ADOLESCENT SEXUAL REPRODUCTIVE HEALTH HEALTH SERVICE PROVIDERS TRAINING – Division of Reproductive Health

Introduction to ASRH and related issues Broad Objective. To acquire knowledge, attitude and skills on adolescent/youth sexual and reproductive health issues.

Specific Objectives Definitions of Adolescents,Youth,Young people and Teenager Describe the target population of young people Discuss ASRH problems faced by young people Discuss the rationale for focusing on the young people

Definitions WHO definition Adolescents 10-19 years Early adolescence 10-13 years Mid-adolescence 14-15 years Later adolescence 16-19 years Youth 15-24 years Young people 10-24 years Teenager 13-19 years

Definitions… Social definition Adolescence is the stage in human development covering the onset of puberty until full social integration of the individual as an adult.  

Definitions… Biological definition This is a period in which an individual goes through physical and psychological changes accompanied by sexual maturation leading to capacity to procreate.  

Definitions… Sexuality This is more than sexual feeling and sexual intercourse sexuality includes thinking of ones self as sexual being feeling attractive and behaving, dressing or communicating in a sexy way it includes feeling thinking or behaving as male or female. Being attractive being in love and being in relationships with sexual intimacy and sexual activities.  

Reproductive Health Reproductive Health is a state of complete physical mental emotional and social well-being and not merely absence of disease or infirmity in all maters relating to reproductive health system and its functions and processes. (ICPD 1994).

Components of Reproductive Health Safe motherhood, Maternal and Neonatal Health Family Planning Adolescent / Youth sexual Reproductive health Gender issues, Sexual and Reproductive Health Rights Reproductive Tract Infections (RTIs) Infertility Cancer of Reproductive Organs Reproductive Health for the Elderly Persons

Population The target population is young people of age 10-24 years constituting 20% of World total population. Majority living in developing countries (83%) with Africa having the largest proportion

Population… Kenya target population Young people 10-24 years constitute 36% of the total population. (MPND 1999 census) Adolescents 10-19 years constitute 25.9% of the total population. (MPND 1999 census)

Why focus on the youth? Transition to adulthood has many challenges Adolescence is confusing and stressful Compounded by many myths, misconceptions and misinformation Inadequate RH information Death in child birth. Lack of Information and range of skills such as decision-making, communication and negotiation skills. Neglected as a group by the health system

Why specialized RH services? Specific biological and psychological needs of adolescents. High risk of RTIs, HIV and pregnancy. Disproportionately high risk of sexual abuse. Importance of behavior related risks that are responsive to education and counseling. Opportune age/stage to learn good health practices. Severities of consequences from lack of reproductive health care during adolescence

ASRH problems faced by young people Female Genital Cutting Menstrual Problems Early and unprotected sex. Early and forced marriages Abortions. Reproductive Tract Infections /HIV/AIDS. Sexual abuse. Drugs and substance abuse Nutrition Mental health problems

Sexual Activity among the youth

Sexual Activity…

Sexual Activity…

Sexual Activity…

Early and forced marriages Early marriage and forced marriages exposes the adolescent to sexual intercourse at a very early age resulting to pregnancy which can lead to several complications during delivery, due to immature reproductive system, e.g. vesico-vaginal fistula, small for dates, Cephalo- Pelvic Disproportion(CPD)  

Early and forced marriages…

Early and forced marriages…

Teenage Pregnancy and Child birth

Child bearing by age and level of education

Child bearing by age and level of education…

ANC and Skilled Attendance among young women ANC is used by about 90% of 15-24 year olds in all provinces except for North Eastern province where only 31% of young women had any antenatal care. Delivery assistance varies by province. About 3 out of 4 young women are assisted at delivery by a health professional in Nairobi and central compared to only 11% in North Eastern province.

ANC and Skilled Attendance among young women…

Unsafe abortions It is estimated that 308,000 abortions occur annually in Kenya, majority of which are among adolescents. It is estimated that 45 percent of all pregnancies among girls 15-19 years are terminated every year. IPAS 2003, magnitude study. 4 out of 10 women who die from unsafe abortion complications are below the age of 20 years.

Contraceptive use

Unmet need for Family planning

Sexually Transmitted Infections /HIV/AIDS Globally sexually transmitted infections including HIV/AIDS affect one in twenty young people. In Kenya 50 percent of all new HIV infections occur among the young people 15-24 years. This manifest most seriously among adolescent girls 15-19 years and young women (20-24 years) who are twice as likely to be infected than males in the same age group

HIV prevalence by age HIV rates among women ages 20-24 are three times higher than among men

HIV prevalence and age at first sex For women, the rate of HIV is highest among those who began sex at an earlier age.

HIV prevalence among men and women aged 15-24 by province Young women have higher infection rates than men of their age

HIV testing

Condom use among young people

Condom use among young people…

Gender Based Violence Sexual Violence and abuse In Kenya there has been an increasing number of sexual abuse particularly on minors, adolescent girls and young women. According to KDHS 2003, 13 percent of adolescent girls (15-19 years) had ever experienced sexual violence while 12 percent had been subjected to sexual abuse

Gender Based Violence… Marital violence Two in 5 young people (20-24) ever married women have experienced violence from their spouses. The most commonly reported types of violence are being pushed / shaken or being slapped and having arm-twisted. Marital violence seems to vary greatly by province. 3 out of 5 young women (15-24) in western province report physical or sexual violence, compared to only 1 in 5 in North eastern

Marital violence

Drugs and substance abuse Alcohol consumption and tobacco smoking are common among young people. According to KDHS 2003, one in five men aged 20-24 smoke cigarettes. Almost one in three men age 20-24 drank alcohol. Young women drink much less frequently than men. Only 4 percent of 20-24 years old women drank alcohol in the month before the survey.

Drugs and substance abuse… According to a recent study by NACADA one in every three youth have taken alcohol and 8.3% smoke cigarettes (these are youth in secondary schools). 23% of primary school going children have taken alcohol while 44% in secondary schools have taken alcohol. 7 out of 10 university students have taken alcohol. 92% of youth aged 16-26 years have experimented with drugs, with boys being three times more likely to experiment with drugs than girls.

Nutrition An inadequate diet can delay or impair health development leading to stunting in childhood or during adolescence. In girls, poor nutrition can delay puberty and lead to development of a small pelvis. Malnourished adolescent girls who have babies at a young age are more likely to experience complications before, during and after pregnancy. Maternal mortality is higher in malnourished and anaemic women especially among adolescents

Mental health problems These problems may become apparent during adolescence. Mental health problems, e.g. depression, frequently start to be felt in this age group especially among adolescents with low self-esteem. A young person who sees no future is more likely to exhibit high-risk behaviour

Education among young people

Education level by province

Employment among the youth

Employment by educational background Significant percentage of young people are in school and are currently employed which should be a concern