Consultancy for the Development of 2 Manuals on Adolescents Sexual and Reproductive Health Counseling (for Service Providers and Community Volunteers/ Adolescent Peer Educators)

Background

Marriage before the age of 18 is a fundamental violation of human rights. The elimination of this practice constitute one target of the Sustainable Development Goals (SDGs). Many international conventions, treaties and agreements address the issue of early marriage and provide directives on why and how to end it. During the past decade, there were decrease of the proportion of young women who were married at early age by 15%, however still about one in six adolescent girls (aged 15 to 19) are currently married or in union[1]. In the Middle East and North Africa region, the level of child marriage is 17 % and 13% among adolescents girls aged 15 to 19 respectively[2].  

There are various predisposing factors for early marriage among girls like for example 1) humanitarian crisis; when families resort to marrying their girls at an early age in order to alleviate the economic burden and/ or to protect these girls from different risks including sexual violence; 2) cultural perceptions and norms where masculinity dominates and girls can be perceived burden and threat to the family hence got to be married early to guarantee their protection and future; 3) lack of non-discriminatory and inclusive laws in relation to prohibiting early marriages and those dealing with Gender Based Violence (GBV). Nevertheless some adolescent girls and boys decide to engage in early marriage to gain freedom and fulfill their different needs including the sexual ones.

The negative impact for early marriage exceed the individual level to encompass the community and the society as a whole. This is reflected through 1) deprivation of girls from their basic rights for education, health, protection, livelihood and development; 2) increased risk maternal and neonatal mortality and morbidity linked mainly with early pregnancies that could be life threatening; and 3) power imbalance with husband and in-laws which makes girls more vulnerable to abuse and increase the risks for domestic and gender based violence.

In Lebanon, the humanitarian context favored early marriage among Syrian refugees. Studies on the Syrian crisis^[3], report decreased age of the girls being forced to marry and that marriage is used by some families as a negative coping mechanism, to protect girls or to alleviate financial burden. A 2015 survey in Lebanon on child marriage among persons displaced from Syria and the Lebanese population^[4], showed that approximately 22.5% of the total married registered refugee women got married before 18 years of age. Another study conducted in 2016  among Syrian refugees in Bekaa area showed that 2 out of 5 girls are married with 13% of the married girls are 15 y old and 37% are 17 years old[5].  Furthermore, in Lebanon there is no law that defines minimum age for marriage; each sect possess its own legislations and regulations that applies for its population.  

Several initiatives were conducted to address the issue of early marriage in Lebanon such as awareness raising, outreach, empowerment of girls, case management, support groups, harm reduction, enhancing livelihood opportunities, etc. Despite all these initiatives, girls marriage is still on the rise in Lebanon in view of the 2018 data that shows increase in the number of teenage pregnancies among Syrian refugees (7,000) and Lebanese people (2000).  While the consequences of child marriage are numerous, it is well known that its impact on the adolescent girls’ health is critical especially with well documented poor reproductive health outcomes, further aggravated in the context of crisis/wars/conflicts/humanitarian situations.  For instance married adolescent girls have lesser access to reproductive health services including family planning and greater risk of unwanted/unintended pregnancies that can lead to complications and death of the adolescent girl and/or infant.  They can also suffer from unsafe abortion specially where abortion is illegal and this matter could be life threatening especially if the health care centers are not equipped with the adequate care and treatment to manage post abortion complications and/or incomplete abortion. Married adolescent girls have also greater risk of contracting Sexually Transmitted Infections (STI) and HIV due to their lack of knowledge about protected sex.    

Based on the above, and given the rising concerns on the issue of girls’ marriage in Lebanon in general and its impact on the sexual and reproductive health of adolescent girls in particular, a desk review was conducted with the support of UNFPA in 2018 to compile, review and analyze existing resources and initiatives related to pre and post marital reproductive health counselling for adolescent girls[6]. The ultimate goal of the review was to provide operational recommendations towards the drafting of an appropriate Sexual and Reproductive Health (SRH) counselling training manual to service providers and adolescents specific to the Lebanese context and which meets the needs and fills the gaps identified in the frame of the review. This manual is intended to be used in the context of a comprehensive girl empowerment approach/model including prevention/response to GBV and child marriage and access to an integrated package of services (i.e. reproductive health, education protection, legal, economic, etc) through capacity development, institutional building, community outreach, advocacy, etc. 

The above review involved - in addition to the desk review - a consultative process via interviews and focus group discussions with line Ministries, UN agencies, NGOs, Community leaders, married and unmarried Lebanese and non-Lebanese girls and women aged 13-24 years old.

Key findings of the desk review indicate that majority of the resources on early marriage used in Lebanon address prevention to gender based violence through awareness raising and education with focus on the psychosocial support information and skills. Few training/resource manuals used address to some extent sexual and reproductive health for adolescents from a rights-based approach, promote inclusive youth participation and community involvement noting that most of them are in English, a matter that reduces their usefulness. Very few manuals were found focusing on counseling to unmarried and married adolescent girls or girls at risk of getting married (like for example the UNFPA Lebanon kit on Youth-friendly services, the Interagency GBV case management guidelines, the Adolescent Sexual and Reproductive Health Toolkit for Humanitarian Settings).  Also few resources address the impact of the humanitarian context on the sexual and reproductive health of youth and many are under the youth friendly services with counseling being more related to HIV/AIDS, STIs and Family Planning than on the full SRH comprehensive service package.

Main findings of the qualitative consultative process reveal a lack of awareness among adolescents about marital issues and needs including information about sexuality, family planning, healthy pregnancy, raising children, financial management of house expenditures etc.  The parental role in preparing adolescent girls for marriage was clearly stated and it was noted that among the reported consequences for early marriage is the physical and emotional effects of adolescents’ pregnancies and deliveries and the coercion to procreate.  No structured stand-alone counseling service on SRH was identified; these services rather melt within GBV case management noting that case workers do not provide detailed SRH information. Counseling on SRH is mostly done by midwives within the general SRH services in PHC and dispensaries. The review also revealed that parents are the primary source of information on sexual and reproductive health for the youth refugee particularly for girls, while boys rely also on friends.   

The desk review concluded lack of a comprehensive manual that is specific to pre and post marital sexual and reproductive health counseling for adolescents (including those affected by the humanitarian crisis) as well as a manual targeting service providers who are expected to offer high and culturally appropriate quality pre/post counseling on SRH issues for adolescents. Moreover it was suggested to provide SRH counseling services by service providers such as public health officers, midwives, nurses etc as well as through peer to peer approach and community based approach to overcome the different barriers related to accepting and acting on the  messages without including conflict with/ within the family and society.

Subsequently and based on the above, it was recommended to develop 2 manuals as follows: one for service providers to provide them with guidance on the different approaches that can be used in SRH counseling including integration of SRH counseling in other services and generation of conducive environment for implementation of SRH services for adolescent girls. The second manual aims to develop the knowledge and skills of community volunteers/ adolescent peer educators about the importance of SRH counseling including providing basic information to their adolescent peers on SRH with the hope that the latter category would eventually seek counselling by specialized service providers. 

Purpose

The main objective of the proposed consultancy is to develop 2 training manuals on adolescent SRH counseling for service providers and for peer educators/ community volunteers based on international standards and accounting for the findings of the “Desk Review and Analysis of Available Resources related to Pre and Post Marital Reproductive Health Counseling for Adolescents” that was conducted in 2018. The 2 manuals would then be rolled out and finalized based on a pilot phase.

The use of the 2 manuals would contribute to ensure adequate communication and flow of information between the health/social service providers and the young people on various health and protection issues including to sexual and reproductive health, early marriage, GBV, etc. It is anticipated that the provision of such information in a proper way would (a) enhance adolescent girls’ knowledge and ability to make sound decision for accessing SRH services and information and (b) contribute to reducing sexual and reproductive health problems associated with early marriage as well to combating early marriage and reducing its consequences in the targeted communities.

The development of the adolescent SRH counseling training manuals that target service providers and community volunteers will improve the targeted population’s knowledge, skills and awareness on SRH and GBV matters through;

• Precise information on different SRH and health related topics including – but not inclusive to - puberty and related various changes, readiness to a sexual relationship, early marriage and early pregnancy, contraception, pregnancy/childbirth; antenatal and postnatal care, breastfeeding, family planning,  sexually transmitted infections and HIV/AIDS, personal and intimate hygiene, vaccinations and tests, mental health, etc;
• Information on GBV related topics including intimate partner violence, sharing responsibilities in marriage, women rights within marriage, self-development and empowerment, self-protection, self-locus of control, building mutual understanding, child registration, family life and interpersonal relationships, non-discrimination, equality and gender roles, sexual behavior and sexual diversity, sexual abuse, harmful practices etc;
• Information regarding child development and upbringing, and adolescents’ psychology namely for adolescent girls;
• Information on pre-marital examinations (including fertility tests), sexual relation and related misconceptions and/or expectations particularly those relevant to adolescent girls;
• Development of positive values and attitudes towards SRH, respect for human rights and gender equality, effective communication skills in general and conflict management within marriage;

• Guidance on counseling methodologies and practices that help both care providers and community workers/ adolescent peer educators to effectively assessing and addressing the reproductive health needs of adolescent married or at risk of getting married hence like for example provide assistance in decision-making, emotional support and assertiveness on prenuptial issues and early marriage.

The developed training manuals would be tailored to each target group as needed (namely in terms of roles, content, specificities, profiles, etc) and rolled out respectively among a group of adolescent peer educators/ community volunteers and service providers to be then finalized accounting for their input/feedback.

Tasks

Under the guidance of UNFPA office, a consultant will be identified and engaged to carry out the following tasks:

• Meet with UNFPA to understand the scope of the consultancy and draw a plan of action, proposed methodology and timetable for accomplishing various components of the consultancy.
• Review the various material mentioned above (with additional relevant ones) and investigate/review similar resources developed/used in the country and/or the region related to training on SRH, sexual education, GBV and early marriage as well as other relevant online material.
• Consult with key stakeholders, selected trainers, facilitators, producers of the existing material/resources etc on the manuals’ content namely the key issues, skills, competencies, concepts, views and reflections on their effectiveness, relevance, cultural appropriateness and approaches
• Propose and develop a framework and structure/ outline for each of the 2 training manuals based on the consultative process
• Develop the 2 manuals including content, guide tools, visual aids, handouts, Q&A etc.
• Prepare and ensure timely delivery of the first draft of the training manuals for review by UNFPA and finalize based on feedback
• Roll out master training for selected candidates (community volunteers and service providers)
• Provide UNFPA with an electronic copy of the final training material (in Arabic).

 Expected Deliverables and Outputs

The consultant shall deliver the 2 training manuals in Arabic based on the objectives and requirements set forth in the terms of reference. The training manuals will constitute the final outcome of this consultancy. The consultant will have to submit

• Consultancy plan and timeline
• Two manuals on adolescent sexual reproductive health counseling for community volunteers/ peer educators and for service providers with standardized components for each module such as objectives, agenda, lesson plan, timeline, supporting material, pre and post-test, proposed trainers, etc
• Visual aids, handouts, monitoring and evaluation tools relevant to the developed manuals
• Brief report summarizing the process of the consultancy and highlighting gaps and needs including related recommendations

Duration of assignment

The consultancy will be carried out over a period of 3.5 months (between August 25^th and December 10^th, 2019)

Required Qualifications

• Advanced Degree in Public Health, Social Sciences or related field with considerable knowledge in development, health, gender issues, youth issues, and human rights.
• Minimum 8-10 years of responsible experience in sensitization and training as well as development of resources/training materials.
• Solid background in health/reproductive health issues and youth issues especially in Humanitarian settings.
• Solid knowledge of the Lebanese context namely governmental and non-governmental actors in the area of development, health, youth, gender equality, etc
• Excellent interpersonal training, facilitation and communication skills.
• Excellent l skills and ability to establish effective and working relations with other stakeholders
• Fluency and excellent writing skills in Arabic and English.
• Knowledge with UNFPA’s work is an asset

Support to be provided by UNFPA

• Provide consultant with necessary guiding documents on pre-marital issues and sexual education and relevant reports and documents
• Facilitate contact with the main stakeholders. 
• Review and provide technical input on the training manuals.
• Facilitate roll out of the training manuals

Candidates who meet the required qualifications set forth in the TORs may apply on line by sending a cover letter expressing interest and updated and comprehensive CV and P11 form (attached) detailing their work experience that is relevant to the consultancy requirements as indicated in the Terms of Reference. The documents must be sent to the following email: info-lebanon@unfpa.org no later than August 12^th 2019 COB.