Crisis in the Triangle: Addressing Adolescent Reproductive Health & Violence Prevention in El Salvador, Guatemala and Honduras psi.org Acknowledgements This publication was made possible through support provided by the United States Agency for International Development (USAID) under the terms of Cooperative Agreement No. AIDOAAA-10-00030, Support for International Family Planning Organizations (SIFPO) project. The contents of this guide are the sole responsibility of Population Services International and do not necessarily reflect the views of USAID or the United States Government. This publication was written by Susan Ruether, Katie Anfinson, Rena Greifinger, Julia Roberts and Judith Heichelheim from PSI. Special thanks to Jennifer Pope for her leadership of the SIFPO project, the entire SIFPO team, USAID Mission offices in El Salvador, Guatemala and Honduras, and the USAID Latin America and Caribbean Regional Bureau for their ongoing support and reviews. Special thanks is also extended to PASMO Honduras for their invaluable support and input that made this publication possible. © 2016 Population Services International (PSI). Any part of this document may be reproduced or adapted to meet local needs without prior permission from PSI provided PSI is acknowledged, and the material is made available free of charge or at cost. 2 Table of Contents ACRONYM LIST ................................................................................................................................................................................................... 5 EXECUTIVE SUMMARY .................................................................................................................................................................................... 6 Background ................................................................................................................................................................................................ 6 Methodology ................................................................................................................................................................................................ 6 Results ........................................................................................................................................................................................................... 6 Recommendations .................................................................................................................................................................................... 6 Conclusion .................................................................................................................................................................................................... 7 INTRODUCTION .................................................................................................................................................................................................. 8 BACKGROUND ..................................................................................................................................................................................................... 8 Sexual and reproductive health and its links to violence .................................................................................................................. 8 Adolescent pregnancy and child-bearing .......................................................................................................................................... 8 Stigma and SRH access ......................................................................................................................................................................... 8 STIs and HIV ................................................................................................................................................................................................ 8 Early marriage ............................................................................................................................................................................................. 8 School completion and employment .................................................................................................................................................. 8 Violence in the Northern Triangle .............................................................................................................................................................. 10 Gangs and organized crime ................................................................................................................................................................... 10 Weak police forces and judicial institutions ...................................................................................................................................... 10 Crime and violence policies .................................................................................................................................................................... 10 Gender-based violence ............................................................................................................................................................................. 11 Sexual violence ............................................................................................................................................................................................ 12 METHODS ............................................................................................................................................................................................................. 15 An evidence-based approach .................................................................................................................................................................... 15 The Socio-ecological Model: Shared risk and protective factors ................................................................................................... 15 Cross-cutting interventions ......................................................................................................................................................................... 17 Multi-component interventions ............................................................................................................................................................. 17 Segmenting and involving youth ........................................................................................................................................................... 17 FINDINGS .............................................................................................................................................................................................................. 18 Individual level interventions ....................................................................................................................................................................... 18 Life-skills, vocational training and social development programs ............................................................................................ 18 Workforce development and employment programs ................................................................................................................... 18 School-based programs .......................................................................................................................................................................... 18 After-school programs .............................................................................................................................................................................. 18 Educational Attainment ............................................................................................................................................................................ 19 3 Relationship level interventions .................................................................................................................................................................... 19 Early childhood education programs ..................................................................................................................................................... 19 Home visit programs ................................................................................................................................................................................... 20 Parent training/family therapy interventions ....................................................................................................................................... 20 Mentoring programs .................................................................................................................................................................................... 20 Community and institutional level interventions .................................................................................................................................... 21 Comprehensive sexuality education ...................................................................................................................................................... 21 Community-based sex education ........................................................................................................................................................... 22 Community