Make adolescent and youth reproductive health programs responsive to needs with better data

The following is a guest post by Bridgit Adamou, MPH, MEASURE Evaluation.

Young people suffer disproportionately from negative reproductive health outcomes, including acquiring HIV and other sexually transmitted infections; unintended, unwanted, or mistimed pregnancies; unsafe abortion; and gender-based violence. As they are not, however, often included in reproductive health programs or outreach, they also can lack access to appropriate information, care, and treatment.

As adolescents and youth are recognized as a key population for reproductive health programs, the outcomes of those programs for youth should be evaluated to determine their success and where improvements are needed. MEASURE Evaluation, funded by USAID, has conducted research to identify gaps in the monitoring and evaluation of programs for adolescent and youth reproductive health.

The research involved a review of interventions, outcomes, and impacts; identification of measurement gaps; and recommendations to improve the monitoring and evaluation of adolescent and youth reproductive health across a spectrum of reproductive health categories. Interviews with key informants in the field provided in-depth knowledge about the monitoring and evaluation of these activities, challenges, best practices, and lessons learned. A document review examined published peer-reviewed and gray literature on adolescent and youth reproductive health. The review found 803 output, outcome, and impact indicators for measuring adolescent and youth reproductive health and — after a systematic assessment of each indicator — 103 were identified as key indicators.

The gaps identified were the lack of data collected from unmarried women and girls, adolescent boys, very young adolescents (ages 10–14), and youth who are marginalized or vulnerable (including refugees, youth with disabilities, and youth living with HIV). It also found that age- and sex-disaggregated data are not always collected and that data on non-heterosexual behavior is seldom collected. The researchers also found that the impact of digital approaches to reach adolescent and youth were sometimes not measured.

There are few good measures for monitoring and evaluating youths’ access to contraceptive information and services, the effects of interventions at the community level (e.g., changes in norms, attitudes, or behaviors of community members), and other key facets of adolescent and youth reproductive health, such as fertility intentions, fertility awareness, and what influences adolescents’ decisions.

The review also showed that gathering sensitive information from adolescents is difficult and often leads to gaps in reporting, particularly among adolescent girls. These gaps include sexual activity, induced abortion, sexually transmitted infections and gender-based violence.

The report, Gaps in Global Monitoring and Evaluation of Adolescent and Youth Reproductive Health, makes these suggestions:

• Use a selection of relevant key indicators, especially from those recommended in the report.
• Use currently defined indicators for adolescent and youth reproductive health whenever possible, rather than creating new ones.
• Develop and validate standardized indicators for sexually transmitted infections.
• Improve the capacity of health management information systems to collect age- and sex-disaggregated data.
• Expand efforts to monitor adolescents’ access to contraceptive information and services.

To obtain reliable data from young people, data collection tools should use terms that adolescents clearly understand. And, because youth are often reticent when discussing reproductive health, these terms should be in unambiguous language and have accompanying definitions. Increasing the use of digital technology and capitalizing on youths’ comfort with mobile devices could improve accuracy of data and reduce under-reporting of sensitive behaviors.

The research further suggests that more adolescents from marginalized groups should be captured in surveys so their needs can be better understood and addressed. Likewise, measures of important social determinants of adolescent health and well-being, such as child marriage and lack of school participation, should be included in program monitoring and evaluation plans.

Better data should help programs be more responsive to the special needs of youth and allow better data comparisons across interventions and countries — all of which can help young people transition into adulthood and lead healthier lives.

For more information, read about MEASURE Evaluation’s youth-focused work.