INTRODUCTIONAim of the session• To provide an overview of the unit including the objectives.
OBJECTIVES• Describe the regional, national and local trends in the onset of puberty and the age of marriage and trends of adolescent fertility• Describe the factors affecting the initiation of sexual relations in adolescents• Identify risk and protective factors that influence adolescent sexual behaviour• Outline the consequences of too early, unprotected sexual activity among adolescents• Describe the barriers to adolescents obtaining sexual and reproductive health information and services.
DEFINITIONS OF SEXUAL AND REPRODUCTIVE HEALTH1. Sexual health• The term sexual health is used to describe the absence of illness and injury associated with sexual behaviour, and a sense of sexual well-being. It has been defined as follows: “… the positive integration of physical, emotional, intellectual and social aspects of sexuality. Sexuality influences thoughts, feelings, interactions and actions among individuals, and motivates people to find love, contact, warmth and intimacy. It can be expressed in many different ways and is closely linked to the environment in which people live.” (1)
1. Reproductive Health• WHO defines reproductive health as “...a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes. Reproductive health therefore implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide when and how often to do so. Implicit in this last condition are the rights of men and women to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice, as well as other methods of their choice for regulation of fertility which are not against the law, and the right to access appropriate health-care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant. In line with the above definition of reproductive health, reproductive health care is defined as the constellation of methods, techniques and services that contribute to reproductive health and well- being by preventing and solving reproductive health problems. It also includes sexual health, the purpose of which is the enhancement of life and personal relations, and not merely counselling and care related to reproduction and sexually transmitted diseases.” (2)
2. Puberty• Adolescence is a period of transition from childhood into adulthood. It is marked by dramatic physical, psychological and social changes. The onset of puberty “announces” an important step on the road to adulthood. Puberty refers to the physiological changes that occur in early adolescence (sometimes beginning in late childhood) which result in the development of sexual and reproductive capacity. Physical growth and development manifest in a growth spurt during which there are marked changes in the size and shape of the body. Differences between boys and girls are accentuated. For instance, girls experience breast development and hip enlargement, whereas in boys, there is the appearance of “man-like” musculature.• These changes are accompanied by others such as the appearance of the axillary and pubic hair in both boys and girls, and the change in the pitch of the voice and the appearance of facial hair in boys. There is rapid maturation of the sexual organs. The onset of menstruation and the initiation of sperm production are important milestones at this time.
REGIONAL AND NATIONAL TRENDS IN THEONSET OF PUBERTY AND AVERAGE AGE OF MARRIAGE
Aim of the Session• To remind the participants on the important physical changes associated with puberty and to describe global trends in the onset of puberty and age of marriage.
Notable changes at puberty and sexual maturation• Growth spurt and changes in body composition• Appearance of secondary sexual characteristics• Changes in social perceptions and expectations
Girls today are experiencing puberty at a younger age• Between the late 1970s and the late 1980s, the average age of menarche in Kenya fell from 14.4 to 12.9• In Malawi, the age at first intercourse also appears to be declining. In the 2004 MDHS, median age at first sexual intercourse for men aged 20-24 years and 45-49 years was 18.1 and 19.0 respectively.• Among women, the age at first intercourse does not appear to be declining. In the 2004 MDHS, median age at first sexual intercourse for women aged 20-24 years and 45-49 years was 17.4 and 17.6 respectively.
Average age at marriage in Malawi.• The median age at first marriage for adolescent females aged 20-24 slightly increased from 17.7 in 1992 to 18.1 in 2004.• The median age for marriage for men is about 5 years later at 22.9 years.• While only 22 percent of men are married by age 20 years, the corresponding proportion for women is 73%
Factors Affecting the Initiation Of Sexual Relations In Young PeopleAim of the session• To describe the factors affecting initiation of sexual relations among young people• To identify risk and protective factors that influences the sexual behaviour of young people.
Group Work• Are young people (boys and girls) in your area / district sexually active?• If so what is the context in which sexual activity occurs?• Are young people (boys and girls) in your area / district more sexually active than young people of about 10 years ago? If so what are the factors contributing to this?
Average age at first sexual experience in Malawi. Proportion of adolescents w ho have had their first sexual experience (life table estim ates), by age and gender, 2004 National Adolescent Survey 0.50 0.45 0.40 0.35 Proportion 0.30 0.25 0.20 0.15 0.10 0.05 0.00 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Age Female Male
Key factors affecting age of first sexual intercourse• Too early” marriages continue to persist in some cultures• Changing social norms and “controls” on sexual activity• Vulnerability of young people to sexual coercion and rape• Poverty
The Consequences of Too Early, Unprotected Sexual ActivityAim of the session• To outline the consequences of the changing patterns of sexual activity among young people.
• Given the changing trends/patterns in the onset of sexual activity, what are the• Consequences for young people?• Consequences for babies born to young people?• Consequences for their families?• Consequences for their communities?
BARRIERS TO YOUNG PEOPLE HAVING ACCESS TO SEXUALAND REPRODUCTIVE HEALTH CARE
Aim of the session• To highlight barriers that young people face in obtaining sexual and reproductive health information and services, and what could be done to address them.
• Case study 1: Why did Chimwemwe’s status change from that of a bright 14-year old schoolgirl to that of a 15-year old single young mother of a premature baby who is homeless and destitute?• Case study 2: Why was Malita so unprepared for this important event in her life?• What could have been done to enable Chimwemwe and Malita to obtain the sexual and reproductive health information and services they needed?