Reimagining Adolescent Sexual and Reproductive Health Promotion in Pakistan: Identifying Indicators, Overcoming Resistance, and Leveraging Social Media

Pakistan, like many South Asian countries, urgently needs to address sexual and reproductive health issues due to high fertility and birth rates and a large adolescent population. However, promoting reproductive health, women's empowerment, and comprehensive sexuality education (CSE) remains challenging due to societal opposition and misconceptions. This dissertation tackled the issue through a three-pronged approach. First, a Delphi expert consultation process was used to create a list of adolescent sexual and reproductive health indicators for South Asia. Second, community readiness and resistance to CSE in Pakistan were assessed. Third, a social media-based intervention was developed, piloted, and evaluated to counter community resistance to CSE. An expert group identified nine categories with 41 indicators for assessing adolescent sexual and reproductive health, prioritized through expert consensus. A community readiness assessment in Islamabad revealed the community was at the denial/resistance stage, which hampers effective CSE promotion. Focus group discussions with key stakeholders were held, leading to the development of an intervention aimed at raising awareness and addressing resistance. Two videos were created and disseminated via social media platforms like Facebook, YouTube, and Instagram, receiving 432,457 and 735,563 views, respectively. The audience was generally receptive to CSE content, and social media showed potential for wide-reaching CSE promotion in Pakistan. Feedback was positive, with a net sentiment score of 0.83. Comments highlighted reasons for both positive and negative reactions. Overall, the findings demonstrate that social media offers a valuable opportunity to promote CSE in Pakistan, providing insights for policymakers and health practitioners in similar developing countries.