Concept of Adolescent Sexual & Reproductive Health (ASRH), Problems, Control & Prevention
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This document discusses adolescent sexual and reproductive health (ASRH). It defines adolescence and explains the physical, emotional, and developmental changes that occur during this period. It identifies key health problems faced by adolescents like early pregnancy, sexually transmitted infections, and mental health issues. It stresses that adolescents need information, skills development, supportive environments and access to health services to grow up healthy. Finally, it argues that governments and societies should invest in adolescent health and development due to demographic, public health, economic and human rights reasons.
![Concept of Adolescent Sexual &
Reproductive Health (ASRH),
Problems, Control & Prevention
Training Course in Sexual and Reproductive Health Research
Geneva 2010
[Dr] Amzad Ali
Email: ali.amzad@gmail.com
Skype: ali.amzad
Cell: +8801713 004696](https://image.slidesharecdn.com/7-150715094538-lva1-app6892/85/Concept-of-Adolescent-Sexual-Reproductive-Health-ASRH-Problems-Control-Prevention-1-320.jpg)
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Concept of Adolescent Sexual & Reproductive Health (ASRH), Problems, Control & Prevention
- 1. Concept of Adolescent Sexual & Reproductive Health (ASRH), Problems, Control & Prevention Training Course in Sexual and Reproductive Health Research Geneva 2010 [Dr] Amzad Ali Email: ali.amzad@gmail.com Skype: ali.amzad Cell: +8801713 004696
- 2. Topics • What is ARSH and meaning of adolescence? • What are the physical and emotional changes that take place during adolescence? • The health problems that adolescents face • What adolescents need to grow & develop in good health • who needs to meet the needs & fulfil the rights of adolescents • Why we should invest in the health & development of adolescents • Frameworks for addressing the health & development of adolescents
- 3. 1. What do we mean by the term 'adolescents' ?
- 4. What is Adolescence? • A phase which involves - Transition period between childhood and adulthood where physical and cognitive changes prepare us for adult responsibilities Progression from appearance of secondary sexual characteristics (puberty) to sexual and reproductive maturity Development of adult mental process and identity Transition from total social-economic dependence to relative independence
- 5. What is early, middle and late Adolescence? • Early (10 – 14) – Growth Spurt, Beginning of Sexual Maturity and Start to think abstractly. • Middle (14 – 15) – Main Physical Change Completed, Develop stronger sense of Identity, relates strongly to peer group, Thinking becomes reflective. • Late (16 – 19) – Body takes adult form, has distinct identity and more settled ideas and opinions.
- 7. The second decade: No longer children, not yet adults ! Adolescents 10 - 19 years Youth 15-24 years Young people 10-24 years Source: A picture of health? A review and annotated bibliography of the health of young people in developing countries (WHO, UNICEF, 1995).
- 8. Adolescents are a diverse population group Different needs Changing needs
- 9. Adolescents are a diverse population group সম্পেকর্ মধুরতা বজায় রাখেত দুজেনর মােঝই থাকেত হেব েয গুণগুেলা
- 11. What is special about adolescence ? (What makes it different from childhood & adulthood ?) Adolescence is a unique time in life requiring special attention- •Characterized by: – Physical, emotional, psychological and developmental changes – Emerging sexuality – Awareness of gender identification and sexual orientation
- 12. What is special…..cont’d • A time of rapid physical and psychological (cognitive and emotional) growth and development. • Distinct from both childhood and adulthood • A time in which new capacities are developed. • A time to test independence from the family • A time of changing new relationships-peers, partners, parents, social relationships, expectations, roles and responsibilities.
- 13. 2. What do we mean by the term 'health' and Adolescent health?
- 14. “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." Source: Constitution of the World Health Organization, 1948.
- 15. 3. What are the main health problems of adolescents ?
- 16. Many adolescents move from childhood through adolescence into adulthood in good health.
- 17. Key Health Problems Sexual & Reproductive health - Too early pregnancy risks to mother risks to baby - Health problems during pregnancy & child birth (including unsafe abortion) - Sexually Transmitted Infections including HIV - Harmful traditional practices e.g. marriage, Sexual coercion Source: United Nations. World Youth Report 2005. Young people today, and in 2015. United Nations. 2005. ISBN 92-1- 130244-7. Other issues - Injuries from accidents & intentional violence - Mental health problems - Substance use problems - Endemic diseases: malaria, HIV schistosomiasis, tuberculosis - Under/over-nutrition
- 18. Other Adolescent Health Problems? Young Adolescents •Menstrual Problems for girl •Men’s reproductive issues- •Teen Pregnancy •Mental Health Problems •Early and Unprotected Sex •Addictive Behaviors •Accidents and violence •Sexual Abuse •Depression and Suicide •Eating Disorders. •Nutrition issues and eating habits
- 19. This lack of proper education induces gender based violence in the community, which mainly affects the adolescent girls. Eve-teasing, sexual abuse of female adolescent girls, dowry related violence, sexual harassment at the workplace or in the educational institutions become headache of the government time to time.
- 20. Menstrual Problems – No prior knowledge – Fail to understand normal and to recognize menstrual problems – School Health Checkups are usually not performed to identify these – Parental support & reassurance is a must need. – Lack of proper information and management
- 21. Mental Health Problems – May first become apparent in Adolescence – Shock appears from friends and lovers – More often not considered as a problem – Thus fail to • Recognize and • Seek medical treatment
- 22. Early and Unprotected Sex Sexual activity is more common than available official data Evidenced by increased no. of- Unwanted Pregnancies Unsafe Abortions Steep Rise in HIV Early and unprotected sexual experience is not planned, and with no knowledge of consequences lead to social problem.
- 23. Predisposing Factors for Early and Unprotected Sex Adolescents live in Increasingly sexualized societies Impact of Media – Electronic and Print Rapid Growth of cities and breakdown of traditional family structure – Erode protective cultural layer Conflict and forced migration – put them at risk Pressured in to desperate situations – forced into sex for survival sp. during economic hardships etc. Trend – earlier sexual maturation while late marriage
- 24. 4. What do adolescents need to grow & develop in good health ?
- 25. What adolescents need & why? • Information & skills (they are still developing) • Safe & supportive environment (they live in an adult world) • Health & counselling services (they need a safety net) Access to economy and decision making options
- 26. Involve young people as key decision-makers in program design, implementation, and evaluation Provide comprehensive, accurate information in a manner appropriate to their age group and sex Address barriers to accessing health and information services Empower adolescents to make life choices that are best for them Use information/Services thru Media Adolescent sexual and reproductive health education for adolescents must:
- 27. MYTH Sexual and reproductive health information promotes promiscuity and early sexual activity. REALITY Sexuality education contributes to: higher levels of abstinence later initiation of sexual activity Sexuality education can help protect young people from some of the potential risks of sexual activity.* *Conclusion from a multi-country study carried out by UNAIDS greater use of contraception fewer sexual partners Providing adolescents with sexual and reproductive health education adolescent sexual and reproductive health ( 7 )
- 28. 5. Who needs to contribute to meeting these needs & fulfilling these rights ?
- 29. Politicians Journalists Bureaucrat sRelatives Friends Family friends Teachers Sports coaches Healthcare providers Religious leaders Traditional leaders Parents Brothers/Sisters Adolescents Musicians Film stars Sports figures
- 30. 6. Why should we invest in the health and development of adolescents ?
- 31. • Demographic rationale • Public health rationale • Economic rationale • Human rights rationale
- 32. • One in five individuals in the world today is an adolescent (around 1.2 billion). • The largest number of adolescents in the history of mankind. • 2/3rd of total pop in Bangladesh Demographic rationale – 1/2
- 33. Demographic rationale – 2/2
- 34. • There are around 2.6 million deaths among the 10-24 year age group worldwide every year. • 97% occur in low and middle income countries. Public health rationale: mortality – 1/5
- 35. Source: UNAIDS/UNICEF, 2002 Public health rationale: morbidity – 3/5 38% 62% South Asia 1.1 million Industrialized Countries 240,000 67% 33% Middle East & North Africa 160,000 31% 69% Central and Eastern Europe 430,00035% 65% 49% 51% East Asia & Pacific 740,000 31% 69% Latin America & Caribbean 560,000 38% 62% Sub-Saharan Africa 8.6 million There are over 10 million young people (15-24) living with HIV/AIDS
- 36. Public health rationale: behaviours – 4/5 • Nearly two thirds of premature deaths and one third of the total disease burden in adults are associated with conditions or behaviours that began in youth. World Development Report 2007 0 0.02 0.04 0.06 0.08 0.1 0.12 0 10 20 30 40 50 60 70 Age female male Age of smoking initiation
- 37. Health problems / health-related behaviours during adolescence Age when this has its major impact Adolescence Adulthood Childhood (next generation) Injuries and violence +++ + Too-early pregnancy ++ + ++ Human Papilloma Virus infection + +++ Tobacco use + +++ + Public health rationale – 5/5 sound reasons for investment for this generation
- 38. Economic rationale – 2/4 The need to make full use of the demographic dividend when one can.
- 39. Economic rationale - 4/4 Socio-economic deprivation: a cause & consequence of adolescent pregnancy Too early pregnancy Loss of educational & employment opportunities Poverty " We young women are not prepared to become mothers. I would like to continue my studies. But since I have had my daughter, my options have changed because I have many more obligations now." Source: World Development Report 2006 (World Bank, 2006.)
- 40. Convention on the rights of the child • Article 24: The right to the highest level of health possible & to access the required health services • Article 17: The right to access appropriate information from the media & to be protected from harmful information • Article 13: The right to seek, receive and impart information and ideas of all kinds Choices: A guide for young people Gill Gordon, 1999. Human rights rationale -1/2
- 41. 6. Frameworks for addressing the health and development of adolescents
- 42. First lens: Broadening opportunities for young people to develop skills and use them productively. Second lens: Helping them acquire the capabilities to make good decisions in pursuing those opportunities Third lens: Offering them second chances to recover from bad decisions, either by them or by others. World Bank framework: Youth transitions seen through three lenses
Editor's Notes
- In this slide, the terms that are commonly used in the literature: adolescents, youth and young people, are listed alongside age bands. WHO defines adolescents as individuals who are going through a very special phase in their lives – adolescence. A phase during which enormous physical and psychological changes occur, as do changes in social perceptions and expectations. A phase when an individual is no longer a child, but not yet an adult. Although according to WHO's definition, adolescents are aged between 10-19, WHO is conscious that adolescence is a phase in an individual's life, rather than a fixed time period.
- Adolescents are a very diverse group. A boy of 12 is very different from a young man of 19. A boy of 12 is also very different - physically but also psychologically from a girl of the same age. A boy of 12 who is part of a caring and financially secure family is growing up in very different circumstances from another of the same age who has run away from home to escape physical violence. Two boys of 12 who are growing up in very similar conditions may develop in very different ways. All these categories of adolescents have different needs; different but also changing needs.
- Adolescence is a time of rapid physical and psychological growth and development, and one in which individuals develop new capacities. It is also a time of changing social relationships, expectations, roles and responsibilities.
- Good health certainly means the absence of disease or infirmity. But it goes beyond that to include well being – physical, mental and social well being.
- In all countries and communities, many adolescents move from childhood through adolescence into adulthood in good health.
- Unfortunately, many other adolescents do not do so. The main health problems affecting adolescents are listed on this slide. These problems vary both between and within countries.
- The Common Agenda for Adolescent Health and Development endorsed by UNFPA, UNICEF and WHO in 1995 lists what adolescents need to grow and develop in good health, and why they need these things. A useful analogy is that of an 8 year old girl who needs to cross the road every day to get to school. She needs information & skills: where to look, what to look for, when to walk across, when not to do so. She needs a safe & supportive environment: a zebra crossing, traffic lights that work or a traffic warden in position, drivers who respect traffic rules or are punished if they do not do so. She may also need health & counselling services, if she stumbles and falls, or is struck down by a vehicle. One problem with this analogy is that it presents health services in a curative context alone. Health workers and health services have important roles to play in promotive and preventive health as well.
- Who needs to contribute to the health and development of adolescents ? To answer this question, it is useful to think of these players in concentric circles of contact & influence. At the centre is the adolescent himself or herself. Parents, siblings and some other family members are in immediate contact with the adolescent & constitute the first circle. The second circle includes people in regular contact with them such as their own friends, family friends, teachers, sports coaches, health workers and religious leaders. The third circle includes musicians, film stars & sports figures who have a tremendous influence on them from afar. Finally in the fourth circle, politicians, journalists and bureaucrats (within the government & private sectors) affect their lives in small & big ways, through their words and deeds.
- There are sound demographic, public health, economic and human rights reasons for addressing the health of adolescents.
- Adolescents represent one fifth of the world's population.
- The global population of adolescents is estimated to continue to increase and to peak just over thirty years from now.
- There are an estimated 2.6 million deaths in the 10-24 year age group every year. 97% of them occur in low and middle income countries. The causes of these deaths are indicated on this slide. There are substantial regional differences in mortality rates and causes of mortality, but that is beyond the scope of this presentation.
- Our case for investing in the health of adolescents becomes stronger when we include those who face illnesses (including nutritional problems) and injuries which hinder their ability to grow and develop to their full potential, and also to function optimally. UNAIDS and WHO estimate that by the beginning of 2004 over 40 million people were infected with HIV. More than 10 million of these were young people. The regional distribution as well as the sex distribution in each region are shown on this slide. All the young people, and those who join their ranks, need care and support. There are other important causes of morbidity including anaemia, depression and vesico-vaginal fistula.
- Our case for attention to adolescent health becomes even stronger as one moves from mortality and morbidity to behaviours. This is a phase of life when important behaviours – habits if you like – that will determine health and disease in adulthood are formed. Smoking, diet and exercise behaviours are cases in point.
- One final point is that some health problems (illnesses and infections) and health-related behaviours acquired during adolescence have their impact during adolescence; others have their impact in adulthood; and still others have their impact in the next generation.
- Given even reasonably good governance, a healthy and productive work force can help move a country from low to middle income. Economists talk about the importance of using the current bulge in the adolescent population to make this leap. Investing in the health and development of adolescents can enable countries to make full use of this demographic dividend. Vietnam has an adolescent bulge today. The bulge has already started reducing in size and will soon be gone.
- Socio-economic deprivation appears to be both a cause and a consequence of adolescent pregnancy. Girls from poor communities get pregnant in their early or middle adolescence. This in turn leads to loss of educational and employment opportunities keeping them in poverty.
- We have an important responsibility in helping to fulfil adolescents' rights as outlined in the Convention on the rights of the child.
- A framework is a structure. Conceptual and operational frameworks provide a structure to think about and to do things. The World Bank, WHO and UNFPA have all developed frameworks on adolescent health and development. The World Bank's framework is the broadest one. It addresses health and development in a broad sense. WHO's framework is one that addresses the role of the health sector in improving the health and development of adolescents. UNFPA's framework addresses sexual and reproductive health.