summarised by natunga ronald

1. Principles of Reproductive Health

2. Course objectives
• Discuss principles & practices of adolescent
RH
• Explain the importance of the safe
motherhood concept
• Discuss the principles & practices of FP
• Describe the regulatory framework of
midwifery

3. Questions for students
• What is health/ define health.
• What is reproductive health?
• What is reproductive adolescent health?

4. Introduction
Definitions
• Adolescence is the period of transition from
childhood to adulthood, and involves physical,
psychological, cognitive and social behavioural
changes.
• an adolescent may vary from country to
country but WHO defines them as people
between the ages of 10 and 19 years

5. Definitions continued
Adolescents may also be referred to as youths or
young persons.
Classifications of adolescents include:
• Early: 10-14 years
• Middle: 15-17 years
• Late: 18-19 years

6. Uganda current Demographic Statistics
on Adolescent Health
• Age structure
– Approximately 52.7% of the population is under 15 years of age.
One in every four Ugandans (23.3%) is an adolescent and one in
every three (37.4%) is a young person
• Fertility
– Fertility among teenagers is increasing
– By 18 years half of the Ugandan women have become mothers
– By 20 years 2/3 of women have had a child
– Adolescent pregnancy rate stands at 24%
• Contraceptive prevalence
– Contraceptive prevalence rate among adolescents remains low
despite universal knowledge of contraceptives

7. Demographics cont’d
• Morbidity and mortality:
– Adolescents account for a significant proportion( 45%)of
maternal deaths.
– Abortion complications are common in this age group
– Females contract HIV/AIDS at younger age than males
– Within the age group 15-24, the female; male ratio of HIV
infection remains 4;1
• Some of the factors predisposing to HIV/AIDS:
– Break down of cultural structures which valued abstinence
and virginity
– Unfriendly Mass media promoting ponography
– Rampant cross generational sex

8. Demographics cont’d
• Teenage fertility has increased in recent years
• According to the 2006 UDHS, contraceptive
use of any family planning method/modern
was low among married girls aged 15 - 19
years at 11.4/8.3 compared to the national
average of 24/18.5.

9. Demographics cont’d
• Unwanted/unplanned pregnancy
–30% of women would have had sexual
intercourse by the age of 15 years
–72% would have had sexual intercourse by
the age of 18 years
–56% are in union by the age of 18 years

10. Why adolescent health?
• Adolescents constitute one of the most
important population groups – a vital bridge
between childhood and adulthood.
• Given their size and characteristics, they are a
country’s most valuable assets.
• With proper investment in their lives &
development, they can play a key role in the
development of their societies and nations.

11. • Properly nurtured and guided, adolescents
have the capacity to achieve their potentials
and grow into productive adults.
• Wrong decisions & actions may lead to
increased morbidity and mortality, &
compromise their future. Hence occupy an
exciting but potentially dangerous position.

12. Cont..
• Adolescence is a period of both opportunities
and challenges. The opportunities include
development of new capabilities and
relationships. On the other hand, transition to
adulthood often involves periods of stress,
innovation, experimentation and
disorganization.

13. Challenges faced by adolescents
• Knowledge of Sexual and Reproductive Health
Issues is very minimal
• Sexual Behaviour, Early, unprotected sexual
exposure
• Teenage Pregnancy and Motherhood
• Nutrition, Very little information is available on
nutritional habits
• Access to Adolescent-friendly health services is
generally very low

14. Challenges continued
• Accidents and Violence; Young people are
witnessing increasing rate of accidents from
road traffic accidents. use of motorcycle
• Substance Use and Mental Health; The use of
mild stimulants is more common among the
students.

15. Health care concerns of adolescents
Infant care
• Children born to adolescents have a higher
morbidity and mortality rate
• An adolescent is still a child with no experience
on child care
• Low/non-breastfeeding babies left with
grandmothers due to economic/social reasons
• Poor weaning practices hence malnutrition
• Babies born to adolescents less likely to complete
immunization

16. STI / HIV / AIDS
• Services still limited in Uganda
• Sex ratio is at M:F 1: 4 to 6
• Sugar daddy syndrome rampant/ Rampant
cross generational sex
• Inadequate exposure to life coping skills

17. Unsafe abortion
• Contributes to about 25 - 30% of maternal deaths
and probably a higher morbidity
– Unmarried girls usually students
– No category is exempted
– clandestine services by both qualified and unqualified
health workers due to restrictive laws on abortion.
• Improving access to contraceptive information and
services including emergency contraception may
reduce the incidence of unwanted/unplanned
pregnancy and induced abortions

18. Harmful traditional practices
• Early marriages
• Female genital mutilation
• Food taboos
Substance abuse
• Tobacco, alcohol, cannabis and other drugs
• Relationship between drug abuse, violence, and risky social
behaviour
• Role of print and electronic media
Mental health
• Traditionally only extreme/overt mental illness i.e. madness
was recognized however subtle deviant behaviour may
occur amongst adolescents.
• Therefore the need for its recognition, prevention and
rehabilitation

19. Care during pregnancy
• Lack of social support
• Delivery under unskilled attendance may lead
to increased mortality and morbidity.
Accidents
• Very active and willing to take risks and
hence prone to accidents
• Physical deformity and death
• Need to have essential preventive care

20. Occupational health
• Poor socio-economic status hence exploitation
• Child labour
• Limited employment opportunities hence
inhuman conditions of work in both formal
and informal sectors therefore there is need
to review and strengthen labour and industrial
laws of protection of adolescents

21. Nutrition
• Micro-nutrient deficient diseases
• Rapid physical growth with poor nutrition has
long term consequences
• Poor nutrition during adolescence for the girl
child has implication on pregnancy and child
bearing
• Poor nutrition and hunger can affect
performance in school and may lead to
dropping out of school

22. Principles of delivery of adolescent
health services
• Integrate into existing services
• Strengthen links through referrals
• Strengthen demand through participation of
adolescents
• Build socio-cultural values and practices that
promote adolescent health and development
• Be sensitive to needs based on gender, age
and vulnerability

23. Principles cont’d
• Provide facts and options for adolescents not
just don’ts
• Mobilize political and financial support at all
levels
• Monitor and provide supervision
• Remember that the health and development
of young people/adolescents are important
for now and the future

24. Where should YFHS/ ADHFS be
provided and what should it
contain?

25. • Home
• School
• Health facility
• Media
• Young groups CBOs and NGOs
• Key Social gathering places

26. Minimum package
• Education on sexuality, growth and
development
• Counseling services
• Reproductive health services
• Life skills education
• Recreation services

27. Reasons for promoting adolescent
health friendly services (AFHS/ADFHS)
To increase availability and utilization of
quality health services for young people
with a focus on:
–Adolescent pregnancy/abortion
–HIV/AIDS prevention
–STD prevention and treatment
–Reduction of substance abuse
–Sexuality, growth and development

28. Quality of AFHS/ADHFS
• Geographically accessible
• Affordable
• Acceptable
• Welcoming
• Provide privacy and confidentiality