Improving the Reproductive Health of Youth in Mexico

Interventions were introduced in 8 cities; 4 similar cities served as control sites. In each intervention site, researchers began by hiring and training one YPP coordinator. They then created and opened a YPP space in each city. The space was a room used to hold meetings and conduct activities such as showing videos and films. In cities with clinics, this space was usually located in MEXFAM's clinic. Each space was provided with the necessary equipment and materials (printed information packets, contraceptive supplies, VRC and TV).

Next, "multipliers" - local community members such as teachers, community leaders, health care providers, and peer educators - were trained. MEXFAM used a set of different courses that were offered to people interested in promoting adolescent sexual and reproductive health regardless of the particular place where they worked. MEXFAM expects that those who take the courses will replicate them in their own settings and help conduct related promotional activities. These courses included:

• a 6-month (180 hours of theory and 100 hours of practice) diploma course on human sexuality, which was offered in coordination with universities and other academic institutions. Graduates of this course could train trainers in sex education.
• a 40-hour course, usually given in 20 2-hour sessions. The course enabled participants to teach 14-hour courses, give talks, and provide individual orientation to others. Project goals were to have 3 teachers in each primary and secondary school attend this course, to have at least 2 service providers in each public health clinic attend the course, and to offer the course to other professionals in project areas. The course was based on a manual developed by MEXFAM and updated and published as part of project activities. The contents included family communication, anatomy of reproduction, human sexual response and dysfunctions, mass media and sexuality, sexually transmitted infections (STIs)/AIDS, contraceptive methods, gender and sexuality, violence and sexuality, sexual and reproductive rights, and attitudes of the counselor toward human sexuality.
• a 14-hour course, usually given in 7 sessions. Project goals were to offer this course to all primary and secondary schoolteachers in the city, to parents of students in each school, to all service providers in the city (including pharmacists) and to have at least 30 youth take this course and be prepared as peer-promoters.
• a 4-day (24 hour) course for health providers on comprehensive health care for adolescents. This course focussed on the illnesses and conditions most frequently affecting adolescents, as well as on basic preventive health care for them. As with other courses, professionals traveled to a nearby city where MEXFAM offered the course. The goal was to have at least 2 providers in each city take this course, but it was offered to all physicians and nurses in the city. During the length of the project, MEXFAM finished an interactive CD that was used as a teaching aid.

In the community intervention, multipliers conducted outreach through individual and group events such as plays, sports events, parades, and concerts. A project goal was to train at least 30 peer-promoters (aged 15 to 20) in each city and to have them disseminate information on contraception, AIDS and STI prevention, and services available for adolescents. These promoters also distributed contraceptives and information, education, and communication (IEC) materials. There were a number of creative promotional activities implemented by YPP staff and collaborators. These include:

• Individual orientations during household visits or at any other event that enabled the interaction of the volunteer or staff member with an individual young person
• Talks to groups organised by the multipliers or YPP coordinators or talks that made use of on-hand opportunities (for example, a series of conferences or a meeting of teachers in which a YPP talk is inserted)
• Messages through mass media (print media, radio or TV) in any type of format, such as spots, participation in roundtables, and interviews
• Screening of videos and films, followed by a debate
• Plays with reproductive health messages; peer-promoters and other multipliers were actors
• Participation in community events, such as health fairs and cultural and inter-institutional events. Typically, the YPP set up one or more stands or modules in which information is provided in a variety of formats. For example, in one module, a volunteer played a bingo game created by MEXFAM to facilitate information exchange with young adolescents; in another, an IEC stand detailed MEXFAM printed and video materials; finally, a "fresh information" stand consisted of a refrigerator filled with different products, each with a card with a question that the adolescent discussed with the volunteer or staff member attending the stand.
• Other types of entertainment for adolescents, such as sports events, graffiti sessions, participation in parades and rock concerts. Although short sexual and reproductive health messages were given, the main goal of these activities was to generate trust and proximity between adolescents and the YPP. Some of these activities were also structured to give information, such as "rallies", bicycle races in which contestants have to respond correctly questions on sexual and reproductive health in each stage.

In the clinic-based component, providers offered youth-friendly services at their health facilities. YPP coordinators provided technical assistance to support service providers by monitoring patient flow, creating special schedules, and devoting a particular space for activities with adolescents. They also provided caregivers with factual sexual and reproductive health information in the form of a sex education-training manual, 7 videos, 6 flipcharts, and brochures and pamphlets. Private service providers (physicians, pharmacies, etc) were also provided with brochures and posters.

Four of the intervention cities also received a school-based intervention in which teachers, trained through the multiplier courses, conducted events to strengthen existing sex education programmes. The sex education-training manual, videos, flipcharts, and brochures and pamphlets were designed to support these activities.

Youth, Reproductive and Sexual Health.