Values clarification: making meaningful reproductive choices Dr Delene Botha School of Nursing University of the Free State

Objectives of reproductive health HEALTH PROFESSIONAL Provide factual correct information Provide services Enable and support responsible voluntarily decisions about childbearing and family planning Meet changing reproductive health needs over the life span… sensitively Still today, with Google and all, teenagers do not have the correct information about reproductive health issues.. We are looking at teenagers, but what are adults meaningful reproductive health care choices?

Strategies to end maternal and child mortalities: facing teenage pregnancy

Meaningful reproductive health choices… “What is meaningful reproductive health choices?” It is a choice that is: significant, deep, far reaching…. Having an important effect…

Expecting this from our teenagers?

… to make serious choices about reproductive health?!

“The teenagers’ brain”

Values: some facts… did you know..? We are not born with values…. Morris Massey (sociologist) describes three stages: Imprint period: (birth-7 years): “sponges” absorb as much as they can accepting all as true, especially if comes from the parent (“blind acceptance”). “follow what they see…” Modeling: (8-13 years): “copy people’s behavior” rather than blind acceptance Impressed by teachers, religion Socialization (14-21 years): Influenced by peers; turns to people who “seem to be more like myself…!” MEDIA

MEDIA!!! Emphasize “sexual double standards…” Two different sets of standards – male and female

Responsible reproductive health education programme Three phases 1 – Caring for a “baby” 2 – Values clarification 3. “Bringing it together”

Values clarification –Grade 8 learners Grade 8 learners: average age: 13-14 yrs According to Massey’s model: modeling, socialization “copy people’s behavior” rather than blind acceptance, impressed by teachers, religion Influenced by peers; turns to people who “seem to be more like myself…!” MEDIA

Purpose Grade 8 learners to identify their main values (n=185) Link this to meaningful reproductive health…

The instrument (adapted from the Iceberg Model of Human behavior) Three main headings: Personal values Socio-economic values Sexual and reproductive health values Under each heading 9-11 items Learner chooses: A= most, most important, B, less….G= least important

Findings: (“how important is it for you to have…”-responded with A,B -G) Personal values Achievement (get results, completes tasks) Advancement ( Moving ahead, striving to grow) Assertiveness (being able to say “no”) Independence ( self-reliant, freedom from others’ control) Inner harmony (being at peace with oneself /do not hold grudges) Integrity (honest, sincerity, living by your values) Health/ well-being (Free from disease) Pleasure ( always having fun, enjoyment) Kindness (do good to others) Humility (being humble) Respect (for yourself and others) Achievement was mostly chosen – one would think independence or assertiveness would be more popular

Personal values - achievement Blue was A choices; 48%; Brown B choices 6.5%; A+B grey =55% so more than half of the group chose achievement as most/second most important

Socio-economic Acceptance by peers Education ( commitment to learning) Freedom from financial worries Fame (being well known) Family happiness ( getting along, respecting family members) Friendship (close companionship with others) Prestige (showing success, rank, status) Spirituality (strong belief in God, devotion) Wealth (material prosperity, abundance) Expect acceptance by peers to be a popular choice or friendship; Education and family happiness was mostly chosen

Socio-economic –education Blue = A choices 12.4%; Brown 9.7% and together =24.1% about a quarter of the group chose education as a socio-economic value

Socio-economic: family happiness With regard to family happiness – one A choice! 5.9% Orange; E and G both 9.7% = 18 choices

Sexual and reproductive health choices: Abstinence (not to have sex) Becoming a parent Body image (your feelings about your body) Caring for a baby (feeding, nappy changing etc.) Dating Self-concept (do you like yourself?) Sexual engagement (being sexually active) Talking to your parents- (about sex) Talking to your peers (getting information; sharing about sex) Talking to any other adult (teachers, nurses, neighbor) Teenage pregnancy (Avoiding pregnancy, prevention)

Sexual and reproductive health choices: Standing out: F choices for self-concept. A choices? Abstinence…only 6%? Avoiding pregnancy??? Dating!?

Discussion: Personal values: Achievement – real value, or modeling period? Socio-economic value: Education -real value, or modeling period? Family happiness –E + G (5th and 6th choices)

(discussion –continued) Sexual and reproductive health values 6% A; in total 24% chose the value - ?out of 185? Body image – for most the 6th choice Dating: - less than 2%!!! As a first choice -? Validity Self-concept: 6th choice the most… Talking to: parents and peers – few; other adults: 4th and 5th choice Avoid pregnancy….seemingly not everyone’s choice?!

Conclusion: Limitations: the learners could maybe misunderstood the instrument… “Halo-effect” provide the “correct” answers What we have learnt: “what we want, is not necessary what learners want…” Take note of “talking to other adults…” (professionals, we have a role to play!!) Getting to meaningful reproductive health is a complexed task…

Thank you!