This study protocol describes a three-stage participatory action research (PAR) approach to develop a national sexual and reproductive health and rights (SRHR) and Family Planning Advocacy Toolkit for adolescents in rural Pakistan.
Key Findings
Background
Adolescents and young people aged 10-24 years comprise 32% of the total population of Pakistan, representing a substantial and heterogeneous group with distinct and changing needs.
The age range defined as adolescents and young people is 10-24 years.
The group is described as 'heterogeneous—in different stages of development, living in different circumstances and with differing and changing needs.'
Neglect of SRH needs can affect 'physical and mental health, future employment, economic well-being and adolescents' ability to reach their full potential.'
Background
Adolescents in Pakistan have poor access to sexual and reproductive health services and limited knowledge of SRHR, contributing to multiple adverse health outcomes.
Poor access includes limited access to contraception and limited knowledge of SRH and rights (SRHR).
Consequences identified include unplanned pregnancies, very early childbearing, short birth intervals, pregnancy complications, maternal death and disability.
Research on SRHR needs and access to SRH information among adolescents in Pakistan is described as 'scarce.'
Methods
The study will use a participatory action research (PAR) framework based on public engagement principles to co-design an SRHR and Family Planning Advocacy Toolkit for adolescents in Pakistan.
PAR is described as based on 'the principles of public engagement in science and innovation.'
The PAR framework involves 'cyclical recurring activities involving planning, acting, observing and reflecting.'
The primary output is a national SRHR and Family Planning Advocacy Toolkit.
The study leverages 'strong, well-established partnerships among researchers, clinicians, lady health workers (LHWs) and adolescent communities living in rural parts of Pakistan.'
Methods
The research will be conducted in three sequential stages: establishment of youth advisory groups and identification of SRHR concerns, co-designing an intervention, and implementation and usability testing of the Advocacy Toolkit.
Stage 1 involves establishment of youth advisory groups and identification and prioritisation of SRHR concerns.
Stage 2 involves planning and co-designing an appropriate intervention, specifically the SRHR and Family Planning Advocacy Toolkit.
Stage 3 involves implementation and usability testing of the Advocacy Toolkit.
Activities are described as cyclical and recurring within the PAR framework.
Methods
The study has received ethics approval from two institutional ethics boards and focuses on rural adolescent communities in Pakistan.
Ethics approval was received from the University of Alberta Research Ethics Board (Pro00129101_REN1).
Ethics approval was also received from the Ethics Review Committee at Aga Khan University (2023-8671-26021).
The study is focused on adolescent communities living in rural parts of Pakistan.
Lady health workers (LHWs) are identified as key partners in engagement and dissemination.
Methods
Dissemination of the Toolkit will involve adolescent advisory group members, youth partners, lady health workers, governmental platforms, community non-governmental organizations, and educational campaigns.
Adolescent advisory group members, youth partners and LHWs will be actively engaged in dissemination.
The goal is to ensure 'SRH knowledge is readily available to young adolescents' in rural communities.
Dissemination channels include peer-reviewed publications, digital stories and conference presentations.
Collaboration with 'governmental platforms, community non-governmental organisations and educational campaigns' is planned.
What This Means
This research describes a study protocol — a detailed plan for research not yet completed — aimed at improving sexual and reproductive health knowledge among teenagers and young people in rural Pakistan. Pakistan has a very large youth population (nearly one-third of all Pakistanis are between 10 and 24 years old), yet young people there have very limited access to information and services related to sexual and reproductive health, including contraception. This lack of access is linked to serious health problems including unplanned pregnancies, complications during childbirth, and even maternal death.
The research team plans to work directly with young people, community health workers known as 'lady health workers,' clinicians, and researchers using an approach called participatory action research (PAR). This means young people themselves will help identify what health information they need most, help design an educational resource called an 'SRHR and Family Planning Advocacy Toolkit,' and then test whether the toolkit is actually useful. The process is designed to be collaborative and cyclical, repeating steps as needed based on feedback.
This research suggests that involving adolescents directly in designing health resources — rather than simply delivering information to them — may be a more effective and culturally appropriate way to address gaps in sexual and reproductive health knowledge in Pakistan. If successful, the toolkit could be distributed through schools, community organizations, and government health programs, potentially improving health outcomes for a large and underserved population of young people in rural Pakistan.
Meherali S, Najmi H, Nausheen S, Lassi Z, Memon Z, Mian A, et al.. (2025). Engaging adolescents for sexual and reproductive health and rights and family planning advocacy in Pakistan: a qualitative study protocol.. BMJ open. https://doi.org/10.1136/bmjopen-2024-093894