Young people's sexuality, sexual behavior, and reproductive health are influenced by the expectations, norms, and practices of peers, parents, and other adults in the communities in which they live. Institutions and informal groups, including religious organizations, schools, and local authorities all influence the roles and responsibilities of young people and their access to sexual and reproductive health information and services. Involving members of the wider community, as well as young people themselves, in reproductive health and HIV/AIDS programs is essential in order to build an enabling environment for young people to improve their well-being and health. Involving communities in health outcomes increases the potential to reach youth who are not in school or who are otherwise more at risk (for example, orphans and vulnerable children).
Although there is an acute need for community involvement in youth programs, only a handful of studies have attempted to measure the added value of incorporating such participation into youth sexual and reproductive health programming. Though an increasing number of such programs exist, community involvement in youth sexual and reproductive health and HIV prevention has not yet been well documented. Thus, understanding the value of community involvement in youth sexual and reproductive health and HIV programs, including the most effective ways to encourage, support, and sustain community members' participation in such programs, requires more research.
This review examines the evidence for the effect of community-based reproductive health interventions for young married couples in lower and middle-income countries. The results suggest that multi-layered community-based interventions can improve the utilization of health services, though with limitations (2015).
This study is a descriptive review of the effectiveness of initiatives to improve adolescent access to and utilization of sexual and reproductive health services (SRHS) in low- and middle-income countries. We examined four SRHS intervention types: (1) facility-based, (2) out-of-facility based, (3) interventions to reach marginalized or vulnerable populations, (4) interventions to generate demand and/or community acceptance. Results suggest weak but positive effects for approaches that use a combination of health worker training, adolescent-friendly facility improvements, and broad information dissemination via the community, schools, and mass media; no effect of out-of-facility–based strategies, especially for those delivered through mixed-use youth centers that “demonstrated that SRHS in these centers are neither well used nor effective at improving SRH outcomes”; positive if mixed effects for demand-generation activities; and positive effects for efforts focused on increasing approval among gatekeepers. The authors conclude that “packages of interventions that train health workers, improve facility adolescent friendliness, and endeavor to generate demand through multiple channels” are likely to be most successful (2015).
The GREAT project aims to promote gender-equitable attitudes and behaviors among adolescents (ages 10-19) and their communities with the goal of reducing gender-based violence and improving sexual and reproductive health outcomes in post-conflict communities in northern Uganda. The full implementation involved multiple interventions aimed at community norm change, including a serial radio drama called Oteka, working with Village Health Systems and health care providers, and a community mobilization approach known as the Community Action Cycle (CAC) (2010-2015).
This project, implemented by Pathfinder International in Bihar, India, emphasized a multi-layer approach to improving the sexual and reproductive health of youth. This included directly engaging community members to shift gender norms. Evaluation results indicate improvements in age at marriage, contraceptive knowledge, attitudes, and use.
Community involvement is considered an important element of most health and development programs. Local knowledge can inform program design when community members are involved from the beginning, and community action extends the reach and scope of interventions. Experience with programs in many sectors has shown that behavior change to improve people's health and well-being requires changes in knowledge and attitudes not only at the individual level but also at the community level. Community-level shifts in attitudes and social norms create a more supportive environment that enables individual to adopt and maintain new behaviors. Community involvement can also create the sense of ownership necessary to sustain behavior change beyond the life of an externally funded program. Involving both youth and adults in communities is particularly important for youth reproductive health (YRH) and HIV programs. Some degree of youth involvement is essential for such programs to function. Greater levels of youth participation may also increase the impact of reproductive health and HIV prevention interventions. Programs for youth that are designed only by adults tend to be based on an idealized view of how young people should behave. Young people's participation in planning, implementation and evaluation is expected to ground programs in the real needs of youth and the support systems they actually use, making interventions more relevant to their intended beneficiaries (2005).
This guide is a compilation of resources, including documents, manuals, and toolkits that provide advice, approaches, and tools for involving community members, including youth in programs focused on youth reproductive health (2006).