Motherhood in Childhood

contraception, through its Competitive Voucher
Scheme. Vouchers for free services are distributed
by local non-governmental organizations
to adolescents and youth in Managua’s markets,
outside public schools, on the streets and in
clinics. Outreach workers also distribute vouchers
door to door. Each voucher is valid for three
months and may be transferred to another adolescent
in greater need. It can be used to cover
one consultation and one follow-up visit for:
counselling, family planning, pregnancy testing,
antenatal care, treatment of sexually transmitted
infections, or any combination of services. The
programme also trained clinic staff in counselling
for adolescents, issues of adolescent sexuality,
and identifying and addressing sexual abuse
(Muewissen, 2006).
Preliminary findings from an evaluation
showed that vouchers were associated with
greater use of sexual and reproductive health
care, knowledge of contraceptives, knowledge
of sexually transmitted infections and increased
use of condoms.
Through Mozambique’s Geração Biz (Busy
Generation) programme, the ministries of health,
education and youth and sports jointly provide
youth-friendly sexual and reproductive health
services, school-based information campaigns
about contraception and HIV prevention and
community-based information to reach young
people who are not in school. Through a network
of 5,000 peer counsellors, Geração Biz
provides non-judgmental, confidential information
and services to Mozambique’s youth. The
multi-sectorial nature of the programme that
engages policymakers, health care providers,
educators and community stakeholders as well
as youth themselves is a key contributing factor
to an increase in adolescents’ and young people’s
knowledge about and use of contraception
(Hainsworth et al. 2009).
The Development Initiative Supporting
Healthy Adolescents (DISHA) programme in
India combines community-level mentoring
and community dialogue with the scaling up
of health services and comprehensive sexuality
education, contraceptive education and provision,
and life skills training. In 176 villages,
the programme has created youth groups and
resource centres where adolescents can learn
about sexual and reproductive health, receive services
and enrol in training for future livelihoods.
The programme also trains local health providers
in youth-friendly care, organizes volunteers to
distribute modern methods of family planning,
deploys peer educators, organizes counselling
sessions, and provides a forum for young people
and adults to come together to talk about youth’s
role in society.
Using a quasi-experimental design with a
comparison group, the evaluation showed that
the age of marriage among programme participants
rose from 15.9 years to 17.9 years; and
married youth exposed to DISHA were nearly
“Once a condom broke, and we only
discovered it afterwards. My girlfriend
panicked, which I fully understand. But I
actually think we managed the situation
well. We found a pharmacy where we
bought emergency contraception.”
Lasse, 18, Denmark
THE STATE OF WORLD POPULATION 2013
71