Nepal: the distributional impact of participatory approaches on reproductive health for disadvantaged youths
Anju Malhotra; Sanyukta Mathur; Rohini Pande; Roca, E.
Reaching the poor with health, nutrition, and population services what works, what doesn' t and why: 211-239
2005
Document Number: 266202
This chapter describes the evaluation of the Nepal Adolescent project (1998-2003), employing a quasi-experimental case-control study design to implement and test the effectiveness of a community-based, client-centered participatory approach aimed at improving the sexual and reproductive health of adolescents in rural and urban Nepal. Two study sites, one rural and one urban, were each selected for the study and the control .The intervention studies ranged from 12-24 months and the first set of interventions began in November 2000, the last set ended in March 2003. Cross-sectional quantitative household and adolescent survey data was collected at baseline and endline as well as relevant qualitative and participatory data, sampling 965 households at baseline and 1003 households at endline. The age range at baseline was 14-21 years, at endline it was 18-25 years with the study design allowing cohort tracking but not tracking of specific individuals. The relationship of various disadvantage measures (household wealth, education, ethnicity, residence) and three dependent variables (receiving prenatal care or using institutional delivery for married young women and knowledge of at least two modes of HIV transmission for both sexes) was compared using multivariate analysis. The results showed that the participatory approach was more successful than non-participatory. A limitation to the study is that no single variable captures disadvantage completely: wealth, residence, education, caste and gender are all important measures of disadvantage in Nepal. Another limitation was that access to health services was a factor in site selection for the study.The results suggest that empowerment and accountability issues, which are considered essential for improving the health of the poor, can be operationalized at multiple levels The participatory approach strengthened the power of the youth in this study to negotiate appropriate, accessible and accurate information and services from providers and policymakers and in turn improved the accountability of the providers. In addition, the study highlights the need for broader definitions of disadvantage.