Promoting sexual and reproductive health education among adolescents through creative and youth-led practice in India, Malawi and Uganda

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In India, Malawi and Uganda high proportions of the population are adolescents, and in each country there is: a) high incidence of marriage and pregnancy amongst adolescents, b) high maternal and child mortality, c) high levels of coercive and violent sexual behaviours; coupled with critically poor sex and reproductive health education in schools. There is also a problem of girls being widely seen as inferior to boys and having low self-esteem, with associated problems of high probability of dropping out of school, marginalisation in household decision making and in local and national politics, poor livelihood outcomes, and poor mental health. Notwithstanding target nations exhibit a range of similar problems, our cumulative international experience has shown that site and culturally specific perceptions in relation to desirable gendered behaviours and sexual and reproductive behaviours are hugely important in determining adolescent thinking and activity.The recent research and practice of the project team in India, Malawi and Uganda demonstrates how participatory, creative methodologies have the potential to enable those concerned with adolescent health and well-being to effectively engage with young people, understand their perspectives and support positive behaviour change. The proposed project will develop an internationally applicable participatory approach empowering adolescents to lead in developing and disseminating effective culturally-embedded sexual and reproductive health education in partnership with public health practitioners that can deliver significant impact across multiple scales.The project aims to work in three phases:Phase One will use arts based and dialogic weekly workshops with separate groups of female and male adolescents in two high schools in each country (600 in total) to explore adolescents' understandings of cultural and gender-specific attitudes, aspirations and beliefs in relation to sexual and reproductive health and behaviour. Public health research will identify local health services and policies.Phase Two will use this learning and draw on public health expertise to empower volunteer teams of adolescent participants (40 in each country) to work together across gender to share and develop mutual knowledge, beginning to shape public health education strategies relevant to, and endorsed by, the participant groups. Adolescents will start to develop small creative outputs to act as education tools (e.g. songs, plays, radio shows) to embody their learning and share with their wider school communities.Phase Three will lead to the co-creation and piloting of creative local health education tools to powerfully disseminate the mutual learning and exchanged knowledges of the participant and research teams, seeking to introduce research-informed creative tools into public health practice through culturally appropriate forms.Phase Four will focus on upscaling and embedding our methodological approach and health education tools across school, community and local public health and education forums; developing sustainable arts-based school clubs promoting gender equality and appropriate sexual and reproductive health education; disseminating our project findings and promoting our tools and methodologies to public health service providers, policy makers, decision-makers and relevant academics.This is a pilot project which will provide the evidential basis enabling us to seek funding and public health support to significantly expand within each of the countries concerned. It will demonstrate to those working in adolescent public health the value of working in participatory and creative ways to develop public health programmes that are relevant to, and led by, the needs of target communities. We will disseminate our methodologies amongst organisations working in this area with a view to making a significant contribution to best practice