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

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

3. 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

4. Definitions WHO definition Adolescents 10-19 years
Early adolescence years
Mid-adolescence years
Later adolescence years
Youth years
Young people years
Teenager years

5. 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.

6. 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.

7. 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.

8. 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).

9. 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

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

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

12. 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

13. 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

14. 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

15. Sexual Activity among the youth

16. Sexual Activity…

17. Sexual Activity…

18. Sexual Activity…

19. 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)

20. Early and forced marriages…

21. Early and forced marriages…

22. Teenage Pregnancy and Child birth

23. Child bearing by age and level of education

24. Child bearing by age and level of education…

25. ANC and Skilled Attendance among young women
ANC is used by about 90% of 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.

26. ANC and Skilled Attendance among young women…

27. 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 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.

28. Contraceptive use

29. Unmet need for Family planning

30. 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 years.
This manifest most seriously among adolescent girls years and young women (20-24 years) who are twice as likely to be infected than males in the same age group

31. HIV prevalence by age
HIV rates among women ages are three times higher than among men

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

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

34. HIV testing

35. Condom use among young people

36. Condom use among young people…

37. 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

38. 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

39. Marital violence

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

41. 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 years have experimented with drugs, with boys being three times more likely to experiment with drugs than girls.

42. 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

43. 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

44. Education among young people

45. Education level by province

46. Employment among the youth

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