ADOLESCENT SEXUALITY

AND PREGNANCY PROBLEMS

Professor Adeyemi O. Adekunle

Department of Obstetrics and Gynaecology
College of Medicine, University of Ibadan
University College Hospital,
Ibadan, Nigeria.

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 SESSION OBJECTIVES
At the end of the session, participants
should be able to:
 Define Adolescence and related terms;
 Describe the current status of adolescent
sexual health in Nigeria;
 Discuss the factors influencing sexual
activities among adolescents;
 Mention the challenges of adolescent
pregnancy and parenthood.
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 DEFINITIONS
 ADOLESCENCE
 Adolescence is the period of physical,

psychological an social changes from

childhood to adulthood.
 It spans the ages of 10 to 19
 TEENAGERS
 These are aged 13 to 19 years

 YOUTHS
 Youths are aged between 15 and 24 years.

 YOUNG PEOPLE
 These are aged between 10 and 24 years.
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 ADOLESCENT SEXUAL AND
REPRODUCTIVE HEALTH
The adolescent years are a tumultuous
period for many individuals.
 It is the period when an individual makes a
gradual transition from childhood to
adulthood.
 During this period:
 The individual progresses from the point
of initial appearance of the secondary
sexual characteristics to that of sexual
maturity; 4
 ADOLESCENT SEXUAL AND
REPRODUCTIVE HEALTH
 The individual’s psychological process
and patterns of identification develop
from those of a child to those of an adult;
 A transition is made from a state of total
socio-economic dependence to one of
relative independence (WHO, 1975).
 This transition period is threatened b
many health and social problems and
thus has become a topical issue in recent
times.
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 ADOLESCENT SEXUALITY
 As physical maturation takes place,
adolescents must acknowledge their
sexuality;
 Today, young people reach reproductive
maturity at an earlier age than did their
counterparts at the turn of the century.
 On the other hand, there has been an
upsurge of interest in pursuing higher
education in many parts of the country
which has led to a delay in marriage.
 The decline in menarcheal age coupled with
the delay in marriage has created a bio-
social gap. 6
 ADOLESCENT SEXUALITY (Contd.)
 Adolescents became sexually active during
this period.
 Therefore, adolescents in Nigeria today, are
biologically mature much before they are
socially mature and independent.
 The high rate of sexual activity coupled with
the ambivalent attitude towards
contraception has been responsible for an
increased rate of pregnancies with their
attendant life threatening complications.
 Thus, the period is fraught with a number of
medical and social consequences.
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 FACTORS INFLUENCING SEXUAL
ACTIVITY AMONG ADOLESCENTS
 Decline in the age of menarche
 Peer-group pressure
 Psychological factors
 Disruption in cultural bonds and traditional
restraints
 Cultural interaction
 Lack of parental care/guidance
 Economic gains
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 SEXUALLY TRANSMITTED
INFECTIONS (STIs) & HIV/AIDS
 There are indications of increasing prevalence
of gonorrhea, Chlamydia, syphilis and
trichomoniasis among adolescents.
 Similarly, there is an increasing trend of HIV
prevalence in this age bracket.
 The prevalence of HIV among young people
between the ages of 20 and 24 years is 8.1%.
 Among adolescents, girls are about twice more
vulnerable than boys.
 About 80% of HIV infections in Nigeria are
contracted through sexual intercourse.
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 EARLY MARRIAGE
 Marriage and motherhood begin early in
Nigeria.
 The two are closely related in the sense that
culturally, Nigerians believe that the major
purpose of marriage is procreation.
 The median age for marriage for Nigeria is
17 years.
 Adolescent nuptuality and fertility pose
enormous challenges to the society and
government.
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 PATTERNS OF ADOLESCENT
MARRIAGE IN NIGERIA
 There are considerable variations in the median
age for marriage among cultural and socio-
economic groups:
 17 years in urban areas and,
 15 years in rural areas
 Marriage is very early in the North, often taking
place before menarche;
 While Christianity has for a long time
discouraged early marriage, the Muslim religion
shows more acquiescence with the culture of
early and child marriage.
 Education also influences the age at marriage.
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 ADOLESCENT PREGNANCY
 Early childbearing poses significant risks for
both the mother and the infant.
 Its adverse effects also affect the society.
 In addition to bearing the costs for maternal
and child health care, it may also loose the
added potential of an educated person.
 The reasons for adolescent pregnancy are
diverse and complex.
 They vary among different cultural and ethnic
sub-groups and the society’s attitude toward
adolescent contraception.
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 ADOLESCENT ABORTION
 Abortion in the discontinuation of pregnancy
when the fetus weighs less 500g. (WHO). i. e.
gestational age of 24 weeks.
 The cut off age of 24 weeks was chosen to
indicate the period when the fetus has some
reasonable chance of extra uterine life.
 Spontaneous abortion (miscarriage):
 occurs naturally, without willful intervention;
rarely associated with death.
 Induced abortion (termination):
 occurs with intervention; can be associated

with severe morbidity and mortality.

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 COMPLICATIONS OF ILLEGAL ABORTION
(UCH, Ibadan)

____________________________________
Type of Complication Percentage
____________________________________
 Sepsis/Infection 86.2
 Haemorrhage 35.2
 Uterine Perforation and
Bowel injury 16.2
 Lower genital tract injury 9.5
 Renal Failure 0.4
 Death 7.0
____________________________________
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FACTORS AFFECTING THE
POSSIBILITY OF COMPLICATIONS
 Skill of the abortionist

 The abortion method

 The environment

 The woman's wealth

 Age of pregnancy

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 FACTORS AFFECTING INCREASED
PREGNANCY/ABORTION AMONG
ADOLESCENTS
 Adolescents are biologically more mature
before they are socially mature and
dependent.
 Lack of factual knowledge on reproductive
health.
 Increased sexual activity:
 timing, lack of planning and frequency,

 multiple sexual partners,

 Ambivalent attitude towards contraceptives.

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 CONSEQUENCES OF TEENAGE
PREGNANCY OUTSIDE WEDLOCK
Consequences Percentage of
Respondents
_____________________________________________________________________________________________________________________________________________________________________________

 Expulsion from school 51.8

 Ashamed to return to school 19.6
 Parents/guardians refuse to
pay school fees 15.4
 Had to get married 7.7
 Future unknown 5.5
_____________________________________
Oronsaye et al. (1982)

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 Medical Complications of
Adolescent Pregnancy
 During Pregnancy
 Nutritional deficiency
 Anaemia
 Threatened abortion
 Pre-eclampsia and eclampsia
 High incidence of abortion and its
complications

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 Medical Complications of
Adolescent Pregnancy (Contd.)
 During Labour
 Premature labour
 Prolonged labour
 Obstructed labour
 High incidence of operative delivery
 Obstetric neuropathies
 Obstetric fistulae – vesico-vaginal and
recto-vaginal
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 SOCIAL AND DEMOGRAPHIC
CONSEQUENCES OF EARLY MARRIAGE
AND CHILDBEARING

 Many young mothers are denied the

opportunity to attend school;

 Those who attend terminate schooling or

training to have babies; thus, reducing
career chances available to women;
 Women who marry early have a longer
period of exposure to the risk of pregnancy;
consequently, have high completed family
size, 20
 ADOLESCENT PARENTHOOD
 It is generally believed that early childbearing
certainly leads to:
 school dropout,

 subsequent unwanted births, and

 economic dependence.

 The belief that adolescents who have children are

destined to poor outcomes has been shown to be
untrue.
 Many young people are put in the family way, not
by adolescent males but by men who are much
older, some even already married.
 However, many adolescent parents and their
children do fare poorly over time. 21
 ADOLESCENT MOTHERS
Maternal Educational Outcome
More likely to experience a shortened
education.

Maternal Economic Status:

This lack of education contributes to
their inability to attain full economic
independence.

22
 ADOLESCENT MOTHERS (Contd.)
Repeated Pregnancy:

 Young people who drop out of school,

remain sexually active, and do not use
effective contraception and are at highest
risk for repeated pregnancy during their
teenage years.
 These mothers have more children than
do older women.

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 ADOLESCENT FATHERS
 Most adolescent males are ill-prepared
for the responsibilities of fatherhood.
 Recent studies have shown that
academic, drug, and conduct problems
were significantly more common among
adolescent fathers than among
adolescent males in general.
 Young men also suffer educational and
economic disadvantages from early
fatherhood.
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 ADOLESCENT FATHERS (Contd.)
 A male student, responsible for a girl's
pregnancy, may be expelled from school
through pressure from the girl's parents, or
forced to abandon school or enter a
premature marriage.
 Such men are less likely to graduate from
school, less likely to have a skill, and more
likely to enter into low-paying occupations
or jobs.
 In general, men suffer less ill-effects of
parenthood than young mothers.
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 CONCLUSIONS
 Adolescent sexuality and reproductive health
issues pose enormous challenges to the
society and government.
 Therefore, there is need to consider policies
and programmes that could help adolescent
women achieve their full potential, including:
 Policies that discourage early marriage and
childbearing by providing educational and
employment alternatives;
 Programmes to help young people stay in
school, even if they have children; 26
 CONCLUSIONS (Contd.)
 Programmes to establish or expand family-life
education, for teenagers in school;
 IEC programmes aimed at partners, parents,
and other relatives of adolescent women;
 Policies that increase access to high quality,
appropriate family planning services and
counseling for sexually active adolescents;
 MCH programmes that seek out teenagers who
may not know what health care they and their
babies need or where to obtain services.
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 CONCLUSIONS (Contd.): Policies
addressing ARH Issues in Nigeria
 Adolescent Health Policy (1995)
 Strategic Framework for Adolescent
Reproductive Health Work (arising from the
National conference on ARH in 1999);
 Reproductive Health Policy (2001);
 HIV/AIDS Emergency Action Plan (HEAP) –
2001 – 2004;
 National Reproductive Health Strategic
Framework and Plan (2002 – 2006)
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CONCLUSIONS (contd.): ADOLESCENT
REPRODUCTIVE HEALTH POLICY
 Has a number of foci:
 Sexual behaviour

 Reproductive health
 Nutrition
 Accidents
 Drug abuse
 Education
 Career and employment
 Parental responsibilities and adjustment
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THANK
YOU

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