ADOLESCENT REPRODUCTIVE HEALTH

Definition:
World Health Organization defines adolescents as individuals between 10 and 19
years of age. The broader terms "youth" and young encompass the 15 to
24 year-old and 10 to 24 year-old age groups, respectively.
For girls, puberty is a process generally marked by the production of estrogen, the growth
of breasts, the appearance of pubic hair, the growth of external genitals, and the start of
menstruation. For boys, it is marked by the production of testosterone, the enlargement
of testes and penis, a deepening of the voice and a growth spurt.

Characteristics of the adolescence period

The period is characterized by:

The period when the individual progresses from the point of initial appearance of
secondary sex characteristics to sexual maturity.

It is period when psychological processes and patterns of identification to those of

an adult.

Transition from the state of total

socio-economic dependence to relative

independence.

Period of rapid physiological changes and vulnerability to physical, psychological

and environmental influences.

Period of physical, biological, psychological and social maturity from childhood to

adulthood.

Transition from childhood to adulthood involves adjustment encompassing physiological,

psychological, cognitive, social and economic changes. The process is universal, but varies
by individual and culture.

Table 5: Effects of social environment on adolescent RH behavior

Factors

Positive influences

Negative influences

Education

Good health and sex

education followed by correct
behavior

Early unwanted pregnancy, school

dropping, unemployment, prostitution,
drug abuse, crime, etc,

Media

Spread information on healthy Pornography, smoking, crime (films,

sexuality
papers, advertisement)

Entertainment

Sports,
in
door
educational films

Family

Integrated stable families are Abusive behaviour in

role models. They can give families Disintegrated
appropriate information and families
guidance on healthy life style

Residence
Religion

games,

Crimes, drugs and alcohol

prostitution, early sexual activities

Healthy neighborhood
Spiritual support

abuse,

"negative neighborhood" e.g.

prostitution areas

Prohibition of information on sexuality

Facilitation of the adolescents

in different activities
Health services

Accessible information
services for adolescents

Reproductive Health

and

Negative attitudes of health professionals

on adolescent sexuality

Risks and consequences for adolescents

Adolescent reproductive health is affected by pregnancy, abortion, STIs, sexual violence,

and by the systems that limit access to information and clinical services. Reproductive
health is also affected by nutrition, psychological well-being, and economic and gender
inequities that can make it difficult to avoid forced, coerced, or commercial sex.

Pregnancy:
In many parts of the world, women marry and begin childbearing during their adolescent
years. Pregnancy and childbirth carry greater risk of morbidity and mortality for adolescents
than for women in their 20s, especially where medical care is scarce. Girls younger than age
18 face two to five times the risk of maternal mortality as women aged 18-25 due to
prolonged and obstructed labor, hemorrhage, and other factors. Potentially life- threatening
pregnancy-related illnesses such as hypertension and anemia also are more common

among adolescent mothers, especially where malnutrition is endemic. One in every 10 births
worldwide and 1 in 6 births in developing countries is to women aged 15-19 years.
Unsafe abortion:
About one in 10 abortions worldwide occurs among women age 15-19 and each year one
million to 4.4 million adolescents in developing countries undergo abortion, and most of
these procedures are performed under unsafe conditions due to:
- Lack of access to safe services.
- Self-induced methods
- Unskilled or non-medical providers
- Delay in seeking procedure

Adolescent unwanted pregnancies often end in abortion. Surveys in developing countries

show that up to 60 percent of pregnancies to women below age 20 are mistimed or
unwanted.
STIs, including HIV/AIDS

The highest rates of infection for STIs, including HIV, are found among young people
aged 20 to 24;

the next highest rate occurs among adolescents aged 15 to 19.

Sexually transmitted infections can lead to life-long health problems, including infertility.
Worldwide, half of all sexually transmitted infections occur in adolescents. Approximately
333 million cases of curable STIs occur each year and each day half a million young
people are infected with a sexually transmitted diseases, available data suggest that onethird of STIs infections in developing countries occur among 13-20 year olds, one out of
every 20 adolescents contracts STI,. In rural Kenya, for example, 41 percent of women
aged 15-24 attending maternal and child health or family planning clinics had STI,
compared to about 16 percent of all women of reproductive age. Adolescents also are at
increased risk of contracting HIV/AIDS. Recent estimates are that over 40 percent of HIV
infections occur in young people aged 15-24; 7,000 of 16,000 new infections each day.
New infections among females out number males by a ratio of 2 to 1.
Female Genital Cutting (FGC)

FGC, the partial or complete removal of external genitalia or other injuries to the
female genitalia, is a deeply rooted traditional practice that has severe reproductive
health consequences for girls. In addition to the psychological trauma at the time of
the cutting, FGC can lead to infection, hemorrhage, and shock. Uncontrolled bleeding or
infection can lead to

death within hours or days. Some forms of FGC can lead to

Dyspareunia, recurrent pelvic infection, and dystocia. The ICPD Programme of Action
calls FGC a basic human rights violation and urges governments to stop the practice. In
some countries, such as India arranged marriage of girl younger than 14 is still common.

Commercial Sex

Sexual exposure is occurring at ages as young as 9-12 years as older men seek
young girls as sexual partners to protect themselves from STD/HIV infection. In
some cultures, young men are expected to have their first sexual encounter with a
prostitute.

Adolescents, especially young girls, often experience forced sexual intercourse in

sub Saharan Africa, some girls first sexual experience is with a sugar daddy, who
provides clothing, school fees, and books in exchange for sex.

Sexual violence
Sexual abuse occurs worldwide. One-third of teenagers experience abuse, with in
heterosexual relationships, in United States. Rape and involuntary prostitution can result
in physical trauma, unintended pregnancy, STIs, psychological trauma and increased
likelihood of high- risk sexual behavior.

The health risks of adolescent sexuality is more

than older people

1. Maternal death: Girls aged 15-19 are up to twice as likely to die during pregnancy or
delivery as women aged 20-34.

2. Infant and child mortality: children born to adolescents are more likely to die
during their first five years of life than those born to women age 20- 29.
3. Sexually transmitted infections (STIs): each year, 1 in 20 adolescents worldwide
contracts STIs (including HIV/AIDS).
4. Violence/sexual abuse: Adolescent girls may lack the confidence and decisionmaking skills to refuse unwanted sex.
5. Unwanted pregnancy
Every year, approximately 50 million unwanted pregnancies are terminated. Some 20
million of these abortions are unsafe. About 95 % of unsafe abortions take place in
developing countries, causing the deaths of at least 200 women each day. Many
adolescents face unintended births for example in sub-Saharan Africa about 50 % of last
births in women under 20 years were unintended, in Latin America about 30 % of last
births in women under 20 years were unintended.

6. Psychological and socio-economic consequences of pregnancy for

unmarried adolescents

Psychological stress, poor self esteem, lack of hope and social stigma

Disrupted

Leaving home and prostitution

Poor

education,

socio-economic

poor

future,

academic achievement

poor

earning capacity: fewer career or job

opportunities.

Unstable marriage

Unwanted child- mistreated, abandoned

Their children face psychological, social and economic obstacles

Causes for early unprotected sexual intercourse in

adolescents

Lack

of

sexuality

knowledge

on

physiology

of

the reproductive system and human

Declining age of menarche

Early marriage

Urbanization,

Sexual violence and coercion

Peer influence

Lack of knowledge on family planning

Unavailability

(negative) attitude of the society (including service providers) towards use of

migration,

and

(western

inaccessibility

cultural influences)

(including culturally) of services

family planning services by the adolescents

Adolescent Reproductive Health Services

Making clinical services available
Adolescent clinical health services are best staffed by providers trained to deal with
specific adolescent health concerns and to counsel adolescents about sensitive
reproductive health issues and contraceptive use. In all interventions, providers must
consider adolescents marital status, over all health, and how much power they have in
sexual activity. Adolescents often name the following characteristics as important to
meeting their health needs confidentiality; convenient location and hours; youth friendly
environment; open to men and women; strong counseling component; specially trained
providers; and comprehensive clinical service.

Providing information
Providing appropriate and relevant information about reproductive health is essential to
any program. Clinic- based education and counseling are important to this effort, as are
school- based programs. Obviously, parents are a key source of information, although
they may feel ill-informed or embarrassed to discuss these topics with their children, or

simply may disapprove of young people expressing an interest in sexuality. Youthfriendly approaches such as radio call-in shows, drop-in centers, magazines, and hotlines
also can be effective strategies for reaching adolescents.
Early sex education

Gives adolescents skills to delay sexual activity

Does not lead to earlier or increased sexual activity

Can increase contraceptive use

Health clinic Designed for adolescents:

Separate units for adolescents

Outreach clinics with specially trained staff

Mobile clinics

Special hours

Convenient and safe locations

Youth-to-youth promotions

Low or no-cost services

Ensuring community support

Programs

for

adolescents

often

acceptance since adults fear

encounter

problems

gaining

community

that access to education and services will

encourage adolescent sexual activity. Program evaluations have shown this not
to be the case. Some programs have found that explaining objectives to

parents,

religious leaders, and community leaders, and inviting them to

discussion sessions with adolescents helps reduce opposition

Components of successful adolescent reproductive health programs

Reproductive health programs for adolescents tend to be most successful when they:
1. Accurately identify and understand the group to be served;
2. involve adolescents in the design of the program;
3. work with community leaders and parents;
4. remove policy barriers and change providers' prejudices;
5. help adolescents rehearse the interpersonal skills needed to avoid risks;
6. Link information and advice to services;
7. Offer role models that make safer behavior attractive;
8. And invest in long-enough time frames and resources