Promoting sexual responsibility among young people in Zimbabwe

Context: A 1997-1998 multimedia campaign promoted sexual responsibility among young people in Zimbabwe, while strengthening their access to reproductive health services by training providers. Methods: Baseline and follow-up surveys, each involving approximately 1,400 women and men aged 10-24, were conducted in five campaign and two comparison sites. Logistic regression analyses were conducted to assess exposure to the campaign and its impact on young people's reproductive health knowledge and discussion, safer sexual behaviors and use of services. Results: The campaign reached 97% of the youth audience. Awareness of contraceptive methods increased in campaign areas, but general reproductive health knowledge changed little. As a result of the campaign, 80% of respondents had discussions about reproductive health - with friends (72%), siblings (49%), parents (44%), teachers (34%) or partners (28%). In response to the campaign, young people in campaign areas were 2.5 times as likely as those in comparison sites to report saying no to sex, 4.7 times as likely to visit a health center and 14.0 times as likely to visit a youth center. Contraceptive use at last sex rose significantly in campaign areas (from 56% to 67%). Launch events, leaflets and dramas were the most influential campaign components. The more components respondents were exposed to, the more likely they were to take action in response. Conclusions: A multimedia approach increases the reach and impact of reproductive health interventions directed to young people. Building community support for behavior change also is essential, to ensure that young people find approval for their actions and have access to services.