Evidence Review on Social and Behavior Change for Child Survival in Africa Scaling Up with Mass Media and ICT

The Health Communication Capacity Collaborative (HC3) conducted a review of peer-reviewed and grey literature on the sexual and reproductive health (SRH) of adolescents and youth in urban areas to explore the behavioral drivers, barriers, and contextual factors influencing SRH behaviors. The review found that SRH behaviors of young people are influenced by the context in which they live and by a range of protective and risk factors operating and interacting at multiple levels. At the individual level, protective factors include education, ability to resist peer pressure, a strong desire to avoid pregnancy, fear of contracting a sexually transmitted infection (STI), and good knowledge of SRH matters. Counteracting these protective factors, the risks include alcohol and drug consumption, poor negotiating skills, and little or no knowledge of SRH. At the family and peer network level, factors that can protect urban youth from unhealthy sexual behaviors include living with at least one parent and open communication about sexual health with peers, family, or partner(s). Common risk factors are living alone, having a sibling with a premarital pregnancy, and poor communication on SRH matters with parents, peers, or partner(s). At the community level, access to reliable information on SRH and social connectedness has been proved to be protective, while access to misinformation, negative attitudes of service providers, and social isolation has all been found to place youth at greater risk of unhealthy sexual behaviors. The review identified 29 SBCC interventions targeting behavior change for urban youth SRH, spanning across three continents: Africa, Asia, and Latin America. The majority of the interventions were implemented in school and community settings, while four were set in informal settlements. There was little variation in the target groups, with most interventions limiting their audience segmentation to a specific age bracket or to whether the youth were in or out of school. Four interventions specified they only targeted vulnerable young women. The programs used a variety of approaches, including scripted sessions, peer education, use of positive role-models, a curriculum providing decision-making skills, and a holistic approach addressing the broader factors that affect the sexual health of urban adolescents, such as poverty or excessive alcohol consumption. Most of the interventions also provided evaluations and an assessment of the results, which helped identify the more promising approaches. Based on the findings, key recommendations for program design and specific SBCC activities include creating an enabling environment, involving young people, segmenting and diversifying audiences, engaging secondary audiences, addressing the broader aspects of the intended audience's lives that affect SRH determinants and behavior change, emphasizing the dangers associated with risky sexual behaviors, creating a positive image of condoms, using TV, the Internet, and social media for reaching youth, making activities and messages fun and appealing for youth, and using popular role models. Creating an enabling environment involves dedicating time to informal discussions and exchange, working with service providers to improve their attitudes and communication skills towards youth on SRH topics, and engaging parents and leaders to change the dominant norms and support positive attitudes around youth sexual health. Involving young people in the design and implementation of interventions can ensure that the needs of the target group are addressed adequately. Segmenting and diversifying audiences involves recognizing the diversity of the audience and including frequently forgotten groups and their particular needs. Engaging secondary audiences, such as parents, community leaders, influential people in the community, and admired community members, can be effective in promoting social and behavior change. Addressing the broader aspects of the intended audience's lives that affect SRH determinants and behavior change involves framing SRH in the context of broader youth needs and including information and activities on SRH as part of more holistic programs, such as income generation and livelihoods interventions.