EDITORIAL: Promoting Youth Sexual and Reproductive Health in Africa: The Need for a Paradigm Shift

Abstract

Over the past two decades, a large body of literature has emerged suggesting a distinct pattern of sexual behavior among adolescents in subSaharan Africa, and its contribution to the rapid population growth, high birth rates and the intractable rates of maternal mortality and HIV/AIDS in the region.  Although there is growing willingness and commitment by national and international actors to address the problem, and despite the existence of several international agreements that affirm the rights of adolescents to access sexual and reproductive health information, several gaps and difficulties exist in the implementation of policies and programs that address adolescent sexual and reproductive health in Africa.  Some of these difficulties are due to multiple factors which include political, economic, religious and cultural factors, which act in a variety of ways to mitigate the effects of systemic programming on adolescent sexual and reproductive health in the region.  One lesson that has evolved in years of work in Africa is that there are no silver bullets for attaining successful programming in adolescent sexual and reproductive health.  Adolescent reproductive health continues to be a field where as many effective interventions exist as there are different com-munities, and where interventions that work in one community are not necessarily guaranteed to work in other areas.

But there are basic principles, which if applied in a strategic manner would likely generate better harmonization of the various nuances that exist in adolescent sexual and reproductive health, leading to the development of more effective policies and programs in the region. It is against this background that the editorial board of the African Journal of Reproductive Health decided to launch this special edition of the journal to stimulate deeper understanding and more coherent thinking about adolescent sexual and reproductive health and its related programming in sub-Saharan Africa. Four types of articles are presented in this issue of the journal.  The first sets of papers describe various theoretical frameworks and scientific arguments for comprehending the complex and sometimes interwoven issues that surround adolescent sexual and reproductive health in sub-Saharan Africa.  Hitherto, there has been limited documentation of a coherent and convergent pattern of ideas that surround adolescent reproductive health in the region, which has reduced the ability to identify and target universal solutions. The article by Eleanor Maticka-Tyndale and Onokerhorhaye¹ and

Barthelemy Defo and colleagues² in this issue of the journal present high-level scientific analysis of the nature of the background determinants of adolescent sexual and reproductive health in Africa.  While the article by Onokerhorhaye and Maticka-Tyndale describes various theoretical frameworks for targeting interventions for the prevention of HIV among adolescents, the paper by Defo and colleagues stimulate deeper understanding of how family structures and transitions can determine the pattern and influence the nature of adolescent sexual behavior.  Africa being deeply rooted in family traditions and practices, it is expected that family relations would strongly influence childhood and adolescent sexual development. Yet, there have been limited interventions that address family development as part of efforts to modify adolescent sexual behavior and improve adolescent reproductive health in the region.

The second set of papers – 8 in all, emanate from a north-south collaborative research project between the University of Windsor, Canada as northern partners and the University of Benin as the southern collaborators, that sought to advance knowledge and build capacity for the implementation of an HIV/AIDS prevention initiative among rural youths in Edo State.  The papers^{3, 4,5,6,7, 8, 9}describe the rationale, methods, results, the challenges and lessons learnt from the project in ways never before described for a project of its kind in an African context.  Although the project was carried out in rural Edo state in the Niger-Delta region of Nigeria, the results and documentations have broader implications for programming on HIV/AIDS throughout the African region.  The project approach which was aimed at building the competencies of rural communities to prevent HIV/AIDS in young persons is a unique model that will resonate in all parts of Africa.  Since HIV/AIDS in African youth is driven largely by norms, patriarchal values, beliefs and traditions, an approach aimed at involving and engaging communities in finding solutions would be most likely to be effective and impactful. In particular, two of these cohort of papers, present the results of systematic and detailed scientific evaluation of the teacher training program⁶ as well as the overall impact of the program⁷, which serve to address the current lack of scientific evaluation of HIV/AIDS programs in the region.

The third sets of papers in the journal highlight the potential role that information and communication technology (ICT) and new media platforms can play in increasing youth access to sexual and reproductive health.  In recent years, internet technology, mobile phones and the new media have grown vastly in the continent, raising the possibility that African youths would be able to use this medium to access a variety of information, including sexual and reproductive health information and services.  To date, there has been limited documentation of the extent to which these methods are used by youths in the region, while little is known of the barriers and difficulties that youths face in using them.  The article by Professor Lindsay Edourd and his daughter in this edition of the journal⁹, provide an overview of opportunities for leveraging ICT use for scaling up and promoting adolescent sexual and reproductive health in Africa.  Further elucidation and assessment of the use of these methods in different communities were very elegantly provided in articles by Michael Kunniji¹⁰ and Fadekemi Akindaderin-Agarau and her colleagues¹¹.  Together, these articles provide deeper understanding of the context under which ICT and related technologies can be used to promote sexual and reproductive health programming in the African youth.

The last set of papers provides overviews and summary results for emerging issues and interventions relating to sexual and reproductive health in the African region. Some of these include: 1) a review of the trends and determinants of early marriage¹², a practice more prevalent in parts of Africa when compared to other regions of the world; 2) a paper that describes the use of a unique method of story-telling for shaping adolescent sexual and reproductive health and behavior¹³; 3) a paper that provides evidence that community norms limiting the use of condoms by youths may be liberalizing in Western Kenya¹⁴; and 4) a paper that describes the characteristics of young women seeking post-abortion care in Malawi¹⁵.  Overall, these papers add to the quantum of available information and are a ready resource for researchers, programmers and advocates for targeting effective programs and policies for improving adolescent sexual and reproductive health and rights in the region.

In conclusion, this compilation of research and intervention results on adolescent sexual and reproductive health from various parts of Africa illustrates what can be gained when there is a systematic evidential documentation of related social change work in the continent.  Such documentation can generate a comprehensive body of knowledge which can pave the way for creativity and innovations in the development of programs for achieving scale and impact on adolescent sexual and reproductive health.  A paradigm shift is indeed desirable that engages scientists, advocates, policymakers and researchers to identify common scientific grounds for targeting impactful programming in adolescent sexual and reproductive health in Africa and one that avoids the current proclivity for knee-jack programming that is often difficult to measure or to replicate.