Lauren VanEnk Institute for Reproductive Health Georgetown University B ECOMING C YCLE S MART ™ An innovative tool to increase fertility awareness & puberty knowledge among very young adolescents

Adolescents often enter puberty with little knowledge of their changing bodies… “I was surprised by bleeding from my genitals, I did not know what it was when it first occurred... a teacher took me in a room that was next to my classroom and explained what was happening to me.” Adolescent girl, Rwanda “ When a boy develops facial acne, it means he has too much sperm which does not come out of the body and would otherwise be harmful for the body.” Adolescent boy, Rwanda

If only I knew then what I know now

10-14 years is a time of critical development for adolescents. Sexual and gender identities are formed at this age. Yet little progress has been made to develop programs for very young adolescents (VYA) related to adolescent sexual and reproductive health. Why Very Young Adolescents and Sexual & Reproductive Health?

Looking back... CycleBeads®: Tool used with the Standard Days Method® that represents the days in a woman’s menstrual cycle CycleBeads has been used in the U.S. and Africa to teach young people about puberty Yet, no guidance or tools on how to use CycleBeads effectively for this purpose My Changing Body: Curriculum that addresses gaps in life skills materials used in youth programs

CycleSmart ™ Kit CYCLEBEADS ®

CycleSmart Kit Includes CycleBeads and a simple, factual brochure about puberty and fertility. It can also include sanitary pads, a diary, a calendar, and information on how to contact local health providers Designed to help young people, ages 10 to 14, develop an awareness of their emerging fertility and make decisions which promote their health Helps parents, teachers, health providers, peer-educators and others talk to young girls and boys about their changing bodies and how to stay healthy and safe

Provides tips and resources on how to use the CycleSmart Kit to teach boys and girls about puberty and fertility Targeted toward youth- focused organizations, parents, educators, health providers, religious leaders and others Intended to be user-friendly and practical CycleSmart Kit Programmatic Guidelines

Phase I: Developed CycleSmart brochure Phase II: Refined CycleSmart brochure Phase III: Tested Brochure + Pads as CycleSmart Kit Product Development Key Informant Interviews Desk Review FGDs with boys and girls (ages ) 6 weeks of field- testing by VYA girls FGDs with VYA boys and girls (ages ) FGD with parents of VYAs 5 weeks of field- testing by 4 youth- serving organizations in 10 sites (urban and rural)

Community Dialogue MicroEnterprise Peer Education

Girls’ Perspectives “Since the time I used the CB, when the ring of my CB crosses the dark brown bead, I take my pads with me (in my bag) because I know my menses are approaching.” VYA girl from Rwamagana “My mum used to ask me every day if I had moved the ring or if I had filled the diary, so I enjoyed it because she was closer to me and more concerned.” VYA girl from Kicukiro

Parent Perspectives “Often we don’t know where to start in terms of talking to our kids about puberty so we just turn them away when they ask us about it. Thanks for this. The children have been more open about discussing and asking questions about their SRH. It’s important that children learn early about puberty changes.” Mother from Rwamagana

Boys’ Perspectives “Using [the CycleSmart Kit] to discuss puberty changes with parents or teachers will make us confident to discuss such things with any person.” VYA boy from Rwamagana “Although the brochure is mostly about girls, it’s important for boys to have this information because it helps us understand what girls are experiencing and to not tease them about it.” VYA boy from Nyabihu

p <0.01 Objectives: Measure changes in knowledge and identify areas of brochure that need strengthening Mean knowledge indices at baseline and endline CycleSmart Evaluation

Helped girls understand changes during their menstrual cycle, including natural secretions and menses Girls able to easily use CycleBeads to track their menstrual cycles, determine their regularity, and prepare accordingly using AfriPads. Appreciated by both VYAs and parents as a needed tool which filled a gap that no other tool or resource was addressing Helped facilitate important puberty discussions between VYAs and their parents, peers and friends. Generated interest among VYA boys regarding girls pubertal changes and their own. Key Findings

What’s next? CycleSmart+ CYCLEBEADS ®

Why CycleSmart+? 1. Pilot study success in Rwanda in Local implementing organizations wanted to expand with additional, effective and engaging programming for VYAs

What is CycleSmart+? A new, interactive puberty and fertility program 1. Facilitator-led curriculum ; weekly educational sessions for VYA boys and girls to teach, catalyze discussion about puberty, body changes, fertility, safety and self- care, and gender-equitable attitudes 2. Distribution of CycleSmart Kits for girls 3. Take-home activities ; encourage communication between VYAs and parents 123 Youth Education Education sessions for parents of VYAs to improve their knowledge of puberty, body changes, fertility, safety and self-care, and gender-equitable attitudes, and their ability to discuss such topics with their children Parent Education Promote an enabling environment for discussion of VYA development, safety and equity Community Sensitizations

CycleSmart+ Package Facilitator Manual Provides guidance for youth facilitators on program introduction, icebreakers, and VYA educational activities CycleSmart Kit Provides information on male and female fertility, menstruation, use of CycleBeads, safety and communication with trusted adults Puberty Storybook Adapted from the GREAT Project storybooks, these engaging and culturally relevant stories follow a boy and girl experiencing puberty, and the adults and friends who support them Interactive Game Also adapted from the GREAT Project, this interactive game provides a fun outlet for VYAs to test their knowledge and continue learning

Partners & Sites OrganizationsDistricts Young Women’s Christian Association 1. Muhanga 2. Nyaruguru 3. Kamonyi 4. Nyabihu 5. Rubavu 6. Kayonza Hope Foundation 1. Ruhango 2. Musanze 3. Burera 4. Gicumbi Guides Association Of Rwana 1. Gakenke 2. Karongi 3. Bugesera 4. Rwamagana 5. Kicukiro

Thank You

Next Session Room Numbers: Please fill out an evaluation by going to this session’s page on your mobile app OR by filling out a paper evaluation in the back of the room. Thank you! Integration of Family Planning Services into MNCH Programming in Liberia301 The Realities of Integration: NCDs and TB in Ethiopia (Continued)302 Integrating Family Planning with Obstetric Fistula Services: Achieving Reproductive Intentions307 Operational Research Training in the 21st Century308 Constant Contact: Reinforcing Provider Training with Mobile Messages and Supervision in Ghana (Continued)310 Indoor Residual Spraying: A Weapon in the Fight Against Malaria311 Increasing District Level, Evidence-Based Decision Making in Cote d'Ivoire405 Making Every Life Count: Strengthening Civil Registration-Vital Statistics Systems407 How Strengthening Medicines Regulatory Authorities Can Increase Access to Medicines (Continued)413 Child TB: No More Crying, No More Dying?414 Creating the Next Condom: TPPs for Next Generation MPTsBetts Theatre Sustainable Health Gain from Smart Governance of Hospitals and Health Systems Continental Ballroom Gender, Medicines, and the Road to Equity #AreWeThereYet? Grand Ballroom