Background
The GUSO programme used the multicomponent systems approach whereby the provision of SRHR information and education was linked to increasing quality and youth-friendly SRH services and at creating an enabling and supportive environment [19]. Interventions under the GUSO programme included, amongst others, the following: - SRHR and CSE training of peer educators and teachers - Provision of CSE in- and out of school - Online SRHR information provision and campaigns on various platforms and social media - Intergenerational dialogues on SRHR in communities, attended by community leaders, religious leaders, parents and young people - Advocacy on local, district and national level to implement SRHR policies and laws - Training of services providers and peers on youth-friendly services - Referrals of young people to SRH services and the provision of these services - Youth-led social accountability activities to hold community and service providers accountable |
Methodology
The study context
Study methods
Methods and participants | Baseline | End-line |
---|---|---|
Focus group discussions | ||
Girls (15-19 years) | 2 | 2 |
Young women (20-24 years) | 1 | 2 |
Boys (15-19 years) | 1 | 2 |
Young men (20-24 years) | 2 | 2 |
Parents or caregivers | 2 | 4 |
Total | 8 | 12 |
In-depth interviews | ||
Girls (15-19 years) | 2 | 2 |
Young women (20-24 years) | 2 | 3 |
Boys (15-19 years) | 2 | 2 |
Young men (20-24 years) | 1 | 3 |
Parents or caregivers | 2 | 2 |
Religious and traditional leaders | 2 | 3 |
Teachers | 2 | 2 |
Health and social workers | 3 | 2 |
CBO and youth organisation staff | 1 | 2 |
Total | 17 | 21 |
Key informant interviews | ||
NGO staff | 4 | 5 |
Policy makers/ county officers | 2 | 2 |
District Health Office | 2 | 4 |
Law enforcement | 0 | 1 |
Total | 8 | 12 |
Ethical considerations
Results
Respondent demographics
Demographic characteristics | Intervention | Control | ||
---|---|---|---|---|
Baseline | End-line | Baseline | End-line | |
Gender | ||||
Female | 515 (59.5) | 447 (52) | 444 (53) | 431 (51) |
Male | 350 (40.5) | 419 (48) | 395 (47) | 416 (49) |
Age | ||||
15-17 | 317 (37) | 332 (38) | 313 (37) | 330 (39) |
18-24 | 548 (63) | 534 (62) | 526 (63) | 517 (61) |
Religion | ||||
Muslim | 459 (53) | 547 (63) | 430 (51) | 406 (48) |
Christian | 402 (46.5) | 319 (37) | 409 (49) | 441 (52) |
Other | 4 (0.5) | 0 | 0 | 0 |
Marital Status | ||||
Single | 603 (70) | 714 (82) | 557 (66) | 703 (83) |
Married | 196 (23) | 122 (14) | 251 (30) | 113 (13) |
Divorced | 28 (3) | 9 (1) | 19 (2) | 9 (1.1) |
Widowed | 1 (0.1) | 0 | 1 (0.1) | 0 |
Living together | 37 (4) | 21 (2) | 11 (1) | 23 (3) |
Current school status | ||||
In school | 323 (37) | 495 (57) | 288 (34) | 524 (62) |
Out-of-school | 542 (63) | 371 (43) | 551 (66) | 323 (38) |
Know about GUSO | ||||
Yes | NA | 548 (63) | NA | 348 (41) |
No | NA | 314 (36) | NA | 496 (59) |
Don’t know | NA | 4 (0.5) | NA | 3 (0.4) |
Participated in GUSO | ||||
Yes | NA | 223 (26) | NA | 105 (12) |
No | NA | 318 (37) | NA | 227 (27) |
I have never heard of GUSO | NA | 6 (0.7) | NA | 12 (1) |
Don’t know | NA | 1 (0.1) | NA | 4 (0.5) |
Sex and relationships in Iganga: setting the scene
Descriptive statisticsa | Intervention Area | Control Area | ||
---|---|---|---|---|
Baseline | End-line | Baseline | End-line | |
Sex and relationships | ||||
Ever had sexual intercourse | 647 (74.8) | 522 (60.3) | 647 (77.1) | 511 (60.3) |
Self expression | ||||
I am able to express my feelings about sexuality and relationships | 613 (70.9) | 599 (69.2) | 602 (71.8) | 599 (70.7) |
Ease in talking to these stakeholders about sexuality, contraception and relationshipsb | ||||
Health workers | NA | 749 (86.5) | NA | 725 (85.6) |
Teachers | 289 (33.4) | 265 (55) | 476 (31.6) | 487 (55.7) |
Girlfriend/boyfriend/spouse/partner | 717 (82.9) | 700 (80.8) | 707 (84.3) | 653 (77.1) |
Peers | 646 (74.7) | 648 (74.8) | 548 (65.3) | 644 (76) |
Parents | 392 (45.3) | 532 (61.4) | 392 (46.7) | 496 (58.6) |
Other family members | 314 (36.3) | 483 (55.8) | 398 (47.4) | 473 (55.8) |
Religious leaders | 145 (16.8) | 238 (27.5) | 154 (18.4) | 263 (31.1) |
Traditional or community chiefs | 56 (6.5) | 90 (10.4) | 54 (6.4) | 128 (15.1) |
(Local) political leader | 53 (6.1) | 100 (11.5) | 110 (13.1) | 128 (13.8) |
Decision making | ||||
Decision making about dating and choice of partner | ||||
I decide for myself who to date | 787 (91) | 814 (94) | 760 (90.6) | 785 (92.7) |
I should have the choice to decide whom to marry | 776 (89.7) | 764 (88.2) | 752 (89.6) | 773 (91.3) |
Decisions about sex | ||||
I feel I am able to make the decision myself if I want to have sex or not | 648 (74.9) | 689 (79.6) | 653 (77.8) | 655 (77.3) |
Decisions about contraceptive use | ||||
I feel confident that I can use a condom every time if I have sexual intercourse in the future | 494 (57.2) | 520 (60) | 452 (53.9) | 480 (56.7 |
I find it appropriate for a boy to propose to use a condom | 686 (79.3) | 694 (80.1) | 627 (74.7) | 680 (80.3) |
I find it appropriate for a girl to propose to use a condom | 635 (73.5) | 634 (73.2) | 586 (69.8) | 628 (74.1) |
A couple should decide together if they want to have children | 794 (91.8) | 794 (91.7) | 772 (92) | 798 (94.2) |
Men should have the final word about decisions in the household | 480 (55.5) | 649 (74.9) | 571 (68.1) | 652 (77) |
I am worried about being denied access to contraceptives | 450 (52) | 612 (70.7) | 466 (55.5) | 596 (70.4) |
Currently use contraception | 328 (37.9) | 314 (36.3) | 334 (39.8) | 252 (29.8) |
Decisions about SRH services | ||||
Ever used SRH services | 715 (82.7) | 574 (66.3) | 701 (83.6) | 509 (60.1) |
I am worried about being denied access to SRH services | 356 (41.2) | 294 (33.9) | 408 (48.6) | 286 (33.8) |
Support felt by the following people in accessing sexuality education and SRH services?b | ||||
Health workers | NA | 737 (85.1) | NA | 736 (86.9) |
Teachers | 306 (35.4) | 485 (56) | 265 (31.6) | 473 (55.8) |
Girlfriend/boyfriend/spouse/partner | 713 (82.4) | 683 (78.9) | 677 (80.7) | 664 (78.4) |
Peers | 601 (69.5) | 629 (72.6) | 553 (66.9) | 621 (73.3) |
Parents | 434 (50.2) | 598 (69.1) | 461 (54.9) | 579 (68.4) |
Other family members | 324 (37.5) | 490 (56.6) | 420 (50.1) | 494 (58.3) |
Religious leaders | 193 (22.3) | 264 (30.5) | 154 (18.4) | 282 (33.3) |
Traditional or community chiefs | 61 (7.1) | 99 (11.4) | 70 (8.3) | 141 (16.6) |
(Local) political leader | 73 (8.4) | 138 (15.9) | 112 (13.3) | 162 (19.1) |
Traditional or community chiefs | 61 (7.1) | 99 (11.4) | 70 (8.3) | 141 (16.6) |
(Local) political leader | 73 (8.4) | 138 (15.9) | 112 (13.3) | 162 (19.1) |
Multivariable regressions | Difference-in-difference analysis odds ratios | |||||||
---|---|---|---|---|---|---|---|---|
Constant | Intervention*time | Intervention area | Time | Over 18 years of age | In-school | In any type of relationship | Female | |
I am able to express my feelings about sexuality and relationships | 0.945 | 0.908 | 1.003 | 1.054 | 1.813*** | 0.886 | 1.652*** | 0.611*** |
I decide for myself who to date | 3.447 | 1.180 | 1.049 | 1.366 | 2.042*** | 0.993 | 1.238 | 0.670** |
I should have the choice to decide whom to marry | 5.086 | 0.704 | 1.017 | 1.230 | 1.202 | 1.097 | 1.345** | 0.979 |
I feel I am able to make the decision myself if I want to have sex or not | 1.902 | 1.282 | 0.881 | 1.043 | 1.286** | 0.984 | 1.557*** | 0.827 |
I feel confident that I can use a condom every time if I have sexual intercourse in the future | 1.039 | 0.964 | 1.195 | 1.149 | 1.091 | 1.067 | 1.437*** | 0.551*** |
Choice to become pregnant | 0.040 | 0.697 | 1.605** | 1.118 | 3.570*** | 0.308** | 1.736 | NA |
Ever used SRH services | 0.304 | 1.270 | 1.071 | 0.291*** | 4.363*** | 0.610*** | 3.571*** | 1.208 |
Currently use contraception | 0.057 | 1.354 | 1.000 | 0.771 | 2.651*** | 0.770*** | 4.207 | 0.613*** |
Ever had sexual intercourse | 0.177 | 0.768 | 1.126 | 0.568*** | 4.861*** | 0.242*** | 13.335*** | 0.585*** |
“…just have to go look for a boy that will give me 5000 shillings and if he says “I love you”- you just accept because you know he will give you 5000 shillings another time so you can purchase sanitary towels or Vaseline or clothes…..” Young woman, Focus group, 15-17 years old, End-line
Self-expression
Decision-making
“To me a child is a child, there is no decision I can leave them to make on their own. I make decisions for them because I am still giving them school fees.” - Mother, Focus group, Baseline.
“Right now we thank organizations like GUSO and the government via the community dialogues being organized, young people have been able to make their own decisions and as of now cases around sex have reduced.”- Key Informant, End-line.
Decisions about dating and choice of partner
Intervention area-only regressions | Constant | Time | Age | In-school | In a relationship | Gender |
---|---|---|---|---|---|---|
I am able to express my feelings about sexuality and relationships | 0.919 | 0.957 | 1.932*** | 0.853 | 1.814*** | 0.55*** |
I decide for myself who to date | 4.790 | 1.704** | 1.948*** | 0.730 | 1.183 | 0.630 |
I should have the choice to decide whom to marry | 3.031 | 0.844 | 1.509** | 1.318 | 1.687** | 0.932 |
I feel I am able to make the decision myself if I want to have sex or not | 1.656 | 1.357** | 1.297 | 0.930 | 1.525*** | 0.874 |
I feel confident that I can use a condom every time if I have sexual intercourse in the future | 1.095 | 1.124 | 1.242 | 0.980 | 1.381** | 0.529*** |
Ever had sex | 0.224 | 0.447*** | 5.133*** | 0.206*** | 11.917*** | 0.538*** |
Ever used SRH services | 0.352 | 0.376*** | 4.237*** | 0.575*** | 3.453*** | 1.230 |
Currently use contraception | 0.067 | 1.070 | 2.936*** | 0.608*** | 3.342*** | 0.525*** |
Choice to become pregnant | 0.084 | 0.782 | 2.877 | 0.286 | 2.016 | NA |
Decisions about sex
Decisions about contraceptive use
“At school, teachers always talk to us on how to keep safe (ABC) i.e. abstinence being faithful and use of condoms.”- Young woman, 18-24, Focus group, Baseline.
“A good youth / adolescent have manners and she is in position to abstain not to indulge in sexual activities with the boys, doesn’t walk anyhow but keeps always at their home.”- Young woman, 18-24, Focus group, End-line.