproductive health, and promote safer sex behaviors and contraceptive use among sexually active adolescents in Nigeria and Ghana.

Methods: Between November 1994 and April 1997, two organizations, the Association for Reproductive and Family Health (ARFH), based in Nigeria, and Advocates for Youth, based in Washington D.C., supported community-based youth-serving organizations in the two countries to implement peer education projects. Consultants from the African Regional Health Education Centre (ARHEC) in Nigeria provided technical assistance in designing and conducting a quasi-experimental process and outcome evaluation of the projects.

Results: There were significant differences over time and between intervention and control groups concerning reproductive health knowledge, use of contraceptives in the previous 3 months, willingness to buy contraceptives, and self-efficacy in contraceptive use.

Conclusions: Overall, the project provides evidence that peer education is most effective at improving knowledge and promoting attitudinal and behavior change among young people in school settings.

Section snippets

The West African youth initiative project

The West African Youth Initiative (WAYI) was developed to improve knowledge of sexuality and reproductive health, and promote safer sex behaviors and contraceptive use among sexually active adolescents in Nigeria and Ghana. The WAYI project had two broad goals:

  • 1.

    To determine whether or not adolescent reproductive health peer education programs could be successfully implemented in Nigeria and Ghana; and,

  • 2.

    To assess the overall impact of such programs on adolescent knowledge, attitudes, and

Methods

The WAYI evaluation was designed and implemented from the outset of the project using a fairly rigorous quasi-experimental operations research design. The evaluation was intended to document the process of developing peer education programs and to quantitatively and qualitatively assess the outcomes of the peer education approach.

A cross-sectional baseline survey was developed from focus group discussions (FGDs) that were held with youth at each project site in mid-1994. Baseline data were

Results

At baseline, respondents were asked to select from among seven choices (parents, friends, older siblings, teachers, health workers, religious leaders, and indigenous healers) with whom they would feel most comfortable discussing 11 issues related to sexuality and reproductive health. Friends were most often mentioned for seven of the issues (menstruation, body changes, sexual feelings, dating, kissing, when to start having sex, and how pregnancy occurs). Health care workers were the next more

Discussion

When conducting the final analysis, several limitations to the data became apparent. Owing to increasing awareness of adolescent reproductive health in both Nigeria and Ghana, youth in both intervention and control communities were routinely exposed to extra-project educational messages from the mass media and other sources. For example, there was an ongoing national social marketing effort specifically targeted to youth to provide low-cost condoms through small-scale retailers. There were also

Acknowledgements

Funding for program implementation in Nigeria was provided by the Ford Foundation. The Public Welfare Foundation provided assistance for program activities in Ghana. The Rockefeller Foundation funded the evaluation component of the total project. Wallace Global Fund supported the implementation activities and technical assistance provided by Advocates for Youth.

The authors also wish to acknowledge Dr. Asha Mohamud, former Director of the International Division at Advocates for Youth, Ms. Susan

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