2.

5 ADOLESCENT REPRODUCTIVE HEALTH

Learning Objects
• At the end of this session the students be able
to
• Define Adolescent
• Explain different category of Adolescent age
group
• Identify Impacts of Adolescent age
• Identify Adolescent reproductive health
services (youth reproductive health service)

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 2.6.1 Introduction
• Adolescents are a critical target population with
regard to influencing global public health outcomes.
• Young people below 25 years of age represent
almost 50% of the world’s population.
• Furthermore, nearly 85% of the world’s adolescent
population lives in developing countries.
• In a number of countries in sub-Saharan Africa,
population below 15 years of age is five times
greater than the population over 55 years of age

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 Intro cont….
• This subset of the world’s population is often
disproportionately affected by social and
economic inequities that characterize the
development landscape
• This makes them more vulnerable to poor health
outcomes, especially outcomes related to sexual
and reproductive health

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 Introd cont..
• Young people constitute one-third of the total
population in Ethiopia.
• Their number is expected to grow from20.3
million in 2000 to 25 million in 2010.
• The reproductive health problems of young
people in Ethiopia are multifaceted and
interrelated
• Childbearing begins at an early age: 45 percent
of the total births in the country occur among
adolescent girls and young women

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 Intro cont…..
• Sexual violence and commercial sex work have
become common phenomena among young girls.
• As a result, they have become primary victims of the
HIV/AIDS crisis that has spread throughout the
country.
• The situation is aggravated by the overall poor
socioeconomic environment and harmful traditional
practices.
• Because of the complex nature of the problems,
youth reproductive health strategies demand a
multisectoral and integrated approach

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 Definition of Adolescent
• The term adolescence is derived from the Latin
word “adolescere” meaning to grow, to mature.
It is considered as a period of transition from
childhood to adulthood
• They are no longer children yet not adults. It is
characterized by rapid physical growth,
significant physical, emotional, psychological and
spiritual changes

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 Def cont…

Agee Category of Adolescent

• Adolescence : 10 – 19 years
• Early Adolescence : 10 – 13 years
• Middle adolescence : 14 – 16 years
• Late adolescence : 17 – 19 years
• Youth : 15 – 24 years
• Young people :10 - 24 years

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 Cont….
Stags of Adolescent
• Early adolescence (10 -13yrs):
• Spurt of growth of development of
secondary sex.
• Middle adolescence (14-16yrs):
• Separate identity from parents, new
relationship to peer groups, with opposite sex
and desire for experiment

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 Cont…..
Late adolescence (17-19yrs):
• Distinct identity, well formed opinion and ideas
• The following changes are taking place during
adolescent period:
• Biological changes – onset of puberty
• Cognitive changes – emergence of more advanced
cognitive abilities

• Emotional changes – self image, intimacy, relation with

adults and peers group
• Social changes – transition into new roles in the society

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 Impact of adolescence:
1) Lack of formal or informal education
2) School dropout and childhood labour
3) Malnutrition and anemia
4) Early marriage, teenage pregnancies
5) Habits and behaviors picked up during adolescence period
have lifelong impact
6) Lot of unmet needs regarding nutrition, reproductive
health and mental health
7) They require safe and supportive environment
8) Desire for experimentation
9) Sexual maturity and onset of sexual activity
10) Transition from dependence to relative independence
11) Ignorance about sex and sexuality
12) Lack of understanding
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 Cont…
13) Sub optimal support at family level
14) Social frustration
15) Inadequate school syllabus about adolescent
health
16) Misdirected peer pressure in absence of
adequate knowledge
17) Lack of recreational, creative, and working
opportunity

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 Adolescent health problems
• Anorexia nervosa
• Obesity & overweight
• Adolescent pregnancy
• Micronutrient deficiency
• Emotional problems
• Behavioral problems
• Substance abuse & injuries
• Sexually transmitted infection
• Thinking and studying problems
• Identity problems

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 2.6.3 What are Adolescent and Youth Sexual
and Reproductive health
• Adolescent and Youth Reproductive health: is a state of
complete physical, mental, and social well being of
adolescent and youths and not merely the absence of
disease or infirmity, in all matters related to the
reproductive system and to its functions and processes
• This includes their ability to remain free from unwanted
pregnancy, unsafe abortion, STIs including HIV/AIDS and all
forms of sexual violence and coercion.
Adapted from ICPD 7.2
• Sexual health: is having a responsible, satisfying, and safe
sex life, that is free from disease, injury, violence, disability,
unnecessary pain, or risk of death
adapted from ICPD 7.2
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 Why focuses to adolescent and youth health
• Lack of messages targeted to Adolescent and youth
• Lack of youth friendly services: little access to Sexual
and Reproductive Health services, treatment or
prevention of STI/HIV
• Provider, parent, teacher, and community attitudes
about youth and sexuality
• False beliefs that young people are not sexually active
and that information will increase sexual activity
• Lack of providers trained to deal with youth
• Specific biological, psychological, social and emotional
needs of developmental stage (s)

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 Cont…

• Young people are curious about their bodies

and they further explore their changes they go
through.

• RH information make them less likely to

experiment with risky sexual behaviors and
able to make good decision to protect their
health

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 Adolescents are different from adults
• They have different needs because of their physical,
emotional, social and psychological developmental
stages.
• They have different cognitive abilities and skills,
which requires different counseling approaches and
more time.
• They tend to be less well-informed and require
more information
• Conflicts between cultural or parental expectations
and adolescents’ emerging values causes serious
challenges for young people

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 Adolescents/Youth is a critical age for risk taking
• Adolescents and youths are moving toward
independence they tend to experiment and test
limits, including practicing risky behaviors.
• Using substances or drugs for the first time
typically occurs during adolescence and youth.
• Sexual experiences (not always voluntary)
usually begin during adolescence.
• Consequences of risky behaviors can have
serious and long-term effects.
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Adolescent and youth are an opportune time for
professional interventions
• Young people can be educated, counseled given
guidance & experiences in school, at home, and
through religious institutions; health education.
• Importance of behavioral-related risks amenable to
education, counseling
• Opportunity age to learn healthy practices
• Interventions can help young people make good
decisions and take responsibility for their actions to
preventing serious negative consequences in the
future.

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 What are the existing opportunities in Ethiopia?
• National Population Policy (1993, PMO)
• Education Policy
• Health Policy (1993, PMO)
• HIV/AIDS Policy (1998, MOH)
• Social Security & Development Policy (MOLSA)
• National Youth Policy (2004, MoYS)
• National RH strategy, 2006 – 15 (2005, MOH)
• National AYRH strategy, 2007 – 15 (2007, MOH)
• Standards and minimum service package on Youth Friendly
RH Services, (2007, MOH)
• The AYRH planning, Implementation and evaluation tool.
• The emerging increased # of the micro finances institutions

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• Adolescent and Youth Sexual and Reproductive
Health (AYSRH) programs should:
• Involve Young people as key decision-makers in
program design, implementation, and evaluation
• Provide comprehensive, accurate information in
a manner apropiarte to their age group and sex
• Address barriers to accessing health and
information services
• Empower adolescentes to make life choices that
are best for them
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• Youth friendly Health service (YFS)
• Definition: Programs and/or services that:
Attract and meet the reproductive health
needs
• Respect and accommodate the unique
psychological, social, cultural, and
economic situations.

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 Cont…..
Comfortable with appropriate environment, Ensure
confidentiality and privacy succeed in retaining
these young clients for continuing care.
• Conveniently located and easily accessible
• Convenient hours
• Separate space or time for adolescents
• Integrated services
• Surroundings are clean and comfortable with
adequate furnishings
• Sign post displays hours and services available

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 Staff/Providers
• Specially trained staff
• Staff are respectful and interested in working
with youth
• Providers treat client information
confidentially
• Providers spend sufficient time interacting
with youth
• Staff and providers speak the local language
• Staff are supportive, open, accepting and
knowledgeable about SRH
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 Well trained peers are available to provide information
and services
• information and counseling on sexuality, safe sex and
reproductive health;
• contraception and protective method provision (with an
emphasis on dual protection);
• STI diagnosis and management;
• HIV counseling (and referral for testing and care);
• pregnancy testing, antenatal and post-natal care;
• counseling on sexual violence and abuse (and referral for
needed services); and
• Post-abortion care (PAC) counseling and contraception
(with referral when necessary).

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 Service Provision
• Staff are sensitive to the needs of males and
females
• IEC/BCC materials are available and appropriate
• A wide choice of services and contraceptive
methods are available
• Referrals are made for other needed services
• Youth are counseled on dual protection
• The pelvic exam can be delayed on the first visit,
if desired

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 Policies and Administration
• Policies and procedures support services for young
people
• Staff appropriately apply policies
• Youth participate in design, implementation, and
evaluation of YFS
• Fees are affordable
• Waiting times reasonable
• Staff are well supervised
• Services are publicized
• Records are kept confidentially

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 Cont….
• A Youth friendly service assessment is designed to collect
detailed information on the range and quality of services
provided to adolescents at a given facility or within a given
program
• Determining minimum requirements for youth-friendly
services is a difficult task given the great differences in
contexts and availability of resources
• In addition to the uses outlined above, this guide may also
be used:
• As an ongoing monitoring tool
• For annual evaluations
• For designing training opportunities
• For developing work plans
• As a self-assessment tool for staff
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 Minimum Standards/packages of YFS
• Provision of relevant Information, counseling and referrals
on HIV, reproductive health, sexual violence and abuse,
post-abortion care and contraceptives
• Prevention of unwanted pregnancy by providing
contraceptives like protective methods (dual protection)
including emergency contraception
• STI diagnosis and management
• Pregnancy testing, antenatal, Delivery and post-natal care
• Provision of Abortion & post abortion care
• Provision of for VCT/ PIHCT/OI & referral ART and other
HIV/AIDS care and support services
• Referral linkage for better service
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 Approaches
• Free standing (usually located in the youth centers,
clubs etc..)
– Advantages
• Very comfortable,
• Accessible
• More friendly
– Disadvantage
• Expensive
– Needs medical staff (nurse, lab tech etc..)
– A question of sustainability (mostly initiated by
NGOs)
» may cause discomfort ( fear to use it)
» staff turnover

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 Where do we integrate AYRH services?
• Home
• School
• Health institution (Health post ---referral hospitals)
• Workplace
• Street
• Community organization
• Residential centre
• Media/entertainment
• Political and legislative systems

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 Who are the Key players?
– Family , Friends, Teachers, Religious leaders Peer
educators ,Health workers
– Social workers ,Low makers ,Politicians, Musician,
Movie and TV stars
• Police ,Sport’s figures ,Journalists ,Employers
,Youth workers ,

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 Challenges
• Building political commitment
• “Young people are healthy”, but behaviours starting
during adolescence are crucial to current and future
health.
• “The issues are too sensitive”, but the stakes are too
high to ignore and there are those able to act.
• “Young people make economic and political
demands”, but they are also a great resource for
social and economic progress.
• “There is no money” but much can be done with
better use of existing resources.
• Cultural and other issues
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• Integrated with the existing services:
• Public health institution
• Private health institutions
• Advantages:
– provides comprehensive service,
– inexpensive,
– sustainable
• Disadvantage:
may cause discomfort ( fear to use it)
staff turnover

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 Cont…..
Where do we integrate AYRH services?
• Home
• School
• Health institution (Health post ---referral hospitals)
• Workplace
• Street
• Community organization
• Residential centre
• Media/entertainment
• Political and legislative systems

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 Cont…..
Who are the Key players?
– Family , Friends, Teachers, Religious leaders Peer
educators ,Health workers
– Social workers ,Low makers ,Politicians, Musician,
Movie and TV stars
– Police ,Sport’s figures ,Journalists ,Employers
,Youth workers .

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 Cont…
Challenges
• Building political commitment
• “Young people are healthy”, but behaviours starting during
adolescence are crucial to current and future health.
• “The issues are too sensitive”, but the stakes are too high to
ignore and there are those able to act.
• “Young people make economic and political demands”, but
they are also a great resource for social and economic
progress.
• “There is no money” but much can be done with better use
of existing resources.
• Cultural and other issues

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THANK YOU !!

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