By Laura Kelley, MPH ’11 in Sociomedical Sciences
Merely waiting for coffee in Dakar wakes you up – before it even arrives in your hands. Exclamations in Wolof punctuate mbalax beats on the radio; raised eyebrows and booming laughter frame the gestures of tall, lanky men.
Senegalese people love to connect – and it’s not subtle. The scene doesn’t change when I reach my office, just the crowd, which consists of Dakar youth under age 25.
For five months I have been working on a peer education program for adolescents at l’Association Sénégalaise pour le Bien-être Familial in Dakar. ASBEF, or the Senegalese Association for the Well-being of Families, is the local partner of International Planned Parenthood Federation. Volunteers founded the organization to improve maternal and child health, but recently it launched one of the most innovative programs for youth in West Africa: the Senegalese Youth Action Movement, or Mouvement d’Action des Jeunes. The program focuses on improving adolescent sexual health and gender equity.
Program activities take advantage of Senegal’s intensely social culture, training youth as “animators” who lead interactive “causerie” sessions on themes such as such as youth sexuality, unintended pregnancy, sexual violence, HIV/AIDS, and early marriage. Additionally, youth attend regional conferences and receive training in leadership and gender issues. The objective is not to encourage certain behaviors or ‘westernize’ adolescents; rather, it is to enable them to seek information, make choices and utilize health services that meet their needs.
Although Senegal has many family planning providers in Dakar and a national strategy for adolescent health, in reality it is difficult for youth to access services. As a predominantly Muslim country, the social unit in Senegal is the nuclear family. Cultural and religious norms sanction sexual activity within the context of marriage and procreation. Thus, it is stigmatizing for adolescents – particularly young women – to be seen entering reproductive health clinics. Additionally, young people generally live with their families until marriage, limiting disposable income for health services they may not wish to disclose to their parents.
In contrast to cultural norms, health indicators demonstrate the need for adolescent sexual health services. Adolescent males cite exchanges with informal sex workers. Young women report drinking corner store bleach and crushed glass to avoid unwanted pregnancy, which occurs among one in ten young Senegalese women. Alarmingly, adolescents account for 1 in 5 unsafe abortions, which can result in sepsis, hemorrhaging, infertility/hysterectomy and sometimes death. Barriers to access for youth also threaten Senegal’s low HIV/AIDS prevalence rate; untreated STDs can spread quickly in a polygamous society where adults may have concurrent sexual partners.
Measuring a program’s impact on changing social norms and subsequent health indicators is neither a quick nor simple business. However, early results from the Senegalese Youth Action Movement are overwhelmingly positive. Since its inception in 2008, the program has reached 1200 Dakar youth during causeries and distributed over 50,000 condoms. Youth also organized to request price reductions for adolescent sexual health services. Over 90% of causerie participants would recommend sessions to a friend. “Today, I learned the importance of messages that come from peer educators,” commented a young man; a 17-year-old girl likes the program because “nothing is taboo”.
Monitoring and evaluation aside – what is the obvious sign of success? The message is so Senegalese that I literally can’t understand: causeries are animated in Wolof, Pulaar, Mandinka, and Diola. But recognizing the look on an empowered young woman’s face – that doesn’t require any talking.