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Clarinda L. BerjaUNESCO PROAP Regional Clearing Houseon Population Education and CommunicationBangkok, Thailand, 1999United NationsPopulation Fund

Berja, Clarinda L.Case study, Philippines: communication and advocacy strategiesadolescent reproductive and sexual health. Bangkok: UNESCO PROAP, 1999.29 p. (Communication and advocacy strategies: adolescentreproductive and sexual health; series two)1. YOUTH. 2. REPRODUCTIVE HEALTH. 3. SEXUAL HEALTH. 4. IEC.5. COMMUNICATION POLICY. 6. COMMUNICATION STRATEGIES.7. COMMUNICATION PLANNING. 8. CASE STUDIES. 9. PHILIPPINES.I. Title. II. Series.613.951 UNESCO 1999Published by theUNESCO Principal Regional Office for Asia and the PacificP.O. Box 967, Prakanong Post OfficeBangkok 10110, ThailandPrinted in Thailandunder UNFPA Project RAS/96/P02The designations employed and the presentation of material throughout the publication do not implythe expression of any opinion whatsoever on the part of UNESCO concerning the legal status of anycountry, territory, city or area or of its authorities, or concerning its frontiers or boundaries.

CONTENTS PREFACE .i DEMOGRAPHIC CHARACTERISTICS OF ADOLESCENTS1 Population composition of adolescents .Age at marriage .Educational level .Health and nutrition .1122Fertility, teen pregnancy and abortion .STDs/HIV/AIDS .Practice of contraception and family planning .Knowledge, attitude and behaviour on sexuality andreproductive health .345 5PROGRAMME RESPONSES TO ADOLESCENTREPRODUCTIVE HEALTH PROBLEMS6 Government programmes .NGO programmes .613 ADVOCACY AND IEC STRATEGIES USED TO PROMOTEADOLESCENT REPRODUCTIVE AND SEXUALHEALTH MESSAGES14 Advocacy strategies .Information, Education and Communication (IEC) strategies1415 LESSONS LEARNED21 Success/failure factors for advocacy strategies .Success/failure factors for IEC strategies .Overall listing of lessons learned .212324

CONTENTS(continued) GUIDELINES FOR FORMULATING AND IMPLEMENTINGADVOCACY AND IEC PROGRAMMES ON ADOLESCENTREPRODUCTIVE AND SEXUAL HEALTH25 Guidelines for advocacy programmes .Guidelines for IEC programmes . 2526REFERENCES. 27Appendix: Directory of Organisations .28

PREFACEBACKGROUNDAlthough adolescent reproductive and sexual health education is anew programme area when taken under the context of the ICPD POAframework, not a few efforts had been ventured though by a number offorward-looking countries in the region to implement educational,advocacy and communication activities in the areas of human sexuality,HIV/AIDS, and family life/population education, and of course morerecently, adolescent reproductive health.Without doubt, these programmes and activities are characterizedby weaknesses and gaps as planners and implementors are usually heldback from trying out innovative approaches by opposition and objectionsfrom concerned quarters. However, there is also not a dearth ofsuccessful innovative strategies and approaches which can documentedand shared for others to learn from and even replicate.Sexuality and reproductive health education is an area that generatemisconceptions, confusion, fear and unwarranted caution, to say theleast. These can be ascribed by many factors. First, policy makers,community members, parents and teachers are reluctant to confrontissues of sexual and reproductive health. Teen-agers often get theirinformation from their peers who may be ignorant of the topic or themass media which may provide sensational and inaccurate information.In many programmes, curriculum and textbooks continue to limit theirfocus on biological, demographic, population and development andfamily life education issues. Sometimes, in spite of a well-designedcurriculum, an ill-prepared or uncomfortable teacher can render aprogramme ineffective. Teaching methods used are often not suited tothe sensitive nature of sexual and reproductive health education issues.However, the developments in this field have not been held backby a few conservatives and traditionalists. Many organizations, especiallythe non-governmental and voluntary organizations as well as boldgovernment agencies have taken steps to undertake innovative strategiesto introduce reproductive and sexual health messages into theirprogrammes to reach the adolescents and influence them into takingresponsible decisions regarding their sexual and health behaviours.i

These strategies and approaches range from energizing in-schooleducation through co-curricular or community support from out-of-schoolsector; setting up counselling services inside a school campus;counselling through telephone hotlines; peer group counselling anddiscussions; development of IEC materials and interactive Internetdiscussion forum; youth camps and debates and competitions andcampaigns in recreational places. Some of these strategies have workedand some failed. How is it that in one country the setting up ofcounselling centre for youth within a school campus is acceptable andnot in another? Why is it that the use of peer approach in reaching theyouth is effective in one cultural setting and not in another? How hasreligion been an obstacle in the introduction of reproductive and sexualhealth education in a few countries and how has this been overcome?Some countries and some sectors of society have raised fears andcaution in introducing reproductive and sexual health which could beunwarranted. The perceptions could be emanating from their ownperspective alone and may not be shared by other sectors or even therecipients themselves, i.e., adolescents. Or even if these fears arejustified, these are not really unsolvable. Bold, innovative strategies andapproaches are now called for if the ICPD POA recommendations dealingwith adolescent health are to see reality. As Dr. Nafis Sadik, ExecutiveDirector of UNFPA states:“The largest challenge facing us does not lie in resources ordelivery systems or even infrastructures, but in the minds ofpeople. We must be sensitive to cultural mores andtraditions, but we must not allow them to stand in the way ofactions we know are needed. We have to overcome theobstacles of superstitions, prejudices, and stereotypes. Thesechanges may not be easy and we face formidable challenges.They involve questioning entrenched beliefs and attitudes,especially toward girls. Lifelong habits must be given up, butthey have to be, because in the end Asia’s future depends onall its people: and it will depend as much on adolescents ason adults”.In order to document the experiences of the countries in theplanning and implementation of best practices and innovative strategiesin the field of adolescent reproductive and sexual health, these series ofcase studies are being commissioned to selected countries which haveaccumulated a pool of knowledge and experiences which can be sharedwith other countries.ii

OBJECTIVESTo document the experiences of countries engaged in planning andimplementing adolescent reproductive and sexual health in the areas ofadvocacy and IEC (information, education and communication), theUNESCO Regional Clearing House on Population Education andCommunication carried out an activity whereby selected countries wereasked to document their experiences in order to:1.Identify the profile and characteristics of adolescents invarious areas such as demographic profile, fertility, teenpregnancies, sexual behaviour, STDs, contraception, etc.2.Describe the policy and programme responses of the countryto address the problems and issues dealing with adolescentreproductive and sexual health3.Document the strategies, best practices and innovativeapproaches used in undertaking advocacy and IEC activitieson this topic and the results or impact of these strategies onthe target recipients4.To examine and bring out the factors/conditions which havecontributed to the success of these best practices or failure ofsome strategies and from these highlight the lessons learned orguidelines for future consideration5.To identify organizations which have achieved successes incarrying out programmes/activities on adolescent reproductiveand sexual healthSeven countries were initally selected to document theirexperiences – Bangladesh, Iran, Malaysia, Mongolia, Philippines,Sri Lanka and Thailand.This volume presents the experiences of the Philippines in planningand implementing the advocacy and IEC strategies for promotingadolescent reproductive and sexual haelth programmes. It was compiledby Clarinda Berja, Assistant Professor, of the Department of Sociology ofthe University of the Philippines.iii

DEMOGRAPHIC CHARACTERISTICSOF ADOLESCENTSA. POPULATION COMPOSITION OF ADOLESCENTSThe population census in 1995recorded 13.7 million adolescents in thePhilippines (Table 1). Though theirnumber doubled over the last 25 yearsits proportionate share to the totalpopulation remains at 20%.Those below 20 years of agecomprised 49% of the country’s totalpopulation in 1995. Although thisproportion is expected to decrease to35% in the year 2020, the numbers willstill increase from 33.6 million in 1995to 37.4 million in 2020.Table 1. Number of Adolescents (ages 15-24) and Their Proportion to theTotal Population (1970 to 1995)YearAdolescent population(in millions)Total population(in millions)Percentage suses of the Philippines.B. AGE AT MARRIAGECompared to women in otherdeveloping countries, Filipino womenmarry late. Trends show an increasingproportion of never marrying in both the15-19 and 20-24 age groups. Marriagebefore completion of high school isconsidered too early but marriage in thelate teens is common. Table 2 showsthat under the 15-19 age group, only9.8% are married. By single ages,however, 20% are already married byage19andnearly60%age 24. The Young Adult Fertility andSexuality Survey (YAFS-II) data alsoreveal that the low educated, ruraldwellers and the poor tend to marryearly compared to their counterparts.These figures may even beunderstated because of the emergenceof the “live-in” phenomenon, wherecouples live together as man and wifewithout the benefit of marriage. Evenyoung people now find this arrangementacceptable. Based on the 1998National Demographic and HealthSurvey (NDHS), 6.2% of women ofreproductive age admitted that they arein a live-in arrangement.1

Table 2. Trends in Non-Marriage Among Adolescent Womenfrom 1948 to ried Adolescent Women (%)Ages 15-19Ages 4.055.757.5Smith (1978), De Guzman (1989) and Philippine Censuses.C. EDUCATIONAL LEVELEnrolment rates in both primaryand secondary schools have increased.The basic literacy rate rose from 93.5%in 1990 to 95.8% in 1995. Functionalliteracy also improved from 75.6% in1989 to 83.8% in 1994.D. HEALTH AND NUTRITIONThere has been substantialprogress in the health status of theyouth. This is demonstrated by theconsistent increase in life expectancyand the decline in infant mortality rate.In the 1997 SWS-NYC survey, 51% ofyouth respondents assessed their stateof health to be either very good or good.Of the total deaths in the country,5.4% or 17,004 cases occurred amongthe youth. More deaths occurred in the20-24 age group than in the 15-19 agegroup. The top three causes ofmortality among the 10-24 age groupare injury (undetermined cause),accidents, and heart diseases. Other2leading causes of mortality among thisgroup are pneumonia, tuberculosis(all forms), malignant neoplasm,diseases of the vascular system,diarrhea and other stomach-relateddiseases, septicemia, and meningitis.Despite these health problems, theNational Programme for Youth andAdolescents under the Department ofHealth points out that there are fewservices that address the specifichealth concerns of the youth. Atpresent health services for this groupare only carried out as part of healthpackages for the general population.