Series J, Number 54
Family Planning Programs

CONTENTS

Home (Key Points)

Bleeding Changes Affect Contraceptive Choice and Use

Counseling and Treatment Can Help

Box: Contraception and Bleeding Changes: What Are the Facts?

Box: Would More Women Use a Family Planning Method That Stops Monthly Bleeding?

What Shapes Women's Attitudes About Bleeding Changes?

Box: Better Understanding Menstruation Helps Girls and Women
Web Table 1. Knowledge of Fertile Time is Poor Among Women and Men of Reproductive Age

Spotlight: Nepal's A GIFT for RH Project Teaches Girls, Changes Attitudes

Bibliography

Coming Soon: Family Planning: A Global Handbook for Providers

Credits

• Provider Guide: Managing Bleeding Changes Caused by Contraceptive Methods
• Counseling Aid: Typical Bleeding Patterns With Selected Contraceptive Methods

• Table: Discontinuation of Contraceptive Methods Due to Bleeding Changes Varies in Clinical Trials
• Box: Hormonal Contraception Relieves Some Reproductive Conditions

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See companion INFO Reports, "Key Facts About the Menstrual Cycle"
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Nepal's A GIFT for RH Project Teaches Girls, Changes Attitudes

In Nepal the project Adolescent Girls Initiate for Their Reproductive Health, known as A GIFT for RH, improved girls' knowledge of menstruation and puberty and increased discussions between girls and their families on reproductive health issues. The project was implemented by the Centre for Development and Population Activities (CEDPA) along with local nongovernmental partners.

The project taught a nine-month education course about reproductive health to illiterate girls ages 10 to 19 who lived in remote regions and had never attended school. Classes were held in available community spaces such as community centers and health posts. Nearly 1,000 girls participated. The program taught girls about the changes that occur to their bodies during adolescence, including menstruation, and also provided literacy training with reproductive health materials.

After completing the course, the girls, sometimes with their mothers, participated in monthly discussion groups for one year. These discussion groups focused on preparing adolescent girls to talk with their families about reproductive health and on making and acting on informed decisions about their reproductive health and marriage.

An evaluation between March 2003 and June 2004 found that:

• Girls' knowledge improved. The percentage of girls who knew that menstruation is a physical change of puberty increased from 19% before the health education program to 70% after among girls ages 10 to 14 and from 57% to 83% among girls 15 to 19. The percentage of girls who could not correctly identify any physical changes that occur during puberty dropped from 60% to 4% among 10- to 14-year olds and from 27% to less than 1% among 15- to 19-year olds. The percentage of girls who did not know why menstruation occurs dropped from 78% to 22%. Among girls who had started menstruating by the time of the evaluation, the percentage who had learned about menstruation beforehand increased from 45% to 73%.
• Girls talked more with their mothers. As a result of the project, women and girls talked more about menstruation. Over 99% of girls were willing to discuss menstruation and other reproductive health matters with parents and others after the program, compared with 54% before.
  Also, as before the project, mothers, friends, and sisters, in that order, continued to be the main sources of information about menstruation for adolescent girls. After the program, however, the percentage of girls naming their mothers as a source of information had risen from 61% to 72%; friends, from 26% to 49%; and sisters, from 22% to 44%. More than one-fourth of the girls said that they learned about menstruation from the project leaders.
• Parental attitudes improved. In focus-group discussions after the project ended, parents recognized that their daughters had learned more about reproductive health. One father commented, "Girls of this community have gained a lot of information about reproductive health such as maintaining proper hygiene during menstruation, taking care during pregnancy, and going to health post during illness."
• In some areas, girls were no longer segregated. Focus-group discussions after the program also revealed that some adolescent girls in the Baglung district reported that they were no longer segregated by their families during monthly bleeding. It is a common practice in some parts of Nepal for girls to be isolated while menstruating and forced to sleep in the cattle shed for many days each month. Girls who have participated in CEDPA programs are currently advocating lessening these taboos in their community.

Building on the success of A GIFT for RH project, in 2004 CEDPA and its partners launched the Building Demand for Reproductive Health (BuD for RH) project among adolescents in conflict-affected districts of Nepal. In addition to reaching adolescent girls not enrolled in school, the BuD for RH project reached girls and boys enrolled in school. More than 3,000 adolescents participated. Before and after evaluation found that the project successfully improved adolescents' knowledge, attitudes, and behaviors on reproductive health, including puberty. Additional analysis is underway to explore girls' concerns about menstrual taboos in their communities.

For more information on these programs, contact CEDPA at 1133 21st Street, NW, Suite 800, Washington, DC 20036, USA
Tel: +1–202–939–2604; Fax: +1–202–332–4496;
E-mail: info@cedpa.org;
Web site: http://www.cedpa.org/section/wherewework/nepal

Sources: CEDPA 2002 (25), 2004 (26), and 2006 (27)