Making reproductive rights real, Zambia

© 2004 International HIV/AIDS Alliance

In Zambia, HIV prevalence is over 15% and rates among young women are up to four times higher than among men. At puberty, girls in the Eastern Province of Zambia are traditionally guided by alangazi, initiation advisers who train them to be ‘good wives’, which includes how to please their husbands sexually and submit to their wishes. Girls who do not learn these lessons can often face physical abuse. This process ends in a stressful public ceremony that requires them to demonstrate what they have learned through dance.

Initiation was just one of the many issues about gender, sexuality and reproductive health identified during a community assessment in 55 sites in six districts. The assessment was the first step in a programme – supported by the Alliance and run by the Planned Parenthood Association of Zambia and the Ministries of Health and Education – that particularly focuses on 10- to 24-year-olds of both sexes.

The assessment involved young people and adult community members who have an influence on young people’s lives. It used lively interactive methods to break down barriers between generations, identify the underlying causes of sexual and reproductive health problems (including helpful and harmful cultural practices) and plan next steps to empower young people, improve services and change the environment.

The assessment led to action on several fronts. Firstly, community reproductive health workers, linked to government clinics, are providing training in sexuality and lifeskills covering issues such as self-esteem, communication skills and rights. They are also providing training in services such as family planning advice, condom supplies, referral for treatment of sexually transmitted infections and voluntary counselling and testing for HIV. The programme also trains young peer educators and works with alangazi – building on their respected position in the community. It supports them to develop their teachings and replace public ceremonies with quiet, supportive discussions with girls about issues such as hygiene, sexual feelings, rights and assertiveness.

In 12 schools in one district, the programme also focuses on sexuality and life-skills education among 10- to 15-year olds. The work started with teacher training, enabling teachers to examine their own sexuality, gender and reproductive health issues. This was followed by a pupils’ needs assessment. Pupils’ books and teachers’ guides were assessed and developed, inspired by issues raised by the pupils. Pupils can contribute their anonymous questions and stories through ideas boxes, which often highlight taboo subjects such as the power and pleasure of sexual feelings and the sexual abuse of boys by older women.

The programme is promoting a ‘whole school site’ approach, which aims to create a safe environment for pupils and teachers by involving the extended school ‘family’, such as the Parent-Teachers’ Association and traditional leaders. By the end of 2004, the programme trained 307 reproductive health workers and peer educators (who facilitated sessions with 80,000 young people), 200 alangazi (who reached 2,000 girls) and 55 teachers (who taught 3,000 pupils).

However, its real results were seen in the changes brought to people’s lives. These included teachers reporting improved sex lives with their partners and better communication with their children, and community members reporting lower rates of early pregnancy, marriage and sexually transmitted infections, and reduced cases of rape. Most importantly, greater understanding, confidence and skills about sexual and reproductive matters and rights has brought benefits for boys and girls themselves.

As community members and young people put it: “Young people are now recognising their rights and making more demands for information and services. If they don’t wish to abstain from sex they have a right to condoms.” “More boys and girls recognise their rights to refuse sex, enjoy their feelings without intercourse or insist on condom use.” “Girls and sometimes boys in school are increasingly reporting sexual harassment and refusing unwanted sexual proposals … More are now able to say no assertively.”