Mary Huang Soo Lee
UNESCO PROAP Regional Clearing House
on Population Education and Communication
United Nations
Bangkok, Thailand, 1999
Population Fund

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Lee, Mary Huang Soo.
Case study, Malaysia: communication and advocacy strategies
adolescent reproductive and sexual health. Bangkok: UNESCO PROAP, 1999.
27 p. (Communication and advocacy strategies: adolescent
reproductive and sexual health; series two)
1. YOUTH. 2. REPRODUCTIVE HEALTH. 3. SEXUAL HEALTH. 4. IEC.
5. COMMUNICATION POLICY. 6. COMMUNICATION STRATEGIES.
7. COMMUNICATION PLANNING. 8. CASE STUDIES. 9. MALAYSIA.
I. Title. II. Series.
613.951
 UNESCO 1999
Published by the
UNESCO Principal Regional Office for Asia and the Pacific
P.O. Box 967, Prakanong Post Office
Bangkok 10110, Thailand
Printed in Thailand
under UNFPA Project RAS/96/P02
The designations employed and the presentation of material throughout the publication do not imply
the expression of any opinion whatsoever on the part of UNESCO concerning the legal status of any
country, territory, city or area or of its authorities, or concerning its frontiers or boundaries.

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◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆ CONTENTS ◆ ◆ ◆ ◆ ◆ ◆ ◆ ◆
PREFACE ......................................................................
i
◆
DEMOGRAPHIC CHARACTERISTICS OF ADOLESCENTS
1
◆
Population composition of adolescents ............................
1
Age at marriage ............................................................
1
Fertility, teen pregnancy and abortion ............................. 2
STDs/HIV/AIDS ............................................................. 3
Practice of contraception and family planning .................
4
Knowledge, attitude and behaviour on sexuality and
reproductive health .......................................................
4
◆
PROGRAMME RESPONSES TO ADOLESCENT
REPRODUCTIVE HEALTH PROBLEMS
6
◆
Government programmes ............................................... 6
NGO programmes ......................................................... 9
◆
ADVOCACY AND IEC STRATEGIES USED TO PROMOTE
ADOLESCENT REPRODUCTIVE AND SEXUAL
HEALTH MESSAGES
11
◆
Advocacy strategies ....................................................... 11
Information, Education and Communication (IEC) strategies
12
◆
LESSONS LEARNED
16
◆
Success/failure factors for advocacy strategies .................. 16
Success/failure factors for IEC strategies ........................... 17
Overall listing of lessons learned .................................... 18

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◆ ◆ ◆ ◆ ◆ ◆ CONTENTS (continued) ◆ ◆ ◆ ◆ ◆
◆
GUIDELINES FOR FORMULATING AND IMPLEMENTING
ADVOCACY AND IEC PROGRAMMES ON ADOLESCENT
REPRODUCTIVE AND SEXUAL HEALTH
21
◆
Guidelines for advocacy programmes .............................. 21
Guidelines for IEC programmes ......................................
21
◆
REFERENCES.................................................................
23
Appendix
Directory of Organisations ........................
26

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PREFACE
BACKGROUND
Although adolescent reproductive and sexual health education is a
new programme area when taken under the context of the ICPD POA
framework, not a few efforts had been ventured though by a number of
forward-looking countries in the region to implement educational,
advocacy and communication activities in the areas of human sexuality,
HIV/AIDS, and family life/population education, and of course more
recently, adolescent reproductive health.
Without doubt, these programmes and activities are characterized
by weaknesses and gaps as planners and implementors are usually held
back from trying out innovative approaches by opposition and objections
from concerned quarters. However, there is also not a dearth of
successful innovative strategies and approaches which can documented
and shared for others to learn from and even replicate.
Sexuality and reproductive health education is an area that generate
misconceptions, confusion, fear and unwarranted caution, to say the
least. These can be ascribed by many factors. First, policy makers,
community members, parents and teachers are reluctant to confront
issues of sexual and reproductive health. Teen-agers often get their
information from their peers who may be ignorant of the topic or the
mass media which may provide sensational and inaccurate information.
In many programmes, curriculum and textbooks continue to limit their
focus on biological, demographic, population and development and
family life education issues. Sometimes, in spite of a well-designed
curriculum, an ill-prepared or uncomfortable teacher can render a
programme ineffective. Teaching methods used are often not suited to
the sensitive nature of sexual and reproductive health education issues.
However, the developments in this field have not been held back
by a few conservatives and traditionalists. Many organizations, especially
the non-governmental and voluntary organizations as well as bold
government agencies have taken steps to undertake innovative strategies
to introduce reproductive and sexual health messages into their
programmes to reach the adolescents and influence them into taking
responsible decisions regarding their sexual and health behaviours.
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These strategies and approaches range from energizing in-school
education through co-curricular or community support from out-of-school
sector; setting up counselling services inside a school campus;
counselling through telephone hotlines; peer group counselling and
discussions; development of IEC materials and interactive Internet
discussion forum; youth camps and debates and competitions and
campaigns in recreational places. Some of these strategies have worked
and some failed. How is it that in one country the setting up of
counselling centre for youth within a school campus is acceptable and
not in another? Why is it that the use of peer approach in reaching the
youth is effective in one cultural setting and not in another? How has
religion been an obstacle in the introduction of reproductive and sexual
health education in a few countries and how has this been overcome?
Some countries and some sectors of society have raised fears and
caution in introducing reproductive and sexual health which could be
unwarranted. The perceptions could be emanating from their own
perspective alone and may not be shared by other sectors or even the
recipients themselves, i.e., adolescents. Or even if these fears are
justified, these are not really unsolvable. Bold, innovative strategies and
approaches are now called for if the ICPD POA recommendations dealing
with adolescent health are to see reality. As Dr. Nafis Sadik, Executive
Director of UNFPA states:
“The largest challenge facing us does not lie in resources or
delivery systems or even infrastructures, but in the minds of
people. We must be sensitive to cultural mores and
traditions, but we must not allow them to stand in the way of
actions we know are needed. We have to overcome the
obstacles of superstitions, prejudices, and stereotypes. These
changes may not be easy and we face formidable challenges.
They involve questioning entrenched beliefs and attitudes,
especially toward girls. Lifelong habits must be given up, but
they have to be, because in the end Asia’s future depends on
all its people: and it will depend as much on adolescents as
on adults”.
In order to document the experiences of the countries in the
planning and implementation of best practices and innovative strategies
in the field of adolescent reproductive and sexual health, these series of
case studies are being commissioned to selected countries which have
accumulated a pool of knowledge and experiences which can be shared
with other countries.
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OBJECTIVES
To document the experiences of countries engaged in planning and
implementing adolescent reproductive and sexual health in the areas of
advocacy and IEC (information, education and communication), the
UNESCO Regional Clearing House on Population Education and
Communication carried out an activity whereby selected countries were
asked to document their experiences in order to:
1.
Identify the profile and characteristics of adolescents in
various areas such as demographic profile, fertility, teen
pregnancies, sexual behaviour, STDs, contraception, etc.
2.
Describe the policy and programme responses of the country
to address the problems and issues dealing with adolescent
reproductive and sexual health
3.
Document the strategies, best practices and innovative
approaches used in undertaking advocacy and IEC activities
on this topic and the results or impact of these strategies on
the target recipients
4.
To examine and bring out the factors/conditions which have
contributed to the success of these best practices or failure of
some strategies and from these highlight the lessons learned or
guidelines for future consideration
5.
To identify organizations which have achieved successes in
carrying out programmes/activities on adolescent reproductive
and sexual health
Seven countries were initally selected to document their
experiences – Bangladesh, Iran, Malaysia, Mongolia, Philippines,
Sri Lanka and Thailand.
This volume presents the experiences of Malaysia in planning and
implementing the advocacy and IEC strategies for promoting adolescent
reproductive and sexual health programmes. It was compiled by Mary
Huang Soo Lee, Ph.D. from the Department of Nutrition and Community
Health, Faculty of Medicine and Health Sciences, Universiti Putra
Malaysia.
iii

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DEMOGRAPHIC CHARACTERISTICS
OF ADOLESCENTS
A. POPULATION COMPOSITION OF ADOLESCENTS
In Malaysia, adolescents
proportion to the total population had
comprised 20.9% of the total population
barely increased by less than 1% in the
of 18.3 million in 1991. By the end of
same period (Figure 1). With no further
1998, they had increased to 21.2%, and
expected increase in their proportion to
by the year 2000, are expected to be
the population and with the total
21.1%.
population growth rate of 2.18%
(Malaysia, 1996), they are likely to
The number of adolescents (ages
reach about 5.0 million by the year
10-19) had grown from 3.7 million in
2000.
1990 to 4.8 million in 1998, but their
5.0
22.0
4.5
21.0
4.0
20.0
% Adolescents
3.5
19.0
Adolescent Population (Millions)
3.0
18.0
1990 1995 1996 1997 1998
1990 1995 1996 1997 1998
Year
Year
Figure 1. Total Population of Adolescents (Ages 10-19) and its Proportion
to the Total Population of Malaysia from 1990-1998
B. AGE AT MARRIAGE
In the past, the age at marriage
new millennium. Opportunities for
was presumed to be the age at which
education have resulted to delayed
women are exposed to the risk of
marriage as well as the migration of
pregnancy. This assumption has now
young people into the cities in search of
lost grounds as Malaysia steps into the
employment commensurate to their
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level of education. In 1990, the average
marriage for the age group 18-19 had
age at marriage was 23.2 years
declined from 36% to 12% (Federation
(Population Reference Bureau in Chan,
of Family Planning Associations of
1997), up from below twenty in the
Malaysia, 1997). At the same time,
seventies.
changing socio-economic conditions,
which favour economic independence
The Second Malaysian Family Life
for women, have resulted to changing
Survey reported a trend of later marriage
norms on marriage and family
among adolescents and youth.
structures.
Between 1970 and 1988, the rate of
C. FERTILITY, TEEN PREGNANCY AND ABORTION
It has been recognised worldwide
even if all these mothers were married,
that 10% of all births each year are
some of these births may have been
attributed to adolescent mothers.
conceived out of wedlock. It is quite
Whether or not these are planned, such
common in Malaysia for parents to
pregnancies are dangerous to the
force or encourage children to marry
mothers as well as the children. Risk
once it is confirmed that a girl is
of maternal mortality has been
pregnant. This has been pointed out as
estimated to be two to four times higher
typical of the Asia and Pacific countries
than for mothers in their twenties. At
(ESCAP, 1992).
the same time, infant mortality is
estimated to be 30% higher among
Data on abortion is illusive in
children born to adolescent mothers
Malaysia partly due to the fact that
than those born to mothers in their
abortion is not allowed, except in
twenties (Network, 1998).
situations where the life of the mother
is threatened. However, it is not
Each year, more than 10,000
uncommon for adolescents to know
adolescent girls in Malaysia get
of a friend who got pregnant as well as
pregnant and give birth, subjecting
someone who has had an abortion,
themselves to the health risks
sometimes paid for by parents or by
accompanying such births. The
the adolescents themselves.
Department of Statistics, Malaysia
reported that birth to mothers aged
Qualitative studies of adolescents
15-19 had declined from 10.8% in 1966
showed that they knew where to get an
to 4.7% in 1984 (Tey, 1996). In 1990,
abortion. These places included clinics
this went down further to 3.4%,
and sites of practice of traditional
numbering 13,566. In 1996, the
healers such as the bomoh or the
corresponding number of births totalled
Chinese
sinseh. Among the
13,274 making up 3.1% of the total live
abortifacients they had cited were
births for the year (Malaysia, 1996).
Panadol, malaria pills and insertion of
objects. Prices quoted for an abortion
Statistical records do not give a
ranged from 500 to 1,000 Malaysian
breakdown of the births by marital
ringgit.
status but it would be safe to say that
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D. STDs/HIV/AIDS
Figures on the incidence of
adolescent population to HIV/AIDS
sexually transmitted diseases among
infection.
adolescents are difficult to obtain.
The Ministry of Health reveals that
In 1994, adolescents made up
between 1987 and the end of 1998,
about 10% of the total population, but
there was an exponential increase in
their proportion to the number of
the number of infections among the
patients in STD clinics was less than
young (Figure 2).
that (Ngeow et al., 1998). It has been
explained that adolescents shy away
In 1990, 364 cases were detected
from such clinics because they do not
in the 20-29 age group, but only eight
want their activities to be discovered.
among those aged 13-19. Two years
Hence, it is hard to find any data
later, 1,148 cases were detected in the
correlating changes in the social mores
older group, and 45 among the younger
and less discriminate sexual behaviour
group. By 1998, 1,861 were diagnosed
with incidence of STD rates among
to be positive with HIV/AIDS in the older
adolescents.
group, while 67 were detected among
the younger group. It is possible that
Although the mandatory testing of
the rates of infection detected in the
drug addicts and prisoners for HIV/AIDS
older group were those of young people
has introduced biases in the records of
who had been infected earlier – some
STD incidence, there are enough signs
perhaps, in their adolescent years, due
of increasing vulnerability of the
to the peculiarities of the virus.
2,000
13-19 Years
1,600
20-29 Years
1,200
AIDS Cases
800
HIV and
400
0
1990 1992 1994 1996 1998
Year
Figure 2. Number of HIV and AIDS Cases Diagnosed by Age Group
from 1990-1998 (Ministry of Health, 1999)
3

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Document Outline

• Contents
• Preface
• Demographic characteristics of adolescents
• Programme responses to adolescent reproductive health problems
• Advocacy & IEC strategies
• Lessons learned
• Guidelines for formulating and implementing advocacy & IEC programmes
• References
• Appendix: Directory of organisations

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