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Rural and Urban: RHIYA works with young people in three Southern Provinces of Laos with Health Unlimited and in the capital at the Vientiane Youth Centre and with CARE International for Health and Development. In these rural and urban zones they can get information about reproductive health, receive training and develop life skills.
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| OVERVIEW |
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The Programme
The overall goal of the RHIYA Lao programme was ‘ Improved Reproductive and Sexual Health of Young People and Adolescents in the Lao PDR’. There were 4 component projects working with a diverse target group: young sex workers in the capital; modern young people in the capital both in and out of school; and rural young people predominantly from the ethnic minorities of southern Lao.
Key approaches for all projects were peer education and outreach. These provided information on ASRH issues including STI, HIV/AIDS, unplanned pregnancy and contraception and gender. Outreach events were also part of a concerted effort to sensitize and raise awareness among parents, communities and local authorities in support of ASRH information and services. Local level advocacy events, youth camps and seminars gave young people a voice on SRH issues for the first time in the country. Radio programmes and Youth Centre based activities also drew young people into the RHIYA programme. More than 15,000 young people benefited directly from RHIYA by participating in project activities.
Clinical services u nder the RHIYA were less comprehensive with only one key service delivery point, the Vientiane Youth Centre Clinic and a Vientiane-based Referral and Counseling Network.
Key Achievements
Comparisons of the RHIYA Lao Baseline and Endline surveys showed that the programme had strongly positive effects on young people’s sexual and reproductive health knowledge and behaviour: almost all the indicators increased significantly. The changes were especially large among the most vulnerable groups (less-educated, poor and rural young people), confirming that RHIYA has contributed to greater equality across socio-economic groups in the project areas. Awareness of STIs increased by over 40% in rural areas and averaged 75% overall. Condom use also increased by 20%, mainly by young unmarried men. Among those who participated in RHIYA project activities, better knowledge and safer sexual be haviour was even more evident.
RHIYA Lao also made an important contribution to the variety and quality of IEC materials in the country to address ASRH. Under the coordination of the UPSUs, a Peer Educators Toolkit was developed to provide accurate information on a variety of topics, in an engaging and participatory way. Booklets on physical changes during adolescence, along with STI and Abortion leaflets completed the IEC package which was broad enough to target both urban sex workers and rural youth. This became an integral part of the training for over XXX Peer educators.
Achievements in providing quality training and support for peer educators have been documented in Peer Education, A Review of Stakeholders Experience. In addition, a case study entitled Just for Young People – Establishing the First Youth Centre in Laos highlights the development of the Vientiane Youth Centre to become a viable local organisation with a wealth of programme experience in delivering sexual and reproductive health information and services to young people in the country.
The Way Forward
The RHIYA together with UNFPA in Lao PDR provided inputs into recent national policy ame ndments which raised the commitment to ASRH. However the RHIYA commissioned ASRH Study highlights t hat national capacity to incorporate ARSH into structures and mec hanisms will not be in place until substantial restructuring of the health sector is completed. International NGOs therefore still have an important role to play in provision of services for young people. The government has committed to setting up a Cross-sectoral Technical Working Group to assess youth frie ndly models for clinical services including those established u nder the RHIYA programme. This will result in a recomme nded ASRH strategy by 2008.
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| PROFILE |
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History / Culture: Lao PDR (People’s Democratic Republic) was established in 1975, following decades of civil war. The main religious trends are Buddhist (60%) and animism. There are various different ethnic groups.
Geography: The country is landlocked – wedged between Myanmar, China, Vietnam, Cambodia and Thailand – and mountainous, with limited agricultural land, and poor transport and communication links. The Mekong River forms the boundary with Burma and Thailand.
Population / Demography: Laos has is inhabited by 5.9 million people, with a population Growth rate of appreciatively 2;4% per year, and a population density of 23.3 people per square kilometer. The country’s high population growth rate results from continued high fertility and declining mortality rates. With a total fertility rate of nearly 5 children per woman, Lao PDR adds about 112,000 people to its population base every year. Though 80% of the population resides in rural areas, the country is rapidly urbanizing: its cities and towns are growing by 4.6% per year, the second highest rate in Southeast Asia.
Economy / Productivity: Nearly 30% of the population (1.7 million) lives below the poverty line. The UNDP Human Development Report ranks Laos as one of the least developed countries in Southeast Asia. The GDP per Capita is $427. There are growing gaps in wealth, economic opportunities and access to basic social services among people living in different region and ethnic groups, with a widening gulf between rural and urban areas.
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| BACKGROUND |
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Characteristics of Youth and Adolescent Population: Lao PDR has a young population with 62% aged less than 24 years, and 20% of the population aged 15-24 years. Although females are more numerous than males in Lao, there is a slight lack of gender equality. It is found acceptable for a fifth of young people that women have no equality of freedom with men. While older people remain conservative, thinking that it is acceptable that males have premarital and extramarital sex and that women should be faithful and respect traditions, youngsters seem to accept social equality rights between males and females.
Education / Socio-economic Development: The literacy level among people aged 15 - 24 is approximately 65/70%, but 60% of the country's illiterate population are female (UNFPA). Enrolment in the secondary level is much lower than in the primary level and numbers of tertiary schools are rather small. Lao being one of the poorest countries in the world according to the 2004 UNDP Development Index (135th out of 177 countries), this trend is not expected to change in a close future (UNESCO). Because of poverty, some women are becoming sex-workers at night besides their normal job to earn more money. “Beer bars” and hotels are well known for this type of activity. The majority of sex workers is illiterate and come from rural areas (UNESCO).
Health and Knowledge on Sexuality and Reproductive Health: There have been few studies into the cultural context of SRH in Laos. There is a critical need for reproductive health services: As of 2000, 40% of married women wanted to limit their fertility but lacked access to appropriate information, services and contraceptives. Only recently has the country begun addressing adolescent health. Average desired family size is 4.2 live births. The maternal mortality rate is the highest in the region, more than 470 mothers in 100,000 die during childbirth; in the remoter areas of the provinces in the south, the figure can be more than 700 deaths. Infant mortality is also high at 93 per 1,000 live births. Data on abortion is not readily available in the Lao PDR. Abortion is illegal but anecdotal evidence suggests that many induced abortions are nevertheless performed clandestinely, often under unhygienic and unsafe conditions.
Traditional Values and Attitude / Marriage: Improving adolescent reproductive health in the Lao PDR presents both challenges and opportunities. The major risk factors for adverse reproductive health status among adolescents result from: cultural practices that promote early marriage and pregnancy; high risk sexual behavior that appears more common than is acknowledged by the community and service providers; women's low social status in comparison to men and, particularly among ethnic minorities; Girls are expected to guard their virginity and adolescents' lack of access to essential RH information and services. Cultural norms prevent parents talking to their children about SRH.
Actions: In 1999, the Lao PDR Government approved the National Population and Development Policy, which is a comprehensive document in line with the ICPD Programme of Action. Most notably, it is the first time in the Lao PDR that the RH needs of adolescents and unmarried youth have been acknowledged. According to UNAIDS (June 2000) the prevalence rate of HIV/AIDS was less than 1 per cent, although this low overall figure conceals high rates in particular locations and among certain vulnerable groups. Pressing SRH concerns include unsafe abortions, unwanted pregnancies, STIs/HIV/AIDS and access to SRH services for unmarried youth. Estimates of total fertility rates in the Lao PDR vary from 4.7 live births for urban women to 7.8 for rural women and from 8.4 for uneducated women to 4.7 for educated women.
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