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INNOVATING FOR MATERNAL AND CHILD HEALTH IN AFRICA

IMPACT BRIEF: Addressing adolescent reproductive health in sub-Saharan Africa

Introduction Nearly 16 million teenage girls between the ages of 15 and 19 in developing countries give birth every year; 90 percent of them are already married when they become mothers. Adolescents need appropriate information and services to avoid an increased risk of adverse reproductive health outcomes. Since 2014, the Innovating for Maternal and Child Health in Africa (IMCHA) initiative has made important strides towards improving the lives of women, children, and adolescents in 11 countries in sub-Saharan Africa. Co-funded by Global Affairs Canada, the Canadian Institutes of Health Research, and Canada’s International Development Research Centre, IMCHA is an eight-year, $36 million initiative. IMCHA has supported 28 projects through 19 research teams, as well as two Health Policy and Research Organizations (HPROs).

Research teams worked to improve education on sexual and reproductive health and rights among adolescents. Some teams adopted a proactive approach to diagnosing perinatal depression, while others encouraged peer discussion and promoted access to and use of healthcare facilities. These efforts contributed to empowering adolescents to look after their sexual and reproductive health, and to developing better parenting skills for mothers.

Overview of the challenges Adolescent girls and boys are more vulnerable and more likely than adults to • face stigma, discrimination, mistreatment, or even denial related to reproductive health services; • lack knowledge about the importance of and access to safe motherhood and family planning services; and • have unplanned and unwanted pregnancies.

Benefits of improving adolescent sexual and reproductive health ANDREW ESIEBO, IDRC

Access to reproductive health information and services can help adolescents better understand how to avoid unwanted pregnancies. Addressing the specific needs of adolescent girls, including mental health related to pregnancy, can help them better care for themselves and their babies. This helps decrease morbidity and mortality.

S U CC E S S S TO R I E S

Encouraging care in rural Tanzania’s health facilities A research team in the Mwanza Region of Tanzania worked to help adolescents feel comfortable seeking prenatal, delivery, and postnatal care at healthcare facilities. The team trained volunteer female and male community health workers to promote gender equality and health equity. They also trained and mentored them to identify households with adolescents, and worked with district hospitals to designate accommodations for adolescent sexual and reproductive health services. Health facilities have assigned specific clinic days and times for pregnant adolescents.

I M PAC T 65% increase in the number of men, including adolescents, who accompany their pregnant partner to prenatal care. This led to more women completing at least 4 prenatal care visits 1,256 community health workers in 65 villages have stronger capacity to reach and engage with adolescents to provide reproductive health education and prenatal care Evidence from this Tanzanian project is informing the design of a new project in Uganda

Treating perinatal depression in Nigeria A research team trained more than 80 staff at the Oyo State Ministry of health in Nigeria to screen and treat perinatal depression, allowing them to train other service providers. The research team screened for and treated perinatal depression among pregnant adolescents and tested a user-centered mobile solution to reach them. Six months after delivery, adolescents who were part of the intervention were more likely to recover from perinatal depression than those who were not. This project demonstrated that screening for and treating perinatal depression can be included in routine maternal care in health facilities to help address the needs of more pregnant adolescents in the community.

Breaking down barriers to services in Mozambique A research team in Mozambique’s Nampula province used community drama groups, radio broadcasts, local champions, and other initiatives to engage the community and address barriers adolescents face in accessing and using services. The research team delivered key messages on maternal and child health to more than 350,000 adolescents. They also trained 38 teachers, 49 activist students, 85 youth initiation ritual teachers, and 337 members of local health committees to deliver messages on sexual and reproductive health and rights. These activities contributed to better knowledge of sexual and reproductive health among female and male adolescents, and an increased use of family planning services.

I M PAC T 55.7% recovery rate from perinatal depression among adolescents receiving the intervention, compared with 37% among those receiving care as usual Increase in the level of parenting skills at 6 months for adolescent mothers receiving the intervention (score of 29.4) compared with those receiving usual care (score of 26.4), contributing to better infant growth and cognitive development

I M PAC T Between 2016 and 2019: 523 adolescent men aged 10–19 accessed family planning visits in the intervention area, up from 66 108% increase in adolescent and youth health visits at the intervention site hospital

LESSONS LEARNED

Understanding the context and engaging the community help to identify and respond to the needs of adolescents – Initiatives that include the voice of adolescents and recognize their specific needs help them overcome barriers and cultural norms to improve health outcomes, including for sexual and reproductive health. Pregnant adolescents are at a higher risk of perinatal depression and are less likely to be diagnosed and treated for it – Screening and treating for adolescents suffering from perinatal depression, and working with them to enhance their parenting skills, can be successfully done at the primary healthcare level. Traditional and community leaders can be leveraged to share information about sexual and reproductive health and rights – Even in settings where religion or traditional practices have a strong influence, sexual and reproductive health messages, such as delaying initiation of sexual activity or avoiding pregnancies before age 18, can be communicated with support from local leaders and initiation ritual teachers.

“At the community level, [we are] start[ing] the discussion. We are going to village meetings to open up discussions about issues of sexuality, issues with family planning, issues with adolescent pregnancies.” Dismas Matovelo, Principal Investigator, Tanzania

Learn more in our videos Promoting Promoting equity equity Overview of of the the Innovating Innovating for for Maternal Maternal and and Child Child Health Health in in Africa Africa initiative Overview initiative w ww ww w .. ii d d rr cc .. cc a a // ii m m cc h ha a

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