Abstract
BackgroundAdolescents in Latin America are at high risk for unwanted and unplanned pregnancies, which often result in unsafe abortions or poor maternal health outcomes. Both young men and women in the region face an increased risk of sexually transmitted infections due to inadequate sexual and reproductive health information, services and counselling. To date, many adolescent health programmes have targeted a single determinant of sexual and reproductive health. However, recent evidence suggests that the complexity of sexual and reproductive health issues demands an equally multi-layered and comprehensive approach.MethodsThis article describes the development, implementation and evaluation design of the community-embedded reproductive health care for adolescents (CERCA) study in three Latin American cities: Cochabamba (Bolivia), Cuenca (Ecuador) and Managua (Nicaragua). Project CERCA’s research methodology builds on existing methodological frameworks, namely: action research, community based participatory research and intervention-mapping.The interventions in each country address distinct target groups (adolescents, parents, local authorities and health providers) and seek improvement of the following sexual health behaviours: communication about sexuality, sexual and reproductive health information-seeking, access to sexual and reproductive health care and safe sexual relationships.In Managua, we implemented a randomised controlled study, and in Cochabamba and Cuenca we adopted a non-randomised controlled study to evaluate the effectiveness of Project CERCA interventions, in addition to a process evaluation.DiscussionThis research will result in a methodological framework that will contribute to the improved design and implementation of future adolescent sexual and reproductive health interventions.Trial registrationClinicalTrials.gov (NCT01722084)
Highlights
Adolescents in Latin America are at high risk for unwanted and unplanned pregnancies, which often result in unsafe abortions or poor maternal health outcomes
For Project community-embedded reproductive health care for adolescents (CERCA), we developed a hypothetical strategy for improving ASRH based on the following: 1) a study on ASRH determinants in each of the three study countries; 2) a literature review of sexual and reproductive health (SRH) and public health intervention models targeting adolescents both in Latin America and globally; and 3) a study of existing knowledge on adolescent SRH
Evaluation In order to measure the impact of Project CERCA interventions, consortium partners have carried out a preintervention baseline survey of both target groups and control groups, and will conduct a post-intervention survey at the 18-month mark
Summary
Adolescents in Latin America are at high risk for unwanted and unplanned pregnancies, which often result in unsafe abortions or poor maternal health outcomes. Both young men and women in the region face an increased risk of sexually transmitted infections due to inadequate sexual and reproductive health information, services and counselling. In Brazil, Colombia, Dominican Republic and Peru between 10 and 21% of the hospitalisations for complications arising from unsafe abortion occurred among women aged 15–19 years [4] These data suggest the number of induced abortions per 100 pregnancies ranges from 23 to 30 [4]. The magnitude of the STI and HIV epidemic in the region is difficult to measure, due to limited data, underreporting, and weak surveillance systems [5]
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