Publications

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Communication Impact! 12

Nicaraguan Youth Begin To Play It Safe (November 2001)

"Together we decide when"... when to have sex, when to get married, when to have a child. Nicaraguan youth have begun talking among themselves about these issues since a behavior change communication program by the same name, "Juntos Decidimos Cuando" began in 1997. They also are beginning to heed the advice "always be safe; don't have sex without a condom," based on increased sales of condoms and sites selling them.

In an effort to create a united front among public and private agencies working in and promoting reproductive health, the Nicaraguan Interagency Commission for Reproductive Health was formed in 1995. Because Nicaragua has one of the highest rates of teenage pregnancy in Latin America (Demographic Health Survey [DHS], 1992-93), the Commission focused on informing Nicaraguans, especially those aged 15-24, about reproductive health issues and promoting responsible behavior. In collaboration with the Commission and with funding from the United States Agency for International Development (USAID), in June 1997, Johns Hopkins Population Communication Services (JHU/ PCS) helped design and implement "Together We Decide When," the first national campaign focusing on reproductive health for Nicaraguan youth. The objective of the campaign was to reduce unwanted adolescent pregnancies by increasing knowledge about reproductive health and promoting child spacing and postponing the first sexual encounter.

Youth committees, an integral component of the program, were responsible for mobilizing more than 20,000 young people to launch the campaign and to work at the grassroots level in towns and cities throughout Nicaragua. Through mini-grants, youth committees were able to conduct activities including singing contests, dances, music, and street theater presentations, while local health organizations provided reproductive health information and counseling at the events. These activities anchored the program and its messages in the communities with a direct link to their local health organizations. In a festive atmosphere, Nicaraguan youth heard messages emphasizing the importance of being responsible and sharing decisions about matters of sexuality and relationships. The first phase of the campaign ran from June 1997 to February 1998. Public and private health clinics used the campaign's symbol (stick figure couple at left) to identify information and services for youth.

In addition to active community participation, mass media was used to implement Phase I. Radio and TV broadcast campaign spots, and popular musicians produced two songs. Print materials developed and disseminated included press releases, posters, brochures, and intercity bus advertising. Youth mobilization activities continued at a lower intensity in various towns after radio and TV spots went off the air.

Phase II of the "Juntos Decidimos Cuando" campaign took place between March and August 2000. This phase continued to focus on reducing unwanted pregnancies and early fertility but also highlighted the prevention of STDs and HIV/ AIDS. A major component of Phase II was promoting the BodyGuard condom (marketed by PRO-FAMILIA, an IPPF affiliate) with a dual protection message: "BodyGuard can protect against both unwanted pregnancies and STDs/ HIV/ AIDS." This dual protection message was disseminated through TV and radio spots and print materials. Condoms were made available to youth in non-traditional outlets such as bars, discos, and gas stations. Along with the dual protection message, Phase II provided information about HIV/ AIDS and its prevention, when a woman can become pregnant, and negotiation skills between sexual partners.

Impact

To measure impact of the campaign, JHU/ PCS included questions in the 1998 Nicaraguan DHS. The DHS revealed that more than 70 percent of men and women 15- 24 years of age (the intended audience) had seen the logo or heard the slogan, "Together we decide when." Seventy-one percent of all women and 68 percent of all men who heard the slogan related it to family planning or reproductive health. When asked what the slogan meant to them, 68 percent of men 15- 24 years old and 72 percent of women the same age described it as meaning a shared decision between a couple on the number of children to have; 42 percent of men and 22 percent of women interpreted it as deciding together when to have sexual relations; and 18 percent of men and 11 percent of women interpreted it to mean deciding together when to get married.

Many men and women aged 15-24 exposed to the campaign took some action due to their exposure. The most prevalent action was talking to someone about the campaign messages, followed by preventing pregnancy (Figure 1). Other notable actions were postponing union, abstinence, waiting to have another child (child spacing), and starting a modern family planning method.

In addition to the DHS, JHU/ PCS designed a comprehensive youth survey, ENJOVEN, which was conducted from September through November 1998. Findings from the ENJOVEN survey, in which 1500 people aged 15-24 were interviewed, revealed that almost 68 percent of male respondents and 32 percent of female respondents engaged in premarital sex. Of those, only 15 percent said they had used some form of contraception the first time they had sex. Reasons given for not using contraception were unanticipated sex (39 percent), lack of knowledge that one needs to use contraception (32 percent), not considering it necessary to use any contraception and lack of knowledge about contraceptives (17 percent). For those youths using contraceptives, condoms were the preferred method (54 percent male and 56 percent female).

The survey also found that 58 percent of men aged 15-24 reported satisfaction after their first sexual encounter, while only about 9 percent of women the same age reported a similar feeling. Women reported higher levels of shame, embarrassment, and guilt than their male counterparts. Motives for the first sexual encounter were different for men and women: 61 percent of men and 18 percent of women reported curiosity and gaining experience as their motive, while 20 percent of men and 43 percent of women reported expressing love.

Overall, youth face strong peer pressure about sex, with almost three out of four males reporting encouragement by their friends to engage in sexual activity. Finally, the ENJOVEN survey revealed that although knowledge about STDs/ HIV/ AIDS in general is high among the study population, several gaps exist. For example, more than 12 percent of respondents believe that it is not possible for a healthy-looking person to have the AIDS virus, and almost 20 percent could not name a single way to avoid contracting HIV/ AIDS.

The findings from these two surveys gave useful information about the sexual attitudes and behaviors of young Nicaraguans. This guided the development of the second and third phases of the campaign. Initial results of Phase II show that more than 2 million BodyGuard condoms were sold in Nicaragua since marketing began (Table 1), and that 2500 sites that had not previously sold condoms began selling them.

Thus Phases I and II of "Juntos Decidimos Cuando" worked on both supply (condoms) and demand (behavior change). The campaign provided critical information about how to reduce unwanted pregnancies and prevent STDs/ HIV/ AIDS while making available a constant supply of condoms to respond to the demand. In October 2001, the third phase of the campaign began with messages reinforcing the dual protection of BodyGuard condoms and highlighting messages of self-efficacy, inter-couple communication, and negotiation skills.

Juntos Decidimos Cuando campaign contact:

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