This piece is a part of A360’s replication series on the UK Aid-funded Vale-a-Pena project. With and for young people, Vale-a-Pena is proving the power in applying A360’s youth-powered approach to determine what it takes to enact effective, resonant and ultimately lasting adolescent and youth sexual and reproductive health (AYSRH) behavior change in Mozambique – and beyond.
In Mozambique, young people face a complex web of socio-cultural barriers too oft barring them from accessing reproductive health services — where, when and how they want.
Resolving this gap requires addressing contextual and systemic market failures: from strengthening how we prime frontline players with the training and resources to deliver youth-centered services to assessing what it takes to build acceptance of and support for AYSRH among all within young people’s worlds.
We’ve outlined our top 5 thoughts on the elements we can address, today, in our mission to reimagine how young people in Mozambique, and beyond, make the health decisions that shape their lives.
1. Address socio-cultural pressures on youth
Traditional Mozambican society places an impetus on girls to marry after puberty’s onset, and then prove their worth by having a child. The latter becomes the entire family’s business – girls face routine questions from their mother-in-law, husband, neighbors, and others regarding their marriage, their fertility and their desired family size. It’s a subtle form of coercion that reinforces the expectation: motherhood is that step to make you a “full woman.”
Within this space, AYSRH services typically target girls and women, leaving boys and men from the conversation – despite their role as decision-makers for if and what methods girls and women use. We have an opportunity to shift cultural perceptions around what male engagement looks like, so boys and men can be girls’ and women’s contraceptive allies.
2. Build and support provider capacity
With no doubt: supply-side challenges exacerbate access to AYSRH services. Building and supporting providers’ ability to deliver judgment-free, quality contraceptive counseling goes a long way in expanding access to and promoting adoption of modern contraception among adolescents. But that begins with strengthening training, streamlining counseling and building out providers’ AYSRH knowledge (including their ability to insert and remove long-acting methods) so they can safely and effectively provide girls with the trusted information.
3. Foster an enabling environment
In Mozambique, ‘madronas’ who lead initiation rituals, religious leaders, traditional healers, mothers-in-law, aunts, midwives and traditional birth attendants lead the charge in educating young people about sexuality. But despite their role, they are generally not included in strategies to promote AYSRH services, and therefore lose key opportunities to capitalize on known socio-cultural standard bearers. As the A360 Blueprint for AYSRH Change notes, sustaining change requires building on key moments communities already know and embrace.
At the same time, we must focus on advocating for and strengthening policies that pave pathways to access, from the community level on up. Already, the Government of Mozambique has committed to mobilizing domestic funds to finance contraceptives from 5% in 2012 and achieve a 34% modern contraceptive prevalence rate by 2020. This will include addressing and reducing structural barriers, including implementing systems to monitor and flag stock outs, supporting in-school AYSRH outreach activities and strengthening systems for quality assurance of service delivery.
4. Address public sector barriers
Mozambique’s public sector may offer free AYSRH services, but the perk loses all value if barriers to access remain. (That’s everything from long travel distances and wait times to commodity stockouts and lack of youth-friendly health service providers). These challenges are exacerbated in poorer provinces, where the contraceptive prevalence rate ranges from 14.4% in Sofala, 17.8% in Zambézia, and 18.1% in Manica – compared to 46.5% in Maputo City. And while poorer provinces have experienced greater increases in the prevalence of contraceptives, overall prevalence remains woefully limited. Mobile health services present an attempt to address the gap, with the caveat that the range of contraceptive options available via mobile outreach must be expanded.
5. Improve the quality of and access to trusted sexual and reproductive health information
Community health workers, activists, health care providers, mass/social media channels, key influencers, family members—you name it—proliferate information, much of which often lacks credibility. Inconsistent and inaccurate messaging, as well as missing the mark on targeted messages that speak to young people’s unique life stages, diminishes the efficacy of social behavior change campaigns intended to reframe the benefit and value of contraceptive use – and give young girls, in particular, the tools to negotiate safe sex. Low literacy rate further affects how young people attain AYSRH information.