Final Report

Exploration of Young People’s Sexual and Reproductive Health Assessment Practices

September 12, 2014

HINDIN & FATUSI [email protected]

Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 2

Table of Contents

Executive Summary ...... 4 Acknowledgements: ...... 6 EARLY MARRIAGE ...... 7 Search Strategy ...... 7 Results ...... 7 Intervention Characteristics ...... 8 Evaluation Characteristics ...... 9 Overall Assessment ...... 9 Case Studies ...... 13 References (Cited) ...... 16 EARLY PREGNANCY ...... 21 Search Strategy ...... 21 Results ...... 21 Intervention Characteristics ...... 21 Evaluation Characteristics ...... 23 Overall Assessment ...... 23 Case Studies ...... 27 References (Cited) ...... 30 References (Full List) ...... 31 NUMBER OF CHILDREN ...... 38 Search Strategy ...... 38 Results ...... 38 Intervention Characteristics ...... 38 Evaluation Characteristics ...... 39 Overall Assessment ...... 40 Case Studies ...... 41 References (Cited) ...... 43 References (Full List) ...... 43 Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 3

Sexually Transmitted Infections (STIs) including HIV ...... 45 Search Strategy ...... 45 Results ...... 45 Intervention Characteristics ...... 46 Evaluation Characteristics ...... 47 Overall Assessment ...... 48 Case Studies ...... 49 References (Cited) ...... 51 References (Full List) ...... 53 RECOMMENDATIONS FOR FUNDERS ...... 62 Lessons Learned from the Four Outcomes ...... 65 Appendix ...... 67 Methodology ...... 67 Developing and Piloting Abstraction Form ...... 67 Search Strategy ...... 67 Abstraction Process ...... 67 Search Terms ...... 68 Early Marriage ...... 68 Early Marriage ...... 72 Number of Children ...... 76 STIs ...... 79 Abstraction Form ...... 83

Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 4

Executive Summary Overview:

The goal of this project was to identify effective interventions to improve young people’s sexual and reproductive health. We systematically reviewed interventions found in the peer-reviewed and gray literature on young people’s sexual and reproductive health based on four outcomes: prevention of early marriage, early pregnancy, limiting the number of children and preventing STIs. We focused our reviews on young people, ages 10-24, in lower- and middle-income countries. French, Spanish Portuguese and English reports or publications were included.

Our reviews focus on both the content and quality of the interventions as well as the evaluations. Selected studies were abstracted and scored in each outcome area. This report summarizes the overall findings, by outcome area, providing two to three case studies of effective interventions for each outcome.

Results:

Table 1 below shows a summary of our search results and ratings for each outcome.

Table 1: Summary across outcomes

Outcome Intervention Evaluation Titles Abstracted Positive No or Negative No High Quality High High Quality Screened Impact Mixed Impact Relevant Interventions Quality Interventions (Published Impact Outcome Evaluations and Only) Evaluations with a Positive Impact Early 3.652 59 37 9 4 9 29 24 16 Marriage Early 27,376 97 62 23 9 3 42 24 14 Pregnancy Number 1,592 11 8 2 1 0 4 2 2 of Children STIs/HIV 22,076 120 39 51 38 1 58 42 9 Total 54,696 287 146 85 52 13 133 92 41

Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 5

Early marriage: We abstracted 59 out of over 3600 titles screened that related to interventions designed to change early marriage or age at first marriage (49 grey literature articles and 10 published peer-reviewed articles). The majority of the studies (n=37) found a positive impact of the intervention on some component of early marriage—practices, knowledge or attitudes. Few studies had mixed or contradictory results (n=9) or negative results (n=4). A final group of interventions had no results reported on early marriage or had no data from which to draw conclusions (n=9). Among 37 studies with positive results, fewer than half (n=16) had high quality interventions and evaluations.

Early Pregnancy: We abstracted 97 out of over 27,000 titles screened that related to interventions designed to prevent early pregnancy (56 grey literature articles and 42 published peer-reviewed articles). The majority of the studies (n=62) found a positive impact of the intervention on some component of early pregnancy—knowledge, attitudes or behavior. A substantial number of studies had mixed or contradictory results (n=23), and just a handful (n=9) had negative results. A final group of interventions had no results reported on early pregnancy or had no data from which to draw conclusions (n=3). Among the studies 62 studies with positive results, few (n=14) had high quality interventions and evaluations.

Number of children: We abstracted 11 articles out of over 1600 titles screened that related to interventions designed to prevent repeat pregnancies and births (5 grey literature and 6 published peer-reviewed articles). The majority of the studies (n=8) found a positive impact of the intervention on some component of preventing repeat pregnancies including uptake of contraception, and avoiding repeat pregnancies. Few studies had mixed or contradictory results (n=2) or negative results (n=1). Among the studies with positive results (n=8), only two had high quality interventions and evaluations.

STIs: We abstracted 120 articles out of over 22,000 titles screened that related to behavior change for STI prevention (64 grey literature and 56 published peer-reviewed articles). Of all the interventions, nearly the same number showed uniformly positive results (n=39) as negative or no results (n=38). The majority of the interventions had mixed outcomes (n=51) and one had no outcomes related to STI prevention behaviors. Nearly the same number of studies had positive (n=38), as had negative results (n=39). Among the studies with positive results (n=38), only nine had high quality interventions and evaluations. Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 6

The report is divided into chapters, based on the four outcomes. The concluding chapter outlines our recommendations for the field as well as some specific recommendations related to each of the four outcomes. We have included more detail on the methodology in the Appendix. Each chapter contains a list of cited references, as well as a full bibliography all of the articles reviewed.

Acknowledgements: We would like to thank those that contributed to the work in this report: Bruce Dick, Bob Blum and Jane Ferguson who composed our group of senior advisors. Angela Bayer, Akin Omisore, Jaya, Susan Lee-Rife, Terri-Ann Thompson, and Ushma Upadhyay who identified and abstracted the studies featured in this report. Virginia Bowen and Carie Muntifering Cox who were instrumental in the coordination and oversight of the work. Amanda Kalamar and Hannah Lantos, JHSPH graduate students, who filled in everywhere to help us meet our deadlines.

Submitted by:

Michelle J. Hindin and Adesegun Fatusi

EARLY MARRIAGE

Search Strategy We undertook a systematic search of published literature to identify interventions that address ‘early marriage’ in low- and middle-income countries (LMIC). We used six databases—PubMed (MEDLINE), Embase, PsycInfo, Cinahl Plus, Popline, and the Cochrane Database—in conducting this search. In building the search, we combined a list of terms that describe young people with a list of terms that describe marriage or marriage-like arrangements. We then combined this search with a list of lower- or middle-income country (LMIC) and regional search terms developed and used in the 2012 WHO Systematic Review on the same topic. We limited hits to those materials published in 2009 or later so as not to replicate the efforts already undertaken by the WHO Review. Detailed search terms for each database are available in the Appendix.

This initial search produced 3,652 hits about early marriage, which were stored using EndNote reference manager software. We then reviewed all 3,652 titles. This title screening reduced the original list of 3,652 hits down to 51 articles that seemed relevant. We read each of the 51 abstracts and pulled all articles that appeared to pertain to early marriage interventions for further review. This narrowed the list from 51 hits to 10 published articles that were included for abstraction.

We searched the ‘early marriage’ grey literature by first targeting organizations involved in early marriage eradication—namely ICRW, Population Council, CEDPA, and Save the Children—as well as the Google search engine were initially explored in the search for publications about early marriage interventions. A total of 13 documents synthesizing early marriage interventions were identified through the initial search process and reference tracing (snowballing) was employed to find as many referenced interventions as possible. Five organizations—Population Council, CEDPA, CARE, ChildFund International (formerly Christian Children’s Fund), and WorldVision—were emailed to inquire about the possibility of mid-term or end-line evaluations for promising programs that had no easily identifiable intervention. In total, we ended up with 49 grey literature articles.

Results We abstracted 59 articles that related to interventions designed to change early marriage or age at first marriage (49 grey literature articles and 10 published peer-reviewed articles). The articles

HINDIN & FATUSI [email protected]

Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 8

contained interventions that focused primarily in Asia (n=32), Africa (n=25), and just two from Latin America.

Intervention Characteristics The articles represented primarily rural interventions (n=37), although some were both rural and urban (n=16) and a minority of the interventions were urban only (n=6). The majority of interventions were community based (n=41), followed by school based (n=13), a mix of community and school based (n=4), and varied (multiple interventions reviewed n=1).

In terms of how early marriage was operationalized, the definitions were not consistent across interventions. This is a major limitation in making comparisons across interventions. The majority of studies had no clear definition of early marriage (n=26), while seventeen used “before age 18” as the definition, with reference to legal age of marriage, a number gave different specific age ranges (e.g. 13-16 years; 14-21 years) (n=7) or milestones such as by secondary school (n=1), during adolescence or childhood (n=6). The remaining interventions focused on being able to negotiate marriage age with parents (n=1) or age at first marriage (n=1). Eleven (19%) of the interventions include some type of randomization (e.g. schools, communities, or individuals).

The quality of the interventions ranged from 1 (worst) to 5 (best). Interventions that scores in the low range (n=11) often had limited information about the intervention and the activities, had broad goals rather than specifically targeting early marriage, or had no comparison group (or an inappropriate comparison group). Many of interventions fell in the moderate quality group (n=19), based on receiving a score of 3. The limitations of these interventions were similar to the lower scoring interventions, but less severe. In addition, limitations also included concern about the impact of the interventions on the targeted groups. Interventions receiving a score of 4 (n=21) had significant positive aspects that outweighed the limitations. Among noted positive aspects were basing the intervention on a theory of change, being well-planned and organized, or targeting a population rather than selected individuals. Limitations focused on ability of the intervention to create the desired change, high participant burden, or omitting what was thought to be a key component for changing early marriage, which was often girls’ education. Of the 59 early marriage intervention articles, eight scored a 5. These five had no major deficiencies and often benefitted from being rigorously designed and theoretically grounded. Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 9

Evaluation Characteristics Of the 59 articles, 27 focused on quantitative assessments, 22 involved mixed methods (combination of qualitative and quantitative assessments) and 10 were purely qualitative. Most of the evaluations were a pre/post design (n=34), three were post-only, and the remaining (n=22) were other designs. The qualitative evaluations often included multiple evaluation methodologies within a single intervention study including focus groups (n=16 ), in-depth interviews (n=12 ), semi-structured interviews (n=6), key informant interviews (n=4) desk review of documents (n=4), case studies (n=3), and others including photovoice and sketching (n=3). Nearly all quantitative evaluations included some sort of survey data, and were analyzed with a range of techniques from simple percentages (n=23), multivariable regression analysis (n=13) and other more advanced techniques including difference –in-difference models and propensity score matching (n=6).

Like the intervention scoring, the evaluation scoring ranged from 1 (worst) to 5 (best). The lowest scoring evaluations (n=22) had few to no strengths, and serious flaws including no statistical analysis for quantitative studies, select samples (e.g., only those exposed to the intervention), no true measure of impact of the intervention, or no comparison group. Thirteen of the evaluations scored in the moderate range (score=3), based on have some strengths but significant limitations. Strengths often included clarity of the evaluation, appropriate sampling strategy and comparison group, and in- depth analyses. Limitations echoed those in the low scoring evaluation group. Nineteen of the evaluations scored in the high quality group, with strengths including strong design that allowed for measuring intervention impact, randomization, and pre-post comparisons. Weaknesses included lack of sufficient detail, lack of randomization, limited depth in the analysis, or inability to follow the same participants from baseline to follow up. Few studies (n=5) scored at the highest level for their evaluation. These studies had strong evaluation designs that could determine intervention impact, and few to no limitations. Several of the top-ranking studies (based on the intervention and evaluation scores) were conditional cash transfer programs.

Table 2 summarizes the high scoring interventions with a positive impact on early marriage.

Overall Assessment The majority of the studies (n=37) found a positive impact of the intervention on some component of early marriage—practices, knowledge or attitudes. Few studies had mixed or contradictory results (n=9) or negative results (n=4). A final group of interventions had no results reported on early Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 10

marriage or had no data from which to draw conclusions (n=9). Among the studies with positive results, fewer than half (n=17) had interventions and evaluations that scored a four or above on both the quality of the intervention and the quality of the evaluation.

Table 2: High Scoring Effective Interventions for Early Marriage Prevention

County Age Range Evaluation Grey/ Key Intervention Citation Methodology Published Components Mexico 13-19 at Quantitative Grey Mothers of enrolled girls Evaluating the impact of baseline and enrolled girls conditional cash transfer received cash transfers; programs on adolescent health component with decisions and marriage education and service and fertility: The case of provision for SRH Opportunidades services (Gulemetova-Swan, 2009) India 14-24 Quantitative & Grey Youth groups were Improving Youth Sexual Qualitative formed to provide youth and Reproductive Health with safe spaces; peer through DISHA, an education; training in Integrated Program in income-generating skills; India. (Kanesathasan et reproductive health al., 2008) services and other health services were revised to be youth friendly; and youth contraceptive depot holders were trained and stocked. Malawi 13-22 at Quantitative & Published Young women received Cash or Condition? baseline Qualitative school fees and Evidence from a Cash conditional cash transfers Transfer Experiment to remain in school or to (Baird et al., 2011) reenroll in school. Colombia Secondary Quantitative Published Provide vouchers for low- Vouchers for Private School income students to pay Schooling in Colombia: for (most of) private Evidence from a secondary school. Randomized Natural Experiment (Angrist et al., 2002) Kenya Median 13.5 Quantitative Grey Free school uniforms and Education, HIV and at baseline; training teachers on how Early Fertility: 20.5 at to deliver the national Experimental Evidence Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 11

endline HIV/ AIDs prevention from Kenya (Duflo et al., curriculum to primary 2011) school students. Ethiopia 10-19 Quantitative Grey Intervention included Evaluation Of Berhane social mobilization, non- Hewan: A Pilot Program formal education and To Promote Education & livelihood training for Delay Marriage in Rural out-of-school girls, or Ethiopia (Erulkar & support to remain in Muthengi, 2007) school. Malawi 13-22 Quantitative Grey Young women received The Short-Term Impact school fees and of a Schooling conditional cash transfers Conditional Cash to remain in school or to Transfer Program on the reenroll in school. Sexual Behavior of Young Women (Baird et al., 2010) Bangladesh 6-19 Quantitative Grey Parents received 15 kg of The Effects of Schooling wheat if their primary- Incentive Programs on school-aged girls and Household Resource boys attend school; Allocation in Bangladesh monthly stipends (Arends-Kuenning & deposited in a girl’s bank Amin, 2000) account if she attends secondary school. Zimbabwe 12 at Quantitative Published Treatment group (orphan Supporting Adolescent baseline girls) received school Orphan Girls to Stay in support (in the form of School as HIV Risk fees, exercise books, Prevention (Hallfors et uniforms, and other al., 2011) school supplies). Teachers were trained to monitor attendance and assist with attendance problems and were provided a modest cash incentive. Egypt 13-15 Quantitative & Grey Safe public spaces for Providing new Qualitative girls; improve girls’ opportunities to functional literacy; and adolescent girls in improve local and socially conservative national policymakers’ settings: The Ishraq support for girl- friendly program in rural Upper measures and policies. Egypt (Brady et al., 2007) Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 12

India 11-15 Quantitative & Grey Life skills course; Improving the Qualitative community service; and Reproductive Health of Parents attended monthly Married & Unmarried information meetings Youth in India (Pande et al., 2006) Bangladesh 13-21 Quantitative & Grey Self-esteem and Program Efforts to Delay Qualitative leadership skills; teach Marriage Through girls about gender and Improved Opportunities: gender discrimination, Some Evidence from health and nutrition; help Rural Bangladesh (Amin girls acquire livelihood & Suran, 2005) skills. Bangladesh Primary and Qualitative Grey Parents received 15 kg of Incentive Schemes for Secondary wheat if their primary- School Attendance school school-aged girls and in Rural Bangladesh boys attend school; (Amin & Sedgh, 1998) monthly stipends deposited in a girl’s bank account if she attends secondary school. Kenya Grades 5-8 Quantitative & Grey Teacher training on Education and HIV/AIDS Qualitative HIV/AIDS curriculum; Prevention: Evidence debate & essay from a randomized competition on condoms evaluation in Western and HIV prevention; and Kenya (Duflo et al., 2002) free school uniforms. Ethiopia 10-19 Quantitative Published Social mobilization, non- Evaluation of Berhane formal education and Hewan: A Program To livelihood training for Delay Child Marriage in out-of-school girls, or Rural Ethiopia (Erulkar support to remain in 2009) school.

Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 13

Case Studies These case studies were selected to highlight a range of intervention types (school-based conditional cash transfer, a multi-component community-based intervention for out-of-school girls, and a school- based multi-component intervention). The evaluation techniques included a randomized control trial, and comparisons between baseline and endline surveys. All had a comparison (not intervention group).

The aim of this intervention (Hallfors et al., 2011) was test whether comprehensive support to keep orphan girls in school can reduce HIV risk. This was a conditional cash transfer program for rural Zimbabwean 12 year olds who had lost one or both parents (orphans). Using a randomized control trial design, orphan girls in the intervention arm received school support in the form of fees, exercise books, uniforms, and other school supplies. Teachers were trained to monitor attendance and assist with attendance problems among treatment girls, but not to provide other training or help. These teachers were provided a modest cash incentive. Girls in the intervention boarding schools received informal boarding arrangements. Both intervention and control schools received universal feeding program. Control girls (also orphans, in control schools) received no other support/intervention. Based on the results of multivariable logistic regression, girls in the intervention were almost 3 times less likely to be married. Participants were also less likely to drop out of school and to be absent from school, and more likely to wait for sex because of the consequences. Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 14

The aim of this multi-component intervention in rural Egypt (Brady et al., 2007) was to help out-of- school girls, ages 13-15, create community, continue to learn, and engage outside of their homes. The intervention, which was conducted in selected villages, included meeting four times a week for 30 months in youth centers or schools, in groups of around 25 girls each. Locally selected and trained female secondary school graduates, served as teachers, role models, and girls’ advocates. The evaluation included a qualitative component and baseline and endline surveys of the same girls The longer the exposure to the intervention, the greater the decline between baseline and endline in the proportion preferring marriage before age 18. Full-term participants had the greatest decline, from 26 percent to 1 percent. Both groups experienced changes in attitudes about ideal age at marriage that were significantly different from the changes recorded among either the control group or the nonparticipants in program villages.

Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 15

The goals of the DISHA (Development Initiative Supporting Healthy Adolescents), a community- based intervention for 14-24 year olds, and implemented in two poor states in India (Kanesathasan et al., 2008), were as follows:

• Increase access to modern family planning and sexual and reproductive health services for married and unmarried male and female youth aged 14-24 years; • Delay marriage and childbearing among youth and strengthen their ability to make informed decisions about reproductive health matters, especially among females; • Provide youth with alternatives to early marriage through livelihoods skills and options; and • Build informed leadership and capacity for promoting youth sexual and reproductive health by addressing the interconnected health, economic, social and cultural issues that are central in their lives.

Implemented starting in June 2005, DISHA had several activities. Youth groups were formed to provide youth with safe spaces and the opportunity to learn health information, to learn communication, negotiation, and leadership skills, and to improve self-confidence. Peer education was conducted in groups and with individuals. Youth were provided with training in income- generating skills. Implementers attempted to develop income-generating opportunities for youth. Implementers built community support for youth SRH needs through individual and group meetings, mass communication, plays, information fares, mobile health clinics, sports events. Adult groups and youth-adult partnerships were formed. Reproductive health services and other health services were revised to be youth friendly. Youth contraceptive depot holders were trained and stocked. NGO capacity building activities and training were conducted throughout. Based on a comparison between baseline and endline surveys, girls and boys in intervention sites were more likely to know the correct legal age of marriage for girls, to believe that girls should wait until age 18 to marry, to believe that the ideal age of marriage is 18 or older. The proportion of girls married during the intervention that were below 18 at marriage declined from baseline to endline in intervention sites but not in control sites. The mean age of marriage increased by almost 2 years in the intervention sites between baseline and endline.

Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 16

References (Cited) Amin, Sajeda. (2007). Empowering adolescent girls in rural Bangladesh: Kishori Abhijan Promoting healthy,safe, and productivetransitions to adulthood Population Council. New York, NY. Amin, Sajeda, & Suran, Luciana. (2005). Program Efforts to Delay Marriage Through Improved Opportunities: Some Evidence from Rural Bangladesh. Population Council. Angrist, Joshua, Bettinger, Eric, Bloom, Erik, King, Elizabeth, & Kremer, Michael. (2002). Vouchers for Private Schooling in Colombia: Evidence from a Randomized Natural Experiment. The American Economic Review 1535-1558. Arends-Kuenning, Mary, & Amin, Sajeda. (2000). The Effects of Schooling Incentive Programs on Household Resource Allocation in Bangladesh. Population Council *Baird, S., Chirwa, E., McIntosh, C., & Ozler, B. (2010). The short-term impacts of a schooling conditional cash transfer program on the sexual behavior of young women. Health Econ, 19 Suppl, 55-68. doi: 10.1002/hec.1569 Baird, Sarah, McIntosh, Craig, & Ozler, Berk. (2011). Cash or Condition? Evidence from a cash transfer experiment. The World Bank Working Paper. Brady, Martha, Assaad, Ragul, Ibrahlm, Barabara, Salem, Salem, Salem, Rania, & Zibani, Nadia. (2007). Providing new opportunities to adolescent girls in socially conservative settings: The Ishraq program in rural Upper Egypt. Population Council. Duflo, Esther, Dupas, Pascaline, & Kremer, Michael. (2011). Education, HIV and Early Fertility: Experimental Evidence from Kenya. World Bank. Duflo, Esther, Dupas, Pascaline, Kremer, Michael, & Sinei, Samuel. (2002). Education and HIV/AIDS Prevention: Evidence from a randomized evaluation in Western Kenya. World Bank. *Erulkar, Annabel, & Muthengi, Eunice. (2007). Evaluation of Berhane Hewan A Pilot Program To Promote Education& Delay Marriage in Rural Ethiopia. Population Council. *Erulkar, Annabel. (2009). Evaluation of Berhane Hewan: A ProgramTo Delay Child Marriage in Rural Ethiopia. International Family Planning Perspectives, 35(1), 6-14. Gulemetova- Swan, Michalea. (2009). Evaluating The Impact of Conditional Cash Transfer Programs on Adolescent Decisions about Marriage and Fertility: The Case of Opportunidades. Thesis. Hallfors, D., Cho, H., Rusakaniko, S., Iritani, B., Mapfumo, J., & Halpern, C. (2011). Supporting adolescent orphan girls to stay in school as HIV risk prevention: evidence from a randomized controlled trial in Zimbabwe. Am J Public Health, 101(6), 1082-1088. doi: 10.2105/AJPH.2010.300042 Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 17

*Kanesathasan, Anjala, Cardinal, Laura, Pearson, Erin, Das Gupta, Sreela, Mukherjee, Sushmita, & Malhortra, Anju. (2008). Improving Youth Sexual and Reproductive Health through DISHA, and Intergrated program in India. ICRW. Pande, Rohini, Kurz, Kathleen, Walia, Sunayana, MacQuarrie, Kerry, & Jain, Saranga. (2006). Improving Reproductive Health of Married and Unmarried Youth in India. ICRW. * Indicates effective, high quality and abstracted for multiple outcomes

Refeences (Full List)

Acharya, Rajib, Kalyanwala, Shveta, & Jejeebhoy, Shireen. (2009). Broadening Girls' Horizons: Effects of a Life Skills Education Programme in Rural Uttar Pradesh. New Delhi: Population Council. ACQUIRE Project. (2008). Mobilizing Married Youth in Nepal to improve reproductive health: The Reproductive Health for Married Adolescent Couples Project, Nepal, 2005–2007 E&R Report No. 12. New York: EngenderHealth/The ACQUIRE Project. Alim, Abdul. (2007). Change in Knowledge, Perception, and Attitudes of the Villagers Towards Gender Roles and Gender Relations: An Evaluation of Gender Quality Action Learning programme Amin, Sajeda. (2007). Empowering adolescent girls in rural Bangladesh: Kishori Abhijan Promoting healthy,safe, and productivetransitions to adulthood (Vol. 13, pp. 4). New York, NY. Amin, Sajeda, Diamond, Ian, Naved, Ruchira, & Newby, Margaret. (1998). Transition to Adulthood of Female Garment-facory workers in Bangladesh Studies in Family Planning (Vol. 29, pp. 185-200). New York, New York. Amin, Sajeda, & Sedgh, Gilda. (1998). Incentive Schemes for School Attendance in Rural Bangladesh (pp. 39). Amin, Sajeda, & Suran, Luciana. (2005). Program Efforts to Delay Marriage Through Improved Opportunities: Some Evidence from Rural Bangladesh (pp. 32). New York, NY. Angrist, Joshua, Bettinger, Eric, Bloom, Erik, King, Elizabeth, & Kremer, Michael. (2002). Vouchers for Private Schooling in Colombia: Evidence from a Randomized Natural Experiment. The American Economic Review 1535-1558. Arends-Kuenning, Mary, & Amin, Sajeda. (2000). The Effects of Schooling Incentive Programs on Household Resource Allocation in Bangladesh (Vol. 133, pp. 45). Baird, S., Chirwa, E., McIntosh, C., & Ozler, B. (2010). The short-term impacts of a schooling conditional cash transfer program on the sexual behavior of young women. Health Econ, 19 Suppl, 55-68. doi: 10.1002/hec.1569 Baird, Sarah, Chirwa, E., McIntosh, Craig, & Ozler, B. (2009). The short-term impacts of a schooling conditional cash transfer program on the sexual behavior of young women. Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 18

Baird, Sarah, McIntosh, Craig, & Ozler, Berk. (2011). Cash or Condition? Evidence from a cash transfer experiment (pp. 1-72). New York, NY. Bhatnagar, Deepti, Dewan, Ankita, Torres, Magui Moreno, & Kanungo, Parameeta. (2003). Female secondary school assistance project, Bangladesh Empowerment Case Studies. Washington, D.C.: Indian Institute of Management and the World Bank. Brady, Martha, Assaad, Ragul, Ibrahlm, Barabara, Salem, Salem, Salem, Rania, & Zibani, Nadia. (2007). Providing new opportunities to adolescent girls in socially conservative settings: The Ishraq program in rural Upper Egypt Ishraq (pp. 46). New York, NY. Burket, Mary, Alauddin, Mohammad, Malek, Abdul, & Rahman, Minzanur. (2006). Raising the Age of Marriage for Young Girls in Bangladesh Pathfinder International. Watertown, MA. CARE. (2006). Impact Assessment of SAT-7 ARABIC’s Female Heads of Households Project. CARE International in Eritrea. (2006). Intergrated Women's Health and Empowement program; Strategic Impact Inquiry (pp. 12). CEDPA. (2001). Adolescent Girls in India Choose a Better Future: An Impact Assessment. CEDPA. (2002). A Gift for RH Project, Nepal: Endline Evaluation (pp. 36). Kathmandu, Nepal. CEDPA. (2003). Impact Study of the New Horizons Program in Egypt. Egypt. Chesterton, Paul (2004). Evaluation of the Meena Communication Initiative: Australian Catholic University. Daniel, Elkan, & Nabda, Rema. (2012). The Effect of Reproductive Health Communication Interventions on Age at Marriage and First Birth in Rural Bihar, India: A retrospective study Pathfinder International. Watertwon, MA. Dongbehounde, Justin. (2005). CAGE (Community Action for Girls' Education): Project Final Evaluation 2001- 2005. Duflo, Esther, Dupas, Pascaline, & Kremer, Michael. (2011). Education, HIV and Early Fertility: Experimental Evidence from Kenya. Duflo, Esther, Dupas, Pascaline, Kremer, Michael, & Sinei, Samuel. (2007). Education and HIV/AIDS Prevention: Evidence from a randomized evaluation in Western Kenya. Eisenberg, Ann. (2011). Law on the Books vs. Law in Action: Under-Enforcement of Morocco’s Reformed 2004 Family Law, the Moudawana. Erulkar, Annabel, & Muthengi, Eunice. (2007). Evaluation of Berhane Hewan A Pilot Program To Promote Education& Delay Marriage in Rural Ethiopia. Erulkar, Annabel. (2009). Evaluation of Berhane Hewan: A ProgramTo Delay Child Marriage in Rural Ethiopia. International Family Planning Perspectives, 35(1), 6-14. Freji, Leah Sawalha. (2009). Safe Age of Marriage” in Yemen: Fostering Change in Social Norms. Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 19

Fuwa, Nobuhiko. (2001). The Net Impact of the Female Secondary School Stipend Program in Bangladesh: Chiba University ; Agricultural Economics. Gandhi K, Krijnen J. Evaluation of Community-Based Rural Livelihoods Programme in Badakhshan, Afghanistan; 2006. Gage, Anastasia J. (2009). Coverage and Effects of Child Marriage Prevention Activities in Amhara Region, Ethiopia. Gatuam, Parajuli. (2012). Final Evaluation of Safer Environment for Girls (TOLI) in Kaski and Tanahun District ( Evaluation on Dec 2011 ). GEMS. (2011). Building Support for Gender Equality among Young Adolescents in School: Findings from Mumbai, India. ICRW. Gulemetova- Swan, Michalea. (2009). Evaluating The Impact of Conditional Cash Transfer Programs on Adolescent Decisions about Marriage and Fertility: The Case of Opportunidades. Hallfors, D., Cho, H., Rusakaniko, S., Iritani, B., Mapfumo, J., & Halpern, C. (2011). Supporting adolescent orphan girls to stay in school as HIV risk prevention: evidence from a randomized controlled trial in Zimbabwe. Am J Public Health, 101(6), 1082-1088. doi: 10.2105/AJPH.2010.300042 Kabore, Gisele, Traore, Kotalama, & Dipama, Saidou. (2010). Eliminer Le Mariage Des Enfants une experience Pilote Dans Cinq Regions Du Burkina Faso. Kanesathasan, Anjala, Cardinal, Laura, Pearson, Erin, Das Gupta, Sreela, Mukherjee, Sushmita, & Malhortra, Anju. (2008). Improving Youth Sexual and Reproductive Health through DISHA, and Intergrated program in India. ICRW. Liang, Xiaoyan. (1996). Bangladesh: Female Secondary School Assistance. World Bank. Mathur, Sanyukta, Mehta, Manisha, & Malhortra, Anju. (2004). Youth Reproductive Health in Nepal Engender Health ICRW. Miller, T., Hallfors, D., Cho, H., Luseno, W., & Waehrer, G. (2013). Cost-effectiveness of school support for orphan girls to prevent HIV infection in Zimbabwe. Prev Sci, 14(5), 503-512. doi: 10.1007/s11121-012- 0315-0 Musoko, Assia Saou, Scoppa, Cristiana, & Manoncourt, Erma. (2012). Girls and Grandmothers Hand-in-Hand Dialogue between generations for community change The Grandmother Project. Narahari, P. (2008). Ladli Laxmi Yojna: Impact Analysis District Seoni. Natoli, Lisa, Renzaho, Andre, & Rinaudo, Tony. (2008). Reducing harmful traditional practices in Adjibar, Ethiopia: Lessons learned from the Adjibar Safe Motherhood Project. Nawaz, Faraha, & Ahumed, Salahuddin. (2009). The Effectiveness of Adolescent Development Program of Bangladesh Rural Advancement Committee (BRAC) in Strengthening Awareness Regarding Social Issues among Rural Adolescent Girls in Bangladesh: An Empirical Study. Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 20

Pande, Rohini, Kurz, Kathleen, Walia, Sunayana, MacQuarrie, Kerry, & Jain, Saranga. (2006). Improving Reproductive Health of Married and Unmarried Youth in India. Pedersen, Kimiko Hibri, Mukred, Adbul Wahed Othman, & Qaid, Eman Mashhour. (2008). Evaluation of 'Integrated Action on Poverty and Early Marriage' Programme in Yemen. Rashid, Sabina Faiz, Sarker, Mahmuda Akhter, & Simmonds, Nicci. (1999). Social Interaction and the Diffusion of Knowledge: BRAC’s Adolescent Reproductive Health Education (ARHE) Program in the Rural Areas of Bangladesh. Save the Children. (2009). Adolescent Reproductive and Sexual Health Program Overview, Narsirnagar, Bangladesh. Shahjahan, Mohammad. (2006). Bangladesh Adolescent Reproductive Health Focused Community Assessment. Shahnaz, Rizwana, & Karim, Raihana. (2008). Providing Microfinance and Social Space to Empower Adolescent Girls: An Evaluation of BRAC’s ELA Centres. Singhal, Arvind, & Greiner. (2006). A Participatory Assessment of Ashreat Al Amal, an Entertainment- Education Radio Soap Opera, in the Sudan: Ohio University. Singhal, Arvind, Hurlburt, Sarah, & Vij, Radha. (2007). A Participatory Assessment of Gugar Goge, an Entertainment-Education Radio Soap Opera, in Nigeria. Sinha, Nistha, & Young, Joanne. (2009). Long-Term Financial Incentives and Investment in Daughters Evidence from Conditional Cash Transfers in North India. UNICEF. (2008). Long Term Evaulation of the TOSTAN Programme in Senegal; Kolda, Thies and Fatick Reigons (pp. UNICEF). USAID. (2007). Extending Service Delivery Project Best Practices Series Report #3 The TAHSEEN Model for Reaching the Urban Poor in Egypt. Watson, Catherine, Walugembe, Patrick, Namubiru, Evelyn, Kato, Issac, & Barton, Tony. (2009). Communication for HIV Prevention and Social Change in Adolescents: A Mid- Term Review. Wilder, Jennifer, Masilamani, Rekha, & Mathew, Annie. (2006). Reproductive Health of Young Adults in India: The Road to Public Health Pathfinder International. World Bank. (2003). Project Performance Assesment Report Bangladesh Female Secondary School Assistance Project. World Bank. (2008). Implementation Completion and Results Report on a Credit in the Amount of SDR 96.4 Million (US 120.9 Million Equivalent) to the People's Republic of Bangladesh for Female Secondary School Assistance Project II

EARLY PREGNANCY

Search Strategy We undertook a systematic search of published literature to identify interventions that address ‘early pregnancy’ in low- and middle-income countries (LMIC). We used six databases—PubMed (MEDLINE), Embase, PsycInfo, Cinahl Plus, Popline, and the Cochrane Database—in conducting this search. In building the search, we combined a list of terms that describe young people with a list of terms that describe pregnancy. We then combined this search with a list of lower- or middle-income country (LMIC) and regional search terms developed and used in the 2012 WHO Systematic Review on the same topic. We limited hits to those materials published in 2005 or later so as not to replicate the efforts already undertaken by the WHO Review. Detailed search terms for each database are available in the Appendix.

This initial search produced 27,376 hits about early pregnancy, which were stored using EndNote reference manager software. We then reviewed all 27,376 titles. After abstract review, and screening for interventions related to early pregnancy, we had 42 articles for abstraction.

We searched the ‘early pregnancy’ grey literature by first targeting organizations involved in prevention of early pregnancy—namely CARE, Population Council, Pathfinder International, and PSI—as well as the Google search engine were initially explored in the search for publications about early pregnancy interventions. In total, we ended up with 55 grey literature articles.

Results We abstracted 97 articles that related to interventions designed to prevent early pregnancy (55 grey literature articles and 42 published peer-reviewed articles). The articles were somewhat evenly distributed between Africa (n=44), Asia (n=32), Africa (n=31), and Latin America and the Caribbean (n=22).

Intervention Characteristics The articles represented primarily urban (n=37) and rural (n=30) interventions, although some were both rural and urban (n=13), four were peri-urban/suburban, and a significant number were not

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Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 22

specified (n=13). The majority of interventions were community based (n=60), followed by school based (n=22), a mix of community and school based (n=13), and varied/other (n=2).

The age range of participants varied substantially across studies. While all selected studies included youth, ages 10-24, the age ranges were not consistent. The most common age ranges were 10-19 years, 15-24 years, and 10-24 years. Other interventions targeted young people based on school grade. Like for early marriage, with no consistent age for “early pregnancy”, interventions are difficult to compare. Thirty-eight (39%) of the interventions include some type of randomization (e.g. schools, communities, or individuals). There was no standard definition of “early pregnancy”.

We used a broad definition of early pregnancy interventions. We included interventions that targeted knowledge (n=42), attitudes (n=9) as well as behavior (n=114) (Note that some studies are double counted depending on outcomes). The most common goals of these interventions were to promote contraceptive use, including condoms (n=47), prevent pregnancy including unplanned pregnancies (n=27) and decrease sexual activity, increase age of sexual debut, and promote abstinence (n=23).

The quality of the interventions ranged from 1 (worst) to 5 (best). Interventions that scores in the low range (n=23) often had limited information about the intervention and the activities, the intervention was too short or limited, the intervention had too many components or concurrent activities to sort out what the intervention was actually impacting, unclear implementation strategy, or there was simply not enough intervention detail to draw conclusions on its strengths and weaknesses. Many of interventions fell in the moderate quality group (n=31), based on receiving a score of 3. The limitations of these interventions were similar to the lower scoring interventions, but less severe. In addition, limitations also included concern about the impact of the interventions on the targeted groups, missing key populations (e.g. out of school youth), implementation problems, and missing detail on training of those implementing the interventions. Interventions receiving a score of 4 (n=37) had significant positive aspects that outweighed the limitations. Among noted positive aspects were including relevant stakeholders in the design and implementation of the intervention, including a pilot phase or formative work, basing the intervention on a theory of change, and being well-planned and organized. Limitations focused on the difficulties of implementing a complex set of components simultaneously, difficulty sorting out the impact of multiple component interventions, concerns about duration of intervention to affect behavior change, and spill-over/contamination effects of the intervention to control groups or populations. Of the 98 early marriage pregnancy Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 23

articles, five scored a 5. These five had no major deficiencies and often benefitted from being rigorously designed and theoretically grounded.

Evaluation Characteristics Of the 98 articles, the vast majority (n=74) were quantitative evaluations, 22 used both quantitative and qualitative assessments, and two involved only qualitative evaluations. The most common type of evaluation was a pre/post design (n=56), followed by post-only (n=20), pre, mid, and post (n=14), other designs (n=2). Three had an unclear design. Nearly all the quantitative evaluations included some sort of survey data, and were analyzed with a range of techniques from simple percentages (n=41), multivariable regression analysis (n=44) and other more advanced techniques including difference –in-difference models, life tables, and others (n=7).

Like the intervention scoring, the evaluation scoring ranged from 1 (worst) to 5 (best). The lowest scoring evaluations (n=44) had few to no strengths, and serious flaws including no to very limited data, no statistical analysis for quantitative studies, limited statistical power to make inferences, no measure of exposure to the intervention, no baseline measure (before intervention), no true measure of impact of the intervention, the evaluation did not match the intervention in terms of measured outcomes, or no comparison group. Thirty of the evaluations scored in the moderate range (score=3), based on having some strength, but significant limitations. Strengths often included pre-post design, a measure of exposure to the intervention, evaluation of the same participants, clarity of the evaluation, appropriate sampling strategy and comparison group, and longitudinal data. Limitations included concerns of spill-over/contamination, self-reported outcome data, limitations in the analyses, no baseline (post-test only), and lack of randomization. Twenty of the evaluations scored in the high quality group, with strengths including strong designs, accounting for exposure levels, sophisticated analyses, randomization, and appropriate control groups. Weaknesses included needing more data to allow for stronger conclusions, loss-to-follow up in longitudinal studies, inability to control for contamination in the analysis, and insufficient detail on sampling and randomization. Few studies (n=4) scored at the highest level for their evaluation. These studies had strong evaluation designs that could determine intervention impact, and few to no limitations.

Overall Assessment The majority of the studies (n=62) found a positive impact of the intervention on some component of early pregnancy—knowledge, attitudes or behavior. A substantial number of studies had mixed or Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 24

contradictory results (n=23), and just a handful (n=9) had negative results (n=4). A final group of interventions had no results reported on early pregnancy or had no data from which to draw conclusions (n=3). Among the studies with positive results, few (n=14) had interventions and evaluations that scored a four or above on both the quality of the intervention and the quality of the evaluation.

Table 3 summarizes the high scoring interventions with a positive impact on early pregnancy prevention.

Table 3: High Scoring Effective Interventions for Early Pregnancy Prevention

County Age Evaluation Grey/ Key Intervention Components Citation Range Methodology Published Ethiopia 10-19 Quantitative Grey Social mobilization, non-formal Evaluation Of Berhane education and livelihood Hewan: A Pilot Program To training for out-of-school girls, or Promote Education & Delay support to remain in school. Marriage in Rural Ethiopia (Erulkar & Muthengi, 2007) Malawi 13-22 Quantitative Published Cash transferred to households The Short-Term Impact of a monthly on the condition that Schooling Conditional Cash the selected girl in the household Transfer Program on the attends school Sexual Behavior of Young Women (Baird et al, 2010) Ethiopia 10-19 Quantitative Published Social mobilization, non-formal Evaluation of Berhane education and livelihood Hewan: A Program To Delay training for out-of-school girls, or Child Marriage in Rural support to remain in school. Ethiopia Ethiopia (Erulkar 2009) Kenya 10-24 Quantitative Published Health education program; Behavior Change Evaluation youth-friendly reproductive of a Culturally Consistent health information and service Reproductive Health environment Program for Young Kenyans (Erulkar, 2004) Uganda 14-20 Quantitative Grey Life skills curriculum and Empowering Adolescent vocational training in teen Girls: Evidence from a community centers. Randomized Control Trial in Uganda (Bandiera et al., 2011) Kenya 18-24 Quantitative Published Participants who came to the Preventing unintended health center looking for oral pregnancy among young contraceptives or injectables women in Kenya: prospective Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 25

were offered a choice between cohort study to offer their initially desired method or contraceptive implants a subdermal implant (Hubacher et al, 2012) China 15-24 Quantitative Published Community-based to build Effects of a Community- awareness and to offer based Sex Education and counseling and services related Reproductive Health Service to sexuality and reproduction. Program on Contraceptive Use of Unmarried Youths in Shanghai (Lou et al, 2004) India 14-24 Quantitative Grey Youth groups were formed to Improving Youth Sexual and and provide youth with safe spaces; Reproductive Health through Qualitative peer education; training in DISHA, an Integrated income-generating skills; Program in India. reproductive health services and (Kanesathasan et al, 2008) other health services were revised to be youth friendly; and youth contraceptive depot holders were trained and stocked. Senegal 15-22 Quantitative Grey Adult sensitization, peer Improving the Reproductive educators; IEC activities; training Health of Adolescents in of trainers; youth-friendly Senegal (Diop et al., 2004) services; and a school-based RH curriculum Bangladesh 13-19 Quantitative Grey Reproductive health curriculum Improving Adolescent (in-school and out of school with Reproductive Health in peer educators); youth friendly Bangladesh (Bhuiya, 2004) services Zimbabwe 10-24 Quantitative Published 6-month mass media campaign. Promoting Sexual Responsibility Among Young People in Zimbabwe (Kim et al., 2001) Kenya 15 on Quantitative Grey Education program on risk Do teenagers respond to HIV average reduction risk information? Evidence from a field experiment in Kenya (Dupas, 2009) Kenya 12-14 Quantitative Published Local adult female “community Keeping Adolescent Orphans visitor” was assigned and was in School to Prevent Human required to visit their households Immunodeficiency Virus at least monthly and schools Infection: Evidence From a weekly to monitor their school Randomized Controlled Trial attendance. Could use in Kenya (Cho et al, 2011) Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 26

intervention funds to address problems resulting in absenteeism India 12-20 Quantitative Grey Vocational skills, leadership Adolescent Girls in India skills, non-formal education and Choose A Better Future: An family life education; and a Impact Assessment (CEDPA, residential training program. 2001)

Of the 14 high quality interventions and evaluations, six were from the peer-reviewed literature and the remaining 8 were from the gray literature. Key organizations involved in the conduct of the intervention and evaluation of the gray literature interventions were CEDPA, ICRW, and Population Council. Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 27

Case Studies Below we describe the intervention, evaluation and results from three studies that represent high quality interventions and evaluations and had a positive impact on early pregnancy. We chose a range of designs including a multicomponent community based intervention focused on youth- friendly services, a school and community based multicomponent intervention, and a conditional cash transfer intervention. Evaluation designs were baseline/endline assessments in all three studies. The analytic techniques included multivariable logistic regression and difference-in-difference

The aim of this study (Lou et al, 2004) was to evaluate the effectiveness of a youth- friendly intervention in promoting safe sex behavior— contraception and condom use among unmarried young people aged 15–24 years in Shanghai, China. A youth-friendly intervention comprised of three key activities intended to build awareness and to offer counseling and services related to sexuality and reproduction among unmarried youth. The first activity focused on building awareness, including disseminating educational materials, playing instructional videos, giving lectures, and conducting small group activities to improve reproductive health knowledge and awareness of services. The second activity focused on the provision of counseling. The final activity was designed to improve contraceptive services. Using an intervention and control group design, the proportions reporting regular contraceptive use and condom use in the intervention group were much higher than that in the control group (p < .001). After adjusting for demographic factors, the subjects from the intervention group were 14.58 (OR) times as likely to use contraceptives at onset of intercourse as those from the control group (95%CI: 8.55– 24.87, p < .0001). Similar results were found for both females and males.

Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 28

The overall objective of this study (Bhuiya, 2004) was to determine the feasibility and effectiveness of a systematic intervention to foster a supportive environment to address the problems faced by adolescents aged 13-19 years by making existing health services more accessible to them and providing them with reproductive health education that will enable them to manage their reproductive health in urban Bangladesh. There were multiple components to the intervention: 1) a 17-session reproductive health curriculum was designed and delivered by 24 teachers in 8 schools, after a 5 day training; 2) youth between 21 and 28 years with 14 years of schooling were recruited as "facilitators” to educate out-of-school adolescents aged 13-19 years on reproductive health issues; 3) peer educators, known as health ambassadors, were also engaged in the community as well as in the schools during the later part of the project period; 4) clinical service providers were trained in April 2000 on being welcoming, maintaining non-judgmental attitudes, and offering minimal waiting time, privacy, confidentiality and affordable services. At the same time non-clinical service providers of the clinics were oriented on adolescent reproductive health service needs and friendly services. Using baseline and endline comparisons, contraceptive awareness was found to be significantly higher in the endline compared to the baseline. Knowledge of at least three risks of early pregnancy were significantly higher in the endline for the two intervention sites (AOR=3.91 for site A, AOR=1.97 for site B). Among those exposed to the intervention, in school and out of school youth were significantly more likely to agree that unmarried and married adolescents can use contraception (AOR=1.67 and AOR=1.41 respectively).

Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 29

The aim of this intervention (Baird 2010) was to examine the effects of a conditional cash program (with only school attendance used as a condition to receive the transfers) on self-reported sexual behavior among 13-22 year olds in Malawi. The intervention transferred cash to households monthly based on whether the selected girl in the household attended school at least 75% of the time during the month. Both the intervention and control groups had two sub-groups--—school- going girls and dropouts. In the intervention arm, $10/a month for 10 months was transferred to the household (split between the girl herself and the girl's guardian) conditioned on the girl attending school for 75% of the time during the month; secondary school fees were paid directly to the school upon confirmation of enrollment. The control group had no intervention. For girls in the intervention arm, who were out of school at baseline, the probability of becoming pregnant declined by more than 30%. In addition, the incidence of the onset of sexual activity was 38% lower among all program beneficiaries than the control group. Baseline dropouts among the treatment group are 5.1 percentage points less likely to have become pregnant over the past year, a reduction in more than 30% that is statistically significant at the 5% level. Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 30

References (Cited) *Baird, Sarah, Chirwa, Ephraim, McIntosh, Craig, & Özler, Berk. (2010). The Short-Term Impacts of a Schooling Conditional Cash Transfer Program on the Sexual Behavior of Young Women. Health Economics, 19(S1), 55-68. doi: 10.1002/hec.1569 Bandiera, Oriana, Buehren, Niklas, Burgess, Robin, Goldstein, Markus, Gulesci, Selim, Rasul, Imran, & Sulaiman, Munshi. (2012). Empowering Adolescent Girls: Evidence from a Randomized Control Trial in Uganda. World Bank. Bhuiya, Ismat. (2004). Improving Adolescent Reproductive Health in Bangladesh. Population Council. Adolescent girls India choose better future. (2001) CEDPA. Cho H, Hallfors DD, Mbai, II, et al. Keeping adolescent orphans in school to prevent human immunodeficiency virus infection: evidence from a randomized controlled trial in Kenya. The Journal of adolescent health : official publication of the Society for Adolescent Medicine 2011 May;48(5):523- 526. *Diop, Nafissatou J., Bathidija, Heli, Tuore, Isseu Diop, Dieng, Thierno, Mane, Babacar, RamaRao, Saumya,et al. (2004). Improving the Reproductive Health of Adolescents in Senegal. Population Council. Dupas, Pascaline. (2009). Do Teenagers Respond to HIV Risk Information? Evidence from a Field Experiment in Kenya Working Paper: NBER. *Erulkar, Annabel. (2004). Behavior Change Evaluation of a Culturally Consistent Reproductive Health Program for Young Kenyans. *Erulkar, Annabel. (2009). Evaluation of Berhane Hewan: A ProgramTo Delay Child Marriage in Rural Ethiopia. International Family Planning Perspectives, 35(1), 6-14. *Erulkar, Annabel, & Muthengi, Eunice. (2007). Evaluation of Berhane Hewan: A Pilot Program To Promote Education & Delay Marriage in Rural Ethiopia. Population Council. Hubacher, David, Olawo, Alice, Manduku, Carolyne, Kiarie, James, & Chen, Pai-Lien. (2012). Preventing unintended pregnancy among young women in Kenya: prospective cohort study to offer contraceptive implants. Contraception, 86(5), 511-517. doi: 10.1016/j.contraception.2012.04.013 *Kanesathasan A, Cardinal L, Pearson E, et al. Improving Youth Sexual and Reproductive Health through DISHA, and Integrated program in India. 2008. ICRW. Kim, Young Mi, Kols, Adrienne, Nyakauru, Ronika, Marangwanda, Caroline, & Chibatamoto, Peter. (2001). Promoting Sex Responsibility Among Young people in Zimbabwe. International Family Planning Perspectives, 27(1), 11-19. Lou, Chao-Hua, Wang, Bo, Shen, Yan, & Gao, Er-Sheng. (2004). Effects of a community-based sex education and reproductive health service program on contraceptive use of unmarried youths in Shanghai. Journal of Adolescent Health, 34(5), 433-440. doi: 10.1016/j.jadohealth.2003.07.020 * Indicates effective, high quality and abstracted for multiple outcomes

References (Full List) Acharya, Rajib, Kalyanwala, Shveta, & Jejeebhoy, Shireen. (2009). Broadening Girls' Horizons: Effects of a Life Skills Education Programme in Rural Uttar Pradesh. New Delhi: Population Council. ACNielson Bangladesh. (2006). ARH Focused Community Assesment: Final Report. ACQUIRE Project. (2008). Mobilizing Married Youth in Nepal to Improve Reproductive Health: The Reproductive Health for Married Adolescent Couples Project, Nepal, 2005-2007. Agha, Sohail. (2002). A Quasi-Experimental Study to Assess the Impact of Four Adolescent Sexual Health Interventions in Sub-Saharan Africa. International Family Planning Perspectives, 28(2), 67–70 & 113–118. Andrade, Heloísa Helena Siqueira Monteiro, Brito de Mello, Maeve, Sousa, Maria Helena, Makuch, Maria Yolanda, Berton, Neilane, & Faundes, Anibal. (2009). Changes in sexual behavior following a sex education program in Brazilian public schools. Cad Saude Publica, 25(5), 1168-1176. Askew, Ian, Chege, jane, Njue, Carolyn, & Radney, Samson. (2004). A Multi-Sectoral Approach To Provding Reprofuctive Health Information and Services to Young People in Western Kenya: Kenya Adolescent Reproductive Health Project. Baird, Sarah, Chirwa, Ephraim, McIntosh, Craig, & Özler, Berk. (2010). The Short-Term Impacts of a Schooling Conditional Cash Transfer Program on the Sexual Behavior of Young Women. Health Economics, 19(S1), 55-68. doi: 10.1002/hec.1569 Bandiera, Oriana, Buehren, Niklas, Burgess, Robin, Goldstein, Markus, Gulesci, Selim, Rasul, Imran, & Sulaiman, Munshi. (2012). Empowering Adolescent Girls: Evidence from a Randomized Control Trial in Uganda. World Bank. Bhuiya, Ismat. (2004). Improving Adolescent Reproductive Health in Bangladesh. Botell, Miguel Lugones, Bermúdez, Marieta Ramírez , & Rodríguez, Héctor Machado. Intervención educativa en adolescentes atendidas en consulta de ginecología infanto-juvenil. Revista Cubana de Pediatría, 80(2). Brieger, William, Delano, Grace, Lane, Catherine, & Oladepo, Oladimeji. (2001). West African Youth Initiative: Outcome of a Reproductive Health Education Program. Cabezón, Carlos, Vigil, Pilar, Rojas, Iván, Leiva, M. Eugenia, Riquelme, Rosa, Aranda, Waldo, & García, Carlos. (2005). Adolescent pregnancy prevention: An abstinence-centered randomized controlled intervention in a Chilean public high school. Journal of Adolescent Health, 36(1), 64-69. doi: 10.1016/j.jadohealth.2003.10.011 Catino, Jennifer, Colom, Alejandra, & Ruiz, Marta Julia. (2011). Equipping Mayan Girls to Improve Their Lives. Population Council. CARE. (2007). Guria adolescent health project (GAHP) Final Evaluation – 2007. CARE. (2007). Promoting Safe Choices for Adolescents (PROSCAD): Final Project Evaluation 2007. CEDPA. (2001). Adolescent Girls in India Choose a Better Future: An Impact Assessment. CEDPA. (2002). Nepal Endline GIFT for RH program. CEDPA. (2003). Impact study New Horizons Project Egypt. CEDPA. (2009). Expanding the Voluntary Use of Contraception in the Central Terai: Family Future Project End of Project Report.

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Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 32

CFPA. (2005a). Evaluation of the Impact of Life-Planning Skills Training Among Senior High School Students in Shangcai County. CFPA. (2005b). Impact of a Comprehensive Youth Reproductive Health Intervention Among Vocational School Students in Shanghai. CFPA. (2005c). A Workplace Based Life Planning Skills Training Program for Migrant Youth in Shenzhen, China: Impact Evaluation Report. Cho H, Hallfors DD, Mbai, II, et al. Keeping adolescent orphans in school to prevent human immunodeficiency virus infection: evidence from a randomized controlled trial in Kenya. The Journal of adolescent health : official publication of the Society for Adolescent Medicine 2011 May;48(5):523- 526. Center for Research on Environment, Health, and Population Activities (CREHPA),. (2004). Determining an Effective and Replicable Communication-Based Mechanism for Improving Young Couples’ Access to and Use of Reproductive Health Information and Services in Nepal - An Operations Research Study. Decker, Martha, & Montagu, Dominic. (2007). Reaching Youth through Franchise Clinics: Assessment of Kenyan Private Sector Involvement in Youth Services. Journal of Adolescent Health, 40(280-282). Daniel, Elkan E., & Nanda, Rema. (2012). The Effect of Reproductive Health Communication Interventions on Age at Marriage and First Birth in Rural Bihar, India: A retrospective study. Diaz, Margarita, Brito de Mello, Maeve, Souza, Maria Helena de, Cabral, Francisco, Silva, Ricardo de Castro e, Campos, Marcia, & Faundes, Anibal. (2005). Outcomes of three different models for sex education and citizenship programs concerning knowledge, attitudes, and behavior of Brazilian adolescents. Cad. Saúde Pública, 21(2), 589-597. Diop, Nafissatou J., Bathidija, Heli, Tuore, Isseu Diop, Dieng, Thierno, Mane, Babacar, RamaRao, Saumya,et al. (2004). Improving the Reproductive Health of Adolescents in Senegal. Population Council. Doyle, Aoife M., Ross, David A., Maganja, Kaballa, Baisley, Kathy, Masesa, Clemens, Andreasen, Aura, . . . Hayes, Richard J. (2010). Long-Term Biological and Behavioural Impact of an Adolescent Sexual Health Intervention in Tanzania: Follow-up Survey of the Community-Based MEMA kwa Vijana Trial. PLoS Medicine, 7(6), e1000287. doi: 10.1371/journal.pmed.1000287 Duflo, Esther. (2007). Education and HIVAIDS prevention Western Kenya. Duflo, Esther, Dupas, Pascaline, & Kremer, Michael. (2011). Education subsidy and HIV training_Kenya. Eggleston, Elizabeth, Jackson, Jean, Rountree, Wesley, & Pan, Zhiying. (2000). Evaluation Of a Sexuality Education Program for Young Adolescents in Jamaica. Pan American Journal of Public Health, 72(2), 102- 112. Dupas, Pascaline. (2009). Do Teenagers Respond to HIV Risk Information? Evidence from a Field Experiment in Kenya Working Paper: NBER. Engebretsen, Sarah. (2012). Baseline and Endline Findings of Filles Éveillées (Girls Awakened): A Pilot Program for Migrant Adolescent Girls in Domestic Service: Cohort 1 (2011-2012), Bobo Dioulasso: Population Council. Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 33

Erulkar, Annabel. (2004). Behavior Change Evaluation of a Culturally Consistent Reproductive Health Program for Young Kenyans. Erulkar, Annabel, & Muthengi, Eunice. (2007). Evaluation of Berhane Hewan : A Pilot Program To Promote Education & Delay Marriage in Rural Ethiopia. Erulkar, Annabel. (2009). Evaluation of Berhane Hewan: A ProgramTo Delay Child Marriage in Rural Ethiopia. International Family Planning Perspectives, 35(1), 6-14. Houvras, Irit. (2007). Community pathways to improved sexual and repdocutive health: Youth and their communities take charge to improve youth reproductive and sexual health in Burkina Faso: CARE. Fatusi, Adesegun O., Wang, Wenjuan, & Anyanti, Jennifer. (2007). Multi-Media Campaign Exposure and Interpersonal Communication on Sexual Abstinence among Young People in Nigeria: A Propensity- Matched Study. International Quarterly of Community Health Education, 28(4), 289-303. doi: 10.2190/IQ.28.4.c Fawole, I.O. (1999). A School Based AIDS Education Programme for Secondary School Students in Nigeria- A Review of Effectiveness. Feldman, Becca S. (2009). Contraceptive use, birth spacing, and autonomy- an analysis of the Oportunidades program in rural Mexico. Golbasi, Zehra. (2009). Evaluation of School-Based Reproductive Health Education Program for Adolescent Girls. Int J Adolesc Med Health, 21(3), 395-404. Gulemetova-Swan, Michaela. (2009). Evaluating The Impact of Conditional Cash Programs on Adolescent Decisions about Marriage and Fertility; the Case of Oportunidades. Hainsworth, Gwyn, Zilhao, Ivone, Badiani, RIta, Gregorio, Deolinda, Jamisse, Lilla, Modan, Amir Aly, & Pacca, Julio. (2009). From inception to large scale:The Geração Biz programme: World Health Organization and Pathfinder International. Hallfors, Denise, Cho, Hyunsan, Rusakaniko, Simbarashe, Iritani, Bonita, Mapfumo, John, & Halpern, Carolyn. (2011). Supporting Adolescent Orphan Girls to Stay in School as HIV Risk Prevention: Evidence From a Randomized Controlled Trial in Zimbabwe. American Journal of Public Health, 101(6), 1082-1088. doi: 10.2105/ajph.2010.300042 Hubacher, David, Olawo, Alice, Manduku, Carolyne, Kiarie, James, & Chen, Pai-Lien. (2012). Preventing unintended pregnancy among young women in Kenya: prospective cohort study to offer contraceptive implants. Contraception, 86(5), 511-517. doi: 10.1016/j.contraception.2012.04.013 Institut de Rechereche et des Etudes des Comportements (IRESCO). (2002). Peer education as a strategy to increase contracpetive prevalencece and reduce the rate of STIs/HIV among adolescents in Cameroon. IFPS Technical Assistance Project (ITAP). (2012). Promoting adolescent reproductive health in Uttarakhand and Uttar Pradesh, India: Futures Group and ITAP. Jewkes, Rachel, Nduna, M., Levin, J., Jama, N., Dunkle, K., Puren, A., & Duvvury, N. (2008). Impact of stepping stones on incidence of HIV and HSV-2 and sexual behaviour in rural South Africa: cluster randomised controlled trial. BMJ, 337. Kabore, Gisele. (2010). Eliminer le mariage des enfants; experience pilote dans cinq regions du Burkina Faso. Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 34

Kaljee, Linda, Genberg, Becky, Riel, Rosemary, Cole, Matthew, Tho, Le Huu, Thoa, Li Thi Kim, et al. (2005). Effectiveness of A Theory- Based Risk Reduction HIV Prevention Program for Rural Vietnamese Adolescents. AIDS Education and Prevention, 17(3), 185-199. Kanesathasan A, Cardinal L, Pearson E, et al. Improving Youth Sexual and Reproductive Health through DISHA, and Integrated program in India. 2008. ICRW. Kim, Young Mi, Kols, Adrienne, Nyakauru, Ronika, Marangwanda, Caroline, & Chibatamoto, Peter. (2001). Promoting Sex Responsibility Among Young people in Zimbabwe. International Family Planning Perspectives, 27(1), 11-19. Kouwonou, Kodjovi, & Speizer, Ilene. (2001). Enquete Evaluation Du Centre Des Jeunes de l'ATBEF-Lome. Lou, Chao-Hua, Wang, Bo, Shen, Yan, & Gao, Er-Sheng. (2004). Effects of a community-based sex education and reproductive health service program on contraceptive use of unmarried youths in Shanghai. Journal of Adolescent Health, 34(5), 433-440. doi: 10.1016/j.jadohealth.2003.07.020 Madeni, Frida, Horiuchi, Shigeko, & Iida, Mariko. (2011). Evaluation of a reproductive health awareness program for adolescence in urban Tanzania-A quasi-experimental pre-test post-test research. Reproductive Health, 8(1), 21. doi: 10.1186/1742-4755-8-21 Magnani, Robert, Robinson, Amara, Seiber, Eric E., & Avila, Graciela. (2000). Evaluation of "Arte y Parte": An Adolescent Reproductive Health Communications Project Implemented in Asuncion, San Lorenzo, and Fernando de la Mora. Final Report.: FOCUS on Young Adults Program/Pathfinder International, PROMESA, and PSI. Magnani, Robert, Gaffkin, Lynne, Leao de Aquino, Estela Maria, & Seiber, Eric E. (2001). Impact of an Integrated Adolescent Reproductive Health Program in Brazil. Studies in Family Planning, 32(3), 230- 243. Magnani, Robert, MacIntyre, Kate, Karim, Ali Mehyrar, Brown, Lisanne, Hutchinson, Paul, Kaufman, Carol, . . . Dallimore, Anthea. (2005). The impact of life skills education on adolescent sexual risk behaviors in KwaZulu-Natal, South Africa. Journal of Adolescent Health, 36(4), 289-304. doi: 10.1016/j.jadohealth.2004.02.025 Malleshappa, K., Krishna, S., & Nandini, C. (2011). Knowledge and attitude about reproductive health among rural adolescent girls in Kuppam mandal: An intervention study. Biomedical Research, 22(3), 305-310. Mantilla, María Dolores Castro, & Antezana, Máriel Loayza. (2004). Evaluation of Community Education Interventions in Sexual and Reproductive Health Services in Urban-Marginal Areas of La Paz, Bolivia: CIDEM. Martiniuk, A. L. C., O'Connor, K. S., & King, W. D. (2003). A Cluster Randomized Trial of a Sex Education Programme in Belize, Central America. International Journal of Epidemiology, 32(1), 131-136. doi: 10.1093/ije/dyg014 Mathur, Sanyukta, Mehta, Manisha, & Malhotra, Anju. (2004). Youth reproductive health in Nepal: Is participation the Answer? : Engender Health and ICRW. Mba, C. I., Obi, S. N., & Ozumba, B. C. (2007). The impact of health education on reproductive health knowledge among adolescents in a rural Nigerian community. Journal of Obstetrics & Gynaecology, 27(5), 513-517. doi: 10.1080/01443610701478991 Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 35

Meuwissen, Liesbeth E., Gorter, Anna C., & Knottnerus, André J. A. (2006). Impact of accessible sexual and reproductive health care on poor and underserved adolescents in Managua, Nicaragua: a quasi- experimental intervention study. Journal of Adolescent Health, 38(1), 56.e51-56.e59. doi: 10.1016/j.jadohealth.2005.01.009 Mmari, Kristin, & Magnani, Robert. (2000). Does Making Clinic-based Reproductive Health Services More Youth-friendly Increase Service Use by Adolescents? Evidence From Lusaka, Zambia. Journal of Adolescent Health, 33(4), 259-270. Musoko, Assia Saou, Scoppa, Cristiana, & Manoncourt, Erma. (2012). Girls and Grandmothers Hand-in-Hand Dialogue between generations for community change. Muyinda, H., Nakuya, J., Pool, R., & Whitworth, J. (2003). Harnessing the senga institution of adolescent sex education for the control of HIV and STDs in rural Uganda. AIDS Care, 15(2), 159-167. doi: 10.1080/0954012031000105414 Nair, M. K. C., Paul, Mini K., Leena, M. L., Thankachi, Yamini, George, Babu, Russell, P. S., & Pillai, H. Vijayan. (2011). Effectiveness of a Reproductive Sexual Health Education Package among School Going Adolescents. The Indian Journal of Pediatrics, 79(S1), 64-68. doi: 10.1007/s12098-011-0433-x Pande, Rohini, Kurz, Kathleen, Walia, Sunayana, MacQuarrie, Kerry, & Jain, Saranga. (2006). Improving Reproductive Health of Married and Unmarried Youth in India. Pathfinder. (2000a). Evaluation of 'Juventud Es Salud': An adolescent and sexual health peer education program implemented in six departments of Peru. Pathfinder. (2000b). Evaluation of an integrated adolescent seuxality education/health service provider training pilot in Salvador, Bahia, Brazil. Pathfinder. (2005). Youth Friendly Services: Botswana End of Program Evaluation Report. Plautz, Andrea, & Meekers, Dominique. (2007). Evaluation of the Reach and Impact of the 100% Jeune Youth Social Marketing Program in Cameroon: Findings From Three Cross-Sectional Surveys. Reproductive Health, 4(1), 1. doi: 10.1186/1742-4755-4-1 Plummer, M. L., Wight, D., Obasi, A. I. N., Wamoyi, J., Mshana, G., Todd, J., . . . Ross, D. A. (2006). A process evaluation of a school-based adolescent sexual health intervention in rural Tanzania: the MEMA kwa Vijana programme. Health Education Research, 22(4), 500-512. doi: 10.1093/her/cyl103 Population Council. (2004). Integrating Adolescent Livelihood Activities within a Reproductive Health Program for Urban Slum Dwellers in India. PSI. (2006). Family Planning TRaC Study Evaluating the Use of Condoms and Oral Contraceptives among Young Females (15- years) in Madagascar. PSI and Research Metrics. (2008). Family Planning TRaC Study Evaluating the Condom Use and Pill Use as Contraceptive Methods among Young Females 15-24 years in Madagascar. Round Three PSI Research Division. (2011). Estudio TRaC de VIH/SIDA evaluando comportamientos saludables en jovenes de los departmentos de San Salvador, La Paz, Santa Ana y Sonsonate, El Salvador. Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 36

PSI and Research Metrics. (2011). Programa de promocion de la salud sexual y reproductiva. Estudio TRaC Evaluando comportamientos de riesfo, factores asociados e impacto del programa entre jovenes de 15- 24 anos en Chetumal, Quintata Roo, Mexico. Segunda Ronda. PSI. (2002). Adolescent Health Project Makes Waves in Paraguay. Rahaman, Mizanur, & Daniel, Elkan E. (2010). A Reproductive Health Communication Model That Helps Improve Young Women’s Reproductive Life and Reduce Population Growth: The Case of PRACHAR from Bihar,India. Roa, R. S. P, Lena, A., Nair, N.S., Kamath, V., & Kamath, A. (2008). Effectiveness of Reproductive Health Education Among Rural Adolescent Girls: A school based Intervention Study in Udupi Taluk, Karnataka. Indian Journal of Medical Sciences, 62(11), 439-443. Ross, D. A., Changalucha, John, Obasi, Angela I.N., Todd, Jim, Plummer, Mary L., Cleophas-Mazige, Bernadette, et al. (2007). Biological and Behavioural Impact of An Adolescent Sexual Health Intervention in Tanzania: A Community-Randomized Trial. AIDS, 21, 1943-1955. Rossem, Ronan Van, & Meekers, Dominique. (2000). An Evaulation of The Effectiveness of Targeted Social Marketing To Promote Adolescents and Young Adult Reproductive Health in Cameroon. AIDS Education and Prevention, 12(5), 383-404. Santhya, K.G, Haberland, Nicole, Das, Arup, Lakhani, Aruna, Ram, F., Sinhan, R.K., et al. (2008). Empowering married young women and improving their sexual and reproductive health:Effects of the First-time Parents Project. Population Council. Save the Children. (2009). Adolescent Reproductive and Sexual Health Program Overview, Narsirnagar, Bangladesh. Thato, R., Jenkins, R. A., & Dusitsin, N. (2008). Effects of the culturally-sensitive comprehensive sex education programme among Thai secondary school students. Journal of Advanced Nursing, 62(4), 457-469. doi: 10.1111/j.1365-2648.2008.04609.x Toledo, Virginia, Luengo, Ximena, Molina, R. , Murray, T. , & Villegas, R. (1998). Impacto del Programa de Educación Sexual: Adolescencia Tiempo de Decisiones. USAID. (2007). The TAHSEEN Model for Reaching the Urban Poor in Egypt: A promising practice. Undie, Chi- Chi, Birungi, Harriet, Obare, Francis, Ochieng, Ben, Liambila, Wilson, Oweya, Erick, & Askew, Ian. (2012). Expanding access to comprehensive reproductive health and HIV information and services for married adolescent girls in Nyanza Province: Population Council: Nairobi, Kenya. Van Rossem, Ronan, & Meekers, Dominique. (1999). An Evaluation of the Effectiveness of Targeted Social Marketing to Promote Adolescent Reproductive Health in Guinea: PSI, Research Division. Walker, D. (2006). HIV prevention in Mexican schools: prospective randomised evaluation of intervention. Bmj, 332(7551), 1189-1194. doi: 10.1136/bmj.38796.457407.80 Wang, Bo, Meier, Ann, Shah, Iqbal, & Li, Xiaoming. (2007). The Impact of a Community-Based Comprehensive Sex Education Program on Chinese Adolescents' Sex-Related Knowledge and Attitudes. Journal of HIV/AIDS Prevention in Children & Youth, 7(2), 43-64. doi: 10.1300/J499v07n02_04 Williams, Tim, Mullen, Stephanie, Karim, Ali, & Posner, Jessica. (2007). Evaluation of The African Youth Alliance (AYA) Program in Ghana, Tanzania and Uganda: JSI. Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 37

Wilder, Jennifer, Masilamani, Rekha, & Mathew, Annie. (2006). Reproductive Health of Young Adults in India: The Road to Public Health. Wusu, O. (2013). Exposure to media content and sexual health behaviour among adolescents in Lagos metropolis, Nigeria. Afr J Reprod Health, 17(2), 157-168.

NUMBER OF CHILDREN

Search Strategy We undertook a systematic search of published literature to identify interventions that address ‘number of children’ in low- and middle-income countries (LMIC). We used six databases—PubMed (MEDLINE), Embase, PsycInfo, Cinahl Plus, Popline, and the Cochrane Database—in conducting this search. In building the search, we combined a list of terms that describe young people with a list of terms that describe the number of children during young adulthood including parity, and repeat pregnancy. We then combined this search with a list of lower- or middle-income country (LMIC) and regional search terms. Detailed search terms for each database are available in the Appendix.

This initial search produced 1,595 hits about limiting the number of children, which were stored using EndNote reference manager software. We then reviewed all 1,592 titles. This title screening reduced the original list of 1,592 hits down to 32 articles that seemed relevant. Of the 32, 6 published articles included interventions to decrease the number of children during young adulthood, and were included for abstraction.

We searched the ‘number of children’ grey literature by searching organizations that are involved in preventing repeat pregnancies or births. ICRW, CARE, Population Council, Pathfinder—as well as the Google search engine. A total of 5 documents in the grey literature were identified as eligible.

Results We abstracted 11 articles that related to interventions designed to prevent repeat pregnancies and births (5 grey literature and 6 published peer-reviewed articles). The articles contained interventions that focused primarily in Asia (n=7), Latin America (n=3) and just one from Africa.

Intervention Characteristics The articles represented a relatively even mix between rural interventions (n=4), urban interventions (n=3), or both rural and urban (n=3). The majority of interventions were community based (n=7) and the remaining (n=4) were based in facilities—clinics or hospitals.

HINDIN & FATUSI [email protected]

Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 39

The interventions included in this section represent several different ways to conceptualize limiting the number of children. Some interventions targeted preventing repeat pregnancies and/or abortions (n=2), most considered contraceptive uptake or use following a birth or abortion (n= 5), contraceptive uptake for those with a child (n=2) and contraceptive uptake in couples (n=2). Age ranges varied considerably across studies. Five of the eleven of the interventions include some type of randomization (e.g. communities, facilities or individuals).

The quality of the interventions ranged from 1 (worst) to 5 (best). Interventions that scores in the low range (n=2) failed to explain how intervention was better than the standard of care or provided very limited detail on the intervention. A majority of the interventions fell in the moderate quality group (n=5), based on receiving a score of 3. The limitations of these interventions included potential contamination in the control group, poor monitoring of the intervention implementation, and too many components to sort out “effective”. Interventions receiving a score of 4 (n=3) had significant positive aspects that outweighed the limitations. Among noted positive aspects were community engagement in the intervention design, thorough training of providers, and a good control group. Limitations included not accounting for or describing existing services in the intervention area, being resource intensive, and sorting out the impact of multicomponent interventions. Of the 11 number of children intervention articles, one scored a 5. This intervention had no major deficiencies and benefitted from being rigorously designed.

Evaluation Characteristics All 11 articles were quantitative assessments. Most of the evaluations were a pre/post design (n=6), three were post-only, and the remaining (n=2) were evaluations that included pre, mid and post. Nearly all quantitative evaluations included some sort of survey data, and were analyzed with a range of techniques from simple percentages (with and without significance testing) (n=7), multivariable regression analysis (n=3) and other more advanced techniques including difference –in- difference models (n=1).

Like the intervention scoring, the evaluation scoring ranged from 1 (worst) to 5 (best). The lowest scoring evaluations (n=5) had few to no strengths, and serious flaws including poorly done statistical analyses, no clear measure of exposure to the intervention, and serious limitations with the control group. Two of the evaluations scored in the moderate range (score=3), based on have some strengths but significant limitations. Strengths often included a good design, and randomization, while Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 40

limitations echoed those in the low scoring evaluation group. Two scored in the high quality group, with strengths including strong design (prospect cohort data), large sample size, and multiple data points. Weaknesses included lack of sufficient detail and concerns about blinding of the interviews to the assignment of participants. Two studies scored at the highest level for their evaluation. These studies had strong evaluation designs that were able that followed the same individuals over time and used rigorous statistical methods.

Overall Assessment The majority of the studies (n=8) found a positive impact of the intervention on some component of preventing repeat pregnancies including uptake of contraception, and avoiding repeat pregnancies. Few studies had mixed or contradictory results (n=2) or negative results (n=1). A final group of interventions had no results reported on avoiding having multiple children during adolescence from which to draw conclusions (n=1). Among the studies with positive results, only two had interventions and evaluations that scored a four or above on both the quality of the intervention and the quality of the evaluation. Below we describe the intervention, evaluation and results from these two studies that represent high quality interventions and evaluations and had a positive impact on limiting the number of children.

Table 4 summarizes the high scoring interventions with a positive impact on limiting the number of children.

Table 4: High Scoring Effective Interventions for Limiting the Number of Children

County Age Evaluation Grey/ Key Intervention Citation Range Methodology Published Components Jamaica 15-20 Quantitative Published Classroom instruction and The Impact of the Women's Centre support for adolescent of Jamaica Foundation Programme mothers; skills training and for Adolescent Mothers on Repeat job placement assistance. Pregnancies (Drayton et al, 2000) Acceptance and use of a family planning method is a requirement for program participation.

India 15-19 Quantitative Published An educational campaign led Increasing postpartum contraception by community workers (of in rural India: Evaluation of a different types: auxiliary community-based behavior change Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 41

nurse midwives, social health communication intervention activists) (Sebastian et al, 2012)

The two high quality interventions and evaluations for prevent repeat pregnancy or multiple children during young adulthood were located in the peer-reviewed literature.

Case Studies As we only located two high quality studies with an impact on repeat pregnancy, we featured both in our case studies. One was a multicomponent program based out of a clinic and the other was a community-based intervention. Both had an intervention group and a comparison or control group—one used a post-only design while the other had a baseline/endline design. Multivariable logistic regression and ANOVA were used to analyze the impact of the interventions. Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 42

The overall aim of this study (Drayton et al, 2000) was to assess the effectiveness of the programs of the Women's Centre of Jamaica Foundation (WCJF) on adolescent mothers, ages 15-20. The study was a retrospective cohort study following women who had a first pregnancy in 1994 and then sought to determine the risk of another pregnancy by program participation. Program participation was contingent on women accepting a family planning method. The program included classroom instruction and support along with job skills training and placement. The evaluation compared participants to non-participants at the end of the intervention. The relative risk of one or more repeat pregnancies was 45% (CI 0.22-0.91) lower for program participants compared to non-participants.

Following young women, ages 15-19, this study (Sebastian et al, 2012) sought to assess whether an intervention to raise awareness about the advantages of birth spacing for the health of mother and child would promote postpartum contraception in rural India. The intervention groups were exposed to the educational campaign, described below and the comparison groups received only the government run health program. The intervention consisted primarily of an educational campaign, led by community health workers. Women in the intervention groups were significantly more likely to know the healthy spacing messages four months postpartum than were those in the comparison group (Odds Ratio=2.1). The results also suggest that compared with women in the comparison group, women exposed to the educational campaign were significantly more likely to know of at least two healthy spacing messages (Odds Ratio=1.5). After multivariable adjustment, women in the intervention group were significantly more likely to be using a contraceptive method postpartum (Odds Ratio=3.5). Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 43

References (Cited) Drayton, VL, Montgomery, SB, Modeste, NN, Frye- Anderson, BA, & McNeil, Pamela. (2000). The Impact of Women's Centre of Jamaica Foundation Programme for Adolesecent Mothers on Repeat Pregnancies. West Indian Medical Journal, 49(4), 316-326. Sebastian, Mary Philip, Khan, Mohammed Ejazduin, Kumari, Kaushal, & Idnani, Rukma. (2012). Increasing Postpartum Contraception in Rural India: Evaluation of a Community-Based Behavior Change Communication Intervention. International Perspectives on Sexual and Reproductive Health, 38(02), 068-077. doi: 10.1363/3806812

References (Full List) Center for Research on Environment, Health, and Population Activities (CREHPA),. (2004). Determining an Effective and Replicable Communication-Based Mechanism for Improving Young Couples’ Access to and Use of Reproductive Health Information and Services in Nepal - An Operations Research Study. Botell, Miguel Lugones, Bermúdez, Marieta Ramírez , & Rodríguez, Héctor Machado. Intervención educativa en adolescentes atendidas en consulta de ginecología infanto-juvenil. Revista Cubana de Pediatría, 80(2). Daniel, Elkan, & Nabda, Rema. (2012). The Effect of Reproductive Health Communication Interventions on Age at Marriage and First Birth in Rural Bihar, India: A retrospective study Pathfinder International. Watertwon, MA. Drayton, VL, Montgomery, SB, Modeste, NN, Frye- Anderson, BA, & McNeil, Pamela. (2000). The Impact of Women's Centre of Jamaica Foundation Programme for Adolesecent Mothers on Repeat Pregnancies. West Indian Medical Journal, 49(4), 316-326. Oliva, Guilherme Sciascia, Medea de Mendonca, Rodrigo Goes , Sant'Anna, Maria José Carvalho, Passarelli, Maria Lucia, Coates, Verônica, & Omar, Hatim A. (2008). Integral care for pregnant adolescents: Impact on offspring. Int J Adolesc Med Health, 20(4), 537-546. Santhya, K.G, Haberland, Nicole, Das, Arup, Lakhani, Aruna, Ram, F., Sinhan, R.K., . . . Mohanty, S.K. (2008). Empowering married young women and improving their sexual and reproductive health:Effects of the First-time Parents Project: Population Council. Sebastian, Mary Philip, Khan, Mohammed Ejazduin, Kumari, Kaushal, & Idnani, Rukma. (2012). Increasing Postpartum Contraception in Rural India: Evaluation of a Community-Based Behavior Change Communication Intervention. International Perspectives on Sexual and Reproductive Health, 38(02), 068-077. doi: 10.1363/3806812 Undie, Chi- Chi, Birungi, Harriet, Obare, Francis, Ochieng, Ben, Liambila, Wilson, Oweya, Erick, & Askew, Ian. (2012). Expanding access to comprehensive reproductive health and HIV information and services for married adolescent girls in Nyanza Province: Population Council: Nairobi, Kenya. Wilder, Jennifer. (2006). Reproductive Health of Young Adults in India: The Road to Public Health Pathfinder. Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 44

Yu. (2010). Explorative Strategy Integrating Unmarried Pregnant Adolescents in China. The European Journal of Contraception and Reproductive Health Care, 15(s1), 60-201. doi: 10.3109/13625181003733194 Zhu, Jin Liang, Zhang, Wei-Hong, Cheng, Yimin, Xu, Juncai, Xu, Xiao, Gibson, Diana, . . . Temmerman, Marleen. (2009). Impact of post-abortion family planning services on contraceptive use and abortion rate among young women in China: a cluster randomised trial. The European Journal of Contraception and Reproductive Health Care, 14(1), 46-54. doi: 10.1080/13625180802512994

Sexually Transmitted Infections (STIs) including HIV

Search Strategy We undertook a systematic search of published literature to identify interventions that address ‘STIs including HIV’ in low- and middle-income countries (LMIC). We used six databases—PubMed (MEDLINE), Embase, PsycInfo, Cinahl Plus, Popline, and the Cochrane Database—in conducting this search. In building the search, we combined a list of terms that describe young people with a list of terms that describe sexually transmitted infections (STI) including human immunodeficiency virus (HIV). We then combined this search with a list of lower- or middle-income country (LMIC) and regional search terms. We further limited the search to only include those studies that included terms for evaluation, assessment and impact. Detailed search terms for each database are available in the Appendix.

This initial search produced 22,076 hits about preventing STIs, which were stored using EndNote reference manager software. Given the large numbers, we decided to focus solely on interventions that targeted a behavior change, rather than including all interventions that only targeting changing knowledge and attitudes as outcomes. We then reviewed all 22,076 titles. This title screening reduced the original list of down to 622 articles that seemed relevant and provided evidence of the impact of the intervention. Of these 56, published articles met our criteria.

We searched the ‘STIs’ grey literature by searching organizations that are involved in preventing STIs and HIV including PSI, PATH, Pathfinder and Population Council—as well as the Google search engine. A total of 64 documents in the grey literature were identified as eligible.

Results We abstracted 120 articles that related to behavior change for STI prevention (64 grey literature and 56 published peer-reviewed articles). The articles contained interventions that focused primarily in Africa (n=56), Latin America (n=32) and Asia (n=32). We had two interventions that were conducted in multiple geographic regions.

HINDIN & FATUSI [email protected]

Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 46

Intervention Characteristics There interventions were carried out in primarily urban areas (n=53), or a mix between rural and urban areas (n=39). Some were just conducted in rural areas (n=19), while nine did not clearly state whether the areas were rural or urban. The articles represented primarily community-based interventions (n=62), followed by school-based interventions (n=39), both community and school- based (n=16) and 4 that took place in other or unknown venues.

The interventions included in this primarily focus on HIV prevention, although some of the interventions included a broader range of STIs including human papilloma virus (HPV). We focused on interventions that targeted behaviors—condom use (n=88), abstinence or delaying initiation of sex (n=36), limiting number of sexual partners (n=33), limiting risky sexual behavior (n=13), and HIV/STI testing (n=19). Forty-one of interventions included some type of randomization (e.g. communities, facilities or individuals).

The quality of the interventions ranged from 1 (worst) to 5 (best). Interventions that scores in the low range (n=26) failed to explain provide adequate detail of the intervention itself, omitted a key population (e.g. out of school youth), or was too broad to provide evidence of “what worked”. Many of the interventions fell in the moderate quality group (n=37), based on receiving a score of 3. The limitations of these interventions included unclear match between intervention activities and potential outcomes, issues of attributing any observed changes to the intervention, limited data to track whether the intervention was implemented well, concern about spill-over or contamination, poor measures of exposure, and too many components to sort out what is “effective”. Interventions receiving a score of 4 (n=49) had significant positive aspects that outweighed the limitations. Among noted positive aspects were involvement of peer educators, having a theoretical basis, engaged relevant stakeholders, relied on a significant formative component, employed a multitude of strategies to change behavior, community engagement in the intervention design, and included both in-school and out-of-school youth. Limitations included not including a control group, concerns about contamination of the control group, difficulty sorting out the impact of multicomponent interventions, and limited duration of the intervention. Of the 123, eight had interventions that scored a 5. These interventions had no major deficiencies and benefitted from factors such as being rigorously designed, theoretically driven, and comprehensive in terms of providing a full complement of services. Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 47

Evaluation Characteristics The vast majority (n=95) were quantitative assessments, followed by mixed methods (n=24) and then only one was qualitative. Most of the evaluations were a pre/post design (n=81), followed by post- only (n=19), pre-mid/during and post (n=15), and the remaining (n=5) were a variety of different combinations such as mid-post, pre only, and mid-post designs. Nearly all the quantitative evaluations included some sort of survey data, and were analyzed with a range of techniques from simple percentages (with and without significance testing) (n=35), multivariable regression analysis (n=79) and other more advanced techniques including difference –in-difference models and propensity score matching (n=4). Two used unclear analytic techniques.

Like the intervention scoring, the evaluation scoring ranged from 1 (worst) to 5 (best). The lowest scoring evaluations (n=28) had few to no strengths, and serious flaws including not enough detail on the evaluation, poor or no statistical analyses, no clear measure of exposure to the intervention, high loss-to-follow up rates without accounting for them in the analyses, no baseline data, no control or comparison group. The majority of the interventions scored a three (n=50), in the moderate range (score=3), based on having some strengths, but significant limitations. Strengths often included having a good set of comparisons (pre-post, exposed-unexposed), longitudinal data, large sample size, good sampling strategy, and randomization. Limitations echoed those in the low scoring evaluation group but also included limited exposure measures (no accounting for how much exposure participants got), concerns about contamination in the control group, failure to account for selection into the intervention group, and difficulty showing attribution of change to the intervention. Thirty-four scored in the high quality group, with strengths including strong design (prospect cohort data), large sample size, appropriate and sometimes innovative statistical methods, and multiple data points, and accounting for “dose” of exposure to the intervention. Weaknesses included insufficient data or populations to show attribution, few sexually active participants, limited power to detect statistically significant differences, and some detail missing about sampling, exposure, and comparison groups. Eight scored at the highest level for their evaluation. These studies had strong evaluation designs, often including randomization, that were able to show the impact of the intervention. Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 48

Overall Assessment Of all the interventions, nearly the same number showed uniformly positive results (n=39) as negative or no results (n=38). The majority of the interventions had mixed outcomes (n=51) and one had no outcomes related to STI prevention. Among the studies with positive results, only nine had interventions and evaluations that scored a four or above on both the quality of the intervention and the quality of the evaluation. It is important to note that for behaviors related to STIs, many focus on change that is based purely on self-reported data—for example, condom use. Given that many programs emphasize the importance of consistent condom use, it is difficult to know how much of condom use is influenced by social desirability bias.

Below we describe the intervention, evaluation and results from three studies that represent high quality interventions and evaluations and had a positive impact on preventing STIs.

Table 5 summarizes the high scoring interventions with a positive impact on preventing STIs.

Table 5: High Scoring Effective Interventions for Preventing STIs

County Age Evaluation Grey/ Key Intervention Citation Range Methodology Published Components Senegal 10-19 Quantitative Grey Adult sensitization, peer Improving the Reproductive educators; IEC activities; Health of Adolescents in Senegal training of trainers; youth- (Diop et al., 2004) friendly services; and a school- based RH curriculum Zambia 13-19 Quantitative Grey A mass multimedia program HEART program offers Zambian Youth hope for an HIV/AIDS-free future (CCP, 2004) Uganda 10-19 Quantitative Grey A mass multimedia program Helping youth prevent HIV: An evaluation of the straight talk program in Uganda (Adamchak, 2007) South 16-24 Quantitative Grey Entertainment-education Tsha Tsha: Key findings of the Africa television drama evaluation of episodes 1-26 (Kelly, 2005) Zambia 13-19 Quantitative Published A mass multimedia program Reducing the risk of HIV transmission among adolescents in Zambia: Psychosocial and behavioral correlates of viewing a risk-reduction media campaign Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 49

(Underwood, 2004) Cameroon 10-25 Quantitative Published Peer Educators and mass An Evaluation of the "Entre Nous media Jeunes" Peer-Educator Program for Adolescents in Cameroon (Speizer, 2001) South 9-18 Quantitative Published School-based curriculum School-based randomized Africa controlled trial of an HIV/STD risk reduction intervention for South African adolescents (Jemmott, 2010) Malawi 15-24 Quantitative Grey Mass media and school HIV/AIDS TRaC Study presentations Evaluating Abstinence among unmarried youth (15-24 years) in Malawi. Second Round (PSI, 2009 ) Tanzania 10-24 Quantitative Published Training of health workers to Impact of the MEMA kwa Vijana deliver of youth-friendly Adolescent Sexual and services; reproductive health Reproductive Health education in primary school; Interventions on Use of Health community-based condom Services by Young People in Rural promotion and distribution Mwanza, Tanzania: Results of a Cluster Randomized Trial (Larke, 2010)

Of the nine high quality interventions and evaluations that had a positive impact on behavior change related to STIs/HIV, four were from the peer-reviewed literature and the remaining five were from the gray literature. The organizations involved in the conduct of these interventions and evaluations included the Center for Communication Programs, Population Council and PSI.

Case Studies The selected case studies for behavior change related to STIs including HIV included a multimedia campaign, a multicomponent community- and school-based intervention, and a community-based intervention. The evaluation designs included matching exposed and unexposed individuals, three different communities with varying levels of intervention (community, community+ school and control), and a community-level randomized design. Analytic techniques included multivariable regression, propensity score matching. and adjusted means. Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 50

“Tsha-Tsha” (Kelly, 2005) was a South African entertainment-education television drama series of 26 episodes focusing on young people and dealing with love, sexuality and relationships in a world affected by HIV/AIDS. The impact of this drama series was evaluated using both quantitative and qualitative methodologies. The quantitative approach was to use propensity score matching between exposed and unexposed 16-24 year olds. In addition, focus group discussions were conducted. Compared with controls, there was a 16% statistically significant difference in number of respondents who decided to be faithful to partner, and a 12% difference in those who remained abstinence for a month or more. There was also a 4% difference in those who decided to have sex less often, and a 6% difference was observed in those who had VCT to find out HIV status.

The overall aim of this multipronged intervention, in urban Senegal (Diop, 2004) was to determine the feasibility, cost, and impact of multiple interventions to improve reproductive health outcomes among 10-19 year old Senegalese adolescents. The intervention was into two sites and the sites had different interventions. In one, the intervention included adult sensitization, peer educators organized classes covering the 17 sessions of the life skills curriculum, IEC activities including radio programs, training of trainers, and making facilities adolescent-friendly at the community level. The second intervention site included the interventions described above and a school-based reproductive health curriculum. The evaluation, based on a quasi-experimental design (randomization at the community level) focused on sexual debut, sexual activity (secondary abstinence), protected first sex, and condom use among 10-19 year olds. Adolescents in school and exposed to the intervention were less likely to report sex in the prior six months than those either in school and not exposed to the intervention or those not in school. When compared with adolescents in the control site, adolescents in the intervention sites were more likely to adopt secondary abstinence (limiting sexual activity following sexual initiation) and had fewer sexual partners. Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 51

MEMA kwa Vijana (Larke, 2010), a community-based health intervention, was conducted in rural Tanzania between 1998-2001. Communities were assigned to intervention or control based on cluster randomization. Health workers from the intervention arm were trained in the provision of youth-friendly health services, as part of a package of interventions. The intervention had four major components: (i) reproductive health education in primary school; (ii) the provision of youth- friendly sexual and reproductive health services; (iii) community-based condom promotion and distribution; and (iv) community-wide activities. The evaluation was designed to assess the impact of the health services component of the intervention using several process and impact indicators on young people. By the end of the study period (2001) significantly more males, and marginally more girls, attended clinics for STI symptoms in intervention communities than comparison communities. Few condoms were distributed, although significantly more were distributed in intervention facilities. Intervention health workers tended to be less judgmental and provided more comprehensive information than health workers in the non-intervention communities.

References (Cited) Adamchak, Susan E. (2007). The Straight Talk Campaign in Uganda Impact of Mass Media Initiatives. Population Council. Center for Communication Programs. (2004). HEART Program Offers Zambian Youth Hope for an HIV AIDSFree Future. *Diop, Nafissatou J., Bathidija, Heli, Toure, Iuseu Dio, Dieng, Thierno, Mane, Babacar, RamaRao, Saumya, et al. (2004). Improving the Reproductive Health of Adolescents in Senegal. Population Council. Jemmott, J. B., 3rd, Jemmott, L. S., O'Leary, A., Ngwane, Z., Icard, L. D., Bellamy, S. L., . . . Makiwane, M. B. (2010). School-based randomized controlled trial of an HIV/STD risk-reduction intervention for South African adolescents. Arch Pediatr Adolesc Med, 164(10), 923-929. doi: 10.1001/archpediatrics.2010.176 Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 52

Kelly, Kevin, Parker, Warren, Hajiyuannis, Helen, Ntlabati, Pumla, Kincaid, Larry, & Do, Mai. (2005). Tsha Tsha: Key findings of the evaluation of episodes 1-26: Centre for AIDS Development, Research and Evaluation (CADRE). Larke, N., Cleophas-Mazige, B., Plummer, M. L., Obasi, A. I., Rwakatare, M., Todd, J., . . . Ross, D. A. (2010). Impact of the MEMA kwa Vijana adolescent sexual and reproductive health interventions on use of health services by young people in rural Mwanza, Tanzania: results of a cluster randomized trial. J Adolesc Health, 47(5), 512-522. doi: 10.1016/j.jadohealth.2010.03.020 PSI and Research Metrics. (2009e). HIV/AIDS TrAC study evaluting abstinence among unmarried youth (15-24 years) in Malawi, Second Round. Speizer, I. S., Tambashe, B. O., & Tegang, S. P. (2001). An evaluation of the "Entre Nous Jeunes" peer-educator program for adolescents in Cameroon. Stud Fam Plann, 32(4), 339-351. Underwood, C., Hachonda, H., Serlemitsos, E., & Bharath-Kumar, U. (2006). Reducing the risk of HIV transmission among adolescents in Zambia: psychosocial and behavioral correlates of viewing a risk- reduction media campaign. J Adolesc Health, 38(1), 55. doi: 10.1016/j.jadohealth.2004.09.022 * Indicates effective, high quality and abstracted for multiple outcomes

Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 53

References (Full List)

Adamchak, Susan E. (2007). The Straight Talk Campaign in Uganda Impact of Mass Media Initiatives. Agha, S., & Van Rossem, R. (2004). Impact of a school-based peer sexual health intervention on normative beliefs, risk perceptions, and sexual behavior of Zambian adolescents. J Adolesc Health, 34(5), 441-452. doi: 10.1016/j.jadohealth.2003.07.016 Andrade, Heloisa Helena Siqueria Monteriro, Brito de Mello, Maeve, Sousa, Maria Helena , Makuch, Maria Yolanda, Bertoni, Neilane, & Faundes, Anaibal. (2009). Changes in sexual behavior following a sex education program in Brazilian public schools. Cad Saude Publica, 25(5), 1168-1176. Arnold, R., Maticka-Tyndale, E., Tenkorang, E., Holland, D., Gaspard, A., Luginaah, I., & Team, Hp Ry. (2012). Evaluation of school- and community-based HIV prevention interventions with junior secondary school students in Edo State, Nigeria. Afr J Reprod Health, 16(2), 103-125. Baird, S. J., Garfein, R. S., McIntosh, C. T., & Ozler, B. (2012). Effect of a cash transfer programme for schooling on prevalence of HIV and herpes simplex type 2 in Malawi: a cluster randomised trial. Lancet, 379(9823), 1320-1329. doi: 10.1016/S0140-6736(11)61709-1 Baird, Sarah, Chirwa, E., McIntosh, Craig, & Ozler, B. (2009). The short-term impacts of a schooling conditional cash transfer program on the sexual behavior of young women. Baker, Simon, & Rumakom, Patchara. (2003). Programming for HIV Prevention Among College Students in Thailand. Bandiera, Oriana, Buehren, Niklas, Burgess, Robin, Goldstein, Markus, Gulesci, Selim, Rasul, Imran, & Suslaiman, Munshi. (2012). Empowering Adolescent Girls: Evidence from a Randomized Control Trial in Uganda. In B. Uganda (Ed.), (pp. 1-46). Bhuiya, Ismat. (2004). Improving Adolescent Reproductive Health in Bangladesh. Brieger, W. R., Delano, G. E., Lane, C. G., Oladepo, O., & Oyediran, K. A. (2001). West African Youth Initiative: outcome of a reproductive health education program. J Adolesc Health, 29(6), 436-446. Burnett, S. M., Weaver, M. R., Mody-Pan, P. N., Thomas, L. A., & Mar, C. M. (2011). Evaluation of an intervention to increase human immunodeficiency virus testing among youth in Manzini, Swaziland: a randomized control trial. J Adolesc Health, 48(5), 507-513. doi: 10.1016/j.jadohealth.2010.08.015 CADRE. (2005). Tsha Tsha: Key Findings of the Evaluation of Episodes 1-26. Cartagena, R. G., Veugelers, P. J., Kipp, W., Magigav, K., & Laing, L. M. (2006). Effectiveness of an HIV prevention program for secondary school students in Mongolia. J Adolesc Health, 39(6), 925 e929-916. doi: 10.1016/j.jadohealth.2006.07.017 Center for Communication Programs. (2003). Guinea Youth Driven Campaign Promotes Right to Abstain or Use Condoms. Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 54

Center for Communication Programs. (2004). HEART Program Offers Zambian Youth Hope for an HIV AIDSFree Future. Center for Communication Programs. (2012). The Health Communication Partnership Uganda Final Report: Empowering Young People to make healthier choices (Y.E.A.H.). Centro Informazione e Educazione allo Svilippo-Italia (CIES). (2010). Programa Integral de Promcion de la Salud Sexual y Reproductiva y Prevencion del VIH/SIDA en Mujeres, Adolescentes, y Jovens Pobres del Gran Buenos Aires, Informe Final. CFPA. (2005a). Evaluation of the Impact of Life-Planning Skills Training Among Senior High School Students in Shangcai County. CFPA. (2005b). Impact of a Comprehensive Youth Reproductive Health Intervention Among Vocational School Students in Shanghai. CFPA. (2005c). A Workplace Based Life Planning Skills Training Program for Migrant Youth in Shenzhen, China: Impact Evaluation Report. Chen, X., Lunn, S., Deveaux, L., Li, X., Brathwaite, N., Cottrell, L., & Stanton, B. (2009). A cluster randomized controlled trial of an adolescent HIV prevention program among Bahamian youth: effect at 12 months post-intervention. AIDS Behav, 13(3), 499-508. doi: 10.1007/s10461-008-9511-0 Chen, X., Stanton, B., Gomez, P., Lunn, S., Deveaux, L., Brathwaite, N., . . . Harris, C. (2010). Effects on condom use of an HIV prevention programme 36 months postintervention: a cluster randomized controlled trial among Bahamian youth. Int J STD AIDS, 21(9), 622-630. doi: 10.1258/ijsa.2010.010039 NY:. Delate, Richard. (2012). Impact and Cost-Effectiveness of the Scrutinize Communication Campaign on Partner Reduction in South Africa. Diaz, Margarita, Brito de Mello, Maeve, Souza, Maria Helena de, Cabral, Francisco, Silva, Ricardo de Castro e, Campos, Marcia, & Faundes, Anibal. (2005). Outcomes of three different models for sex education and citizenship programs concerning knowledge, attitudes, and behavior of Brazilian adolescents. Cad. Saúde Pública, 21(2), 589-597. Diop, Nafissatou J., Bathidija, Heli, Toure, Iuseu Dio, Dieng, Thierno, Mane, Babacar, RamaRao, et al.. (2004). Improving the Reproductive Health of Adolescents in Senegal. Doyle, Aoife, M., Ross, David A., Manganja, K. Long-term biological and behavioural impact of an adolescent sexual health intervention in Tanzania: follow-up survey of the community-based MEMA kwa Vijana Trial. PLoS Med 2010 Jun;7(6):e1000287. Duflo, Esther. (2007). Education and HIVAIDS prevention Western Kenya. Duflo, Esther, Dupas, Pascaline, & Kremer, Michael. (2011). Education, HIV and Early Fertility: Experimental Evidence from Kenya. Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 55

Dupas, Pascaline. (2009). Do Teenagers Respond to HIV Risk Information? Evidence from a Field Experiment in Kenya Working Paper: NBER. Ergene, T., Cok, F., Tumer, A., & Unal, S. (2005). A controlled-study of preventive effects of peer education and single-session lectures on HIV/AIDS knowledge and attitudes among university students in Turkey. AIDS Educ Prev, 17(3), 268-278. doi: 10.1521/aeap.17.4.268.66533 Erulkar, Annabel. (2004). Behavior Change Evaluation of a Culturally Consistent Reproductive Health Program for Young Kenyans. Erulkar, Annabel, & Chong, Erica. (2005). Evaluation of a Savings & Micro-Credit Program for Vulnerable Young Womemen in Nairobi. Esere, Mary Ogechi. (2008). Effect of sex education programme on at-risk sexual behaviour of school-going adolescents in Ilorin, Nigeria. African Health Sciences, 8(2), 120-125. Fonseca-Becker, Fanny, Bakadi, Guillaume, & Sow, Amelie. (2005). Mobilizing communities for behavior change: HIV/AIDS and pregnancy prevention among youth in Upper Guinea. CCP. Givaudan, Martha (1999). Effects of a School-Based Life Skills and HIV Prevention Program for High School Mexican Adolescents. Hainsworth, Gwyn, Zilhao, Ivone, Badiani, RIta, Gregorio, Deolinda, Jamisse, Lilla, Modan, Amir Aly, & Pacca, Julio. (2009). From inception to large scale:The Geração Biz programme: World Health Organization and Pathfinder International. Harvey, B., Stuart, J., & Swan, T. (2000). Evaluation of a drama-in-education programme to increase AIDS awareness in South African high schools: a randomized community intervention trial. Int J STD AIDS, 11(2), 105-111. Houvras, Irit. (2007). Community pathways to improved sexual and repdocutive health: Youth and their communities take charge to improve youth reproductive and sexual health in Burkina Faso: CARE. Hughes--d'Aeth, A. (2002). Evaluation of HIV/AIDS peer education projects in Zambia. Evaluation and Program Planning, 397–407. Inter-Agency Working Group (IAWG) on the Role of Involvement in ASRH. (2007). Community Pathways to Improved Adolescent Sexual and Reproductive Health: A conceptual framework and suggested outcome indicators (see Burkina Faso case study by Houvras). Washington, DC and New York Institut de Rechereche et des Etudes des Comportements (IRESCO). (2002). Peer education as a strategy to increase contracpetive prevalencece and reduce the rate of STIs/HIV among adolescents in Cameroon. Iurcovich, Mariana, Lourie, Kevin, & Brown, Larry. (1998). The AIDS Prevention Training Program for High School Students in Buenos Aires, Argentina. Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 56

Jahanfar, S., Lye, M.S., & Rampal, L. (2009). A randomised controlled trial of peer-adult-led intervention on improvement of knowledge, attitudes and behaviour of university students regarding HIV/AIDS in Malaysia. Singapore Medical Journal, 50(2), 173-180. James S, Reddy PS, Ruiter RA, et al. The effects of a systematically developed photo-novella on knowledge, attitudes, communication and behavioural intentions with respect to sexually transmitted infections among secondary school learners in South Africa. Health promotion international 2005 Jun;20(2):157- 165. James, Shamagonam, Reddy, Priscilla, Ruiter, Robert, McCauley, Ann, & Borne, Bart Van Den. (2006). The Impact Of An HIV And AIDS Life Skills Program On Secondary School Students In Kwazulu–Natal, South Africa. AIDS Education and Prevention 18(4)381-94. Jansen, William, & James, Victoria. (2008). Zimbabwe HIV/AIDS partnership project & behavior change programme. Jemmott, J. B., 3rd, Jemmott, L. S., O'Leary, A., Ngwane, Z., Icard, L. D., Bellamy, S. L., . . . Makiwane, M. B. (2010). School-based randomized controlled trial of an HIV/STD risk-reduction intervention for South African adolescents. Arch Pediatr Adolesc Med, 164(10), 923-929. doi: 10.1001/archpediatrics.2010.176 Jewkes, R., Nduna, M., Levin, J., Jama, N., Dunkle, K., Puren, A., & Duvvury, N. (2008). Impact of stepping stones on incidence of HIV and HSV-2 and sexual behaviour in rural South Africa: cluster randomised controlled trial. BMJ, 337, a506. doi: 10.1136/bmj.a506 Kelly, Kevin, Parker, Warren, Hajiyuannis, Helen, Ntlabati, Pumla, Kincaid, Larry, & Do, Mai. (2005). Tsha Tsha: Key findings of the evaluation of episodes 1-26: Centre for AIDS Development, Research and Evaluation (CADRE). Kinsler, J., Sneed, C. D., Morisky, D. E., & Ang, A. (2004). Evaluation of a school-based intervention for HIV/AIDS prevention among Belizean adolescents. Health Educ Res, 19(6), 730-738. doi: 10.1093/her/cyg091 LaMontagne, D Scott. (2011). Human papillomavirus vaccine delivery strategies that achieved high coverage in low- and middle-income countries. doi: 10.2471/blt.11.089862 Larke, N., Cleophas-Mazige, B., Plummer, M. L., Obasi, A. I., Rwakatare, M., Todd, J., . . . Ross, D. A. (2010). Impact of the MEMA kwa Vijana adolescent sexual and reproductive health interventions on use of health services by young people in rural Mwanza, Tanzania: results of a cluster randomized trial. J Adolesc Health, 47(5), 512-522. doi: 10.1016/j.jadohealth.2010.03.020 Limaye, R, ,Rimal,, R. N., Brown, J., Mkandawire, G., Böse, K., Kakhobwe, T., Boulay, M.,, . . . Nakoma, P., & Suzi. (2009). Promoting HIV Prevention Behaviors in Malawi Through the BRIDGE Project. Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 57

Lipovsek, Varja, Tashkhodjaeva, Shakhnoza, Tuyen, Tracey, Hoffman, Leah, & Joldasova, Elizaveta. (2008). Knowledge, Attitudes and Practices of At-Risk Youth Relating to Injecting Drug Use and Sexual Behavior in Four Countries of Central Asia: PSI/Central Asia. Lou, Chao-Hua, Wang, Bo, Shen, Yan, & Gao, Er-Sheng. (2004). Effects of a community-based sex education and reproductive health service program on contraceptive use of unmarried youths in Shanghai. Journal of Adolescent Health, 34(5), 433-440. doi: 10.1016/j.jadohealth.2003.07.020 Magnani, Robert, Robinson, Amara, Seiber, Eric E., & Avila, Graciela. (2000). Evaluation of "Arte y Parte": An Adolescent Reproductive Health Communications Project Implemented in Asuncion, San Lorenzo, and Fernando de la Mora. Final Report.: FOCUS on Young Adults Program/Pathfinder International, PROMESA, and PSI. Magnani, Robert, Gaffkin, Lynne, Leao de Aquino, Estela Maria, & Seiber, Eric E. (2001). Impact of an Integrated Adolescent Reproductive Health Program in Brazil. Studies in Family Planning, 32(3), 230- 243. Maganani, Robert, Karim, Al Mehyrar, Macintyre, Kate, Brown, Lisanne, & Hutchinson, Paul. (2004). Transitions to Adulthood in the Context of AIDS in South Africa: The Impact of Exposure to Life Skills Education on Adolescent Knowledge, Skills, and Behavior. Magnani, R. (2003). The Impact of Life Skills Education on Adolescent Sexual Risk Behaviors. Martinez-Donate, A. P., Hovell, M. F., Zellner, J., Sipan, C. L., Blumberg, E. J., & Carrizosa, C. (2004). Evaluation of two school-based HIV prevention interventions in the border city of Tijuana, Mexico. J Sex Res, 41(3), 267-278. doi: 10.1080/00224490409552234 Mash, R., & Mash, R. J. (2012). A quasi-experimental evaluation of an HIV prevention programme by peer education in the Anglican Church of the Western Cape, South Africa. BMJ Open, 2(2), e000638. doi: 10.1136/bmjopen-2011-000638 Mason-Jones, Amanda J., Mathews, Catherine, & Flisher, Alan J. (2011). Can Peer Education Make a Difference? Evaluation of a South African Adolescent Peer Education Program to Promote Sexual and Reproductive Health. AIDS and Behavior, 15(8), 1605-1611. doi: 10.1007/s10461-011-0012-1 Mathews, C., Aaro, L. E., Grimsrud, A., Flisher, A. J., Kaaya, S., Onya, H., . . . Klepp, K. I. (2012). Effects of the SATZ teacher-led school HIV prevention programmes on adolescent sexual behaviour: cluster randomised controlled trials in three sub-Saharan African sites. Int Health, 4(2), 111-122. doi: 10.1016/j.inhe.2012.02.001 Mathur, Sanyukta, Metha, Manisha, & Malhotra, Anju. (2004). Youth reproductive health in Nepal: Is participation the answer? : Engender Health and ICRW. Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 58

Maticka-Tyndale, Eleanor, Wildish, Janet, & Gichuru, Mary. (2007). Quasi-experimental evaluation of a national primary school HIV intervention in Kenya. Evaluation and Program Planning, 30(2), 172-186. doi: 10.1016/j.evalprogplan.2007.01.006 McCombie, Susan, Hornik, Robert C., & Anarfi, JK. (2002). Effects of a mass media campaign to prevent AIDS among young people in Ghana Public Health Commincation: Evidence for Behavior Change (pp. 147-161). Meekers, Dominique. (1998). The Effectiveness of Targeted Social Marketing to Promote Adolescent Reproductive Health: The Case of Soweto, South Africa. Meuwissen, Liesbeth E., Gorter, Anna C., & Knottnerus, André J. A. (2006). Impact of accessible sexual and reproductive health care on poor and underserved adolescents in Managua, Nicaragua: a quasi- experimental intervention study. Journal of Adolescent Health, 38(1), 56.e51-56.e59. doi: 10.1016/j.jadohealth.2005.01.009 Minaya, Jasmin. (2008). The impact of sex education on HIV knowledge and condom use among adolescent females in the Dominican Republic. Muyinda, H., Nakuya, J., Pool, R., & Whitworth, J. (2003). Harnessing the senga institution of adolescent sex education for the control of HIV and STDs in rural Uganda. AIDS Care, 15(2), 159-167. doi: 10.1080/0954012031000105414 Nguyen, Huy V., Giang, Le M., Nguyen, Son M., Tran, Mai N., & Ha, Nguyet M. (2012). The effect of participatory community communication on HIV preventive behaviors among ethnic minority youth in central Vietnam. BMC Public Health 12. Okonofua, F. E., Coplan, P., Collins, S., Oronsaye, F., Ogunsakin, D., Ogonor, J. T., . . . Heggenhougen, K. (2003). Impact of an intervention to improve treatment-seeking behavior and prevent sexually transmitted diseases among Nigerian youths. Int J Infect Dis, 7(1), 61-73. Padian, N. S., van der Straten, A., Ramjee, G., Chipato, T., de Bruyn, G., Blanchard, K., . . . Team, Mira. (2007). Diaphragm and lubricant gel for prevention of HIV acquisition in southern African women: a randomised controlled trial. Lancet, 370(9583), 251-261. doi: 10.1016/S0140-6736(07)60950-7 Parker, Edward, & Parker, Susan. (2009). Evaluating the Family Life and Education Programme in Lagos State Nigeria: A Five Year Study: Philiber Research Associates. Pathfinder. (2000a). Evaluation of 'Juventud Es Salud': An adolescent and sexual health peer education program implemented in six departments of Peru. Pathfinder. (2000b). Evaluation of an integrated adolescent seuxality education/health service provider training pilot in Salvador, Bahia, Brazil. Pathfinder. (2005). Youth Friendly Services: Botswana End of Program Evaluation Report. Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 59

Peltzer, K., Ramlagan, S., Chirinda, W., Mlambo, G., & McHunu, G. (2012). A community-based study to examine the effect of a youth HIV prevention programme in South Africa. Int J STD AIDS, 23(9), 653- 658. doi: 10.1258/ijsa.2012.011457 PSI. HIV/AIDS TRaC Study Evaluating the Effect of a POL-type Program among Young People Frequenting Dance Clubs in Bucharest, Second Round. Romania. PSI. (2006b). HIV/AIDS TRaC study evaluating abstinence among urban youth (10-14 years) in Kenya, Second Round. PSI. (2008a). Estudio TRaC de VIH/SIDA entre jovenes de 15 a 24 anos de Ciudad de Guatemala, Guatemala, Segunda Ronda. PSI. (2008b). Estudio TRaC de VIH/SIDA entre jovenes de 15 a 24 anos de San Salvador, El Salvador. PSI. (2008c). Estudio TRaC de VIH/SIDA entre jovenes de 15 a 24 anow de San Pedro Sula y Tegucugalpa, Honduras, Segunda Ronda. PSI. (2008d). Evaluation de l'utilisation systematique du preservatif lors des rapports sexuels chez les jeunes scolaires au Togo. PSI. (2009). Enquête TRaC sur les déterminants de l’utilisation du condom chez les jeunes âgés de 15 – 24 ans au Burundi. PSI. (2011a). Estudio TRaC de VIH/SIDA: Evaluando comportamientos saludables en Jovens de los departmentos de Chimaltenango, Guatemale 3a Ronda. PSI. (2011b). Estudio TRaC de VIH/SIDA: Evaluando comportamientos saludables en Jovens de lost departmentos de Chinandega, Leon y Managua, Nicaragua. 3a Ronda. PSI and Research Metrics. (2006a). Evaluation de la campagne sur l'abstinence sexuelle secondarie chez les jeunes ages de 15-24 ans au Burundi, Deuxieme Passage. PSI and Research Metrics. (2006b). Evaluation de la campagne sur l'abstinence sexualle secondaire chez les adolescents sexuallement actifs de 13-19 ans dans quatre deparments au sud Benin, Deuxieme Passage. PSI and Research Metrics. (2007). HIV/AIDS TRaC study evaluating condom use among youth (15-24) in Madagascar. PSI and Research Metrics. (2008). HIV/AIDS TRaC study evaluating condom use among youth (15-24) in Madagascar, Second Round. PSI and Research Metrics. (2009a). Evaluation de l'utilisation systematique de preservatif chez les eleves non maries de 15-24 ans des zones d'intervention du projet IMPACT au Benin, Deuxieme Passage. PSI and Research Metrics. (2009b). Evaluation de l'utilisation du comdom chez les jeunes apprentis non maries de 15-24 ans des zones d'intervention du projet KfW au Benin, Deuxieme Passage. PSI and Research Metrics. (2009d). HIV/AIDS TRaC study evaluating condom use among youth aged 15-24 years in Kenya. Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 60

PSI and Research Metrics. (2009e). HIV/AIDS TrAC study evaluting abstinence among unmarried youth (15-24 years) in Malawi, Second Round. PSI and Research Metrics. (2011). Programa de promocion de la salud sexual y reproductiva. Estudio TRaC Evaluando comportamientos de riesfo, factores asociados e impacto del programa entre jovenes de 15- 24 anos en Chetumal, Quintata Roo, Mexico. Segunda Ronda. PSI Research Division. (2011). Estudio TRaC de VIH/SIDA Evaluando comportamientos saludables en jovenes de los departmentos de San Salvador, La Paz, Santa Ana y Sonsonate, El Salvador. Pulerwitz, Julie, Barker, Gary, Segundo, Márcio, & Nascimento, Marcos. (2006). Promoting more gender- equitable norms and behaviors among young men as an HIV/AIDS prevention strategy: Promundo. Reddy, Priscilla., James, Shegs., & McCauley Ann (2005). Programming for HIV Prevention in South African Schools A Report on Program Implementation. Center for Communication Programs (CCP) Save the Children. (2009). Adolescent Reproductive and Sexual Health Program Overview, Narsirnagar, Bangladesh. Solorzano, Irela., Bank, A., Pena, R. et al. (2008). Catalyzing Personal and Social Change Around Gender, Sexuality, and HIV: Impact Evaluation of Puntos de Encuentro’s Communication Strategy in Nicaragua. Soul City. (2008). Soul City Institute Regional Programme: Impact Evaulation Summary Speizer, I. S., Tambashe, B. O., & Tegang, S. P. (2001). An evaluation of the "Entre Nous Jeunes" peer-educator program for adolescents in Cameroon. Stud Fam Plann, 32(4), 339-351. Stanton, B., Chen, X., Koci, V., Deveaux, L., Lunn, S., Harris, C., . . . Marshall, S. (2012). Effect of a grade 6 HIV risk reduction intervention four years later among students who were and were not enrolled in the study trial. J Adolesc Health, 50(3), 243-249. doi: 10.1016/j.jadohealth.2011.06.012 Sweat, M., Morin, S., Celentano, D., Mulawa, M., Singh, B., Mbwambo, J., . . . Project Accept study, team. (2011). Community-based intervention to increase HIV testing and case detection in people aged 16-32 years in Tanzania, Zimbabwe, and Thailand (NIMH Project Accept, HPTN 043): a randomised study. Lancet Infect Dis, 11(7), 525-532. doi: 10.1016/S1473-3099(11)70060-3 Thato, R., Jenkins, R. A., & Dusitsin, N. (2008). Effects of the culturally-sensitive comprehensive sex education programme among Thai secondary school students. Journal of Advanced Nursing, 62(4), 457-469. doi: 10.1111/j.1365-2648.2008.04609.x Underwood, C., Hachonda, H., Serlemitsos, E., & Bharath-Kumar, U. (2006). Reducing the risk of HIV transmission among adolescents in Zambia: psychosocial and behavioral correlates of viewing a risk- reduction media campaign. J Adolesc Health, 38(1), 55. doi: 10.1016/j.jadohealth.2004.09.022 Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 61

Undie, Chi- Chi, Birungi, Harriet, Obare, Francis, Ochieng, Ben, Liambila, Wilson, Oweya, Erick, & Askew, Ian. (2012). Expanding access to comprehensive reproductive health and HIV information and services for married adolescent girls in Nyanza Province: Population Council: Nairobi, Kenya. USAID. (2012). Grassroot Soccer Football for an HIV Free Generation. van der Maas, F., & Otte, W. M. (2009). Evaluation of HIV/AIDS secondary school peer education in rural Nigeria. Health Educ Res, 24(4), 547-557. doi: 10.1093/her/cyn056 Van Rossem, Ronan, & Meekers, Dominique. (2000). An evaluation of the effectivenes of targeted social marketing to promote adolescent and young adult reporodutive health in Cameroon. AIDS Education and Prevention, 12(5), 383-404. Verma, Ravi. (2008). Promoting Gender Equity as a Strategy to Reduce HIV Risk and Gender-based Violence Among Young Men in India. Visser, M. J. (2005). Life skills training as HIV/AIDS preventive strategy in secondary schools: evaluation of a large-scale implementation process. SAHARA J, 2(1), 203-216. doi: 10.1080/17290376.2005.9724843 Walker, D. (2006). HIV prevention in Mexican schools: prospective randomised evaluation of intervention. Bmj, 332(7551), 1189-1194. doi: 10.1136/bmj.38796.457407.80 Wang, Bo, Meier, Ann, Shah, Iqbal, & Li, Xiaoming. (2007). The Impact of a Community-Based Comprehensive Sex Education Program on Chinese Adolescents' Sex-Related Knowledge and Attitudes. Journal of HIV/AIDS Prevention in Children & Youth, 7(2), 43-64. doi: 10.1300/J499v07n02_04 Williams, Tim, Mullen, Stephanie, Karim, Ali, & Posner, Jessica. (2007). Evaluation of The African Youth Alliance (AYA) Program in Ghana, Tanzania and Uganda: JSI. Wolf, R. Cameron. (2003). The Influence of Peer versus Adult Communication on AIDS-Protective Behaviors among Ghanaian Youth. doi: 10.1080/10810730390233280 Wusu, O. (2013). Exposure to media content and sexual health behaviour among adolescents in Lagos metropolis, Nigeria. Afr J Reprod Health, 17(2), 157-168.

RECOMMENDATIONS FOR FUNDERS • Insist on High Quality Evaluation: We strongly recommend that funders and implementers focus on developing high quality evaluation and monitoring activities as part of the study design—before implementation. If this is not feasible, evaluations can be implemented during the intervention but limits inferences about effectiveness. It is essential to match the evaluation to the intervention. This focus will prevent the field from replicating ineffective interventions repeatedly. In addition it will allow for funders to show “what works” and replicate successful interventions in different settings. Ideally evaluations will include measures of cost (a significant gap in the interventions found for this project), fidelity (was the intervention implemented effectively), measures of exposure to the intervention when control groups are unavailable, costs for dissemination of results (meeting costs, publication), and attention to the feasibility of scale up. In the current review, none of the effective high quality interventions and evaluations included cost data.

• Create a Youth Sexual and Reproductive Health e-Inventory: Our searches for literature were relatively easy for the published literature, but for the gray literature the searches required “snowball” approaches or reference tracing. We were familiar with some of the NGOs in the field so we could use connections to facilitate the location of the gray literature. But even as we complete this report, more literature is emerging. It is worthwhile developing a virtual library of resources on interventions, by outcome, for the field to use as the basis for deciding on effective interventions. This e-inventory would require updates and maintenance, but once in place, researchers and organizations would be interested in making sure their projects are reviewed and added to the inventory.

• Consider multiple outcomes or proxy indicators: For many sexual and reproductive health outcomes, there are “proximate” measures of impact. This is particularly important for interventions where the “outcome” of interest is several years away from the intervention. While the push (and rightfully so) is to change the targeted behaviors, decrease early marriage, early pregnancy, repeat pregnancy or STIs, the behavior change is often an important precursor to these outcomes. Interventions need to consider increasing age at first sex, improving contraceptive use, and condom use. These overlooked outcomes are seen more broadly as less appealing and less marketable—but this may be changing. For example, given

HINDIN & FATUSI [email protected]

Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 63

the global interest and investment in FP2020, evidence about increasing contraceptive use (both uptake and continuation) will be an important area for young people. In addition, it is important to look at the potential gap between the intervention and the intended outcome. For example, if a sexuality education curriculum is presented to 11 year olds and the goal is to prevent STIs, the gap between the “exposure” to the intervention and when the young person may engage in the behavior may be significant especially in settings where sexual debut is later. Theories of behavior change and logic models can be helpful in this process. Below is a list of proxy outcomes that can be considered in future interventions: o Age at first sex; ever had sex; sexual frequency o Number of sexual partners (lifetime history; concurrent or multiple sexual partners; age difference with sexual partner) o Contraceptive use; condom use (ever, at first sex, current use and consistent use; method type) o Pregnancy (ever pregnant; ever had an abortion (spontaneous and/or induced) o Pregnancy intentions (particularly important for number of children or repeat pregnancy

• Intervention Fidelity—the ‘Missing Link’? One of the limitations in nearly every evaluation in the field is that we have little to no evidence on whether the designed intervention was implemented as designed. Process measures such as exposure to the intervention, or the degree of exposure (e.g. how many messages were heard on the radio) are often missing from the evaluations. Process measures as well as measures of exposure may help elucidate why what may have been a well-designed, theoretically driven and even piloted intervention, fails to show impact. It is also import to assess whether the impact can be credibly ascribed to the intervention.

• Sustainability and Scale Up—Easy does it?: Questions of whether effective interventions are sustainable and scalable require a range of data from political will, community buy-in, evidence of effectiveness as well as cost and others. By sustainable we mean whether the intervention could continue without the resources of the donors. For example, we found that conditional cash transfer programs, which provide economic incentives have been effective for Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 64

several YPSRH outcomes; however, most communities and governments cannot afford to maintain these programs without external support. Evaluations that include cost data will help determine what is needed for sustainability.

Scalability, or the ability to expand beyond the target group for the intervention, can often be accomplished with additional resources (financial and human capital) but attention to the quality (and fidelity) of the intervention requires careful attention and continued monitoring and evaluation. We did not find evidence in this review that programs are looking at the possibility of scale up. Another way to think about scale up is moving from a pilot to a full- fledged intervention (e.g. Berhane Hewan is a good example). This may be common, but there was limited evidence of pilot studies in our searches. For interventions to be adopted more broadly than the original intervention sites with external funding, it is often necessary to have local (or national) champions as well as the capacity to carry out the intervention independently.

• Cost—The Final Frontier?: A very small minority of interventions and evaluations included cost data. Most of the interventions and evaluations that included cost data were conditional cash transfers—primarily because this is an economic intervention model. Calculating cost per participant is usually part of the conditional cash transfer intervention and evaluation designs. In order assess whether the intervention provides “enough bang for the buck” it is essential to consider all costs involved in the intervention from training costs to participant incentives. There are often intervention inputs that have hidden costs—for example, an after school intervention can be cost-neutral for meeting space, may have “hidden costs” that include costs for staff to work a longer day or the cost to provide electricity to the building. As discussed under scale up, the cost for the same intervention may vary from setting to setting. Cost data is often easier to calculate when commodities (e.g. contraceptives or condoms) are the focus of the intervention. In addition, collecting detailed cost data can often been burdensome for project staff and needs to be included as part of the evaluation from the beginning of the project.

Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 65

• Don’t Hide Failure!: This report focuses on interventions that were well conducted, well evaluated, and had a positive impact on the outcome of interest. It is important to really understand well-designed interventions and evaluations where the intervention did not succeed and why they failed to change the outcomes of interest. In addition, there is significant value in learning more about which interventions were unsuccessful (especially if well-implemented) so the field doesn’t continue to replicate them. In addition, there are many interventions that were well implemented and either poorly evaluated (lacked a control group, poor measures of intervention impact) or not evaluated at all. Without evidence of impact, the group that supported the intervention cannot determine the impact of the intervention.

Lessons Learned from the Four Outcomes • Define the outcome: It is essential to develop clear definitions of the outcome under study. For example, “early” pregnancy or “early” marriage is subjective and highly contextually based. If we do have a standard definition, consensus is needed in the field as to whether definitions should be based on legal standards, health concerns/risks or simply an age cut-off. While this issue is controversial, in considering the broader area of YSRH we cannot gain consensus on what works without a clear set of indicators and outcomes.

• Missed Opportunities: Young people, are often relatively healthy, and have few connections with health facilities. When they do interact with health facilities (for delivery or abortion) we have an opportunity for improving their health outcomes. Post-partum (and post-abortion) visits are missed opportunities for intervention, particularly contraception interventions, especially for this age range. We would recommend interventions focusing efforts on contraceptive provision in these populations.

• Aim for Behavior Change: The gold standard for interventions should be to improve young people’s sexual and reproductive health behaviors. It is relative easy to impact knowledge and even attitudes, but effective interventions should show change in behavior (or differences in behavior from a similar comparison group). For three of our four outcomes, we allowed for Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 66

impact to be measured by knowledge, attitudes and behaviors, but given the large number of STI interventions, we limited our abstraction to behavior change interventions only. Despite beginning with over 22,00 titles in STIs, our analysis shows that only nine high quality interventions and evaluations positively impacted behavior. Interesting it was only for this outcome that we saw the use of mass media approaches. Mass media approaches have been abandoned because they are don’t target individuals well by nature and because it difficult to show impact without good measures of exposure to mass media. That said, it is an approach worth visiting—especially to improve knowledge about incorrect norms such as fear of contraceptive side effects. While improved knowledge may not cause behavior to change, it may be a necessary before people change their behaviors. In general, behavior change interventions tend to be more time intensive, more expensive and depending on the behavior, may be harder to achieve success.

• Don’t Omit the Gray Literature!: The majority of interventions that were effective based on high quality evaluations were located in the grey literature for three of four outcomes. Future reviews and further updates to our work should be sure to include these studies that often don’t make it into the “evidence-base” as they are not easily searchable. Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 67

Appendix

Methodology The goal of this project was to review and assess interventions in low- and middle-income countries for young people for four outcomes: early marriage, early pregnancy, number of children and STIs including HIV..

Developing and Piloting Abstraction Form We sought several sources from other systematic literature reviews to develop an appropriate abstraction form for this project. While most systematic reviews focus on the intervention and outcome (how effective the intervention was), we wanted to include an additional set of components that focused on the evaluation itself and the quality of both the evaluation and intervention. We asked our advisory group (Bruce Dick, Jane Ferguson, and Robert Blum) for feedback on the form and modified it accordingly. This group also reviewed our search terms and were asked about additional studies we may have missed in our searches.

We initially developed an on-line abstraction form using Google docs, but the online form was problematic for those members of our team with limited Internet connectivity as well as abstractors who wanted to stop and return to the abstraction form before submitting it. Based on this feedback, we opted for an Excel spreadsheet for abstraction. The final abstraction form itself is available from the authors.

Search Strategy We undertook a systematic search of published literature to identify interventions that address each of the outcomes. We used six databases—PubMed (MEDLINE), Embase, PsycInfo, Cinahl Plus, Popline, and the Cochrane Database—in conducting these searches. In building the search, we combined a list of terms that describe young people with a list of terms that describe the outcome of interest. We then combined this search with a list of lower- or middle-income country (LMIC) and regional search terms.

We also searched the grey literature for each outcome of interest. Depending on the outcome, we searched websites of non-governmental organizations (e.g. ICRW, Population Council, CEDPA, and Save the Children) and Google. In addition to formally searching, we also used a snowball technique to track references mentioned in identified documents.

Abstracted studies are those that met the age range (10-24), were interventions, and included information on evaluation. We included studies in English, French, Spanish and Portuguese.

Abstraction Process For each study located, we assigned an abstractor from our team to pull information from that intervention. We abstracted details about both the intervention design and the evaluation design (form available from first author upon request). For each study we ranked the quality of the intervention and the quality of the evaluation. For intervention quality, we asked about study design (including study population, location of intervention, duration, gender), intervention objectives, intervention description, and subjective measures about how well thought out (strengths and Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 68

weaknesses) the intervention was. For evaluation, we asked the type of evaluation (quantitative, qualitative, or mixed methods), sampling, randomization (where relevant), key independent variables, control group composition, analytic techniques, key findings, and a subjective measure of overall quality of the evaluation, with higher quality reflecting having a comparison group, measures of exposure to the intervention, and limited weaknesses. It should be noted that some studies had multiple outcomes, and were therefore abstracted in multiple chapters of this report. We ranked studies on a scale from one to five, with five being the best and one being the worst. These are clearly subjective measures but after doing practices abstractions, we felt that although subjective, similar criteria were used by the abstractors. Based on a combined score, we determined some of the best examples of each outcome. In each chapter we feature two to three of these top-ranking studies that represent different methodologies and broad regional scope as case studies.

Search Terms

Early Marriage PubMed: 2 searches run: 1 and 2 and 4, not 5; 3 and 4, not 5

1. (Adolescent[mesh] OR Minors[mesh] OR teen[all fields] OR teens[all fields] OR teenager[all fields] OR teenagers[all fields] OR teenaged[all fields] OR juvenile* OR preteen* OR pre-teen* OR minor OR minors OR adolescent OR youth[text] OR youths[text] OR girl[all fields] OR girls[all fields] OR "young people"[all fields] OR "young person"[all fields] OR "young adult"[all fields])

2. (Marriage[mesh] OR spouses[mesh] OR conjugal relationship OR marriage* OR marital OR nuptial OR spouse OR spouses OR wedlock OR wedding OR weddings OR “consensual union” OR cohabit*)

3. “early marriage” OR “child marriage”

4. Argentina or Bolivia or Brazil or Chile or Colombia or Ecuador or “French Guiana”or Guyana or Paraguay or Peru or Suriname or Uruguay or Venezuela or Mexico or Belize or “Costa Rica” or “El Salvador” or Guatemala or Honduras or Nicaragua or Panama or “West Indies” or Antigua or Bahamas or Barbados or Cuba or Dominica or “Dominican Republic” or Grenada or Guadeloupe or Haiti or Jamaica or Martinique or Antilles or “Saint Kitts and Nevis” or “Saint Lucia” or “Saint Vincent and the Grenadines” or Trinidad or Tobago or “Virgin Islands” or Kazakhstan or Kyrgyzstan or Tajikistan or Turkmenistan or Uzbekistan or Borneo or Brunei or Cambodia or “East Timor” or Indonesia or Laos or Malaysia or “Mekong Valley” or Myanmar or Burma or Philippines or Singapore or Thailand or Vietnam or Bangladesh or Bhutan or India or Nepal or Pakistan or “Sri Lanka” or China or Korea or Macao or Mongolia or Taiwan or Afghanistan or Bahrain or Iran or Iraq or Israel or Jordan or Kuwait or Lebanon or Oman or Qatar or “Saudi Arabia” or Syria or Turkey or “United Arab Emirates” or Yemen or Fiji or “New Caledonia” or “Papua New Guinea” or Vanuatu or Micronesia or Melanesia or Guam or Palau or Polynesia or Samoa or Tonga or Armenia or Azerbaijan or (Georgia NOT Georgia[MeSH]) or Albania or Estonia or Latvia or Lithuania or Bosnia or Herzegovina or Bulgaria or Belarus or Croatia or “Czech Republic” or Hungary or Macedonia or Moldova or Montenegro or Poland or Romania or Russia or Bashkiria or Dagestan or Slovakia or Slovenia or Ukraine or Cameroon or “Central African Republic” or Chad or Congo or “Democratic Republic of the Congo” or “Equatorial Guinea” or Gabon or Burundi or Djibouti or Eritrea or Ethiopia or Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 69

Kenya or Rwanda or Somalia or Sudan or Tanzania or Uganda or Angola or Botswana or Lesotho or Malawi or Mozambique or Namibia or “South Africa” or Swaziland or Zambia or Zimbabwe or Benin or “Burkina Faso” or “Cote d’Ivoire” or Gambia or Ghana or Guinea or “Guinea-Bissau” or Liberia or Mali or Mauritania or Niger or Nigeria or Senegal or “Sierra Leone” or Togo or Algeria or Egypt or Libya or Morocco or Tunisia or Comoros or Madagascar or Mauritius or Reunion or Seychelles or “developing country” or “third-world country” or “third world country” or “less developed” or “sub-Saharan” or “Caribbean Region”[Mesh] OR “Pacific Islands”[Mesh] OR “Mexico”[Mesh] OR “Latin America”[Mesh] OR “Indian Ocean Islands”[Mesh] OR “Central America”[Mesh] OR “Asia”[Mesh] OR “Africa”[Mesh] OR “Europe, Eastern”[Mesh] OR “South America”[Mesh] OR “Africa, Northern” [Mesh] or “Africa South of the Sahara” [Mesh] or “Asia, Central”[Mesh] or “Asia, Southeastern” [Mesh] or “Asia, Western” [Mesh] or “Far East” [Mesh] or “Developing Countries”[MeSH]

5. case reports[pt] OR comment[pt] OR editorial[pt] OR legal cases[pt] OR legislation[pt] OR newspaper article[pt] OR patient education handout[pt] OR retracted publication[pt]

Embase: 2 searches run: 1 and 2 and 4 and 5; 3 and 4 and 5

1. 'juvenile'/exp OR 'adolescent'/exp OR 'girl'/exp OR teen OR teens OR teenager* OR teenaged OR juvenile* OR adolescent OR preteen OR 'pre teen' OR preteens OR 'pre teens' OR minor OR minors OR youth:ab,ti OR youths:ab,ti OR girl OR girls OR 'young people' OR 'young person' OR 'young adult'

2. ‘marriage’/exp OR ‘spouse’/exp OR ‘conjugal relationship’ OR marriage* OR marital OR nuptial OR spouse OR spouses OR wedlock OR wedding OR weddings OR ‘consensual union’ OR cohabit*

3. ‘early marriage’ OR ‘child marriage’

4. Argentina or Bolivia or Brazil or Chile or Colombia or Ecuador or “French Guiana” or Guyana or Paraguay or Peru or Suriname or Uruguay or Venezuela or Mexico or Belize or “Costa Rica” or “El Salvador” or Guatemala or Honduras or Nicaragua or Panama or “West Indies” or Antigua or Bahamas or Barbados or Cuba or Dominica or “Dominican Republic” or Grenada or Guadeloupe or Haiti or Jamaica or Martinique or Antilles or “Saint Kitts and Nevis” or “Saint Lucia” or “Saint Vincent and the Grenadines” or Trinidad or Tobago or “Virgin Islands” or Kazakhstan or Kyrgyzstan or Tajikistan or Turkmenistan or Uzbekistan or Borneo or Brunei or Cambodia or “East Timor” or Indonesia or Laos or Malaysia or “Mekong Valley” or Myanmar or Burma or Philippines or Singapore or Thailand or Vietnam or Bangladesh or Bhutan or India or Nepal or Pakistan or “Sri Lanka” or China or Korea or Macao or Mongolia or Taiwan or Afghanistan or Bahrain or Iran or Iraq or Israel or Jordan or Kuwait or Lebanon or Oman or Qatar or “Saudi Arabia” or Syria or Turkey or “United Arab Emirates” or Yemen or Fiji or “New Caledonia” or “Papua New Guinea” or Vanuatu or Micronesia or Melanesia or Guam or Palau or Polynesia or Samoa or Tonga or Armenia or Azerbaijan or ‘Georgia (republic)’/exp or Albania or Estonia or Latvia or Lithuania or Bosnia or Herzegovina or Bulgaria or Belarus or Croatia or “Czech Republic” or Hungary or Macedonia or Moldova or Montenegro or Poland or Romania or Russia or Bashkiria or Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 70

Dagestan or Slovakia or Slovenia or Ukraine OR Cameroon or “Central African Republic” or Chad or Congo or “Democratic Republic of the Congo” or “Equatorial Guinea” or Gabon or Burundi or Djibouti or Eritrea or Ethiopia or Kenya or Rwanda or Somalia or Sudan or Tanzania or Uganda or Angola or Botswana or Lesotho or Malawi or Mozambique or Namibia or “South Africa” or Swaziland or Zambia or Zimbabwe or Benin or “Burkina Faso” or Cote* OR Gambia or Ghana or Guinea or “Guinea-Bissau” or Liberia or Mali or Mauritania or Niger or Nigeria or Senegal or “Sierra Leone” or Togo or Algeria or Egypt or Libya or Morocco or Tunisia or Comoros or Madagascar or Mauritius or Reunion or Seychelles OR “developing country” or ‘developing country’/exp or “third-world country” or “third world country” or “less developed” or “sub-Saharan” or ‘Central America’/exp OR ‘Caribbean Islands’/exp OR ‘Pacific islands’/exp OR ‘Mexico’/exp OR ‘South and Central America’/exp OR ‘Indian Ocean’/exp OR ‘Central America’/exp OR ‘Asia’/exp OR ‘Eastern Europe’/exp OR ‘South America’/exp r ‘Africa south of the Sahara’/exp or ‘Far East’/exp or ‘Southeast Asia’/exp or ‘South Asia’/exp or ‘Central Africa’/exp or ‘Africa’/exp or ‘North Africa’/exp

5. 'article'/it OR 'article in press'/it OR 'conference abstract'/it OR 'conference paper'/it OR 'conference review'/it OR 'review'/it OR 'short survey'/it

Cinahl Plus and PsycInfo: 2 searches run: 1 and 2 and 4; 3 and 4

1. (teen OR teens OR teenager OR teenagers OR teenaged OR juvenile* OR preteen* OR pre-teen* OR minor OR minors OR adolescent OR girl OR girls OR "young people" OR "young person" OR "young adult") OR (MH Adolescence OR MH Young adults OR MH Minors) OR (TX youth OR TX youths)

2. (conjugal relationship OR marriage* OR marital OR nuptial OR spouse OR spouses OR wedlock OR wedding OR weddings OR “consensual union” OR cohabit*) OR (MH Spouses OR MH Marriage)

3. “early marriage” OR “child marriage”

4. Argentina or Bolivia or Brazil or Chile or Colombia or Ecuador or “French Guiana” or Guyana or Paraguay or Peru or Suriname or Uruguay or Venezuela or Mexico or Belize or “Costa Rica” or “El Salvador” or Guatemala or Honduras or Nicaragua or Panama or “West Indies” or Antigua or Bahamas or Barbados or Cuba or Dominica or “Dominican Republic” or Grenada or Guadeloupe or Haiti or Jamaica or Martinique or Antilles or “Saint Kitts and Nevis” or “Saint Lucia” or “Saint Vincent and the Grenadines” or Trinidad or Tobago or “Virgin Islands” or Kazakhstan or Kyrgyzstan or Tajikistan or Turkmenistan or Uzbekistan or Borneo or Brunei or Cambodia or “East Timor” or Indonesia or Laos or Malaysia or “Mekong Valley” or Myanmar or Burma or Philippines or Singapore or Thailand or Vietnam or Bangladesh or Bhutan or India or Nepal or Pakistan or “Sri Lanka” or China or Korea or Macao or Mongolia or Taiwan or Afghanistan or Bahrain or Iran or Iraq or Israel or Jordan or Kuwait or Lebanon or Oman or Qatar or “Saudi Arabia” or Syria or Turkey or “United Arab Emirates” or Yemen or Fiji or “New Caledonia” or “Papua New Guinea” or Vanuatu or Micronesia or Melanesia or Guam or Palau or Polynesia or Samoa or Tonga or Armenia or Azerbaijan or Georgia or Albania or Estonia or Latvia or Lithuania or Bosnia or Herzegovina or Bulgaria or Belarus or Croatia or “Czech Republic” or Hungary or Macedonia or Moldova or Montenegro or Poland or Romania or Russia or Bashkiria or Dagestan or Slovakia or Slovenia or Ukraine OR Cameroon or “Central African Republic” or Chad or Congo or “Democratic Republic Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 71

of the Congo” or “Equatorial Guinea” or Gabon or Burundi or Djibouti or Eritrea or Ethiopia or Kenya or Rwanda or Somalia or Sudan or Tanzania or Uganda or Angola or Botswana or Lesotho or Malawi or Mozambique or Namibia or “South Africa” or Swaziland or Zambia or Zimbabwe or Benin or “Burkina Faso” or “Cote*” OR Gambia or Ghana or Guinea or “Guinea-Bissau” or Liberia or Mali or Mauritania or Niger or Nigeria or Senegal or “Sierra Leone” or Togo or Algeria or Egypt or Libya or Morocco or Tunisia or Comoros or Madagascar or Mauritius or Reunion or Seychelles OR “developing country” or “third-world country” or “third world country” or “less developed” or “sub-Saharan” or “Central America” OR Caribbean OR “Pacific Islands” OR “South and Central America” OR “Indian Ocean” OR “Central America” OR Asia OR “Eastern Europe” OR “South America” or “Africa south of the Sahara” or “Far East” or “Southeast Asia” or “South Asia” or “Central Africa” or Africa or “North Africa”

Popline: adolescents; youth; minors; marriage; marriage age; marriage postponement; spouse; consensual union

Cochrane: 2 searches run: 1 and 2 and 4; 3 and 4

1. teen OR teens OR teenager OR teenagers OR teenaged OR juvenile* OR preteen* OR pre-teen* OR minor OR minors OR adolescent OR girl OR girls OR "young people" OR "young person" OR "young adult"

2. conjugal relationship OR marriage OR marital OR nuptial OR spouse OR spouses OR wedlock OR wedding OR weddings OR “consensual union” OR cohabit OR cohabitate OR cohabitated OR cohabitation

3. “early marriage” OR “child marriage”

4. Argentina or Bolivia or Brazil or Chile or Colombia or Ecuador or “French Guiana” or Guyana or Paraguay or Peru or Suriname or Uruguay or Venezuela or Mexico or Belize or “Costa Rica” or “El Salvador” or Guatemala or Honduras or Nicaragua or Panama or “West Indies” or Antigua or Bahamas or Barbados or Cuba or Dominica or “Dominican Republic” or Grenada or Guadeloupe or Haiti or Jamaica or Martinique or Antilles or “Saint Kitts and Nevis” or “Saint Lucia” or “Saint Vincent and the Grenadines” or Trinidad or Tobago or “Virgin Islands” or Kazakhstan or Kyrgyzstan or Tajikistan or Turkmenistan or Uzbekistan or Borneo or Brunei or Cambodia or “East Timor” or Indonesia or Laos or Malaysia or “Mekong Valley” or Myanmar or Burma or Philippines or Singapore or Thailand or Vietnam or Bangladesh or Bhutan or India or Nepal or Pakistan or “Sri Lanka” or China or Korea or Macao or Mongolia or Taiwan or Afghanistan or Bahrain or Iran or Iraq or Israel or Jordan or Kuwait or Lebanon or Oman or Qatar or “Saudi Arabia” or Syria or Turkey or “United Arab Emirates” or Yemen or Fiji or “New Caledonia” or “Papua New Guinea” or Vanuatu or Micronesia or Melanesia or Guam or Palau or Polynesia or Samoa or Tonga or Armenia or Azerbaijan or Georgia or Albania or Estonia or Latvia or Lithuania or Bosnia or Herzegovina or Bulgaria or Belarus or Croatia or “Czech Republic” or Hungary or Macedonia or Moldova or Montenegro or Poland or Romania or Russia or Bashkiria or Dagestan or Slovakia or Slovenia or Ukraine OR Cameroon or “Central African Republic” or Chad or Congo or “Democratic Republic of the Congo” or “Equatorial Guinea” or Gabon or Burundi or Djibouti or Eritrea or Ethiopia or Kenya or Rwanda or Somalia or Sudan or Tanzania or Uganda or Angola or Botswana or Lesotho or Malawi or Mozambique or Namibia or “South Africa” or Swaziland or Zambia or Zimbabwe or Benin or “Burkina Faso” or “Cote*” OR Gambia or Ghana or Guinea or “Guinea-Bissau” or Liberia or Mali or Mauritania or Niger or Nigeria or Senegal or “Sierra Leone” or Togo or Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 72

Algeria or Egypt or Libya or Morocco or Tunisia or Comoros or Madagascar or Mauritius or Reunion or Seychelles OR “developing country” or “third-world country” or “third world country” or “less developed” or “sub-Saharan” or “Central America” OR Caribbean OR “Pacific Islands” OR “South and Central America” OR “Indian Ocean” OR “Central America” OR Asia OR “Eastern Europe” OR “South America” or “Africa south of the Sahara” or “Far East” or “Southeast Asia” or “South Asia” or “Central Africa” or Africa or “North Africa”

Early Marriage PubMed: Adolescent[mesh] OR Minors[mesh] OR teen[all fields] OR teens[all fields] OR teenager[all fields] OR teenagers[all fields] OR teenaged[all fields] OR juvenile* OR preteen* OR pre-teen* OR minor OR minors OR adolescent OR youth[text] OR youths[text] OR girl[all fields] OR girls[all fields] OR "young people"[all fields] OR "young person"[all fields] OR "young adult"[all fields]

AND

Pregnancy[mesh] or “pregnant women” or parturition[mesh] or mothers[mesh] or “maternal health services”[mesh] or pregnancy or pregnant or parturition or mother* or gestation or gestational or childbirth or childbirths or maternal or maternity

AND

Argentina or Bolivia or Brazil or Chile or Colombia or Ecuador or “French Guiana”or Guyana or Paraguay or Peru or Suriname or Uruguay or Venezuela or Mexico or Belize or “Costa Rica” or “El Salvador” or Guatemala or Honduras or Nicaragua or Panama or “West Indies” or Antigua or Bahamas or Barbados or Cuba or Dominica or “Dominican Republic” or Grenada or Guadeloupe or Haiti or Jamaica or Martinique or Antilles or “Saint Kitts and Nevis” or “Saint Lucia” or “Saint Vincent and the Grenadines” or Trinidad or Tobago or “Virgin Islands” or Kazakhstan or Kyrgyzstan or Tajikistan or Turkmenistan or Uzbekistan or Borneo or Brunei or Cambodia or “East Timor” or Indonesia or Laos or Malaysia or “Mekong Valley” or Myanmar or Burma or Philippines or Singapore or Thailand or Vietnam or Bangladesh or Bhutan or India or Nepal or Pakistan or “Sri Lanka” or China or Korea or Macao or Mongolia or Taiwan or Afghanistan or Bahrain or Iran or Iraq or Israel or Jordan or Kuwait or Lebanon or Oman or Qatar or “Saudi Arabia” or Syria or Turkey or “United Arab Emirates” or Yemen or Fiji or “New Caledonia” or “Papua New Guinea” or Vanuatu or Micronesia or Melanesia or Guam or Palau or Polynesia or Samoa or Tonga or Armenia or Azerbaijan or (Georgia NOT Georgia[MeSH]) or Albania or Estonia or Latvia or Lithuania or Bosnia or Herzegovina or Bulgaria or Belarus or Croatia or “Czech Republic” or Hungary or Macedonia or Moldova or Montenegro or Poland or Romania or Russia or Bashkiria or Dagestan or Slovakia or Slovenia or Ukraine or Cameroon or “Central African Republic” or Chad or Congo or “Democratic Republic of the Congo” or “Equatorial Guinea” or Gabon or Burundi or Djibouti or Eritrea or Ethiopia or Kenya or Rwanda or Somalia or Sudan or Tanzania or Uganda or Angola or Botswana or Lesotho or Malawi or Mozambique or Namibia or “South Africa” or Swaziland or Zambia or Zimbabwe or Benin or “Burkina Faso” or “Cote d’Ivoire” or Gambia or Ghana or Guinea or “Guinea-Bissau” or Liberia or Mali or Mauritania or Niger or Nigeria or Senegal or “Sierra Leone” or Togo or Algeria or Egypt or Libya or Morocco or Tunisia or Comoros or Madagascar or Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 73

Mauritius or Reunion or Seychelles or “developing country” or “third-world country” or “third world country” or “less developed” or “sub-Saharan” or “Caribbean Region”[Mesh] OR “Pacific Islands”[Mesh] OR “Mexico”[Mesh] OR “Latin America”[Mesh] OR “Indian Ocean Islands”[Mesh] OR “Central America”[Mesh] OR “Asia”[Mesh] OR “Africa”[Mesh] OR “Europe, Eastern”[Mesh] OR “South America”[Mesh] OR “Africa, Northern” [Mesh] or “Africa South of the Sahara” [Mesh] or “Asia, Central”[Mesh] or “Asia, Southeastern” [Mesh] or “Asia, Western” [Mesh] or “Far East” [Mesh] or “Developing Countries”[MeSH]

NOT case reports[pt] OR comment[pt] OR editorial[pt] OR legal cases[pt] OR legislation[pt] OR newspaper article[pt] OR patient education handout[pt] OR retracted publication[pt]

Embase:'juvenile'/exp OR 'adolescent'/exp OR 'girl'/exp OR teen OR teens OR teenager* OR teenaged OR juvenile* OR adolescent OR preteen OR 'pre teen' OR preteens OR 'pre teens' OR minor OR minors OR youth:ab,ti OR youths:ab,ti OR girl OR girls OR 'young people' OR 'young person' OR 'young adult'

AND

‘pregnancy’/exp or ‘pregnant woman’/exp or ‘birth’/exp or ‘maternal care’/exp or ‘mother’/exp or pregnancy or pregnant or parturition or mother* or gestation* or childbirth* or maternal or maternity or ‘adolescent pregnancy’/exp or ‘adolescent mother’/exp

AND

Argentina or Bolivia or Brazil or Chile or Colombia or Ecuador or “French Guiana” or Guyana or Paraguay or Peru or Suriname or Uruguay or Venezuela or Mexico or Belize or “Costa Rica” or “El Salvador” or Guatemala or Honduras or Nicaragua or Panama or “West Indies” or Antigua or Bahamas or Barbados or Cuba or Dominica or “Dominican Republic” or Grenada or Guadeloupe or Haiti or Jamaica or Martinique or Antilles or “Saint Kitts and Nevis” or “Saint Lucia” or “Saint Vincent and the Grenadines” or Trinidad or Tobago or “Virgin Islands” or Kazakhstan or Kyrgyzstan or Tajikistan or Turkmenistan or Uzbekistan or Borneo or Brunei or Cambodia or “East Timor” or Indonesia or Laos or Malaysia or “Mekong Valley” or Myanmar or Burma or Philippines or Singapore or Thailand or Vietnam or Bangladesh or Bhutan or India or Nepal or Pakistan or “Sri Lanka” or China or Korea or Macao or Mongolia or Taiwan or Afghanistan or Bahrain or Iran or Iraq or Israel or Jordan or Kuwait or Lebanon or Oman or Qatar or “Saudi Arabia” or Syria or Turkey or “United Arab Emirates” or Yemen or Fiji or “New Caledonia” or “Papua New Guinea” or Vanuatu or Micronesia or Melanesia or Guam or Palau or Polynesia or Samoa or Tonga or Armenia or Azerbaijan or ‘Georgia (republic)’/exp or Albania or Estonia or Latvia or Lithuania or Bosnia or Herzegovina or Bulgaria or Belarus or Croatia or “Czech Republic” or Hungary or Macedonia or Moldova or Montenegro or Poland or Romania or Russia or Bashkiria or Dagestan or Slovakia or Slovenia or Ukraine OR Cameroon or “Central African Republic” or Chad or Congo or “Democratic Republic of the Congo” or “Equatorial Guinea” or Gabon or Burundi or Djibouti or Eritrea or Ethiopia or Kenya or Rwanda or Somalia or Sudan or Tanzania or Uganda or Angola or Botswana or Lesotho or Malawi or Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 74

Mozambique or Namibia or “South Africa” or Swaziland or Zambia or Zimbabwe or Benin or “Burkina Faso” or Cote* OR Gambia or Ghana or Guinea or “Guinea-Bissau” or Liberia or Mali or Mauritania or Niger or Nigeria or Senegal or “Sierra Leone” or Togo or Algeria or Egypt or Libya or Morocco or Tunisia or Comoros or Madagascar or Mauritius or Reunion or Seychelles OR “developing country” or ‘developing country’/exp or “third-world country” or “third world country” or “less developed” or “sub-Saharan” or ‘Central America’/exp OR ‘Caribbean Islands’/exp OR ‘Pacific islands’/exp OR ‘Mexico’/exp OR ‘South and Central America’/exp OR ‘Indian Ocean’/exp OR ‘Central America’/exp OR ‘Asia’/exp OR ‘Eastern Europe’/exp OR ‘South America’/exp or ‘Africa south of the Sahara’/exp or ‘Far East’/exp or ‘Southeast Asia’/exp or ‘South Asia’/exp or ‘Central Africa’/exp or ‘Africa’/exp or ‘North Africa’/exp

AND

'article'/it OR 'article in press'/it OR 'conference abstract'/it OR 'conference paper'/it OR 'conference review'/it OR 'review'/it OR 'short survey'/it

Cinahl Plus and PsycInfo: (teen OR teens OR teenager OR teenagers OR teenaged OR juvenile* OR preteen* OR pre-teen* OR minor OR minors OR adolescent OR girl OR girls OR "young people" OR "young person" OR "young adult") OR (MH Adolescence OR MH Young adults OR MH Minors) OR (TX youth OR TX youths)

AND

(MH adolescent pregnancy or MH teen pregnancy or MH parturition or MH births or MH birthing or MH maternal or MH maternal health services or MH maternity or MH pregnancy and teens or MH pregnancy or MH pregnant or MH pregnant teenage girl or MH childbirth) OR (“pregnant women” or pregnancy or pregnant or parturition or mother* or gestation or gestational or childbirth* or maternal or maternity)

AND

Argentina or Bolivia or Brazil or Chile or Colombia or Ecuador or “French Guiana” or Guyana or Paraguay or Peru or Suriname or Uruguay or Venezuela or Mexico or Belize or “Costa Rica” or “El Salvador” or Guatemala or Honduras or Nicaragua or Panama or “West Indies” or Antigua or Bahamas or Barbados or Cuba or Dominica or “Dominican Republic” or Grenada or Guadeloupe or Haiti or Jamaica or Martinique or Antilles or “Saint Kitts and Nevis” or “Saint Lucia” or “Saint Vincent and the Grenadines” or Trinidad or Tobago or “Virgin Islands” or Kazakhstan or Kyrgyzstan or Tajikistan or Turkmenistan or Uzbekistan or Borneo or Brunei or Cambodia or “East Timor” or Indonesia or Laos or Malaysia or “Mekong Valley” or Myanmar or Burma or Philippines or Singapore or Thailand or Vietnam or Bangladesh or Bhutan or India or Nepal or Pakistan or “Sri Lanka” or China or Korea or Macao or Mongolia or Taiwan or Afghanistan or Bahrain or Iran or Iraq or Israel or Jordan or Kuwait or Lebanon or Oman or Qatar or “Saudi Arabia” or Syria or Turkey or “United Arab Emirates” or Yemen or Fiji or “New Caledonia” or “Papua New Guinea” or Vanuatu or Micronesia or Melanesia or Guam or Palau or Polynesia or Samoa or Tonga or Armenia or Azerbaijan or Georgia or Albania or Estonia or Latvia or Lithuania or Bosnia or Herzegovina or Bulgaria or Belarus or Croatia or “Czech Republic” or Hungary or Macedonia or Moldova or Montenegro or Poland or Romania or Russia or Bashkiria or Dagestan or Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 75

Slovakia or Slovenia or Ukraine OR Cameroon or “Central African Republic” or Chad or Congo or “Democratic Republic of the Congo” or “Equatorial Guinea” or Gabon or Burundi or Djibouti or Eritrea or Ethiopia or Kenya or Rwanda or Somalia or Sudan or Tanzania or Uganda or Angola or Botswana or Lesotho or Malawi or Mozambique or Namibia or “South Africa” or Swaziland or Zambia or Zimbabwe or Benin or “Burkina Faso” or “Cote*” OR Gambia or Ghana or Guinea or “Guinea-Bissau” or Liberia or Mali or Mauritania or Niger or Nigeria or Senegal or “Sierra Leone” or Togo or Algeria or Egypt or Libya or Morocco or Tunisia or Comoros or Madagascar or Mauritius or Reunion or Seychelles OR “developing country” or “third-world country” or “third world country” or “less developed” or “sub-Saharan” or “Central America” OR Caribbean OR “Pacific Islands” OR “South and Central America” OR “Indian Ocean” OR “Central America” OR Asia OR “Eastern Europe” OR “South America” or “Africa south of the Sahara” or “Far East” or “Southeast Asia” or “South Asia” or “Central Africa” or Africa or “North Africa”

Popline: adolescents; youth; minors; adolescent pregnancy; childbirth; pregnancy; pregnant women; pregnancy, unplanned; pregnancy, unwanted premarital pregnancy; maternal health services; mothers

Cochrane: “pregnant women” or pregnancy or pregnancies or pregnant or parturition or mother* or gestation or gestational or childbirth* or maternal or maternity or births or birthing

AND teen OR teens OR teenager OR teenagers OR teenaged OR juvenile* OR preteen* OR pre-teen* OR minor OR minors OR adolescent OR girl OR girls OR "young people" OR "young person" OR "young adult"

AND

Argentina or Bolivia or Brazil or Chile or Colombia or Ecuador or “French Guiana” or Guyana or Paraguay or Peru or Suriname or Uruguay or Venezuela or Mexico or Belize or “Costa Rica” or “El Salvador” or Guatemala or Honduras or Nicaragua or Panama or “West Indies” or Antigua or Bahamas or Barbados or Cuba or Dominica or “Dominican Republic” or Grenada or Guadeloupe or Haiti or Jamaica or Martinique or Antilles or “Saint Kitts and Nevis” or “Saint Lucia” or “Saint Vincent and the Grenadines” or Trinidad or Tobago or “Virgin Islands” or Kazakhstan or Kyrgyzstan or Tajikistan or Turkmenistan or Uzbekistan or Borneo or Brunei or Cambodia or “East Timor” or Indonesia or Laos or Malaysia or “Mekong Valley” or Myanmar or Burma or Philippines or Singapore or Thailand or Vietnam or Bangladesh or Bhutan or India or Nepal or Pakistan or “Sri Lanka” or China or Korea or Macao or Mongolia or Taiwan or Afghanistan or Bahrain or Iran or Iraq or Israel or Jordan or Kuwait or Lebanon or Oman or Qatar or “Saudi Arabia” or Syria or Turkey or “United Arab Emirates” or Yemen or Fiji or “New Caledonia” or “Papua New Guinea” or Vanuatu or Micronesia or Melanesia or Guam or Palau or Polynesia or Samoa or Tonga or Armenia or Azerbaijan or Georgia or Albania or Estonia or Latvia or Lithuania or Bosnia or Herzegovina or Bulgaria or Belarus or Croatia or “Czech Republic” or Hungary or Macedonia or Moldova or Montenegro or Poland or Romania or Russia or Bashkiria or Dagestan or Slovakia or Slovenia or Ukraine OR Cameroon or “Central African Republic” or Chad or Congo or “Democratic Republic of the Congo” or “Equatorial Guinea” or Gabon or Burundi or Djibouti or Eritrea or Ethiopia or Kenya or Rwanda or Somalia or Sudan or Tanzania or Uganda or Angola or Botswana or Lesotho or Malawi or Mozambique or Namibia or Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 76

“South Africa” or Swaziland or Zambia or Zimbabwe or Benin or “Burkina Faso” or “Cote*” OR Gambia or Ghana or Guinea or “Guinea-Bissau” or Liberia or Mali or Mauritania or Niger or Nigeria or Senegal or “Sierra Leone” or Togo or Algeria or Egypt or Libya or Morocco or Tunisia or Comoros or Madagascar or Mauritius or Reunion or Seychelles OR “developing country” or “third-world country” or “third world country” or “less developed” or “sub-Saharan” or “Central America” OR Caribbean OR “Pacific Islands” OR “South and Central America” OR “Indian Ocean” OR “Central America” OR Asia OR “Eastern Europe” OR “South America” or “Africa south of the Sahara” or “Far East” or “Southeast Asia” or “South Asia” or “Central Africa” or Africa or “North Africa”

Number of Children PubMed (filtered dates: 1990-Sept 2012)

Adolescent[mesh] OR Minors[mesh] OR teen[all fields] OR teens[all fields] OR teenager[all fields] OR teenagers[all fields] OR teenaged[all fields] OR juvenile* OR preteen* OR pre-teen* OR minor OR minors OR adolescent OR youth[text] OR youths[text] OR girl[all fields] OR girls[all fields] OR "young people"[all fields] OR "young person"[all fields] OR "young adult"[all fields]

AND tempo OR "postpartum contraception" OR "postpartum contraceptives" OR "multiple births" OR "multiple pregnancies" OR "postpone second birth" OR "postponing second birth" OR "postponed second birth" OR "delay second birth" OR "delaying second birth" OR "delayed second birth" OR "repeat childbearing" OR "repeat abortion" OR "repeat abortions" OR "repeat pregnancy" OR "repeat pregnancies" OR "repeat birth" OR "repeat births" OR "birth spacing" OR "birth- spacing" OR childbearing, delayed[MeSH Terms] OR abortion seeker, repeated[MeSH Terms]

AND

Argentina OR Bolivia OR Brazil OR Chile OR Colombia OR Ecuador OR "French Guiana" OR Guyana OR Paraguay OR Peru OR Suriname OR Uruguay OR Venezuela OR Mexico OR Belize OR "Costa Rica" OR "El Salvador" OR Guatemala OR Honduras OR Nicaragua OR Panama OR "West Indies" OR Antigua OR Bahamas OR Barbados OR Cuba OR Dominica OR "Dominican Republic" OR Grenada OR Guadeloupe OR Haiti OR Jamaica OR Martinique OR Antilles OR "Saint Kitts and Nevis" OR "Saint Lucia" OR "Saint Vincent and the Grenadines" OR Trinidad OR Tobago OR "Virgin Islands" OR Kazakhstan OR Kyrgyzstan OR Tajikistan OR Turkmenistan OR Uzbekistan OR Borneo OR Brunei OR Cambodia OR "East Timor" OR Indonesia OR Laos OR Malaysia OR "Mekong Valley" OR Myanmar OR Burma OR Philippines OR Singapore OR Thailand OR Vietnam OR Bangladesh OR Bhutan OR India OR Nepal OR Pakistan OR "Sri Lanka" OR China OR Korea OR Macao OR Mongolia OR Taiwan OR Afghanistan OR Bahrain OR Iran OR Iraq OR Israel OR Jordan OR Kuwait OR Lebanon OR Oman OR Qatar OR "Saudi Arabia" OR Syria OR Turkey OR "United Arab Emirates" OR Yemen OR Fiji OR "New Caledonia" OR "Papua New Guinea" OR Vanuatu OR Micronesia OR Melanesia OR Guam OR Palau OR Polynesia OR Samoa OR Tonga OR Armenia OR Azerbaijan OR (Georgia NOT Georgia[MeSH]) OR Albania OR Estonia OR Latvia OR Lithuania OR Bosnia OR Herzegovina OR Bulgaria OR Belarus OR Croatia OR "Czech Republic" OR Hungary OR Macedonia OR Moldova OR Montenegro OR Poland OR Romania OR Russia OR Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 77

Bashkiria OR Dagestan OR Slovakia OR Slovenia OR Ukraine OR Cameroon OR "Central African Republic" OR Chad OR Congo OR "Democratic Republic of the Congo" OR "Equatorial Guinea" OR Gabon OR Burundi OR Djibouti OR Eritrea OR Ethiopia OR Kenya OR Rwanda OR Somalia OR Sudan OR Tanzania OR Uganda OR Angola OR Botswana OR Lesotho OR Malawi OR Mozambique OR Namibia OR "South Africa" OR Swaziland OR Zambia OR Zimbabwe OR Benin OR "Burkina Faso" OR "Cote d'Ivoire" OR Gambia OR Ghana OR Guinea OR "Guinea-Bissau" OR Liberia OR Mali OR Mauritania OR Niger OR Nigeria OR Senegal OR "Sierra Leone" OR Togo OR Algeria OR Egypt OR Libya OR Morocco OR Tunisia OR Comoros OR Madagascar OR Mauritius OR Reunion OR Seychelles OR "developing country" OR "third- world country" OR "third world country" OR "less developed" OR "sub-Saharan" OR "Caribbean Region"[Mesh] OR "Pacific Islands"[Mesh] OR "Mexico"[Mesh] OR "Latin America"[Mesh] OR "Indian Ocean Islands"[Mesh] OR "Central America"[Mesh] OR "Asia"[Mesh] OR "Africa"[Mesh] OR "Europe, Eastern"[Mesh] OR "South America"[Mesh] OR "Africa, Northern"[Mesh] OR "Africa South of the Sahara"[Mesh] OR "Asia, Central"[Mesh] OR "Asia, Southeastern"[Mesh] OR "Asia, Western"[Mesh] OR "Far East"[Mesh] OR "Developing Countries"[MeSH]

NOT case reports[pt] OR comment[pt] OR editorial[pt] OR legal cases[pt] OR legislation[pt] OR newspaper article[pt] OR patient education handout[pt] OR retracted publication[pt]

Embase 'juvenile'/exp OR 'adolescent'/exp OR 'girl'/exp OR teen OR teens OR teenager* OR teenaged OR juvenile* OR adolescent OR preteen OR 'pre teen' OR preteens OR 'pre teens' OR minor OR minors OR youth:ab,ti OR youths:ab,ti OR girl OR girls OR 'young people' OR 'young person' OR 'young adult'

AND

Argentina or Bolivia or Brazil or Chile or Colombia or Ecuador or “French Guiana”or Guyana or Paraguay or Peru or Suriname or Uruguay or Venezuela or Mexico or Belize or “Costa Rica” or “El Salvador” or Guatemala or Honduras or Nicaragua or Panama or “West Indies” or Antigua or Bahamas or Barbados or Cuba or Dominica or “Dominican Republic” or Grenada or Guadeloupe or Haiti or Jamaica or Martinique or Antilles or “Saint Kitts and Nevis” or “Saint Lucia” or “Saint Vincent and the Grenadines” or Trinidad or Tobago or “Virgin Islands” or Kazakhstan or Kyrgyzstan or Tajikistan or Turkmenistan or Uzbekistan or Borneo or Brunei or Cambodia or “East Timor” or Indonesia or Laos or Malaysia or “Mekong Valley” or Myanmar or Burma or Philippines or Singapore or Thailand or Vietnam or Bangladesh or Bhutan or India or Nepal or Pakistan or “Sri Lanka” or China or Korea or Macao or Mongolia or Taiwan or Afghanistan or Bahrain or Iran or Iraq or Israel or Jordan or Kuwait or Lebanon or Oman or Qatar or “Saudi Arabia” or Syria or Turkey or “United Arab Emirates” or Yemen or Fiji or “New Caledonia” or “Papua New Guinea” or Vanuatu or Micronesia or Melanesia or Guam or Palau or Polynesia or Samoa or Tonga or Armenia or Azerbaijan or ‘Georgia (republic)’/exp or Albania or Estonia or Latvia or Lithuania or Bosnia or Herzegovina or Bulgaria or Belarus or Croatia or “Czech Republic” or Hungary or Macedonia or Moldova or Montenegro or Poland or Romania or Russia or Bashkiria or Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 78

Dagestan or Slovakia or Slovenia or Ukraine OR Cameroon or “Central African Republic” or Chad or Congo or “Democratic Republic of the Congo” or “Equatorial Guinea” or Gabon or Burundi or Djibouti or Eritrea or

Ethiopia or Kenya or Rwanda or Somalia or Sudan or Tanzania or Uganda or Angola or Botswana or Lesotho or Malawi or Mozambique or Namibia or “South Africa” or Swaziland or Zambia or Zimbabwe or Benin or “Burkina Faso” or Cote* OR Gambia or Ghana or Guinea or “Guinea-Bissau” or Liberia or Mali or Mauritania or Niger or Nigeria or Senegal or “Sierra Leone” or Togo or Algeria or Egypt or Libya or Morocco or Tunisia or Comoros or Madagascar or Mauritius or Reunion or Seychelles OR “developing country” or ‘developing country’/exp or “third-world country” or “third world country” or “less developed” or “sub-Saharan” or ‘Central America’/exp OR ‘Caribbean Islands’/exp OR ‘Pacific islands’/exp OR ‘Mexico’/exp OR ‘South and Central America’/exp OR ‘Indian Ocean’/exp OR ‘Central America’/exp OR ‘Asia’/exp OR ‘Eastern Europe’/exp OR ‘South America’/exp or ‘Africa south of the Sahara’/exp or ‘Far East’/exp or ‘Southeast Asia’/exp or ‘South Asia’/exp or ‘Central Africa’/exp or ‘Africa’/exp or ‘North Africa’/exp

AND

'article'/it OR 'article in press'/it OR 'conference abstract'/it OR 'conference paper'/it OR 'conference review'/it OR 'review'/it OR 'short survey'/it

PsycInfo and Cinahl Plus (teen OR teens OR teenager OR teenagers OR teenaged OR juvenile* OR preteen* OR pre-teen* OR minor OR minors OR adolescent OR girl OR girls OR "young people" OR "young person" OR "young adult") OR (MH Adolescence OR MH Young adults OR MH Minors) OR (TX youth OR TX youths)

AND

(MH abortion, habitual OR MH birth interval) OR (tempo OR "postpartum contraceptives" OR "postpartum contraception" OR "multiple births" OR "multiple pregnancies" OR "postpone second birth" OR "postponing second birth" OR "postponed second birth" OR "delay second birth" OR "delaying second birth" OR "delayed second birth" OR "repeat childbearing" OR "repeat abortion" OR "repeat abortions" OR "repeat pregnancy" OR "repeat pregnancies" OR "repeat birth" OR "repeat births" OR "birth spacing" OR "birth-spacing")

AND

Argentina or Bolivia or Brazil or Chile or Colombia or Ecuador or “French Guiana” or Guyana or Paraguay or Peru or Suriname or Uruguay or Venezuela or Mexico or Belize or “Costa Rica” or “El Salvador” or Guatemala or Honduras or Nicaragua or Panama or “West Indies” or Antigua or Bahamas or Barbados or Cuba or Dominica or “Dominican Republic” or Grenada or Guadeloupe or Haiti or Jamaica or Martinique or Antilles or “Saint Kitts and Nevis” or “Saint Lucia” or “Saint Vincent and the Grenadines” or Trinidad or Tobago or “Virgin Islands” or Kazakhstan or Kyrgyzstan or Tajikistan or Turkmenistan or Uzbekistan or Borneo or Brunei or Cambodia or “East Timor” or Indonesia or Laos or Malaysia or “Mekong Valley” or Myanmar or Burma or Philippines or Singapore or Thailand or Vietnam or Bangladesh or Bhutan or India or Nepal or Pakistan or “Sri Lanka” or China or Korea or Macao or Mongolia or Taiwan or Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 79

Afghanistan or Bahrain or Iran or Iraq or Israel or Jordan or Kuwait or Lebanon or Oman or Qatar or “Saudi Arabia” or Syria or Turkey or “United Arab Emirates” or Yemen or Fiji or “New Caledonia” or “Papua New Guinea” or Vanuatu or Micronesia or Melanesia or Guam or Palau or Polynesia or Samoa or Tonga or Armenia or Azerbaijan or Georgia or Albania or Estonia or Latvia or Lithuania or Bosnia or Herzegovina or Bulgaria or Belarus or Croatia or “Czech Republic” or Hungary or Macedonia or Moldova or Montenegro or Poland or Romania or Russia or Bashkiria or Dagestan or Slovakia or Slovenia or Ukraine OR Cameroon or “Central African Republic” or Chad or Congo or “Democratic Republic of the Congo” or “Equatorial Guinea” or Gabon or Burundi or Djibouti or Eritrea or Ethiopia or Kenya or Rwanda or Somalia or Sudan or Tanzania or Uganda or Angola or Botswana or Lesotho or Malawi or Mozambique or Namibia or “South Africa” or Swaziland or Zambia or Zimbabwe or Benin or “Burkina Faso” or “Cote d’Ivoire” OR Gambia or Ghana or Guinea or “Guinea-Bissau” or Liberia or Mali or Mauritania or Niger or Nigeria or Senegal or “Sierra Leone” or Togo or Algeria or Egypt or Libya or Morocco or Tunisia or Comoros or Madagascar or Mauritius or Reunion or Seychelles OR “developing country” or “third-world country” or “third world country” or “less developed” or “sub-Saharan” or “Central America” OR Caribbean OR “Pacific Islands” OR “South and Central America” OR “Indian Ocean” OR “Central America” OR Asia OR “Eastern Europe” OR “South America” or “Africa south of the Sahara” or “Far East” or “Southeast Asia” or “South Asia” or “Central Africa” or Africa or “North Africa”

Cochrane "family planning" OR contraception OR contraceptives

AND

"repeat pregnancy" OR “repeat abortion” OR “second birth”

Popline adolescent OR adolescents OR girl OR girls OR teen OR teens OR teenager OR teenagers OR teenaged OR juvenile OR pre-teen OR preteen OR minor OR minors OR "young people" OR "young person" OR "young adult" OR youth OR youths OR newlywed

AND

"postpartum contraception" OR "postpartum contraceptive" OR "multiple births" OR "postpartum contraceptives" OR "multiple pregnancies" OR "postponing second birth" OR "postpone second birth" OR "postponed second birth" OR "delaying second birth" OR "delay second birth" OR "delayed second birth" OR "repeat childbearing" OR "repeat abortion" OR "birth spacing" OR "birth-spacing" OR "repeat pregnancy" OR "repeat pregnancies" OR "repeat abortions"

STIs PubMed (filtered: 1990-2012) Adolescent[mesh] OR Minors[mesh] OR teen[all fields] OR teens[all fields] OR teenager[all fields] OR teenagers[all fields] OR teenaged[all fields] OR juvenile* OR preteen* OR pre-teen* OR minor OR minors OR adolescent OR youth[text] OR youths[text] OR girl[all fields] OR girls[all fields] OR "young people"[all fields] OR "young person"[all fields] OR "young adult"[all fields]

AND Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 80

(sexually transmitted diseases OR sexually transmitted diseases, bacterial OR sexually transmitted diseases, viral OR chlamydia infection OR gonorrhea OR syphilis OR trichomonas infection OR scabies OR crab lice OR molluscum contagiosum OR granuloma inguinale OR chancroid OR candidiasis OR hepatitis b OR genital herpes OR human immunodeficiency virus OR human papillomavirus 6 OR human papillomavirus 11 OR human papillomavirus 16 OR human papillomavirus 18[MeSH Terms]) OR "sexually transmitted disease" OR "sexually transmitted infection" OR "venereal disease" OR STD OR STI OR HPV OR "human papillomavirus" OR "human immunodeficiency virus" OR HIV OR AIDS OR "pelvic inflammatory disease" OR PID OR "yeast infection" OR candidiasis OR gonorrhea OR chlamydia OR "pubic lice" OR "crab louse" OR trichomonas OR trichomoniasis OR scabies OR "molluscum contagiosum" OR "granuloma inguinale" OR chancroid OR syphilis OR chancre OR (genital AND herpes) OR HSV-2 OR "hepatitis b"

AND

Argentina or Bolivia or Brazil or Chile or Colombia or Ecuador or “French Guiana” or Guyana or Paraguay or Peru or Suriname or Uruguay or Venezuela or Mexico or Belize or “Costa Rica” or “El Salvador” or Guatemala or Honduras or Nicaragua or Panama or “West Indies” or Antigua or Bahamas or Barbados or Cuba or Dominica or “Dominican Republic” or Grenada or Guadeloupe or Haiti or Jamaica or Martiniqueor Antilles or “Saint Kitts and Nevis” or “Saint Lucia” or “Saint Vincent and the Grenadines” or Trinidad or Tobago or “Virgin Islands” or Kazakhstan or Kyrgyzstan or Tajikistan or Turkmenistan or Uzbekistan or Borneo or Brunei or Cambodia or “East Timor” or Indonesia or Laos or Malaysia or “Mekong Valley” or Myanmar or Burma or Philippines or Singapore or Thailand or Vietnam or Bangladesh or Bhutanor India or Nepal or Pakistan or “Sri Lanka” or China or Korea or Macao or Mongolia or Taiwan or Afghanistan or Bahrain or Iran or Iraq or Israel or Jordan or Kuwait or Lebanon or Oman or Qatar or “Saudi Arabia” or Syria or Turkey or “United Arab Emirates” or Yemen or Fiji or “New Caledonia” or “Papua New Guinea” or Vanuatu or Micronesia or Melanesia or Guam or Palau or Polynesia or Samoa or Tonga orArmenia or Azerbaijan or (Georgia NOT Georgia[MeSH]) or Albania or Estonia or Latvia or Lithuania or Bosnia or Herzegovina or Bulgaria or Belarus or Croatia or “Czech Republic” or Hungary or Macedonia or Moldova or Montenegro or Poland or Romania or Russia or Bashkiria or Dagestan or Slovakia or Slovenia or Ukraine or Cameroon or “Central African Republic” or Chad or Congo or “Democratic Republic of the Congo” or “Equatorial Guinea” or Gabon or Burundi or Djibouti or Eritrea or Ethiopia or Kenya or Rwanda or Somalia or Sudan or Tanzania or Uganda or Angola or Botswana or Lesotho or Malawi or Mozambique or Namibia or “South Africa” or Swaziland or Zambia or Zimbabwe or Benin or “Burkina Faso” or “Cote d’Ivoire” or Gambia or Ghana or Guinea or “Guinea-Bissau” or Liberia or Mali or Mauritania or Niger or Nigeria or Senegal or “Sierra Leone” or Togo or Algeria or Egypt or Libya or Morocco or Tunisia or Comoros or Madagascar or Mauritius or Reunion or Seychelles or “developing country” or “third-world country” or “third world country” or “less developed” or “sub-Saharan” or “Caribbean Region”[Mesh] OR “Pacific Islands”[Mesh] OR “Mexico”[Mesh] OR “Latin America”[Mesh] OR “Indian Ocean Islands”[Mesh] OR “Central America”[Mesh] OR “Asia”[Mesh] OR “Africa”[Mesh] OR “Europe, Eastern”[Mesh] OR “South America”[Mesh] OR “Africa, Northern” [Mesh] or “Africa South of the Sahara” [Mesh] or “Asia, Central”[Mesh] or “Asia, Southeastern” [Mesh] or “Asia, Western” [Mesh] or “Far East” [Mesh] or “Developing Countries”[MeSH]

AND Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 81

programs OR program OR programme OR programmes OR effect OR effects OR effective OR effectiveness OR efficiency OR efficacy OR efficacious OR evaluation OR evaluate OR evaluated OR impact OR assessment OR assessments OR campaign OR campaigns OR prevent OR prevention OR outcome OR outcomes OR feasibility OR intervention OR interventions

NOT genetic OR gene OR genes OR protein OR proteins OR antigen OR antigens OR "T cell" OR "T cells" OR lymphocyte OR lymphocytes OR genotyping OR protease OR cytological

NOT case reports[pt] OR comment[pt] OR editorial[pt] OR legal cases[pt] OR legislation[pt] OR newspaper article[pt] OR patient education handout[pt] OR retracted publication[pt]

Embase ‘sexually transmitted disease’/exp OR ‘chlamydiasis’/exp OR ‘gonorrhea’/exp OR ‘syphilis’/exp OR ‘trichomoniasis’/exp OR ‘scabies’/exp OR ‘phthirus’/exp OR ‘molluscum contagiosum’/exp OR ‘granuloma inguinale’/exp OR ‘ulcus molle’/exp OR ‘papillomavirus infection’/exp OR ‘wart virus vaccine’/exp OR ‘vagina candidiasis’/exp OR ‘genital herpes’/exp OR ‘hepatitis B’/exp OR ‘Human immunodeficiency virus’/exp OR ‘pelvic inflammatory disease’/exp OR "sexually transmitted disease" OR "sexually transmitted infection" OR "venereal disease" OR STD OR STI OR HPV OR "human papillomavirus" OR "human immunodeficiency virus" OR HIV OR AIDS OR "pelvic inflammatory disease" OR PID OR "yeast infection" OR candidiasis OR gonorrhea OR chlamydia OR "pubic lice" OR "crab louse" OR trichomonas OR trichomoniasis OR scabies OR "molluscum contagiosum" OR "granuloma inguinale" OR chancroid OR syphilis OR chancre OR (genital AND herpes) OR HSV-2 OR "hepatitis b"

CinahlPlus and PsycInfo (teen OR teens OR teenager OR teenagers OR teenaged OR juvenile* OR preteen* OR pre-teen* OR minor OR minors OR adolescent OR girl OR girls OR "young people" OR "young person" OR "young adult") OR (MH Adolescence OR MH Young adults OR MH Minors) OR (TX youth OR TX youths)

(MH "Sexually Transmitted Diseases") OR (MH "Sexually Transmitted Diseases, Bacterial") OR (MH "Sexually Transmitted Diseases, Fungal") OR (MH "Sexually Transmitted Diseases, Protozoal") OR (MH "Sexually Transmitted Diseases, Viral") OR (MH “Chlamydia”) OR (MH “Chlamydia Infections”) OR (MH “Gonorrhea”) OR (MH “Syphilis”) OR (MH “Trichomonas Infections”) OR (MH “Trichomonas Vaginitis”) OR (MH “Scabies”) OR (MH “Life Infestations”) OR (MH “Granuloma Inguinale”) OR (MH “Chancroid”) OR (MH “Papillomaviruses”) OR (MH “Papillomavirus Infections”) OR (MH “Papillomavirus Vaccine”) OR (MH “Candidiasis, Vulvovaginal”) OR (MH “Herpes Genitalis”) OR (MH “Hepatitis B”) OR (MH “Human Immunodeficiency Virus”) OR (MH “Pelvic Inflammatory Disease”) OR "sexually transmitted disease" OR "sexually transmitted infection" OR "venereal disease" OR STD OR STI OR HPV OR "human papillomavirus" OR "human immunodeficiency virus" OR HIV OR AIDS OR "pelvic inflammatory disease" OR PID OR "yeast infection" OR candidiasis OR gonorrhea OR chlamydia OR "pubic lice" OR "crab louse" OR trichomonas OR Exploration of Young People’s Sexual and Reproductive Health Assessment Practices 82

trichomoniasis OR scabies OR "molluscum contagiosum" OR "granuloma inguinale" OR chancroid OR syphilis OR chancre OR (genital AND herpes) OR HSV-2 OR "hepatitis b"

Abstraction Form

HINDIN & FATUSI [email protected]

GRAY LIT BACKGROUND INFORMATION

If from the gray lit, please list the URL where the Type of Publication publication was Abstractor (gray literature vs. Year of found? Name Publication Title published literature) Publication Where was the Was the study intervention In what sample from an based? (e.g. country/ies urban or rural school-based, Authors names did the study population? Or community-based, (up to 3) Journal Name take place? both? etc.) OUTCOMES

What is the Were the SRH outcome Age range of adolescent Other important for which you adolescent participants male, characteristics of the are abstracting participants female or both? participants this study? What is the operational Are there other definition for the primary Are there additional If so, what are important SRH outcome? SRH outcomes? they? outcomes? INTERVENTION

When did the What were this study's reported Please describe the intervention take objectives? intervention. place? Please describe in your opinion Please describe in your opinion what the strengths of the what the weaknesses of the Are there other important intervention (Did it seem well intervention (Did it seem well details about the thought out, organized, thought out, organized, intervention? impactful etc?) impactful etc?) EVALUATION

Please rank the overall quality of the intervention? (on a scale What type of evaluation from 1-5 with 1 being What was the purpose was it? Quant, qual, mixed, worse and 5 being best) of the evaluation? other? If the evaluation was quantitave or mixed methods please answer the Was the intervention following questions. If it randomly allocated? (To was qualitative ONLY individuals, to groups, no, What was/were the please skip to column: AP other) independent variables(s)? How many groups were there? (eg: intervention, Please describe each arm and Describe variation in exposure control, more than one of what kind of intervention (or level if not the same for all in each) none) they received. the intervention group(s) How was exposure to the intervention measured? If data was collected pre Please indicate whether it When was data and post, were the same was well-operationalized or collected? (eg: pre, post, people surveyed at each not. both, during?) time point? If sampling occurred to Please describe the sample What type of data determine SURVEY size used in the analysis of comparisons were participation (not the primary SRH outcome. REPORTED in the study? necessarily intervention (This may be 1 number or 10 (baseline-endline, participation), how would numbers; give sufficient exposure etc) you describe it? detail to explain). QUALITATIVE

What methods of Are there other important qualitative data collection How or when was the details about the study design? were used? qualitative data used? ANALYSIS

Please desccribe the What analytic techniques Please describe the key qualitative research design. were used? findings. Statistical measure of impact and significance for primary What are the strengths of the evaluation SRH outcome (e.g. ORs and p-(study design, variable selection, values) comparison group, etc.)? What is your What are the weaknesses of the evaluation opinion of the (study design, variable selection, comparison overall quality of group, power, etc.)? the evaluation?