One of the six strategies Her Choice applies in the field addresses Strategy I: Invest in girls, their knowledge and skills related to Sexual and Reproductive Health and Rights (SRHR) and participation in society; including enhancing their comprehension of the negative effects of child marriage and of alternative options.
The long-term goal of the Her Choice programme is to support the creation of child marriage-free communities in which girls and young women are free to decide if, when and whom to marry. The six intervention strategies are based on evidence, which shows that the most consistent results of targeting child marriages are achieved by fostering information, skills and networks for girls in combination with community mobilization and creating an enabling legal and policy environment.
Within the framework of Strategy I, girls are offered various educational programmes which aim to build their knowledge and skills related to SRHR, and their lobby and advocacy skills. A central output of the programme concerns increasing the number of young women educated on SRHR, including on negative effects of child marriage and FGM/C. Expected intermediate outcomes relate to young women’s comprehensive knowledge on SRHR, and the outcome that they have confidence in opposing a marriage against their will. In addition, expected outcomes relate to girls’ abilities to use contraception in a sexual relationship, and that they speak out in community meetings on girls’ rights and against child marriage and FGM/C.
In all countries, teachers and HC partners conducted SRHR training of girls in various settings – either within the framework of school girl clubs, or during regular classes, or in the community. Overall, less training is provided to out-of-school girls than to those in school. Figure 1 shows an increase in single girls receiving SRHR education – with in the midline in all countries 60% or more having received such education, compared to lower figures in the baseline study. The increase is particularly steep in Mali and Pakistan.
Figure 1: Share of single girls who received education on SRHR-related issues (%)
When discussing the preliminary midline study findings during regional meetings, local Her Choice implementing partners acknowledged there is considerable variation in the quality and degree of comprehensiveness of training provided across countries. For example, Ethiopian partners are at an advantage–one of the partners being a SRHR-related education specialist and providing teacher training for all other Her Choice partners’ programmes. In Burkina Faso, Nepal and Benin, partners liaise with government concerning the design of SRHR-related training manuals.
Young women who had received training were asked who provided this training, that is, whether this was a school, church, NGO (Her Choice partner and/or other), or a health institution. At ML, we found that training was mainly organised by schools and NGOs –with a Her Choice partner being the main NGO offering SRHR training. It should be noted that if they answered ‘’school’’, the teachers were trained by a Her Choice partner. Particularly in in Nepal, Senegal, Mali, Benin, and Ghana a large share of young women were trained by a Her Choice partner.
Young women who had taken part in SRHR-related education were asked about the topics that had been covered during lessons. We used a checklist of topics that should be included in a comprehensive sexuality education initiative. Similar topics were addressed in most countries, including laws against and negative effects of child marriage, puberty, menstrual cycle and pregnancy, sexual violence and abuse. Strikingly, in African countries (except Uganda), during training more attention was given to intimate and sexual relations and contraceptives when compared to Asian countries. It is important to note that since 2016, the Ministry of Gender in Uganda banned the provision of comprehensive sexuality education, and for this reason educators cannot engage with issues such as contraceptives and intimate relationships. From the list of reported topics, we can deduct that hardly any training can be considered comprehensive.
Case: Satisfaction with school-based SRHR-related education (information from midline FGDs with female and male secondary school students)
Views differed among young people as to the quality of their SRHR-related education, with opinions most consistently positive regarding information provided by a Her Choice partner and most varied in relation to the education offered in schools. Concerning the latter, young women in Bangladesh and boys in Pakistan indicated they had not received (much) SRHR-related education in schools and/or were told by their teachers to learn about these issues at home. Satisfaction with Her Choice SRHR-related education was explicitly mentioned in a) Bangladesh: by girls and boys , b) Ghana: by boys, and c) Pakistan: by girls, with boys indicating their dissatisfaction because the ‘NGO came only once or twice to discuss it,’ however. The latter could be read as a criticism of the Her Choice partner –if indeed ‘the NGO’ referred to an Her Choice partner. The remark could also be an indication that the young men involved in the FGDs simply want and need more sessions on SRHR-related issues with the NGO concerned.
Data from FGDs with young people in Bangladesh, Ghana, Nepal and Uganda are most detailed as to the contents of SRHR-related education in schools. These FGDs also provide most detail as to suggested areas for improvement. As mentioned above, young women and men in treatment sites in Bangladesh mentioned having received SRHR-related education from the Her Choice partner, indicating their satisfaction with the format used, that is, they appreciated the space for discussion and Q&A (here referring to questions and advices). Girls in Bangladesh also mentioned female teachers providing girls ‘advices.’
In Ghana, young people spoke of their science and social studies teachers, the ‘patron teacher’ in the girls/boys’ clubs and epicentre nurses providing SRHR-related education. Young women talked about lessons dealing with ‘how to use condom [and other contraceptives] so that you will not get pregnant, and how to abstain from sex for our education’. Young men were most vocal as to what could be improved, for example, that teachers should use pictures and other visual aids, for clarity, adding that SRH teachers should be clear and use appropriate terms and names during SRHR education. Young men recommended teachers: ‘[D]escribe issues clearly and into detail to avoid doubt, confusion and misconception, and to prevent curious students from seeking clarity at inappropriate places.’ One young man further clarified: ‘The teachers do not go into the specifics of what happens during sex so curious students always try to find out what the teachers are not explaining to them.’
These data clearly highlight young people’s desire for more comprehensive information and more openness from teachers. According to some young men, SRHR lessons taught by the (epicentre) nurse were better than those provided by the teachers, suggesting she was more ‘suited to the topic and knows more’ than their teachers. These young men also indicated that they wanted ‘more practical’ SRHR lessons, suggesting that lessons may be taught in too abstract a manner.
Young women in Nepal explicitly mentioned receiving SRHR-related education from a female health teacher, highlighting their satisfaction with ‘menstrual hygiene’ information they received and skills they developed (in making re-usable sanitary pads). Young men in Nepal expressed the wish to have a ‘proper’ health teacher, clarifying they currently received SRHR education from their English and maths teachers who were not sufficiently knowledgeable.
Young women and men in Uganda talked about taking part in SRHR-related education, provided by teachers (‘senior woman’ teachers, in the case of girls) and health workers. The list of topics on which they had received education was quite detailed, and suggested a clear normative position, that is, young people were given many ‘do not’s’, such as having sexual intercourse (before marriage), spending time with ‘bad peer groups, ’sugar daddies,’ elongating the clitoris, and marrying early. One group of girls reported being told not to have sexual intercourse during or directly after menstruation to avoid pregnancy, suggesting that information provided in schools was not always accurate.
Case: SRHR training in Ethiopia
In Ethiopia the NGO Wabe Children’s Aid and Training (WCAT), one of Her Choice’s 27 partners in the field, trains teachers of the Mekuabia school to give education on sexual and reproductive health and rights (SRHR), to both girls and boys.
13-year old Agegnehu Acheye is the leader of a Girls Club at the Mekuabia school in South Gondar, Ethiopia. As a Girls Club they have a relax room, which was created at the initiative of Her Choice. Agegnehu shows us a nice mattress, a jerry can with water and soap so that the girls can wash themselves and a drain for the sewage. On the door there is a sign with ‘open’ or ‘closed’, so that the girls can wash and rest during their menstruation, undisturbed.
While several religious leaders and other communitity members are standing in the room and listen to her, Agegnehu explains us how the birth control pills work: ‘You take the pink pills when you menstruate.’ On the wall behind her Agegnehu and her classmates made drawings of several contraceptives such as condoms, birth control pills and contraceptive injections. The education on SRHR consists of 14 lessons, including about contraception, marriage, friendship and love. Agegnehu learned something very important in these lessons, she says: ‘Love should not hurt.’
In 2018, after three years of programme implementation, independent research shows that we are making progress. In the midline girls (and boys) have increased knowledge about SRHR compared to the baseline in all countries (figure 2). They have more knowledge about adverse effects of early marriage and female genital mutilation, child marriage law and policies, and speak out more about those subjects in community meetings. They thus will be able to make more informed decisions with respect for example to contraception and marriage.
Figure 2: Mean degree of knowledge of single girls on SRHR (range 0-5)
NB: Young women were deemed to have ‘comprehensive knowledge’ (i.e. score 5), if they were able to answer correctly on questions regarding the following five issues: 1) when in the menstrual cycle a girl has most chance/risk to get pregnant, 2) whether a girl can get pregnant the first time she has sexual intercourse, 3) knowledge of existence of male condom, 4) knowledge of existence of contraceptive pills, and 5) able to mention at least one negative effect of child marriage.
We see an increase in contraceptive use among single girls in most countries: in the midline approximately half to three-quarters of young women who reported being sexually active used a contraceptive method – mainly condoms – compared to lower figures in the baseline. Increase was particularly pronounced in Mali and Burkina Faso (respectively from 40% at baseline to 75% at midline, and from 50% at baseline to 76% at midline). Contraceptive use among single girls will lead to a reduction in the rates of premarital pregnancy – which as we know is one of the reasons why girls are married at young age.
One of the intended outcomes of SRHR-related education is an increase in girls’ ability to publicly speak out about young people’s rights, including their right to education, not to marry before the legal age of marriage and against FGM/C. The programme encourages young women to speak out during community meetings or rallies, or in school, for example
Figure 3: IND9 Share of single girls who have spoken out in community meetings/rallies on their rights (%)
Figure 3 shows that compared to baseline, a larger share of single girls in all countries, excluding in Benin, reported at midline that they had spoken out about their rights in public meetings. The increase is especially striking in Mali and Pakistan. The share of single girls speaking out is generally higher than the share of married girls – with the exception of Senegal and Mali, where figures for married and single young women were comparable. In most countries, girls who indicated that they spoke out about SRHR-related issues in public, against CM and/or FGM/C, reported that their audience tended to be their peers. Common settings for such ‘speaking out’ were classrooms or school meetings. In Senegal, Benin and Ghana a considerable share of girls reported speaking out also did so during community meetings or at public places, such as markets. (In Senegal 83%, all girls in Benin and 50% in Ghana).
Challenge: SRHR is a sensitive issue
Albeit training and increased knowledge about SRHR, girls’ knowledge is still low, especially on their sexuality and ways to prevent pregnancy. This could have something to do with the fact that the training of teachers is not optimal: although more teachers have been trained on giving SRHR education, many teachers (also those trained) report to feel uncomfortable to address some SRHR related issues, including sexuality, contraception and intimate relationships.
At midline, still a large share of teachers in most countries reported they occasionally lacked confidence to speak to students about SRHR-related issues and are not able to address all questions that learners raise. The exceptions were in Nepal, Ethiopia and Uganda, where (nearly) all teachers indicated they felt able and confident.
Teachers were asked an open question as to what kinds of SRHR-related questions they found difficult to address. Responses varied across countries. Topics that were mentioned most frequently across countries related to: sexual intercourse, sexual orientation, sexual pleasure, sexual abuse, masturbation, and same sex relations. These are all topics that would be part of comprehensive sexuality education.
When probing teachers who had difficulties with answering certain questions as to why they experienced certain questions as (more) difficult, they explained that they were concerned about community reactions, that they struggled to teach students of the opposite sex, with younger teachers also speaking of their difficulties in teaching older students. Additionally, some teachers raised their concern with regard to teaching young people about contraception and how this might, in their view, make students ‘curious’ to try out (and engage in premarital sexual relations).
Overall, Her Choice is on the way to create an environment in which SRHR can be talked about safely and openly, but lesson materials and training tools have to be further developed. Read more in the article on the Her Choice website ‘Children who have children’.
 The baseline study was conducted in 2016 by the AISSR (University of Amsterdam) and the midline study in 2018.