Sexual and reproductive health of adolescents
Asking young people about sexual and reproductive behaviours
John Cleland, Roger Ingham, Nicole Stone
Introduction to illustrative core instruments
In 1998-99 the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) launched a social science research initiative on adolescent sexual and reproductive health in developing countries. The aim of this initiative was to support research that addresses factors that contribute to positive sexual and reproductive health outcomes, especially those that can be influenced by appropriate interventions in developing countries. Between 1999 and 2001, a total of 38 projects have been supported under this research initiative.
Investigations cover an array of research topics – factors obstructing and facilitating safe and wanted sex, including among vulnerable groups; unwanted pregnancy and its consequences, gender roles and sexual attitudes; health seeking, quality of care and provider perspectives. The feasibility of such interventions as peer education and wide ranging and friendly service structures was also tested in a couple of studies. Most studies, as indeed most studies on this subject more generally, employed a mix of qualitative and quantitative designs.
It became clear that whatever the topic, a core set of questions would need to be asked by almost every study. Most studies on adolescent sexual and reproductive health will indeed explore sexual conduct including age at debut, outcomes including pregnancy, abortion and infection, sexual ideology/attitudes to gender, sexual and reproductive health knowledge and sources of information, protective, or risk behaviour, condom use, or health seeking and perceived quality of care. In recognition of this, the idea evolved of developing a core set of instruments covering these themes – survey questionnaire, focus group discussion and in-depth interview field guides – that could be adapted as appropriate by researchers to suit the needs of their particular research question and the cultural context in which the study would take place.
Three instruments were designed to meet these needs. These include an Illustrative Questionnaire for Interview-Surveys with Young People designed by John Cleland, and Topics for Individual In-Depth Interviews and Focus Group Discussions: Partner Selection, Sexual Behaviour and Risk Taking designed by Roger Ingham and Nicole Stone. Each of these instruments focuses on documenting knowledge, beliefs, behaviour and outcomes in the areas of sexual and reproductive health, and thereby outlines the needs and concerns of young people. Findings should provide direction for interventions or advocacy
However, it must be clearly stated that these instruments are intended to be no more than a starting point for investigators wishing to study the sexual and reproductive health of young people. Authors caution that these instruments should always be adapted to local circumstances and research priorities and, wherever possible, be used in conjunction with each other. For example, a study on sexual coercion or quality of care would clearly need to expand the set of questions concerning these topics. Similarly, studies in very traditional settings may find some of the questions too explicit and unacceptable and would hence need to replace these. Finally, the importance of rigorous pre-testing, particularly where questions have been translated into other languages cannot be sufficiently emphasised.
The study population of these instruments is, for the most part, young people – both female and male - - who have reached puberty but have not yet married or entered long term partnerships. They are designed to be applicable to a wide range of young people – those in and out of school, those employed outside the home or engaged in work within the home setting, and those who are both sexually experienced and those who are not. Appropriate modifications will of course be required if the study population is in very early adolescence or is married.
Researchers in several countries – including China, India, Kenya, Nigeria and Tanzania – have made use of these instruments in the course of their research and their feedback has been positive. There is now a considerable interest from researchers more generally to have access to these instruments.