Chowdhary Pari, Kalyanpur Anushka, Mekuria Feven Tassaw, Altinci Ihlas
Health Equity and Rights Team, CARE USA, Atlanta, GA, United States.
Sexual and Reproductive Health Team, CARE Turkey, Gaziantep, Turkey.
Front Reprod Health. 2022 Jan 28;4:780952. doi: 10.3389/frph.2022.780952. eCollection 2022.
Increases in early marriage and pregnancy resulting from Syria's humanitarian crisis highlight a critical gap in adolescents' access to life-saving sexual and reproductive health information and services, and a larger need for adolescent-specific interventions grounded in gender transformative approaches. Seeking to address this, CARE, UNFPA and Syria Relief and Development adapted global evidence-based approaches to humanitarian contexts to create the Adolescent Mothers Against all Odds (AMAL) Initiative for pregnant girls and first-time mothers aged 10 to 18 years. Designed to improve the lives of young girls through responsive health systems and enabling environments, AMAL includes three components: a Young Mothers Club for first-time mothers and pregnant girls, participatory dialogues with health providers, and reflective dialogues with girls' marital family and community members. The AMAL Initiative intends to ensure responsiveness to the unique vulnerabilities of adolescent sub-groups by co-implementing with them. Select girls undergo additional leadership training and serve as adolescent representatives on community advisory groups sharing feedback for program improvement. One hundred-four first-time mothers and pregnant girls, 219 community members, and 120 health providers participated in AMAL in northwest Syria. In a mixed methods evaluation, facilitators administered monitoring tools to identify program improvements, pre-post surveys to assess outcomes, and end-line discussions to gather perceptions of impact. Girls reported a 47% overall increase in self-esteem, confidence, health-seeking capacity, and communication ability. Community support for girls' use of family planning increased by 27% and girls' equal access to services by 35%. Findings across all participant groups demonstrate decreased expectations of early marriage and increased acceptance of family planning post-marriage. Areas that participants cited for potential improvement included programming for girls/women above the age of 18 years, and additional training for health providers on long-acting contraceptive methods. These results show that participatory adolescent-centered sexual and reproductive health programming is not only feasible in crisis settings but can improve the self-efficacy of vulnerable adolescents to overcome barriers to accessing healthcare and improving well-being. The AMAL Initiative is now being scaled up through local partners in Syria and piloted in northern Nigeria.
叙利亚人道主义危机导致早婚和早孕情况增加，凸显出青少年在获取救生性健康和生殖健康信息及服务方面存在的关键差距，也更需要基于性别变革方法的针对青少年的干预措施。为解决这一问题，救助儿童会、联合国人口基金以及叙利亚救济与发展组织将全球循证方法调整应用于人道主义背景，为10至18岁的怀孕女孩和初为人母者创建了“不畏艰难的少女母亲”（AMAL）倡议。AMAL旨在通过响应式卫生系统和有利环境改善年轻女孩的生活，包括三个组成部分：为初为人母者和怀孕女孩设立的年轻母亲俱乐部、与医疗服务提供者的参与式对话，以及与女孩的婚姻家庭和社区成员的反思性对话。AMAL倡议旨在通过与青少年子群体共同实施来确保对其独特脆弱性做出响应。挑选出的女孩接受额外的领导力培训，并作为青少年代表加入社区咨询小组，为项目改进提供反馈。在叙利亚西北部，104名初为人母者和怀孕女孩、219名社区成员以及120名医疗服务提供者参与了AMAL倡议。在一项混合方法评估中，协调人使用监测工具来确定项目改进之处，通过前后调查评估成果，并进行终期讨论以收集对影响的看法。女孩们报告说，她们的自尊、自信、寻求健康的能力和沟通能力总体提高了47%。社区对女孩使用计划生育的支持增加了27%，女孩平等获得服务的比例增加了35%。所有参与群体的调查结果都表明，早婚的预期降低，婚后对计划生育的接受度提高。参与者提到的可能需要改进的方面包括针对18岁以上女孩/妇女的项目，以及为医疗服务提供者提供关于长效避孕方法的额外培训。这些结果表明，以青少年为中心的参与式性健康和生殖健康项目不仅在危机环境中可行，而且可以提高弱势青少年克服获取医疗保健和改善福祉障碍的自我效能。AMAL倡议目前正在通过叙利亚当地合作伙伴进行扩大规模，并在尼日利亚北部进行试点。
