Lessons learned from a sexual and reproductive health and rights peer education program to prevent adolescent pregnancies in high schools in Rwanda

Aimable Nkurunziza, Nadja Van Endert, Justine Bagirisano, Jean Bosco Henri Hitayezu, Olive Tengera, Godfrey Katende

Abstract

Adolescent pregnancies that occur in schools remain a major public concern in Rwanda. Sexual and Reproductive Health and Rights (SRHR) school based programs are less effective and discussing sexual health with adolescents is considered as taboo in Rwandan societies. Yet, adolescents still seek information about SRHR from their peers and research shows that peers are often incorrectly informed about SRHR topics. One of the effective strategies to reduce adolescent pregnancies in secondary schools is equipping adolescents with accurate and reliable knowledge. In 2019, we conducted our first network event with different stakeholders. The stakeholders included: school directors, head teachers, biology teachers, local political delegates, religious people among others to help gain insights into SRHR. A survey was conducted and administered to in-school adolescents in Kirehe district (S3 – S6 level, n=563) with the aim of examining adolescents’ level of knowledge and attitudes regarding SRHR. In addition, six focus group discussions (FGDs) were conducted to obtain a deeper understanding of the SRHR needs and the possible contributions and content of a peer -to- peer education program (PEP). The lessons learned included: a) engaging parents in the network event and development of PEP; b) constant communication utilizing the different social media platforms, c) enhanced collaboration between the project implementers and stakeholders a facet of bottom-up approaches to expedite this project; and d) the project should have better anticipated on possible and unforeseen external barriers. Implementing a PEP in Kirehe secondary schools resulted in substantive changes such as positively transforming peer educators (PEs) and the elimination of teenage pregnancies in the selected schools. Overall, the number of PEs was not adequate to cover the number of students and anti-bullying training should have been provided to all students before the project implementation. (Afr J Reprod Health 2023; 27 [4]: 16-23).

Full Text:

PDF

References

Darroch JE, Woog V, Bankole A and Ashford LS. Adding

It Up: Costs and Benefits of Meeting the

Contraceptive Needs of Adolescents.; 2016.

www.guttmacher.org/report/%0Aadding-it-meetingcontraceptive-needs-of-adolescents.

Ameyaw EK. Prevalence and correlates of unintended

pregnancy in Ghana : Analysis of 2014 Ghana

Demographic and Health Survey. Matern Heal

Neonatol Perinatol. 2018;4(17):1-6.

doi:10.1186/s40748-018-0085-1

Habitu YA, Yalew A and Bisetegn TA. Prevalence and

Factors Associated with Teenage Pregnancy ,

Northeast Ethiopia , 2017 : A Cross-Sectional Study.

J Pregnancy. 2018:1-7. doi:10.1155/2018/1714527

Kaphagawani NC and Kalipeni E. Sociocultural factors

contributing to teenage pregnancy in Zomba district ,

Malawi. Glob Public Health. 2017;12(6):694-710.

doi:10.1080/17441692.2016.1229354

Omoro T, Gray SC, Otieno G, Mbeda C, Phillips-Howard

PA, Hayes T, Otieno F and Gust DA. Teen pregnancy

in rural western Kenya : a public health issue. Int J

Adolesc Youth. 2018;23(4):399-408.

doi:10.1080/02673843.2017.1402794

Yakubu I and Salisu WJ. Determinants of adolescent

pregnancy in sub-Saharan Africa : a systematic

review. Reprod Health. 2018;15(15):1-11.

doi:10.1186/s12978-018-0460-4

NISR, MoH and ICF. Rwanda Demographic Health Survey

-15. Rockville, Maryland, USA; 2015.

National Youth Council (2015). Prevent Teen Pregnancy in

Rwandan Schools. NYC.

Mbarushimana V, Goldstein S and Conco DN. “ Not just the

consequences , but also the pleasurable sex ”: a

review of the content of comprehensive sexuality

education for early adolescents in Rwanda. BMC

Public Health. 2023;23(49):1-14.

doi:10.1186/s12889-022-14966-0

Chandra-mouli V and Lane C. What Does Not Work in

Adolescent Sexual and Reproductive Health Rights

Rights : A Review of Evidence on Interventions

Commonly Accepted as Best Practices. Glob Heal Sci

Pract. 2015;3(3):333-340.

doi:http://dx.doi.org/10.9745/GHSP-D-15-00126

Michielsen K, Beauclair R, Delva W, Roelens K, Rossem

R Van and Temmerman M. Effectiveness of a peerled HIV prevention intervention in secondary schools

in Rwanda : results from a non-randomized

controlled trial. BMC Public Health. 2012;12(1):1.

doi:10.1186/1471-2458-12-729

Mbarushimana V, Conco DN and Goldstein S. “ Such

conversations are not had in the families ”: a

qualitative study of the determinants of young

adolescents ’ access to Sexual and Reproductive

Health Rights Rights and rights information in

Rwanda. BMC Public Health. 2022;22(1867):1-14.

doi:10.1186/s12889-022-14256-9

Collectif des Ligues et Associations de Défense des Droits

de l’Homme au Rwanda. Report on Early/ Unwanted

Pregnancy for under 18 Years in 10 Districts of

Rwanda.; 2016.

Michielsen K, Remes P, Rugabo J, Van Rossem R and

Temmerman M. Rwandan young people’s

perceptions on sexuality and relationships: results

from a qualitative study using the “mailbox

technique”. SAHARA J J Soc Asp HIV/AIDS Res

Alliance. 2014;11(1):51-60.

doi:10.1080/17290376.2014.927950

Nkurunziza A, Endert N Van, Bagirisano J Hitayezu JBH,

Dawale S, Tengera O and Jans G. Breaking barriers

in the prevention of adolescent pregnancies for inschool children in Kirehe district ( Rwanda ): a

mixed-method study for the development of a peer

education program on Sexual and Reproductive

Health Rights Rights. Reprod Health.

;17(137):1-8.

Agu C, Mbachu C, Agu I, Iloabachie U and Onwujekwe

O. An analysis on the roles and involvements of

different stakeholders in the provision of adolescent

Sexual and Reproductive Health Rights Rights

services in Southeast Nigeria. BMC Public Health.

;22(1):1-14. doi:10.1186/s12889-022-14644-1

Mbachu CO, Agu IC and Onwujekwe O. Collaborating to

co-produce strategies for delivering adolescent

Sexual and Reproductive Health Rights Rights

interventions: Processes and experiences from an

implementation research project in Nigeria. Health

Policy Plan. 2021;35:II84-II97.

doi:10.1093/HEAPOL/CZAA130

Finlay JE, Assefa N, Mwanyika-Sando M, Dessle Y,

Harling G, Njau T, Chukwu A, Oduola A, Shah I,

Adanu R and Bukenya J. Europe PMC Funders Group

Sexual and Reproductive Health Rights Rights

knowledge among adolescents in eight sites across

sub-Saharan Africa. Trop Med Int Heal.

;25(1):44-53. doi:10.1111/tmi.13332.Sexual

Mcharo RD, Mayaud P and Msuya SE. Where and how do

young people like to get their Sexual and

Reproductive Health Rights Rights Rights (SRHRR)

information? Experiences from students in higher

learning institutions in Mbeya, Tanzania: a crosssectional study. BMC Public Health. 2021;21(1):1-

doi:10.1186/s12889-021-11728-2

International Planned Parenthood Federation. Peer to

Peer: Creating Successful Peer Education

Programs.; 2004.

https://www.iwtc.org/ideas/16_peer.pdf. Accessed

April 13, 2023.

Human Rights Watch. Impact of Covid-19 on Children ’ s

Education in Africa: Submission to The African

Committee of Experts on the Rights and Welfare of

the Child.; 2020.

https://www.hrw.org/sites/default/files/media_2020/

/Discussion Paper - Covid for ACERWC.pdf.

Ramaiya A, Chandra-mouli V, Both R, Gottert A,

Guglielmi S, Beckwith Sam, Li Mengmeng and Blum

RW. Assessing the health , social , educational and

economic impact of the COVID-19 pandemic on

adolescents in low- and middle- income countries : a

rapid review of the literature. Sex Reprod Heal

Matters. 2023;31(1):1-25.

Nkurunziza et al. SRHR peer education program

African Journal of Reproductive Health April 2023; 27 (4): 23

doi:10.1080/26410397.2023.2187170

Ali AK, Barua A, Nyoni Y, Ganapathee S, Plesons M and

Chandra V. Lessons learned from nimble adaptations

to organisations’ responses to the Sexual and

Reproductive Health Rights Rights Rights (SRHRR)

needs of adolescents in the context of the COVID-19

crisis: A synthesis of lessons learned from 36 case

studies from 16 countries. Medicus Mundi

Switzerland.

https://www.medicusmundi.ch/en/forums-forreflection-and-learning/who-case-studies/. Published

Accessed April 13, 2023.

Duby Z, Bunce B, Fowler C, Jonas K, Govindasamy D,

Wagner C, Mangoale K, Ambrose A and Mathews C.

Adaptation and Resilience : Lessons Learned From

Implementing a Combination Health and Education

Intervention for Adolescent Girls and Young Women

in South Africa During the COVID-19 Pandemic.

Front Heal Serv. 2022;2(903583):1-15.

doi:10.3389/frhs.2022.903583

Nkurunziza A, Endert N Van, Tengera O, Bagirisano J and

Hitayezu JBH. Prevention of Adolescent Pregnancies

in School Adolescents : A Collaborative Approach.

Rwanda J Med Heal Sci. 2023;6(1):7-8.

doi:https://doi.org/10.4314/rjmhs.v6i1.1

Refbacks

  • There are currently no refbacks.