By Prof. Jody Gan
It was on the very first day of my first OCHO brigade in June 2015 that I learned of Atima’s alarming teen pregnancy rate of 67%, and quickly recognized where I could best make a contribution. I was eager to join OCHO, but as a college professor and public health professional, I hadn’t been sure as to exactly how I would help.
Honduras has the second highest rate of teen pregnancy in the world and this remains a major obstacle for Atima’s quest for improved health and prosperity. The recent threat of the Zika virus on the health and development of babies added even more fuel to the immediate need for interventions that encourage young people in this area to delay pregnancy–especially in a community already overwhelmed with a disproportionate number of children born with birth defects. However, Zika also provided an unprecedented opportunity for greater community acceptance of pregnancy prevention measures, especially with the Pope condoning the use of contraceptives at this time to slow the spread of the virus and its damaging effects. The First Lady of Honduras has also increased attention on reduce teen pregnancy which has helped reduce resistance to changing powerful cultural norms.
Planning
After my first visit to Atima, I was excited to begin planning during the “off-season” to address teen pregnancy during the brigade’s next visit. I created a needs assessment survey for Dr. Sarmiento, Atima’s medical director and Karen Vega, the teen director to learn more about the teen pregnancy problem, current practices and attitudes, and more about the role of promotores de salud in the community. Promotores are trusted community members trained to provide health information and support to their neighbors, and have a long history of delivering health promotion and disease prevention in Latin America. I also began collecting and creating Spanish health education materials . My health promotion students at American University created posters designed to empower Atima teens to stay in school and set personal goals before starting a family. In keeping with the community’s love for festivities and in an effort to get teens more comfortable with Atima’s new medical clinic, we planned a teen party to be held in the clinic and shipped a bounty of healthy snacks for the party in the container that arrived ahead of the brigade.
With help from Chloe Abarbanel, a public health major,andSpanish minor from Tulane, and wonderful assistant to the project, I developed a training that could be adapted to fit the different needs of the key stakeholders with whom I’d be meeting–the teens, teen leaders, parents, andpromotores. Components of the training included information about the risks of early pregnancy including an interactive game that demonstrated the financial burdens placed on large families, strategies for safe and non-sexual ways to be close and have fun with a romantic partner, hallmarks of healthy relationships, and a presentation from Atima’s Nurse Dani about methods of contraception available at the clinic. We administered a pre-test and post-test that yielded information about the effectiveness of the training while also providing more insight about the teens’ personal life goals and how the clinic and the community could help them wait to become parents. We also collected the names of those teens and young adults who were most admired and respected in the community for a future social norming campaign.
Summer 2016 Successes
During our short week in Atima, we conducted trainings with 18 teen leaders, 33 teens from the high school, 8 promotores, and 45 concerned parents and grandparents. Training participants were attentive, very receptive, and seemed to thoroughly enjoy the interactive activities planned. The teen party held at the clinic was a resounding success. What was planned as a small gathering for about 30 Atima teens and the 10 OCHO teens with the purpose of getting Atima teens more comfortable with coming to the clinic, turned about to be a huge, town fiesta in which over 100 teens were in attendance! Our youthful subset of the OCHO brigade walked into a rocking party where they received a standing ovation from a beautifully dressed, spirited crowd, the town’s popular mayor, and a five-piece live band! The teen leaders presented a comical skit about a young father who was unable to raise his son properly and then an “edgy” video (that they had produced just that afternoon after our training!) that featured these articulate role models highlighting the many reasons and strategies they would employ for delaying parenthood. It was truly touching and the most rewarding moment I’ve ever had as a health educator. Afterwards, everyone enjoyed the snacks and joined in festive dancing with the band until late in the evening. A few nights later, Chloe and I were invited to be guests on the town’s popular evening news television show on “El Canal”. After the nightly news program, we saw first-hand that during the times there wasn’t any television programming on the station, the television producers were running the Spanish Planned Parenthood video I brought about how to talk to your kids about sex!
Next Steps
From my analysis of the pre and post-tests and the rich open ended responses provided (thanks to Sara Lever and Elena Loane for their help translating responses on the plane ride back), I compiled a list of recommendations to help Atima reduce teen pregnancy that I’m happy to share with anyone interested. It is very encouraging that our intense week of activities were so well-received and that this health educator was made to feel like a celebrity rather than criticized or shunned for talking about sensitive issues. It is our hope that the momentum will continue to increase the residents’ comfort with using the clinic to assist with family planning. There is promising evidence for increasing the role of the promotores in family planning, perhaps combining forces with the town’s powerful teen leaders to address and prevent early pregnancy among teens. As one promotora shared in her written response about how she could be helpful to the teens.
"I can talk to them about how beautiful life is and to enjoy their very special teenage years by waiting until after age 21 to become a parent….an early pregnancy robs you of enjoying this stage of life and reaching your goals."
In Atima, while many teens are having children very early, there are inspiring young adults who are postponing parenthood in order to pursue educational and career goals. Stay tuned to hear how OCHO will help amplify their positive influence in the community.