Running head: FAMILY PLANNING 1

Family Planning in Ecuador

Jessica Armas, Gurdeep Mann, Lauren Kalanta,

Alexandra Santella, Hannah Smith, and Therese Valenzona

California State University, Stanislaus

Family Planning in Ecuador

FAMILY PLANNING 2

Executive Summary

The rate of unintentional pregnancy among Ecuadorian adolescent females is one of the

highest in the world (Crdova Pozo et al., 2015). The alarming pregnancy rate along with

reduced contraceptive use can be attributed to limited access to sexual education and

contraceptive materials. The proposed project, Salud Familiar, was created to address the

growing issue of teen pregnancy and unprotected sex in Ecuador. The project targets students

aged 10-17 in the San Sebastian parish of Cuenca, Ecuador. Its main goal is to reduce the

adolescent pregnancy rate through sexual education and communication workshops. There are

three objectives in this proposal: a 3% reduction of the adolescent pregnancy rate, a 15%

increase in self-reported use of contraceptives among adolescents, and a 50% increase in

reproductive knowledge. The project aims to complete these objectives by the year 2023.

Salud Familiar will utilize the support of local and international partnerships to create

relevant curricula, workshops, and training. Adolescents within the community will be trained to

implement these programs as part of Cuenca Friends of the Youth (CFY). CFY run mobile clinics

will provide computerized reproductive education and adolescent-centered medical services. The

project utilizes a two-part workshop series lasting nine months. The first part is a Healthy Living

workshop, which focuses on sexual and reproductive health (SRH) knowledge and attitudes,

gender roles, and communication between partners. The second part is a communication

workshop that increases parental involvement, offering education on how to discuss reproductive

topics with their families. After the first three months, these workshops will be combined to

create one family-oriented workshop to continue the SRH discussion.

The success of this project will be monitored using pre- and post-tests, as well as data
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collected and reported by local health agencies in San Sebastian. Evaluation, adaptation, and the

involvement of CFYs make this program sustainable beyond the pilot year. This project hopes to

create a lasting change in San Sebastians culture of sexual health and communication.

Background

In the Catholic country of Ecuador, unprotected sex and teenage pregnancy are a major

contemporary issue. According to United Nations Population Fund (UNFPA), the birth rate in

Latin America is particularly high for adolescents (Loaiza & Liang, 2013). "Latin America is the

only region in the world where births among girls under the age of 15 years are increasing and

are projected to rise through 2030" (Ivanova et al., 2016, p. 98). In Ecuador, 21% of girls will

give birth before the age of 18, one of the highest rates of adolescent pregnancy in the world

(Crdova Pozo et al., 2015). This vulnerable population faces a combination of issues, most

significantly, a lack of access to contraceptives, no formal sexual education, and gender

inequalities. Part of the reason for these issues is the countrys foundation in the traditional

Catholic faith.

The Catholic Church promotes virginity until marriage and believes that procreation is

the only purpose for sex (Jerves et al., 2014). In Latin America, these ideas are strictly adhered to

(Jerves et al., 2014). For this reason, contraceptives are not widely used or accessible for

adolescents in Ecuador. Only 30% of sexually active adolescents between the ages of 14 and 18

in this region use modern contraceptives (De Meyer et al., 2014). This religious idealism has also

had an impact on the way the country views sexual education. Due to the focus on virginity,

much of the country believes that sex education is in direct opposition with the teachings of the

church (Jerves et al., 2014). In recent years, there has been a widespread rejection of formal sex
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education programs (Jerves et al., 2014). For those adolescents who choose not to practice

abstinence until marriage, however, this way of thinking leaves them utterly unequipped.

The last of these contributing issues is a lack of respect for women and inadequate understanding

and communication between genders. In Ecuador, the cultural and religious concepts of

machismo and marianismo have led to inequalities in sexual expectations of men and women

(Goicolea, Wulff, San Sebastian, & Ohman, 2010). Men are expected to be hyper-masculine and

dominate over women, while women are expected to be submissive and bear children. Women

are held responsible for all sexual health and pregnancy, and yet are stuck in a traditional

powerless role (Goicolea et al., 2010).

There have been many attempts to rectify these issues in the past, but the most relevant

was a project called Community-Embedded Reproductive Health Care for Adolescents (CERCA)

(Decat et al., 2013). Research lasted from 2010 to 2014 in three Latin American cities: Cuenca,

Ecuador; Cochabamba, Bolivia; and Managua, Nicaragua. The objectives of CERCA included

improving communication about SRH, dissemination of accurate information, utilization of

reproductive services for adolescents, and increased use of contraceptives. CERCA was intended

to provide an initial framework for SRH interventions that were practical, community centered,

and culturally competent (Decat et al., 2013). It included outreach campaigns, sex education

workshops in schools, free text-message and Internet hotlines, adolescent-friendly

communication training for health providers, and mobile health clinics and condom

dispensaries (Nelson, Edmonds, Ballesteros, Encalada Soto, & Rodriguez, 2014, p. 191).

The action plan proposed in this paper will focus on the city of Cuenca, where a 2010

census gleaned evidence that adolescents in this region are having sex at an earlier age, and the

rates ofteen pregnancy and marriage are significantly higher (Jerves et al., 2014). It will be a
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multifaceted approach that builds upon the successes of CERCA, while adding new ideas for a

sustainable program. The following literature review evaluates the effectiveness of CERCA and

other previous studies on this issue.

Literature Review

There are numerous studies regarding adolescent SRH in Ecuador. A qualitative study on

the parental views of adolescent sexuality and sex education was conducted in Cuenca, Ecuador

(Jerves et al., 2014). Data was collected from focus groups, which consisted of Parents

Committees members from three high schools. The study found that parents became anxious

when initiating SRH conversations and stated religion set the parameters on SRH. Parents

refused to talk about contraception and emphasized abstinence, likely due to a personal lack of

formal sexual education. Women learned about menstruation, virginity, fidelity and marriage

from their mothers and men did not receive sex education from their fathers (Jerves et al., 2014,

p. 20). It was concluded that parents believed SRH should be taught in schools due to teachers

knowledge on the subject. SRH only focused on the biology of sex. The limitations of the study

included a wide age range of children, limited participation from high school parents, and

heterogeneous focus groups in terms of age and levels of education (Jerves et al., 2014).

Planned Parenthood Global created the Youth Peer Provider program, which trains peers under

age 20 to provide information about contraceptives to teenagers in Ecuador and Nicaragua

(Tebbets & Redwine, 2013). Peers were utilized due to their influence on fellow peers SRH

decisions. Peer education resulted in an increase of SRH knowledge in three months and

increased self-esteem. Youth Peers Providers are trained for several weeks before distributing

contraceptive materials. Youth Peer Providers conduct youth outreach at local schools, sports,

and community groups. During 2007 and 2011, 27,418 individuals received contraceptive
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education or materials from the Youth Peer Providers. In 2011, an additional 50,559 community

members participated in educational activities offered by the program. Outcomes include a self-

reported 22% increase in self-esteem and a 6% decrease in teenage pregnancy. The greatest

challenge of the Youth Peer Provider program was gaining rapport from community and religious

leaders. They expressed concern over the programs approach to SRH (Tebbets & Redwine,

2013).

A study about SRH communication among parents and teens was conducted by using

structured and informal interviews with CERCA participants and community members (Nelson

et al., 2014). Trust was used when discussing open-communication about SRH between

adolescents and parents. However, the different interpretations of trust among the stakeholders

hindered the goal of open SRH communication. Adolescents were unlikely to disclose their

sexual activities and preventive measures due to stigma derived from gossip and contradictions

from their families. Additionally, adolescents were reluctant in divulging about sexual activity

with their parents, since it was viewed as inappropriate and an invasion of privacy. It was

concluded that Ecuadorian culture may not foster CERCAs goal of open SRH communication

(Nelson et al., 2014).

A partial study of CERCA aimed to identify a correlation between gender equality and

sexual behavior (De Meyer et al., 2014). A cross-sectional study was conducted in 2011, and data

was gathered from adolescents between 14 and 18 years old in secondary schools in Cuenca,

Ecuador and Cochabamba, Bolivia. Results indicated that there was a positive correlation

between sexually active adolescents who value gender equality and the use of contraceptives.

Those who believed in gender equality were more likely to use contraceptives, viewed

intercourse as a positive experience, and were able to facilitate discussions about SRH with their
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partners. Furthermore, this group did not consider sexual intercourse as a necessity in romantic

relationships. Also, those who were not sexually-active and believed in gender equality viewed

sex as a positive experience. Religious adolescents participated less in sexual behaviors and

reported that sexual intercourse was necessary to maintain a romantic relationship. The non-

random sample of adolescents created a non-diverse group of adolescents, and females were

underrepresented due to surveying students at male technical schools. The study revealed deeply

rooted gender roles where men are considered dominant and women are seen as submissive and

self-sacrificing (De Meyer et al., 2014).

In 2014, CERCAs effectiveness was evaluated at a congressional convention called

Promoting Adolescent and Reproductive Health (ASRH) (Crdova Pozo et al., 2015). Data was

collected through comprehensive interviews from CERCA participants and providers. The first

key finding was that those who believed in gender equality had positive sexual experiences and

increased communication between partners. It was reiterated that improvement in open

communication about SRH between parents and adolescents is necessary. Texting and internet

resources reduced the stigma concerning adolescents, since it allowed them to get answers to

their SRH questions (Crdova Pozo et al. 2015). The study concluded there was an additional

need to expand in the community, address gender cultural norms, provide innovative techniques

including a comprehensive SRH program, and improve intervention evaluation methods.

Another evaluation of CERCA was conducted through a quasi-experimental study that consisted

of pre- and post-surveys (Ivanova et al., 2016). There was a slight improvement in condom use

and in the use of SRH services in Cuenca. This was due to CERCA bypassing the first three

stages of change, pre-contemplation, contemplation, and preparation, which are crucial in

implementing change. Therefore, a resistance regarding SRH topics persisted. Additionally,

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CERCA was too short to successfully decrease teenage pregnancies. The CERCA team consisted

of medical professionals, who emphasized increasing accessibility to SRH services rather than

SRH education. Another barrier was parents, especially fathers, refusing to participate in school

and community CERCA activities. Participants also mentioned that they were unable to attend

activities, because times and locations were not disclosed. Although there were many

shortcomings, CERCA successfully partnered with 26 non-governmental and governmental

organizations and had a wide range of participants. Workshops, social media, and telephone

hotlines were effective, since it facilitated immediate responses and open discussions about SRH.

Health fairs and sporting events were useful, since it included participants who were not actively

involved in the educational workshops. Consortium management believed that CERCA was a

good initiation in family planning and reproductive topics, since it opened an avenue for

increased SRH communication (Ivanova et al., 2016). The findings from these articles will assist

the creation of a more effective SRH intervention based program in Cuenca, Ecuador.

Logic Model

Salud Familiar is a program initiative based out of Cuenca, Ecuador that was developed

through the use of a logic model. The logic model displays the program outputs designed to

change the knowledge, attitudes, and practices of the participating students and their families.

The target population of Salud Familiar are students aged 10 to 17 from San Sebastian parish in

Cuenca, Ecuador. The program aims to reduce the adolescent pregnancy rate in the parish

community. The change will be implemented through sexual education and communication

workshops embedded within family events such as movie nights. An increase in knowledge will

be used as the primary tool in changing contraceptive attitudes and practices. The additional
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activities and outputs required to enable this change in the community, along with further effects,

are outlined in the logic model (see Appendix A).

Goals and Objectives

Adolescent birth rates in Ecuador are considered the highest in the world (Crdova Pozo

et al., 2015). The goal of Salud Familiar is to reduce pregnancy rates among adolescents in the

San Sebastian parish of Cuenca, Ecuador. The goal will be realized through three objectives

based on research and the work by other agencies to reduce the current pregnancy rate among

adolescents. The first objective is to reduce the adolescent pregnancy rate within the parish from

the national estimate of 8.2% to 5.2% by 2023 (Salazar et al., 2015). Reducing the pregnancy

rate would directly reduce the birth rate among adolescents. The second objective is to increase

the self-reported use of contraceptives among adolescents by 15% from the initial findings by

2023. In addition to preventing pregnancy and sexually transmitted infections (STIs), there is a

positive correlation between contraceptive use and gender equality (De Meyer et al., 2014).

When female adolescents report feeling equal to their male counterparts, they report improved

self-esteem and assertiveness in their relationships leading to an increase in contraceptive use.

The final objective is to improve SRH knowledge by 50% by 2023, which will be measured

through pre- and post- knowledge assessments. An increase in SRH education will allow

participants to make conscious reproductive decisions.

Technical Approach

The Salud Familiar project will change knowledge, attitudes, and practices by

implementing programs and activities to accomplish its three objectives. The projects objectives

can be achieved by forming partnerships with community members, local institutions, and

international agencies currently working in Ecuador. Local partnerships will help to delineate the
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problem, increasing the relevance of the programs and activities created by the Salud Familiar

project. International agencies will provide access to pre-existing partnerships within Ecuador,

resources and materials, and lessons from previous programs. Support from local and

international partnerships will help implement a culturally relevant SRH curricula, create

workshops to promote SRH behavioral changes, and train youth and adults as future facilitators.

Salud Familiar will enhance communication through media and technology to support mobile

clinics, focusing on computerized SRH education and access to adolescent-friendly medical

services. These collaborative partnerships and program activities will have a synergistic effect

that will reduce the adolescent pregnancy rate.

Local and International Partnerships

Local and international partnerships are crucial in developing and implementing a

sustainable program. The preparatory period for contracting the necessary personnel will be

completed one year prior to beginning Salud Familiar. CERCA established a network of agencies

for SRH at local, state, and national levels (European Union, 2016). The major local institutions

included the Universidad de Cuenca, Ministry of Public Health of Ecuador, and the Centro

Medico de Orientacion y Planificacion Familiar (CEMOPLAF). These organizations will help

build relationships with local healthcare agencies within the parish. Local medical staff and

Salud Familiar personnel will work within the parish to implement and improve proposed

programs and activities.

To be effective and relevant, a partnership between local religious leaders within the San

Sebastian parish and Salud Familiar must be formed. Association with local partnerships

mentioned above will substantiate Salud Familiars purpose before a partnership is attempted

with local churches. The project will form partnerships with churches by engaging in meetings
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with religious leaders in the first three months of implementation. The conversations will

emphasize necessary immediate solutions to address high-risk pregnancies caused by the Zika

Virus in the female adolescent population (WHO, 2016). Research has revealed a correlation

between infants with microcephaly and the Zika Virus (WHO, 2016). This compelling reality

will help to create a collaborative coalition that focuses on protecting adolescent females in the

parish.

Upon approval from church authorities, churches will become a valuable asset with

church buildings to serve as workshop and mobile clinic sites. Input from local priests will be

encouraged to create community collaboration, thus, increasing the repute of workshops and

mobile clinics. Salud Familiar does not need the permission, in a legislative sense, of local

religious leaders to begin the project. However, it is a priority to establish a working relationship

with local religious leaders, because literature suggests their value and influence in the

community.

International partners will help to provide the tangibles for Salud Familiar. Salud Familiar

will be partnered with Advocates for Youth to acquire SRH movies that will be played during

family workshops. The Centers for Disease Control and Prevention (CDC) requires that

credentials be attained before Cudate! is used within the parish (CDC, n.d.). SRH research

from the World Health Organization (WHO) will be utilized for its expansive knowledge base to

provide effective SRH education in mobile clinics and workshops. Planned Parenthood Global

will garnish resources and contraceptive products that will be provided by mobile clinics. Seattle

and King County Public Health Department will initially teach program implementers about the

Family Life and Sexual Health (FLASH) curriculum. Local personnel such as community

medical professionals, teachers and administrative staff, religious leaders, and CFYs will serve as
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proponents and instructors of the FLASH curriculum within workshops. These local and

international partnerships will allow Salud Familiar to be prepared from a logistical standpoint

and gain momentum within the first year of implementation. The project will empower local

assets to utilize international resources to attain the projects goal.

Infrastructure of the Salud Familiar Project

The infrastructure of the project will be based on what other international agencies have

done and are currently doing in Ecuador to address adolescent pregnancy. International

partnerships will be formed with the International Centre of Reproductive Health of the Ghent

University and Lithuanian Society of Health Sciences Department of Family Medicine (Decat,

Orozco, Cordova, & Vega, 2014). These two partners possess the personnel to replicate the staff

of experts necessary for the Salud Familiar project. Experts will provide knowledge and

experience for health research in Latin America and adolescent SRH (Decat et al., 2014). The

experts working in Ecuador will be consulted for feedback to improve the project. These experts

will help Salud Familiar become effective in reducing the adolescent pregnancy rate within the

San Sebastian parish.

Generating Involvement

CFY will be created to achieve the goal and sustainability of Salud Familiar in San

Sebastian. CFYs will enhance the communication between adolescent clients and medical staff.

The project will use the Youth Peer Provider program created by Planned Parenthood Global to

train CFYs as community health workers and to provide accurate SRH education to their

respective peer groups (Planned Parenthood Global, n.d.). CFYs will be adults and adolescents

within the parish. CFYs are similar to what CERCA attempted and what the Ministry of Health is

attempting to create in Ecuador (IPPF, n.d.; Ivanova et al., 2016). By training CFYs, the project
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will decrease the intimidation associated with medical clinics within the parish (Decat et al.,

2014). The familiar environment created by CFYs will increase the level of confidentiality

within the medical clinics of the parish (Crdova Pozo et al., 2015). The presence of CFYs in

workshops, mobile clinics, and local medical clinics will create an environment that is conducive

to changing SRH knowledge, attitudes, and practices in the parish.

The presence of CFYs within mobile and local clinic settings will increase the number of

adolescents seeking contraceptive education and materials. 50 CFYs will be trained within the

first year of implementation, creating a strong peer presence. Recruitment will be conducted by

visiting local schools and advertising employment opportunities within the community.

Subsequent efforts, after the first year, the recruitment and training of future CFYs will be based

on the demand for SRH services in the community. Once trained, CFYs will teach the FLASH

curriculum within workshops and serve as familiar faces within mobile clinics. It is expected that

CFYs will continue to expand and share their knowledge with their peers and future generations

upon completing their training.

Community Workshops

Salud Familiar will create a two-part workshop series lasting nine months. The two-part

workshop series will be Healthy Living and Communication. The Salud Familiar workshops will

be effective based on the analysis of CERCA by Ivanova et al. (2016). Workshops will use the

FLASH curriculum to improve SRH knowledge, and create incremental changes in behavior for

parents and students that will help decrease the adolescent pregnancy rate. The curriculum is

based on changes in planned behavior, relies on family involvement, and respects diverse

community values (King County, 2016). FLASH includes lesson plans about family, self-esteem,

gender roles, decision making, sexual development, reproductive systems, STIs, contraceptives
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and their application, and abstinence (King County, 2016). The curriculum will be proposed to

the administrative staff and teachers of three primary, three secondary, and three high schools in

the San Sebastian parish. Upon acceptance of the curriculum, workshops will be taught on school

grounds as an extension of current health education courses, and parent-student workshops will

be conducted in churches within the parish.

Salud Familiar will differ from CERCA by increasing parental involvement. This will be

accomplished by conducting communication workshops for parents that teach and encourage

SRH discussions within their families. The Healthy Living workshops will focus on SRH

knowledge and attitudes, gender roles, and communication between partners. Healthy Living and

Communication classes will be provided to parents and students individually at first. This will

allow parents and students to examine where they stand on SRH issues without feeling pressured

by social norms. The two workshops will be combined after three months to form a family

framework and will continue to build on SRH knowledge and attitudes. Multiple workshops of

30 people will be run simultaneously to accommodate for a large number of families. Workshops

will be conducted on the first Saturday of every month from 4:00 p.m. to 8:00 p.m. Citizens of

the parish will be notified by advertising workshop events at workplaces, schools, and sporting

events. Discussion and teaching will be conducted for the first three hours. Dinner will be served

to the families and movies will be played for the final hour of the workshops.

Media, Technology, and Mobile Clinics

Within the CERCA project, the use of media, technology, and mobile clinics proved

effective (Ivanova et al., 2016). Salud Familiar will utilize these concepts to reduce the

adolescent pregnancy rate, increase self-reported usage of contraceptives, and improve

reproductive knowledge in the parish. Social media sites, such as Facebook and Twitter, will be
FAMILY PLANNING 15

used to provide immediate information to questions and establish continuous communication

between Salud Familiar and the community. The use of media allows for communication that

may not have occurred otherwise. In a similar approach, 507 questions regarding culturally

specific SRH issues that were asked via text messages in 18 months (Crdova Pozo et al., 2015).

Mobile clinics will use the After School software application, which is geared toward

adolescents to ask questions and make confessions anonymously in a non-judgmental and

humorous manner. Transparent dialog will aid in measuring the incidences of self-reported

contraceptive use and in understanding beliefs and practices; thus, forming future interventions.

The CFY managed mobile clinics will promote safe-sex practices and provide SRH information

via computers. The mobile clinics will provide STI testing and contraceptives as well. Mobile

clinics will use a computer-based education program emphasizing HIV prevention and condom

use called Cudate!, which has been effective as a teaching platform for SRH in the United

States (U.S.) (CDC, n.d.). Planned Parenthood Global will provide contraceptives and

educational materials that will be distributed by the mobile clinics. The mobile clinics will place

condom dispensaries in schools, churches, and other important community locations. The use of

technology and media to enhance the capabilities and influence of mobile clinics within the

community will help to reduce the adolescent pregnancy rate to 5.2%.

Work Plan

The Salud Familiar program will begin in January 2017 and run through September 2018,

including the initial setup of the program through the dissemination of results to participants and

supporting agencies. Beginning January 2017, the initial phase will include the assessment of the

community and partnership establishment within the community. In April 2017, peer-to-peer

involvement will be established through the recruitment and training of 50 CFYs. In May 2017,
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the Healthy Living and Communication workshops will be established along with the

curriculum. Training of administrative staff and teachers within schools and hiring of

communication specialists will also occur at this time. The use of media and technology will be

established in July 2017 with the creation of a Facebook and Twitter page. Establishment of

partnerships with Cuenca mobile health clinics, recruitment and hiring of CFYs, and obtaining

contraceptives from Planned Parenthood Global will occur in the month of July as well.

Implementation of the curriculum will begin October 2017 and end in June 2018. The evaluation

of the programs overall effectiveness will be conducted in July 2018 with the dissemination of

results occurring in September 2018 (see Appendix B for detailed Work Plan).

Anticipated Barriers

Before implementing the project, there are a number of potential barriers that need to be

addressed. FLASH has unique features including the systematic progression of SRH knowledge,

but it was created in the U.S. Key leaders in the community such as teachers, medical

professionals, and religious leaders will have to be consulted to make the curriculum culturally

appropriate. The CERCA project reported that they underestimated the resistance of parents in

allowing adolescents to participate in the project (Ivanova et al., 2016). This barrier will be

addressed by involving parents in every phase of the project. Framing the significance of family

planning by providing information on adolescent pregnancy and the impact it has on the

community will, in theory, enhance the cooperation of parents. Currently, there has been a shift

in political ideology and Salud Familiar may face challenges that were not observed by CERCA.

Knowledge of current pregnancy rates should provide adolescents the opportunities to receive

SRH education and materials given the support of local and state leaders.

Monitoring and Evaluation

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Key participants must effectively monitor and evaluate findings in order to reach the

goals and objectives of a program. In the San Sebastian parish, monitoring Salud Familiar's

training, involvement, and impact will create consistency within the program. Monitoring will

also provide information on how the program is working thus far. Evaluating findings is a crucial

step that allows field staff and program managers to understand if the goals and objectives have

been met (UN Women, 2012). Indicators are helpful tools that can accurately measure the

monitoring and evaluation process either qualitatively or quantitatively. Gathering data will

establish a baseline prior to implementing the program which will aid comparisons and

evaluations upon program completion (UN Women, 2012). These factors will ensure that Salud

Familiar will accomplish its goals and objectives within the parish.

A process indicator that will be used to monitor and evaluate the training process of Salud

Familiar is the delivery and quality of training. Trainings will occur twice a month and will be

delivered over a course of four months to hired staff, CFYs, and volunteers. In order to monitor

the trainings, there will be an attendance sheet at each training session. Evaluation of feedback

from participants regarding quality and applicability will be done in the form of a plus/delta

chart. This type of evaluation will provide honesty along with qualitative data (Newman, 2016).

This process relates to the output indicator of improving SRH knowledge and practice by 50%

by 2023. If the staff are adequately trained, then they will be able to appropriately educate the

adolescents and families of Cuenca.

The outcome indicator used to measure the reduction in the adolescent pregnancy rate

will be to estimate before implementation and after completion of the program (Salazar et al.,

2015). The desired change will be a decrease in pregnancy rates. In order to monitor the rate,

field workers will contact local health agencies in the parish and confidentially acquire the total
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amount of pregnancies by girls under the age of 18. Field workers will analyze the collected

information, calculate the annual pregnancy rate, and report results to program managers. In

2023, the final percentage will be compared to the initial percentage. If the percentage of

adolescent pregnancy has decreased from 8.2% to 5.2%, then the finding indicates that the

project has met this objective (Salazar et al., 2015). The statistics gathered by this quantitative

method will be compiled into a report that will be shared with stakeholders and the public via

social media. Providing statistics to the public and community members of Cuenca will reiterate

the importance of SRH education.

The final objective is to increase the self-reported use of contraceptives among

adolescents by 15% by 2023. The output indicator of this objective will be the percentage of self-

reporting contraceptive usage and amount of contraceptives distributed each year. A qualitative

approach will include conducting written pre- and post-tests. An anonymous survey will be

handed out to program recipients at the beginning of the program, at the three and six month

markers, and upon completion of the intervention. The surveys and anonymous confessions from

the app will provide data to gather before and after application of the program. Staff and

volunteers will analyze surveys and social media platforms for possible trends as the program

progresses. A quantitative method of recording the number of contraceptives handed out each

year by mobile clinics will also provide data about contraceptive use. At the completion of each

annual program, the percentage of self-reported contraceptive use will be calculated. The

percentages will be evaluated and compared to years prior. If the final percentage of self-reported

contraceptive use has increased by 15% in the year 2023, then the program will have

accomplished its stated objective.

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Salud Familiar operationalizes knowledge, comprehension, and application of evidenced-

based SRH education through culturally cognizant and community embedded interventions. The

evidenced-based interventions were developed with the goal of reducing adolescent pregnancy

rates in the San Sebastian parish through changes in knowledge, attitudes, and ultimately

practices. Salud Familiar is based on existing work by international and local entities that address

the issue of pregnancy and has promising potential in the San Sebastian parish. The involvement

of local entities and international partnerships will improve the sustainability and future

applicability of the program. The surge in the adolescent pregnancy rate is not a problem unique

to San Sebastian making the program beneficial for numerous areas in Ecuador and throughout

Latin America.
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Michielsen, K. (2015). Improving adolescent sexual and reproductive health in Latin

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Health, 13(31), 1-10.

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