Promoting sexual and reproductive health among adolescents: What works?

Background: Young women often face social, economic, logistical, policy and health system barriers to access to sexual and reproductive health services, including safe abortion care.
Method: An OR project is launched in Jharkhand to assess the strategy of using youth leaders to link young women to SRH issues including safe abortion services. Using quasi-experimental longitudinal design a baseline household survey is conducted in July-August 2012 and interviewed 1381 young women (15-24 years) to assess the knowledge, attitude, and skills on SRH issues and barriers and forces of influence that lead to any particular behavior, decision, or service utilization.
Results: Even with high levels of literacy (66%-91%) and mass media exposures (65%-80%), the composite knowledge score on SRH (2.4 of 6), contraception (2.4 of 8), and abortion (0.5 of 8) related issues were significantly low. Multivariate analyses revealed age, education, family composition, living standard, and exposure to mass media as the influencing attributes of knowledge level. Around 4% of married young women reported experiencing induced abortion; one-third of them had no role in taking decision. 92% of them had approached private and illegal providers. Findings of this study had major policy implication for guiding the youth focused intervention strategy.

Using data from a Demographic and Health Survey (DHS) of 2010 from Colombia and multivariate descriptive methods (correspondence analysis), this paper compares school performance (scholar qualities) and socioeconomic welfare of women that became mothers at early ages (specifically at the age of teenagers) and women that didn’t. Differences among regions and residence zones (urban/rural) are established in order to claim for a differential design and implementation of public policies. Using papers of the past years as a basis, we focused on checking teenage childbearing adding the regional approach. We established the intensity and duration of consequences of teenage childbearing in terms of years of schooling, educational level and socioeconomic welfare of mothers. We ended this paper proposing a discussion about the uses of these indicators as a sign of a successful life, discussion that emerged from regional characteristics and our theoretical perspective.

Abstract :

Background: Internal migration is increasingly putting pressure on health care for the population in large cities and on the organization of health service delivery in Vietnam. Migration from rural to urban areas creates many problems that influence health. Safe motherhood was main issues with increasing alarming unwanted pregnancy and abortion amongst those groups.

Objective: To increase availability and accessibility to quality SRHs information and clinical services amongst factory workers.

Results: The intervention program in both in supply side and demand side proved resulting in some positive changes in accessing SRH services. In the demand side, a series of demand generation activities was used including setting up and operating a network of 350 peer educators. In the supply side, a satellite clinic near by the factory was established to serve that migrant worker plus with mobile team bring services during the weekday and weekend to facilitate for client receiving SRH services. Perception, knowledge and practices relating to health problem in general and STIs/HIV particularly have been obviously improved.

Conclusion: A comprehensive model of intervention in factories is effective way in regard to the imporvement in awareness of workers, service utilisation, capacity building for health staffs.

Objectives:
- Analyze prevalence of early marriage among adolescent girls in Egypt.
- Recognize misbelieves of female early marriage.
- Identify the common hazards of young bride.
Background:
Child marriage is a gratification for overcoming the family’s financial and social needs. Adolescent childbearing carries higher risks of morbidity and mortality for the mother and child.
Methodology:
A total of 245 adult women aged 15-49 years were surveyed in the period from July 2011 to February 2012. A standard questionnaire in semi structured interview was used in surveillance.
Results and Findings:
The study revealed that 10 percent of women were married at age 15-19 and 90 % of them were pregnant with their first child at this age.
About 85% consider early marriage to get rid of girl’s burden. 62% feels that it is a religious demand, and 50% think that it prevents adultery.
The incidence of anemia with pregnancy 42%, pregnancy induced hypertension 12%, abortion 20%, premature labor 7% and cesarean delivery 33%. Divorce occurred in 14.4%, physical violence 33%, sexual violence 8% and illiteracy in 44.5%.
Conclusions:
Raising community awareness proved to be more successful in preventing child marriages than banning. Reproductive health agencies should contribute by offering proper health education and counseling.

The reproductive choices made by young women and men have an enormous impact on their health, schooling and employment prospects, as well as their overall transition to adulthood. The knowledge of temporary methods of contraception is fundamental to the ability of married and unmarried women (including youths) to make informed choices about reproductive health decisions. Knowledge of contraception and HIV/AIDS is examined for unmarried women with family life education and married women with health sector interaction. Knowledge of different methods of contraception is better among married adolescent in comparison to unmarried women except for emergency contraceptive pills. Unmarried women discussed contraception with friends followed by brother and sister and one-fifth of them also discussed with parents. However, only seven percent and fourteen percent unmarried women ever discussed with health provider/sex education expert and teacher respectively. Neither family life education, nor formal education was related to reproductive knowledge (conception), which was poor among the unmarried adolescents. Awareness about HIV/AIDS is better among unmarried women in comparison to married women in the age group 15-24. Understanding of sexual issues among young people is inadequate and current format of family life education may be ineffe

Few studies have evaluated whether youth-friendly health services improve young people’s experiences of using services, and none in South Africa have done so since the Department of Health took over management of the Youth Friendly Services program. This study investigated whether clinics providing Youth Friendly Services in Soweto, South Africa delivered a more positive experience to young people requesting advice on condom reliability or contraceptive methods than those not providing this program, using a simulated client method. 15 randomly selected primary healthcare clinics each received 3-4 simulated client visits. After each visit semi-structured debrief interviews were conducted with simulated clients. Multi-level linear regression was used to investigate associations between Youth Friendly Services provision and visit outcomes. Framework analysis of qualitative data was conducted. There was no evidence that clinics providing Youth Friendly Services delivered a more positive experience (difference in mean clinic visit score -0.18, 95% CI: -0.95, 0.60, p=0.656) than those not providing this program. More positive experiences were categorised by positive healthcare worker behaviour and less positive experiences by unnecessary protocols, negative attitudes to information seeking and lack of information or of privacy.

Early sexual debut is associated with increased risk of HIV and other negative sexual health outcomes. This indicates a need for early use of health services among this group. This study investigated whether early sexual debut was associated with lower usage of health services during adolescence in urban South Africa. Health-seeking behaviour data was collected from the Birth-to-Twenty cohort at 13, 15 and 17 years of age. Early sexual debut, defined as <15 years of age, was based on annual, self-completed questionnaires. Multivariate random effects regression models were used to test the association between healthcare use and frequency of healthcare use during adolescence with early sexual debut. Data was available on 1783 adolescents, 19% of whom had early sexual debut. Adolescents’ healthcare usage was low, declined through adolescence (23% at 13 years, 18% at 15 years and 17% at 17 years) and was significantly lower among adolescents with early sexual debut (adjusted OR 0.77, 95% CI 0.59-0.99, p 0.041). There was no evidence of an association between early sexual debut and frequency of adolescents’ healthcare usage (adjusted IRR 0.86, 95% CI 0.70-1.04, p 0.116). Better linkages between health services and youth programs may help reach vulnerable adolescents with health services.

Concepts of sexuality and health find their roots in the notions of gender, thinking on masculinity and femininity, attitude towards the opposite sex, and validation of the use of violence – all of which set-in early through various socialization processes. This paper presents findings from an operations research Gender Equity Movement in Schools (GEMS). It was conducted in 45 schools with adolescent aged 12-14 years and reached to over 8000. Using gender transformative approach, the intervention included group education activities (GEA) and campaign, which were developed based on a formative research. A total of 909 students participated in baseline and 2nd follow-up survey. In addition, indepth interviews were conducted with 60 students. Multivariate analysis reveals that students who participated in GEA were significantly more likely to support gender equitable attitude, higher education and delay age at marriage for girls, and oppose violence compared to those with no intervention. Further, students from intervention arms reported being more confident in protesting and complaining in case of sexual violence. Evidences suggest the need to engage young children in discussions around fundamental constructions to shifts norms that in turn influence attitudes and behaviors underlying outcomes related to sexuality and health.

The role of women’s decision-making in reproductive health cannot be ignored. Current research and policies on maternal and child health-care in India focus primarily on female education and employment, little attention is placed on women’s decision-making autonomy. In this paper women autonomy index has been constructed and women’s autonomy and their relationship to maternal and child health care utilization are investigated using data from the National Family Health Survey-3. The results of the study show that most of socio-economic factors including women's autonomy have significant influence on maternal and child health care services. Women's autonomy has strong positive association with health-care utilization. The impact of women's autonomy is not much on antenatal visit but very much on institutional delivery and child immunization. Finally, it may be concluded that women with higher autonomy are more likely to use maternal and child health care services as compared to women with low autonomy.

Utilization of maternal health services has a potentially important role in the improvement of reproductive health status of adolescent women. Understanding the challenges of different aspects of adolescent’s reproductive health is very important. In order to get better understandings of adolescent mothers' needs, health seeking practices of first time adolescent and adult mothers during pregnancy and early motherhood are compared. The National Family Health Survey-3 data is used for analysis purpose which provides a comprehensive picture of population and health conditions in India. Findings suggest that first adolescent mothers are more disadvantaged in terms of health care seeking for reproductive health services during pregnancy and delivery compared to first time adult mothers. First time adolescent mothers were less likely to use all three services (any antenatal care, full antenatal care and institutional delivery) compared to first time adult mothers. These results are compelling and call for urgent adolescent focused interventions.