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

在印度、马拉维和乌干达，很大比例的人口是青少年，每个国家都有：(A)青少年结婚和怀孕的高发生率；(B)高孕产妇和儿童死亡率；(C)高水平的强迫和暴力性行为；以及学校的性健康和生殖健康教育极差。还有一个问题是，女孩普遍被认为不如男孩，自尊心低，并伴随着辍学概率高、在家庭决策以及地方和国家政治中被边缘化、生计结果差和心理健康差等问题。尽管目标国家表现出一系列类似的问题，但我们积累的国际经验表明，与理想的性行为以及性和生殖行为有关的地点和文化上的具体看法在确定青少年的思维和活动方面非常重要。项目小组最近在印度、马拉维和乌干达的研究和实践表明，参与性和创造性的方法具有潜力，使那些关心青少年健康和福祉的人能够有效地与年轻人接触，了解他们的观点，并支持积极的行为改变。拟议的项目将制定一种国际适用的参与性办法，使青少年能够与公共卫生从业者合作，带头制定和传播有效的、具有文化内涵的性健康和生殖健康教育，能够在多个层面产生重大影响。该项目分三个阶段开展工作：第一阶段将在每个国家的两所高中(共600所)举办以艺术为基础的每周对话讲习班，以探讨青少年对性健康和生殖健康和行为的文化和性别态度、愿望和信仰的理解。公共卫生研究将确定当地的卫生服务和政策。第二阶段将利用这一学习并利用公共卫生专业知识，使青少年参与者(每个国家40人)志愿者团队能够跨性别合作，分享和发展共同知识，开始制定与参与者群体相关并得到参与者群体认可的公共健康教育战略。青少年将开始开发小的创造性成果作为教育工具(如歌曲、戏剧、广播节目)，以体现他们的学习，并与更广泛的学校社区分享。第三阶段将导致共同创建和试点创造性的地方健康教育工具，大力传播参与者和研究小组的相互学习和交流知识，寻求通过文化适当的形式将了解研究情况的创意工具引入公共卫生实践。第四阶段将侧重于在学校、社区和地方公共卫生和教育论坛中提升和嵌入我们的方法方法和健康教育工具；发展可持续的以艺术为基础的学校俱乐部，促进性别平等和适当性健康和生殖健康教育；向公共卫生服务提供者、政策制定者、决策者和相关学术机构传播我们的项目结果，并推广我们的工具和方法。这是一个试点项目，将提供证据基础，使我们能够寻求资金和公共卫生支持，以便在每个相关国家大幅扩张。它将向从事青少年公共卫生工作的人展示以参与性和创造性的方式开展工作的价值，以制定与目标社区的需求相关并由其主导的公共卫生方案。我们将在这一领域的组织中传播我们的方法，以期对最佳实践做出重大贡献。

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