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Adolescent reproductive health education in Panama.
– Reported, June 06, 2013
The need for preventive reproductive care and health education is widely acknowledged in international medical and public health communities. Specifically, the need for high-impact adolescent sexual and reproductive healthcare programs has become a primary concern for global health organizations such as the World Health Organization (WHO) and the United Nations. Sexual education is related to many other markers of health and well-being, including maternal and child health, extreme poverty and gender equality. Therefore, it has become the focus of many youth health advocacy programs. Efforts in Panama to address this concern by government and non-government entities alike provide scenarios in which diverse methods of addressing public health needs can undergo comparative analyses and serve as indicators of area-wide changes. The development of multiple targeted programs in Panama may be a useful model for other countries with similar circumstances, namely limited resources, infrastructure challenges and highly diverse populations.
However, Panama does have certain unique healthcare characteristics that distinguish it from similar countries. Regarding HIV/AIDS prevalence, the country is at a critical point in which the situation can either drastically improve or deteriorate depending on how it is addressed. As a result, the government has chosen to support a variety of programs that address adolescent sexual health in efforts to decrease the prevalence of HIV/AIDS. Government entities disburse discretionary funds to programs, and the National Assembly has passed legislation promoting youth rights, in order to improve adolescent health. Non-governmental organizations (NGOs), both international and Panama-based, have increased their involvement in the country. Programs by three NGOs Aid for AIDS, APLAFA and PROBIDSIDA are attempting to create HIV/AIDS and reproductive health education opportunities within formal and informal education sectors.
The Greater Impact of Reproductive Health Education
Adolescent reproductive health is a widespread global concern. Sexually transmitted infection (STI) incidence rates are the highest in individuals younger than 25 years of age. It is estimated that 20% to 50% of the annual 340 million curable infections of syphilis, gonorrhea, chlamydia and trichomoniasis occur in this age group, but incidence is underreported due to a lack of routine reproductive health services. Worldwide, an estimated 6000 young people aged 15 to 24 are newly infected with HIV every day. In 2008, 45% of new global HIV infections were found in individuals from this age group. In Panama, 22% of new HIV infections have been diagnosed in individuals that are 10 to 29 years of age.
Sexual behavior as a whole should be viewed within its sociocultural context. Generalizing motivations for sexual activity is misleading, as factors including socioeconomic status, gender, cultural norms and the media play notable roles in shaping individuals sexual behavior. These contexts vary not only between populations, but also in sub-demographics within populations. Linda Bearinger, who studied sexual education programs, advocates a system of clinical services, education and youth empowerment programs to counter and adapt to these variable influences. The WHO acknowledges the need for context and specificity with its statement that no general approach to sexual-health promotion will work everywhere, and no single-component intervention will work anywhere.
Unfortunately, studies advocating tailored methods often combine data from disparate settings and contexts, counter-intuitively offering generalized recommendations for public health providers and workers. For example, Wellings et al. used research based in Sub-Saharan Africa and Southern Asia and extrapolated recommendations for Latin America. This cultural translation homogenizes different groups and ignores the importance of specific cultural, political and regional contexts. In Latin America, within-population and between-population variations are significant due to immigration and the large number of indigenous groups. Therefore, underestimating diversity undermines the development of custom programs.
The Lens of the UN Millennium Development Goals
In September 2000, the United Nations (UN) approved what are now known as the Millennium Development Goals (MDGs). These eight areas for improvement were built around the realization that public and individual well-being are influenced by a number of social, cultural and political factors. These goals are: 1) to eradicate extreme poverty and hunger; 2) to achieve universal primary education; 3) to promote gender equality and empower women; 4) to reduce child mortality; 5) to improve maternal health; 6) to combat HIV/AIDS, malaria and other diseases; 7) to ensure environmental sustainability; and 8 ) to develop a global partnership for development.
Reproductive education programs, including those focusing on HIV/AIDS, therefore, have a purpose beyond eradicating a disease.
The UN recognizes that these goals are inter-related and inter-dependent, reflecting the belief that progress toward one goal renders the other goals more attainable. The web that connects HIV/AIDS to reproductive and sexual health also includes maternal health (MDG 5), gender equality and womens empowerment (MDG 3), extreme poverty (MDG 1) and global cooperation (MDG 8). Reproductive education programs, including those focusing on HIV/AIDS, therefore, have a purpose beyond eradicating a disease. These programs further numerous MDGs that improve both the individuals quality of life and the communitys overall health. In-depth analysis focusing on maximizing impact with limited resources can help optimize a single nations reproductive health education programs as well as provide opportunities for progress towards an overall higher standard of health and well-being.
Reproductive Health in Panama: Local Context and Framework for Analysis
As stated by the 2002 WHO World Health Report, [u]nderstanding the contribution of the different [education intervention] components would be very useful in deciding on the appropriate overall strategy for reproductive education. In-depth consideration of the strengths and weaknesses of each method and their impact as a whole facilitates this process. As such, attempts have been made to provide as comprehensive an evaluation as possible. The analysis will be tripartite, examining political context, statistical data and cultural impact.
The Republic of Panamas National Constitution Article 106 assigns primary responsibility for developing prevention and health education strategies to the state. The Ministry of Health dictates resource allocation and implementation strategies as approved by the executive branch. Article 76 of 2001s Ministry of Health Law 119 explicitly outlines that the Ministry of Health will coordinate education and prevention campaigns with all government and autonomous (non-government) entities in the public and private sector.
The cultural diversity of Panama must be taken into account when analyzing the efficacy of health education programs. In addition to mestizo and immigrant populations, the country is home to seven indigenous groups. To protect the rights of these tribes, three indigenous regions and two indigenous sub-regions (or comarcas) have been established in addition to the nine provinces that subdivide Panama. The comarcas are given substantial administrative autonomy by the state, and the laws of its people are established within its boundaries. Legislative policies are usually developed by national branches in cooperation with the local governing body as opposed to unilaterally by the state (UNDP Panama). As these groups have unique characteristics with respect to public health, they must be looked at individually, rather than subsuming them within the larger population. Although 75% of Panamanians live in urban areas (with that proportion increasing 2.3% per year), socioeconomic conditions in cities are highly variable. These differences in living conditions and cultural heritage illustrate the need for nuanced approaches to public health and education in Panama.
In such a heterogeneous population, it must be considered how each type of education program addresses changing cultural factors such as youth rights and political status, legal and social discrimination against homosexuality, interpersonal violence, sex-negative media (portrayals of sex as dirty or taboo) and traditional gender roles. Incorporating such context-specific influences is vital to developing well-designed reproductive health education programs. Discussion of these social pressures and their influence on sexual behavior and quality of life denotes the broader significance of these education programs. The ways by which each strategy does so will serve as the final criteria for comparative study of HIV/AIDS prevention efforts.
Using the perspectives of political support, statistical data and cultural context, three types of HIV/AIDS and reproductive health education programs will be analyzed: formal education efforts in public Panamanian school systems with a top-down structure, NGO-led informal sector approach using peer community agents in a grassroots dissemination strategy and the mixed approach using peer community agents in coordination with school infrastructure. Source data includes first-hand materials the author collected during the summer of 2011 through an internship with Universidad Latina Panama and several NGOs.
The informal method of reproductive education consists of NGOs initiatives in which youth leaders disseminate information to their peers in lectures and meetings. Two noteworthy examples of NGO operations active in Panama are the Aid for AIDSs workshops and the program of the Asociación Panameña para el Planeamiento de la Familia (APLAFA). Both efforts share political support and work to change similar cultural norms using comparable methodology of grassroots peer education. A discussion of Aid for AIDS workshops serves as a representative example for both organizations.
The informal method of educational outreach among adolescents enjoys national and international political support as part of NGO-led initiatives. The Office of the President and First Lady use discretionary funds to support Aid for AIDS, while the government-owned National Lottery sponsors APLAFA.
CREDITS.
Jhalak Dholakia, Rhonda Buchanan, Whitney Nash
http://www.ghjournal.org/
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