The document provides an introduction to sexual and reproductive health. It defines key terms like sexual health, reproductive health, and puberty. It then discusses regional and national trends in the onset of puberty, average age of marriage, and factors affecting the initiation of sexual relations among adolescents. The consequences of early, unprotected sexual activity are outlined. Finally, barriers to adolescents obtaining sexual and reproductive health information and services are described.

1. SEXUAL AND REPRODUCTIVE
HEALTH

2. INTRODUCTION TO SEXUAL AND
REPRODUCTIVE HEALTH

3. INTRODUCTION
Aim of the session
• To provide an overview of the unit including
the objectives.

4. 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.

5. DEFINITIONS OF SEXUAL AND
REPRODUCTIVE HEALTH
1. 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)

6. 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)

7. 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.

8. REGIONAL AND NATIONAL TRENDS IN THE
ONSET OF PUBERTY AND AVERAGE AGE OF
MARRIAGE

9. 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.

10. 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

11. 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.

12. 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%

13. Factors Affecting the Initiation Of Sexual
Relations In Young People
Aim 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.

14. 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?

15. 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

16. 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

17. The Consequences of Too Early,
Unprotected Sexual Activity
Aim of the session
• To outline the consequences of the changing
patterns of sexual activity among young
people.

18. • 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?

19. BARRIERS TO YOUNG PEOPLE
HAVING ACCESS TO SEXUAL
AND REPRODUCTIVE HEALTH CARE

20. 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.

21. • 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?