‘Championing women led SRHR services’

Community Development Services, established in 1978, played a pioneering role as one of the lead CSOs to deliver the national family planning, SRH and birth spacing programme for close to a decade. We have learnt through several decades of work in the SRH field that when sexual and reproductive health and rights (SRHR) are realized, the impact on girls’ and women’s lives is significant, transformative, and lasting. We have also learnt that sexual and reproductive health can only be achieved by acknowledging that every individual has the right to make informed decisions regarding their lives and bodies. This includes choices about when to become sexually active, with who, and in what way; options and access to contraception and reproductive health care; partners and marriage, including when to have a family; and access to information, services, and resources to navigate these choices free from discrimination, violence, and coercion.

The sad reality in Sri Lanka however is due to traditional and cultural inhibitions compounded by fundamentalist religious ideology, there is a deafening culture of silence around SRHR. Despite advocacy efforts of many organizations, discourse on SRHR is avoided even within families and the school curriculum does not provide for comprehensive sex education. (https://srilanka.unfpa.org/sites/default/files/pub-pdf/NEW%20CRHE%20Policy%20Brief%20%283%29_0.pdf).

According to the National Strategic Plan on adolescent and youth health 2018-2025 (https://platform.who.int/docs/...) out of a population of 21.8 million, nearly one fourth (5 million) consists of young persons aged 10-24-years. Adolescents within 10-19-year age group, accounts for 16% of which 71% are school going and 29% are non-school going. It is important to note that youth within 15-24 year age group consists of 16% of the total population and therefore investing in their health and well-being is crucial.

Young people in Sri Lanka are faced with additional problems such as sexual violence, coercion and abuse through intimate partner relations, incest, or commercial sexual exploitation, including cyber-sex. Furthermore, unmarried young persons faced with pregnancies and abortions invariably lack support and guidance to prevent disruption of their education and career aspirations and are vulnerable to mental health issues including suicide.

There are limited youth friendly services in Sri Lanka to discuss young people’s concerns and issues in an open and inclusive community environment. There is a clear lack of life skills in accessing quality information and services on SRH for young people to make informed decisions. (https://www.dailymirror.lk/news-features/Teen-Pregnancy-A-Hidden-Crisis/131-225852 ).

The concept of youth friendly health services was introduced to Sri Lanka in 2005. “Youth friendly” clinics were established mainly in hospitals. However, with time and lack of resources, only a few remain functional and resourced. The Family Health Bureau states that government directives / circulars have been sent to all MoH clinics to offer youth services (https://fhb.health.gov.lk/images/FHB%20resources/Adolecent%20Health/circulars/Provision%20of%20Adolescent%20and%20Youth%20Friendly%20Services%20in%20the%20Field.pdf). However, the reality is that young people are unaware of the services been offered and perceive the services to be non-inclusive, impersonal, and critical when offering services to young people. Many youth, especially young unmarried women and girls are unlikely to access a hospital based SRH service for this reason. 

The overall goal of the project is to ensure that the SRHR of girls and young women between 15-35 years are fully realized through improved capacities to make informed decisions and improved access to quality SRHR information and services by strengthening youth friendly community outcomes. Thus, the knowledge and agency of the girls and young women to make informed decisions about their SRHR is central to the project’s holistic and rights-based approach. Advancing girls’ demand and access to SRHR information and services along with the engagement of young men and boys will be paramount to close a persistent gender gap in socio-economic outcomes and impact positively on gender equality and community and social prosperity.

This project will be implemented in 5 districts in collaboration with the National Youth Services Council (NYSC) in Kurunegala, Kalutara, Colombo, Gampaha and Kegalle with the aim of scaling up and replicating in all local languages across the island in subsequent years following a comprehensive evaluation of this phase. These districts have a high incidence of HIV and STI infection, high drug use, unregulated pleasure seeking businesses, sexual rape, harassment and intimidation, clinically unsafe and unwanted abortions, gender based violence and low knowledge and respect on gender issues.

The strategy outlined here will be validated through on going gender-sensitive participatory action research of the project with a view to generating evidence for programming and policy influencing. The information elicited from the assessments will also contribute to shaping youth friendly communication platforms (pop song, flash mob, TikTok videos, etc.)  that will be used as tools to engage with and educate young people and breakdown negative attitudes and social norms surrounding SRH. The data collected on perceptions of SRHR services provided at the MOH office and in hospitals will be shared with the relevant authorities with a view to understanding gaps and challenges faced by service providers and advocating for improved services.

The central component of the project is in empowering and building transformative capacity of selected young women and men in the identified districts. The purpose is to draw on all learnings over the years and to develop a transformative, intentional process and model in which adolescents and youth are in positions of power and leadership alongside other stakeholders able to design and create policies, programs, and initiatives, to make decisions and set agendas on SRHR within their peer structures and their communities.

CDS sensitization training for a minimum of 75 men and boys will include:

• the Bodies section which focuses on men’s knowledge and management of their own bodies and health;
• the Relationships section which will highlight the ways in which men interact with partners in their intimate lives;
• the Lives section identifies men’s decisions about sex and reproduction as central to their health and well-being, satisfaction, economic security, and humanity.

The success of the project will hinge on the catalytic partnership established between the NYSC (https://www.nysc.lk/), the government health services in each district, the Family Health Bureau (https://fhb.health.gov.lk/index.php/en/) and CDS. 

Youth peer leaders will be selected from the five identified districts representing urban and rural, female and male. Given that rural girls and young women lack access to information and exposure regarding their sexual and reproductive health, as they have less access to technology and the internet, literature books and social media. Young people in rural areas are more conservative than their urban counterparts as they live in societies which consider sex a taboo subject. The topic of sex is rarely discussed at home or even in schools as teachers too are very conservative and reluctant to discuss this topic. Therefore, many have different myths and misconceptions regarding puberty, conception, reproduction, family planning and sexuality.

Young women in rural areas can also be more easily taken advantage of by men and boys as their naïve nature and lack of sex education can lead them to be misled and duped by others. Thus, the knowledge and agency of the girls and young women from rural areas to make informed decisions about their SRHR is central to the project’s holistic and rights-based approach. Primarily, the solution will therefore serve adolescent girls and young women from rural areas in the selected 5 districts.

Advancing girls’ demand and access to SRHR information and services along with the engagement of young men and boys from rural areas will be paramount to close a persistent gender gap in socio-economic outcomes and impact positively on gender equality and community and social prosperity. Men and boys therefore will also be engaged in the 5 districts as trainees, peer educators and influencers given they are central to the SRHR discourse.

The young people will be selected from diverse backgrounds in order to reach a wider demography. The peer leaders will be recruited from universities, technical colleges, estates, coastal areas, schools and also include out of school youth.

In the past decade, CDS has developed SRHR capacity to over 200 CSO’s throughout the years and gained experience in building decentralized SRHR capacity and training peer leaders.

During which period CDS has learnt that sexual and reproductive health can only be achieved through recognition of sexual and reproductive rights where every individual has the right to make informed decisions in being in control of their bodies. This includes choices about if and when to become sexually active, with whom, and in what way; options and access to contraception and reproductive health care; partners and marriage, including whether and when to have children; and access to the information, services, and resources to navigate these choices free from discrimination, violence, and coercion. It is only when SRHR is fully realized understood and respected, that the impact on girls’ and women’s lives will become significant, transformative, and lasting.

The project will commence with participatory research with young people to identify their SRH needs, their perceptions and expectations from youth friendly centres and their suggestions to improve access to quality information and services. They will also visit the existing centers themselves experience the services offered and give constructive feedback. This will be used as the basis for CDS’ advocacy efforts with government service providers. Once the research report is completed a consultation will be organized inviting government stakeholders and youth and they will present the research findings and their experience directly to the decision makers.

Since its inception in 1978 CDS has been engaged in SRH knowledge building to vulnerable and underserved communities. With the advent of HIV & AIDS, the SRH capacity and institutional development model became so important where SRH was brought in to the national HIV & AIDs policy. CDS underscores the relevance and importance of SRHR among young people and continue its knowledge delivery offerings to other vulnerable and at risk population groups like MSMs, CSWs and migrant workers. CDS ensured that SRHR is included in migration health and in to the national labour migration policy.

Today, we have to deal with many other health complexities among the population shifts taking place such as engaging with the millennials and GenZs, and their SRH needs. The covid pandemic has brought about a new set of challenges to this social strata of the population.

SRH knowledge and its sensitivities are an important aspect in the information and education process. It must bring about impactful behaviour change among young people and also among service delivery personnel at government and non-government levels.

We strongly believe in strengthening the community response to SRHR. We do have the infrastructure with the establishment of the “Life Integrators Coalition” civil society network who are already engaged with addressing the needs of vulnerable and at risk population groups.

Throughout the years CDS has developed the capacity of over 200 youth peer leaders in the districts of Ratnapura, Hambanthota, Anuradhapura, Colombo and Vavuniya to educate their peers on SRHR. These trained youth peer leaders have been educating their peers and communities and referring them for services long after the project has been completed. Approximately 3000 young people have accessed SRHR services through our projects in the past including psycho-social counselling within these districts. Some still reach out to their CSO partners in their communities for more advice and guidance. They have also incorporated this knowledge into their own lives and have become model citizens in their communities taking this message into the future generations.

Successive governments have made halfhearted efforts to develop any meaningful policy on youth and SRH and have caved into political and religious pressure. This has resulted in young people being denied their SRH right and their right to knowledge.

The communications strategy will bring about an open, inclusive, and honest dialogue with young people on SRHR to make informed life-giving and lifesaving decisions without stigma and discrimination and without being judgmental about sexuality, sexual orientation, masculinities, and other gender concerns that the modern world is faced with.

In the 5 selected districts, we will engage with young people who will not only receive the necessary knowledge but to lead the project and take it to their peers as a transformational process that will not have any backlash or reluctance to engage in open conversations and dialogue.

As we would be dealing with millennials and GenZ populations, a striking feature of these two groups are that they are a digitally wired community living in a world of electronic devices and smart phones. We propose using digital media as communication tools to drive the campaign. The following communication strategies will be applied to achieve the project objectives.

• Select up to 200 youth peer leaders 40 from each district
• Plan an ongoing gender sensitive participatory action research (PAR) among the selected youth peer leaders on SRHR and utilise findings for policy influencing.
• Provide a thorough orientation on SRHR with technical and referral support
• Develop comprehensive and engaging training tools and IEC material for the peer leaders and community distribution.  
• Conduct training and knowledge sessions for peer groups.
• Conduct quarterly discussion forums and make reports for policymakers to take note of.
• Promote the use of short message videos on TikTok
• Promote the use of message posters and bulletin boards in platforms like Instagram and WhatsApp.
• Create and manage an exclusive facebook page
• Create other nontraditional communication like flash mobs, forum theatre and acapella
• Develop a media monitoring service on SRHR for policy change and influencing. 
• Organise radio talk shows initiated by the NYSC centers in the districts.
• Set up SRHR counselling and discussion centers by offering qualified psychosocial counselling facilities and establishing district level referral support points.

Audience coverage and reach

As per the NYSC officials there are community based youth societies established in every Grama Niladari Division. Each of these youth societies consists of around 20 youth. The Divisional level NYSC officer overseas and guides them. District wise the number of youth attached to the NYSC are as follows:

Colombo NYSC – 15,000

Gampaha NYSC- 50,000

Kurunegala NYSC – 150,000

Kalutara NYSC – 25,000

Kegalle NYSC – 12,000

40 youth peer leaders from each district will be empowered. Each peer leader will be able to reach approximately 100 peers covering 4000 youth from each district. We envisage reaching around 20,000 youth through the peer leadership structure.  

Within the project period, we believe that each peer leader group consisting of 40 from each NYSC cluster will educate at least 100 of their peers. Therefore 200 peer leaders will reach approximately 20,000 adolescent girls, young women and men within the NYSC settings. Additionally, these peer leaders will address SRHR needs to other youth groups and the general population through other communication means. We envisage that at the town and street level a further 3000 people will access knowledge on SRHR, gender based violence, sexual harassment and intimidation.  These peer leaders will also educate members in their families such as their siblings, cousins and neighbors thus enabling whole communities of young people to become aware of their sexual and reproductive health and rights and services.

We also believe that the findings from the PAR will assist policy makers and influencers to advocate for more youth friendly health services helping them to integrate reproductive health feedback of young people into national strategies and programmes in a more effective, holistic, and inclusive manner which would encourage more young people to access these services. Furthermore the trained, skilled and empowered peer leaders on the ground will be closely working with young people and advocate for changes at the local level encouraging change from the bottom up. We feel this top down and bottom up advocacy will lead to a real change in programs and policies for better youth friendly health services.

In the longer term, it is our hope that this project will be replicated into other districts where SRHR and youth friendly sexual health education is covered without intimidation or pressure from political and religious forces.

We also believe that we could tailor-make knowledge tools to specific audiences such as migrant women, PLHIV groups and influence curriculum development at the secondary school level and at the university level in the regions.

Whilst these are longer term sustainability possibilities, we believe they will support the relevant SDGs that promote universal health and sexual health knowledge among young people.

More specifically, the SDGs that we’d like to highlight and concentrate on are

SDG 3 – 3.3 and 3.7, and 3.8, SDG 5 – 5.1, 5.2, 5.3, 5.6, 5c and SDG 16 – 16.6, 16.7, 16.10, and 16b.

The project would at the start establish strategic partnerships between NYSC, government health services and CDS for provision of youth friendly SRHR services. Once this partnership is established CDS would conduct an assessment to understand expectations from a youth friendly SRHR clinics among 250 youth in selected districts. The PAR (research) would also assess youth friendly service providers to understand gaps and challenges in delivering SRH services. Once the research is completed CDS would discuss the assessment findings with stakeholders to advocate to improve the quality of youth friendly services.

CDS would then develop the capacity building methodologies and tools for youth peer leaders. To improve access to SRHR services for young people, CDS will empower 200 peer leaders from five districts who will educate their peers, provide basic counselling, and refer them for services when required to the government youth friendly clinics. These peer leaders will also accompany their peers to the youth friendly clinics in order to help them access these services if some are reluctant to go by themselves. They will also refer their peers to other rights based organizations for service provision in their respective districts.

Youth peer leaders would take the lead in advocating with policy makers on the changes they would like to see by way of consultations organized during the project period. These consultations would bring to light the current gaps in information and service provision and how these can be improved at the district and National levels.

The project will also expand SRHR messaging among young people by using youth friendly media such as street drama/flash mobs, TikTok videos, songs and by using social media influencers popular among young people. These strategies would also create awareness among young people about SRHR and encourage them to access services.

By using this bottom up and top down approach CDS envisions bringing about real change in the SRHR landscape for young people in Sri Lanka

Full time staff – 06

Partners – 1 NYSC project coordinator and 5 NYSC supporting coordinators from the 5 districts

200 selected peer leaders from the five NYSC centers.

CDS has used the peer led approach for about 30 years and has over four decades of experience working on SRH with vulnerable and underserved populations.

CDS has developed migrant friendly health guidelines as a national and Asian advocacy tool for sending and receiving country governments to act upon.

CDS has influenced the Sri Lanka Bureau of Foreign Employment (SLBFE) on the importance of SRH education for migrant women.

In 2021 CDS initiated a civil society network to advocate for low skilled migrant workers and underserved communities most at risk of HIV and other health concerns such as SRH. This network currently has 24 CSO’s spread across 12 districts in the country. This network established its working group consisting of 7 members whilst CDS will continue to act as the convenor and technical support.

It was decided that the network would work with the following target groups:

• PLHIV and families
• Migrants (potential & returnees) and their families
• Communities at risk to HIV (FSW’s, IDU’s, Transgender, beach boys, MSM, migrants, FTZ workers)

It was decided that the network would address the following areas with room to expand when the need arose.

• HIV
• SRH
• Safe migration
• Covid 19 and future pandemics
• NCD’s

CDS is committed to diversity, equity and inclusion. As a national independent CSO, CDS develops its own project proposals to national and international funding organisations within a rights framework to serve vulnerable and marginalised populations and communities. Our network partners are always consulted when developing these proposals as ground level assessments by way of qualitative research tools and methodologies are conducted and key stakeholder and influencer groups are consulted so that their needs are at the heart of any project we envision.

It has been the CDS policy to engage with national and subnational officials in rolling out programmes at the district or national level.

CDS is a member of CARAM Asia, and at the Asian level, it has access to migration health and SRHR by way of knowledge sharing with over 42 CSO’s across 18 countries.  

As a national CSO, working for the rights of marginalised and vulnerable populations, our business model at present is to centrally manage projects once they are ready to be implemented either at the national or district level. We don’t believe in patronizing and perpetuating ourselves in any region or with any community. It is for these reasons that we continue to support local partner organisations in their capacity building and institution building, thereby giving them ownership of the project, they will partner with us.

We believe this model also helps in scaling up knowledge levels of the local partner organisations, giving them the freedom to achieve the project objectives.

There are certain management frameworks that CDS is responsible for namely taking full and complete ownership and accountability of the project, project and financial reporting, monitoring and evaluation, partnership building, institution building and knowledge giving to subnational administrative bodies.

Over the years CDS has developed a series of knowledge tools to train trainers in the delivery of such knowledge. CDS has developed training and knowledge tools on HIV and migration, migrant friendly medical testing practices, SRH for migrant women, SRH for PLHIV, NCDs, to name some.   

As a nonprofit and government-approved charity, our core mandate is to serve vulnerable, marginalised and at-risk population groups whose rights and privileges have been overlooked by governments in policy and practice.

As of now, our business sustainability model is through the development of project proposals to international and local donors and funders who support our core cause. We have not relied on any government funding as there is a reluctance for the government to designate budgets for the nonprofit sector and to the CSO community. Our funding sources also come from networks we have built in the Asian region to collaborate on multi country initiatives.

The more recent funding sources have been from the Swiss government, the American Embassy, Migrant Forum in Asia, Solidarity Center, Robert Carr Fund, GAATW, CARAM Asia, Australian Embassy, ILO, and IOM.

In more recent times we have embarked in supporting the eradication of poverty through micro and small entrepreneurship programmes for women. We hope that Sri Lanka’s private sector will see the merits of this programme and support our initiative.