综合性性教育与性与生殖健康服务相结合，可减少赞比亚在校少女的早婚和意外怀孕。

BACKGROUND

Advancing the health of adolescents, particularly their sexual and reproductive health, including HIV prevention and care, is a development imperative. A critical part for improving their wellbeing and economic development is the social status accorded to adolescent girls and young women (AGYW). However, AGYW in many countries including Zambia, encounter health challenges that stem from gender inequalities, lack of empowerment, inaccurate knowledge on sexuality, and poor access to sexual and reproductive health (SRH) services and information. Addressing the knowledge gaps through comprehensive sexuality education (CSE) and improving access to SRH services and appropriate information, should reduce school attrition from early and unintended pregnancies (EUP) and enhance realization of their full potential.

METHODS

The aim was to reduce EUP and improve SRH outcomes among AGYW in Zambia through provision of CSE linked to receptive SRH services. A 3-Arm randomized control study collected cross-sectional data at baseline, midline and Endline. Schools where CSE was being routinely provided were randomized into a non-intervention arm (arm1), an intervention arm in which information on available SRH services was provided in schools by health workers to complement CSE, (arm 2), and arm 3 in which pupils receiving CSE were also encouraged or supported to access pre-sensitized, receptive SRH services.

RESULTS

Following 3 years of intervention exposure (CSE-Health Facility linkages), findings showed a significant decline of in-school pregnancies amongst AGYW in both intervention arms, with arm two exhibiting a more significant decline, having recorded only 0.74% pregnancies at endline (p < 0.001), as well as arm 3, which recorded 1.34% pregnancies (p < 0.001). No significant decline was recorded in the CSE only control arm. Trends in decline of pregnancies started to show by midline, and persisted at endline (2020), and when difference in differences test was applied, the incident rate ratios (IRR) between the none and exposed arms were equally significant (p < 0.001).

CONCLUSION

Linking provision of CSE with accessible SRH services that are receptive to needs of adolescents and young people reduces EUP, which provides the opportunity for higher retention in school for adolescent girls.

背景

促进青少年的健康，特别是他们的性健康和生殖健康，包括艾滋病毒的预防和护理，是发展的当务之急。提高青少年女孩和年轻妇女（AGYW）的社会地位，是改善她们福祉和经济发展的关键。然而，包括赞比亚在内的许多国家的 AGYW 面临着健康挑战，这些挑战源于性别不平等、缺乏赋权、对性知识的不准确认识以及获得性健康和生殖健康（SRH）服务和信息的机会有限。通过全面性教育（CSE）来填补知识空白，并改善 SRH 服务和适当信息的获取，应该可以减少因早期和意外怀孕（EUP）而导致的辍学，并增强她们实现自身潜力的能力。

方法

本研究旨在通过提供与接受性 SRH 服务相关的 CSE，减少赞比亚 AGYW 的 EUP，并改善其 SRH 结果。一项 3 臂随机对照研究在基线、中程和终线收集了横断面数据。正在常规提供 CSE 的学校被随机分为非干预组（第 1 组）、干预组，卫生工作者在学校提供有关现有 SRH 服务的信息，以补充 CSE（第 2 组），以及第 3 组，接受 CSE 的学生也被鼓励或支持获得预先敏感、接受性的 SRH 服务。

结果

经过 3 年的干预暴露（CSE- 医疗机构联系），结果表明，在两个干预组中，在校 AGYW 的怀孕率都显著下降，第 2 组的下降更为显著，在终线时仅记录到 0.74%的怀孕率（p < 0.001），以及第 3 组，记录到 1.34%的怀孕率（p < 0.001）。在仅接受 CSE 的对照组中，没有记录到显著的下降。怀孕率的下降趋势从中线开始，并在终线（2020 年）持续存在，当应用差异发生率比（IRR）时，无暴露和暴露组之间的发生率比值（IRR）同样显著（p < 0.001）。