Parallel 7 - Oral Session 4 (061 – 064)

Background/Objectives
Menstrual Health (MH) is an integral part of sexual and reproductive health and rights (SRHR). Recent findings from LMICs suggest that < 50% of women reported having everything needed to manage their periods. This has spurred interest in demonstrating MH's importance as determinant of SRHR, especially relating to biological/sociocultural barriers experienced by girls. In addition, "contraceptive-induced menstrual bleeding changes" and its influences on non-use, discontinuation, and resultant anxieties about the effects of contraceptives has led to a missed opportunity in meeting adolescent needs for SRHR.
Materials
The USAID/YPE4AH project piloted integration of MH into its existing FP program for adolescents 15-19 years in urban slums in Lagos and Kano, starting March 2022. Program approach (including GBV/Substance Abuse) was pivoted to deploy channels reaching adolescents with MH services/products, while providing SRH services within safe spaces, and through community events. Menstrual pads were donated by USAID through Kimberly Clark Corporation. Evidence is provided through routine and qualitative data from beneficiaries. 
Results
From March-September 2022, the project has distributed 10,808 menstrual-pads to 2,263 girls. This has also coincided with >150 percent increase in adolescents being available for FP counselling and those that took FP methods between October-March 2022 (2,220; 1,166) and April-August 2022 (5,713; 2,964). Qualitative findings also revealed the improved well-being and positive change of outlook of adolescent girls towards life, especially in Kano state.
Conclusion
While attribution may be a challenge, integrating MH into existing adolescent program increases the ability of young girls to have all their needs met, improves agency, autonomy, and rights. These early years of menstruation present an opportunity to introduce RH knowledge early and provide a safe route to FP uptake (especially in Kano). Thus, signifying an opportunity for future programming that aim to provide a youth-responsive health system that offer integrated SRHR services.

Background
Modern contraception use, and total fertility rates are concerning in Bauchi (6.5%,  and 7.2), Kebbi (3.5%, and 6.5) and Sokoto (2.3%, and 7.0) [source:NDHS 2018]. The maldistribution of skilled healthcare workers and traditional offsite training negatively affect access to quality family planning (FP) services. 
The USAID-funded Integrated Health Program (IHP) implemented and evaluated the Low-Dose High-Frequency (LDHF) onsite training at primary healthcare facilities in Bauchi, Kebbi, and Sokoto to strengthen clinical competencies of frontline healthcare workers teams in FP. 
Methodology
Between January and December 2021, IHP worked with state governments/stakeholders to develop modular training packages, standardize training methodology , and rapidly scale-up high-impact FP practices in 792 public facilities across the states. IHP provided grants to local organizations to conduct training in three LGA cycles. With 17 days per facility, trainers delivered modules in 3- to 4-hour increments. IHP provided equipment, job aids, and anatomical models for continued practice with peer-learning coordinators. 
Results
IHP trained 4,474 primary healthcare workers on FP services at one PHC per ward. Knowledge and skills scores pre-training were 51 percent and 46 percent respectively and both reached 92 percent post-training. In 2021 following training, healthcare workers provided 346,858 doses of injectable contraceptives, 14,376 IUD insertions, and 165,530 implants. Monthly CYPs doubled from 26,777 at training onset in January 2021 to 52,617 in December 2021. This generated 301,789 CYPs, prevented 135,963 unintended pregnancies, and averted 791 maternal deaths.
Conclusion
IHP demonstrated how LDHF training delivered at scale can significantly improve the competence and confidence for improved availability, accessibility, and utilization of quality FP services at the primary healthcare level. Local organizations enabled IHP to train thousands of healthcare workers and reach all wards and LGAs in the states. 

By: Nwangwu Eudora Ogechukwu


In Nigeria, there is a high level of social injustice and violations of the fundamental human rights of vulnerable groups, especially women.[1] Women, in general, are disproportionately affected by poverty, HIV and AIDS, gender-based violence; sexual and reproductive rights abuses and limited access to information and basic health and legal services[2]. Adolescent's girls and young women (AGYW) face double stigma of being a woman and dealing with age of consent too. With the effect of Covid-19, many adolescents and young women experience sexual violence, there is high rate of teenage pregnancy which is as a result of no access to information around contraceptives and family planning. This issue has led to death as most of these young girls' resort to quack nurses for unsafe abortion.
Silent voices conducted a focus group discussion across the 6 geopolitical zones, we realize that 75% of adolescents and young girls have no knowledge about mensural cycle, 10% have the basic idea. We recommended an innovative way of teaching AGYW on how to count their mensural cycle using colorful beads.
BEADING OUR FUTURE (BOF) was born out of passion to teach AGYW how to count mensural cycle using colorful beads, so far, due to limited resources, we are able to coach 10 AGYW on how to bead their future, and these young women will serve as influencers in their respective communities. There is a need to extend this knowledge down to AGWY in rural areas no help keep our young women safe.
[1]British Council Nigeria. Gender in Nigeria Report 2012: Improving the Lives of Girls and Women in Nigeria. 2012. Available from http://www.dfid.gov.uk/What-we-do/Publications/?c=NG. Accessed on March 3, 2013
[2] US Department of State Nigeria Country Report on Human Rights Practices 2011. Available from http://www.state.gov/j/drl/rls/hrrpt/humanrightsreport/index.htm#wrapper. Accessed on March 3, 2013.