Promoting sexual and reproductive health among adolescents: What works?

CARE-Bangladesh has conducted a study to explore the knowledge of the adolescent boys and girls on reproductive and sexual health using Participatory Research Appraisal and Focus Group Discussion. Data suggests that adolescent boys and girls are aware of physical and mental development that might take place during this period. Adolescent girls were concerned more about menarche and its management. Attaining menarche is still being treated as threshold point to adulthood in the society. This is the period when restriction on girl’s mobility is imposed.

While most of the adolescent boys admit that harassment of girls in the street is undesirable, they all seem subject to a “sense of thrill” obtained from passing comment to girls. Girls face gender discrimination from the parents, family and society from birth. This attitude of the community towards female children has lead to the development of a “hypothesis” to identify the female fetus at pregnancy which in turn has often evoked the need of clandestine unsafe abortion endangering the life of the women. Study suggests that adolescents have reasonable knowledge on reproductive and sexual health. There is also a sign of change in attitude of adolescents in the field of girl’s education and marriage.

The studies conducted so far in Colombia do not emphasize the historical analysis of the levels of teenage fertility, just focus on the study of sociodemographic variables that may be motivating the occurrence of such event. This research proposes the analysis of the trajectory of the adolescent fertility rate in the period 1990-2010, using more sophisticated statistical models that allow the study of the variables identified as determinants of teenage childbearing. Preliminary results show the heterogeneous nature of the phenomenon when analyzed by place of residence, socioeconomic status, educational level and marital status, besides an evident spatial distribution in certain regions of the country. The probabilistic models and the survival analysis for women aged 20-24, will allow an accurate analysis of the phenomenon eliminating the issue of lack of simultaneity of the events.

The knowledge and attitudes of young Palestinian men with regards to contraceptive use has to a large extent been neglected in the literature dealing with family planning (FP) methods among Palestinians. In particular, information on the awareness of family planning methods among youth (15-29 years of age) has generally focused on the female population, with accounts of the male youth population rare. Indeed, it was only in 2010 that the Palestinian Central Bureau of Statistics (PCBS) included questions related to information on family planning methods among male youth. Moreover, the use of FP methods is quite low (52%). This paper will present an analysis of the related findings of the 2010 Multiple Indicators Cluster Survey in relation to awareness of condom use in particular. It will point to significant differences between young men and women in their knowledge and awareness of condom use in different locations and within different subgroups. Moreover, given the relatively low level of FP use among Palestinians, understanding the lower levels of awareness of condom use among specific groups is an important element to recognize in relation to increasing the use of FP methods on a national level and sexually transmitted diseases (STDs) awareness and prevention.

Background: Studies conducted in Bangladesh reported a high maternal mortality ratio for the past decades. Approximately 80 percent girls become mother before they reached age 18. Lack of knowledge on SRHR among adolescents and lack of skills for empowerment are two major factors responsible for this low performance in maternal health sector.
Objectives: To improve reproductive and maternal health of UCEP students by providing SRHR education and life skill based training to delay marriage and subsequent childbearing.
Intervention area: Providing SRHR education to 4 UCEP school students. Organized FGDs to assess the need of SRHR education in the save intervention area.
Intervention process: The study conducted by using SRHR manual for the students with a pre and post test survey. The Findings suggest that knowledge and attitude of adolescent have changed significantly and those who received the education are more knowledgeable on safe motherhood compared to those who have not. Both vicariate and multivariate analyses identified several key factors which have influenced their behavior.
Conclusion: Considering the importance of SRHR education for adolescent, UCEP-Bangladesh engaged their students in SRHR education and life skill vocational trainings to reduce early marriage and economic dependency.

The Katanga Province in the south-east of DRC covers an area of 496,877 square kms with an estimated population over 11.462.290 inhabitants out of 68% are under age of 25 ; maternal mortality rate is high 612 per 100.000 live births; the modern CPR is low 2,3%; one in four adolescent girls aged 15-19 has already given birth or been pregnant. HIV prevalence rate is 5,6%. However, local authorities’ financial commitment to advance ICPD agenda is strong. Thus, UNFPA decided to support provincial government’s initiatives where financial commitment is expressed.Three types of programs were identified: i) Maternal and newborn health; ii) Integrating Youth Friendly Services and HIV prevention; iii) Availability of data for development. The key challenge faced was the limited resources of UNFPA and youth community as well. Advocacy and BCC activities, building alliances with media professionals, partnerships, resources mobilization and auto financing were implemented. From 2009 to date, the local government has invested 15,000,000USD for renovation/ construction of over 15 maternity wards and health facilities, 383,000USD for construction of the multifunctional youth center including promotion HIV VCT and 262,901USD for the setting up of a population statistics center to avail accurate data in prevision of the census.

The increasing incidences of reproductive tract infection and sexually transmitted diseases including HIV/AIDS are a great challenge today. Due to consequences of sexually transmitted infections and diseases, it is necessary to increase awareness on reproductive and sexual health matters among unmarried youth. Thus, in an attempt to identify the sources through which youth get information on reproductive and sexual health issues and which source need to be focused more in promoting the reproductive and sexual health awareness among youth, this study reveals that majority of youth get information on reproductive and sexual health through their friends and peer networks. Mass media is the second most commonly used source of information on several issues related to the issue. Parent’s of youth plays very negligible role in increasing awareness among youth. To some extent, school/teachers and health care providers are also supportive in promoting awareness among youth on reproductive and sexual health.

Varied forms of structural shifts associated with the process of globalization, including deteriorating state provision of health services, the spread of market ethic, economic polarization and large-scale internal migration, have altered the structural and cultural circumstances of youth access to essential sexual and reproductive health services in contemporary China. In spite of these trends, their profound impacts have never been examined before. Drawing primarily upon data from semi-structured interviews with 45 conveniently selected service providers and managers from 26 health sites in 6 provinces of China between 2009 and 2010, this study seeks to shed light on five interrelated challenges, as an illustration of the adverse impact of globalization. These five effects and dilemmas related to globalized shifts include rising user fees, weakening preventive care, pervasive commercial advertising, poorly unregulated health market, and unequal access to health care, thus contributing to a better understanding of the social determinants of sexual and reproductive health among young people. Findings from the study highlight the Chinese Government should respond to these entangled trends in a more sensitive and integrated way to meet the need of this neglected population in an era of rapid globalization.

The study reveals that merely one-tenth of the young women have comprehensive knowledge about sexual and reproductive rights. A sizable number of them have experienced domestic violence as well as non-consensual marital sex. Women not only have a little say in contraceptive decision making but also, half of them are unaware of the other contraceptive methods before adopting any specific method. The qualitative data reveals that the women succumb to the traditionally expected gendered role of 'real woman' often resulting into adverse reproductive health outcomes such as unintended pregnancy, sexually transmitted infections and psychological stress, owing to domestic violence, marital discord, tension to natal family, economically dependence status, and gendered socialization. As the young women are in a disadvantageous position in almost all fronts of sexual and reproductive rights, special emphasis ought to be laid on them in every program, which should lead to gender equity.

In India, low female age at marriage, early childbearing initiation, high infant and maternal mortality are the major barriers in attaining the MDGs. Thus, family life education (FLE) that includes basic understanding of human reproduction, sex education, contraceptive knowledge and women's rights is a necessary condition to meet the goals. This paper attempts to examine the level, source of receiving FLE among unmarried women aged 15-24 and factors affecting its access and quality in India. The information available on FLE from 1,66,260 unmarried women (15-24) in the nationwide district level household survey (2007-08) have been analysed. At all India level 73% of unmarried women are aware of FLE and 49% ever received FLE. The minimum 10 years of formal education increases the odds of receiving FLE by six folds in India. Above half of the respondents reported that they felt embarrassed in the sessions of FLE irrespective to the sources. Implementation of govt. prog. significantly increases the likelihood of having FLE. Those who received FLE are rated significantly high on the index of contraceptive and SRH knowledge. 28% of unmarried women expressed their desire to receive FLE only from their family members. Thus, this study also recommends to involving these stakeholders in the culturally suited community FLE programmes.

India accounts for the highest number of maternal deaths (2010) in the world suggesting poor utilization of maternal health care services. The proportion of adolescent deaths (due to pregnancy or during childbirth) to total maternal mortality is high as well. This paper assesses the socioeconomic differentials in accessing full antenatal care (ANC) and professional attendance at delivery (PAD) by adolescent mothers in India during 1990-2006. Data from the three rounds of the National Family Health Survey of India conducted during 1992-93, 1998-99 and 2005-06 were analyzed. The Cochran-Armitage and χ2 tests were applied to examine the trend in proportion. Using pooled multivariate logistic regression model, and adjusting for potential socio-demographic and economic characteristics, the likelihood of adolescent women accessing full ANC increased by only 4%, while PAD increased by 79% from 1990 to 2006. Women’s education manifested the largest differential in service use when compared to other key socioeconomic indicators.