GENNEXT: REDUCING UNINTENDED ADOLESCENT BIRTHS THROUGH SEXUAL HEALTH EDUCATION AND SOCCER

CALLIE KAPLAN, MPH, JUDY LEWIS, MPHIL, BETTE GEBRIAN, RN, PHD, KATHERINE THEALL, PHD HAITIAN HEALTH FOUNDATION, UNIVERSITY OF CONNECTICUT, TULANE SCHOOL OF PUBLIC HEALTH AND TROPICAL MEDICINE

SPORTS AND SEXUAL AND REPRODUCTIVE HEALTH

Positive Youth Development (PYD) programs focusing on SRH and sports have shown positive outcome across the globe Martha Brady, 1998: Laying the Foundation for Girls Healthy Futures: Can Sports Play a role? Ishraq Program in Egypt utilized literacy, sports, life skills, livelihoods (Brady, 2007)

Change in attitudes around marriage Change in attitudes around reproductive decision-making Increased knowledge in reproductive health
Mathare Youth Sport Association (MYSA) in Kenya (Kidd, 2008) Increased condom use Grassroot Soccer (Zimbabwe) Increased HIV/AIDS related knowledge (Clark, 2006) Meeting the Goal Posts in Kilifi, Kenya (Forde, 2010)

HAITI HEALTH STATISTICS

Population (DHS, 2012) 10,250,200 population 46% literacy 62% of population below international poverty line Rural income $400 Health (UNICEF) Life expectancy 60.7 male/64.3 female Under 5 death rate 76/1000 Neonatal 25/1000 Maternal mortality 350/100,000 Young Women 15-19 (DHS, 2012) 11.7% of total population 66/1000 Birth Rate

View of Jrmie from mountains

Grand Anse Department

Population 425,000

MADAME AN SANTE YO POU DEMEN

4 programmatic components:
Education Health Screenings Soccer League Youth Groups

Pilot program 2005-2006 boys and girls Program focused only on young women (12-19) in 2006

Over 5550 young women educated to date

Over 3145 young women received both education and participated in soccer

SRH EDUCATION AND HEALTH SCREENINGS

All youth part of family registration by community health workers Course taught in Haitian Kreyol by a nurse educator Co-ed/single sex groups depending on the group Health Screenings Malnutrition Anemia Blood pressure Vitamin distribution Girls Passport to Health

FOUTBO AND YOUTH GROUPS

Largest all-female soccer league
Male and female coaches Supplies are donated and bought in-country Community support for teams Health education courses through youth groups Soccer activities and tournaments Small business ventures World AIDS day

METHODS

Retrospective cohort study design Data drawn from HHFs Visual FoxPro HIS (2006) Exposure: Successful completion of education course (EDU) Successful completion of the education course AND participation in soccer (SO) No participation in program (NON-PROG) Outcome: Delivery (15-19), January 1, 2006-August 15, 2009 Bivariate Analysis conducted between exposures and outcome (2) Multivariate logistic regression analyses (OR) Hazards Ratio estimation with Cox Regression (HR)

RESULTS
21 villages in 2 communes Program Participants (N= 756); EDU (N=441); SO (N= 315) Non Program Participants (N =3,495)

Births by Program Participation Women (15-19) 2006-2009

Mean Age across groups: 15.9

Pre-Test/Post-Test Mean Difference: 5.94 points, 29.7% improvement SO group had significantly greater number of days between intervention and delivery

15 10 5 0
EDU SO Non-Prog DHS (country)

Lower birth rate as compared to country rate but no significant difference among groups

RESULTS, CONT
Only EDU was protective in logistic regression analysis EDU and SO were protective in cox regression analysis SO more protective over time in cox regression
Table 2: Crude and Adjusted odds and hazard ratios for delivery while aged 15-19 by type of program participation, compared to non-participation (n=4251), GenNext, 2006 Type of Crude 95% CL Adjusted 95% CL Crude 95% CI Adjusted 95% CL Particip OR OR HR HR* ation EDU .653 .375, .535 .304, .877 .788, .893 .802, 1.138 .940 .975 .994 SO .927 .531, .819 .465, .668 .591, .631 .558, 1.619 1.442 .755 .714 aadjusted for age at participation and village badjusted for age at participation, village and age/time interaction

CHALLENGES
Research
Delivery rates vs. Pregnancy rates Miscarriage Pregnancy termination Finding participants who had left area Selection bias Programmatic Limited access availability to SRH services and options Conservative environment Gender and power hierarchies

LESSONS LEARNED
Effectiveness of combining a positive activity (sports) with sex education over time Sustained funding necessary for impact Gender transformative curricula more effective Youth Participatory Action Research projects could explore health outcomes and community needs and assets Need to address macro-level factors which contribute to unintended adolescent pregnancy Post-earthquake aid Decentralizationeducation, healthcare, employment Gender and class power hierarchies Support for agriculture and employment in rural areas

ACKNOWLEDGMENTS
I would like to acknowledge the Haitian Health Foundation, the staff for their help and support, and the young women who are inspiring everyday. In particular I would like to thank Roxane Dimanche and Sergo Jean Juste
For questions or comments please email: Callie Kaplan: kckaplan@gmail.com Judy Lewis: lewisj@nso.uchc.edu