A Liberian grandmother sits in a classroom filled with young adults and teenagers, some as young as 13. She’s a bit uncomfortable with the class’s subject matter—which includes frank talk about reproductive body parts and sex, family planning, and HIV/AIDS prevention—and she gets up to leave. “No, no, please stay,” the younger people urge the older woman. “It is important.”
It’s a new kind of conversation in Liberia, where the need for reproductive health education and HIV/AIDS prevention is critical—for all ages. These students are participating in HealthyActions, an education program that addresses some of the country’s most urgent health and social issues.
Developed as a collaboration between EDC and Population Services International, Liberia (PSI/Liberia), HealthyActions is based on curriculum designed by PSI’s youth communication specialist. It involves a week of classes on family planning and preventing sexually transmitted infections (STIs), including HIV/AIDS, and culminates with a Clinic Celebration Day, during which HIV counseling and testing and family planning services are offered by the Government of Liberia.
Liberia has one of the highest teen pregnancy rates in the world. The Liberia Demographic and Health Survey 2007 shows that more than 59 percent of 19-year-old women had either already given birth or were pregnant for the first time. The survey also showed a high unmet need for family planning: 43 percent of married women under age 24 said they wanted to delay or prevent pregnancy. Out-of-school, unemployed women are also at risk for engaging in transactional sex, which puts them at even greater risk for unwanted pregnancy and contracting STIs.
“We’re breaking down barriers that exist within communities,” says EDC Senior International Technical Advisor Simon James, who observed HealthyActions at JW Pearson school in Ganta, Nimba County. “People who wouldn’t normally talk to each other about sex are now learning how to make healthy choices together. There’s a huge interest in attending these classes.”
Learning to be healthy
The majority of the participants in the HealthyActions classes are also enrolled in the USAID Advancing Youth Project, which provides literacy, numeracy, and work readiness training to out-of-school youth and young adults. The Advancing Youth Project expects to reach an estimated 16,000 young Liberians by 2016.
Classes are taught by county health leads, who facilitate the week of classes and organize the Clinic Celebration Day where services are offered. The county health leads also train Advancing Youth learners as peer health educators who will serve as program promoters within their own communities.
“Learners learn how to negotiate to use condoms to prevent disease and pregnancy,” says Advancing Youth’s Community Outreach Team Leader Charles Wleh. “We encourage them to use family planning, and teach them that voluntary counseling and testing should be an ongoing thing.”
Voluntary counseling and testing are offered on the last day of HealthyActions classes. HIV/AIDS testing is conducted via the Liberian Ministry of Health at the Clinic Celebration Day; if participants test positive, they are then referred to government health facilities for follow-up and treatment.
Reasons for optimism
Early results from the HealthyActions pilot, carried out in Montserrado and Nimba Counties, are encouraging: more than 1,300 youth and 2,100 community members reached, 72 percent of learners received an HIV test, and more than 50 percent of women received contraceptives (oral, injectables, or implants). The next phase, which will take place in 6 of Liberia’s 15 counties, expects to reach an additional 3,000 Advancing Youth learners and more than 5,000 community members.
Responses from participants have been positive. “I have four children by two different fathers,” said one participant. “From this program, I will now know how to plan my family.” Another young mother said, “I will take my family planning tablets or implant so I will not get pregnant for the next five years to come.”
“The HealthyActions meetings break down barriers,” says Wleh. “It gets people talking.”
PSI’s SRH Program Manager Marilyn Luke Urey says HealthyActions is effective because of the combination of activities offered. “Initially, participants learn about reproductive health. Then they learn where to access services,” she says. “Then through the Clinic Celebration Day, they actually visit the clinic.”
“HealthyActions is directly contributing to improved health outcomes as well as delayed or lower pregnancy rates,” says Lisa Hartenberger-Toby, EDC’s chief of party in Liberia. “This is beneficial to individual Liberians, their families and communities, and Liberia as whole.”