adolescent health

1. Unit VI: Adolescent
Reproductive and Sexual Health
Ibne Amin
Lecturer-KMU

2. “Adolescence is a journey from the
world of the child to the world of the
adult”.

3. Objectives
At the end of this session the students will be able to:
• Define the terms: Adolescence, Reproductive Health
& Sexual Health
• Identify Changes During Puberty
• Identify Common Problems During Puberty
• Discuss Nursing Care and Counselling

4. Adolescence
• The term adolescence is derived from the Latin word “adolescere”
meaning “to grow/ to mature”.
• Adolescence is a period of transition from childhood to adulthood.
• It is a time of physical and emotional change as the body matures and the
mind becomes more questioning and independent.
• The World Health Organization defines adolescents as young people
aged 10-19 years.
• Young people 10 - 24 years
• Adolescence: 10 – 19 years
• Early Adolescence 10 – 13 years
• Middle Adolescence 14 – 15 years
• Late Adolescence 16 – 19 years

5. Adolescence
 Early Adolescence (10-13 yrs):
• Growth spurt and beginnings of sexual maturation
 Mid-Adolescence (14-15 yrs):
i. Main physical changes are completed,
ii. Individual develops a stronger sense of identity, and relates more
strongly to his or her peer group, although families usually remain
important.
 Later Adolescence (16-19 yrs):
i. Body takes its adult form,
ii. The individual now has a distinct identity and more settled ideas and
opinions

6. Reproductive Health
• Reproductive health is a state of complete physical, mental and
social well being and not merely the absence of disease and
infirmity, in all matters relating to the reproductive system and to
its functions and processes
• Reproductive health addresses the human sexuality and
reproductive processes, functions and system at all stages of life
and implies that people are able to have “a responsible, satisfying
and safe sex life and that they have the capability to reproduce and
the freedom to decide if, when and how often to do so

7. Sexual Health
• A state of physical, emotional, mental and social well-being in
relation to sexuality; it is not merely the absence of disease,
dysfunction or infirmity
• Sexual health requires a positive and respectful approach to
sexuality and sexual relationships, as well as the possibility of
having pleasurable and safe sexual experiences, free of
coercion, discrimination and violence.
• For sexual health to be attained and maintained, the sexual
rights of all persons must be respected, protected and
fulfilled.” (WHO, 2000)
•

8. Sexuality
• Sexual health cannot be defined, understood or made
operational without a broad consideration of sexuality, which
underlies important behaviors and outcomes related to sexual
health.
• The definition of sexuality is: A central aspect of being human
throughout life encompasses sex, gender identities and roles,
sexual orientation, eroticism, pleasure, intimacy and
reproduction.

9. Sexual Health
• Sexuality is experienced and expressed in thoughts, fantasies,
desires, beliefs, attitudes, values, behaviors, practices, roles
and relationships.
• While sexuality can include all of these dimensions, not all of
them are always experienced or expressed.
• Sexuality is influenced by the interaction of biological,
psychological, social, economic, political, cultural, legal,
historical, religious and spiritual factors.” (WHO, 2006a)

10. Puberty
• Puberty is the time in life when a boy or girl becomes sexually
mature.
• It is the time when our bodies change toward an adult body
• It is a process that usually happens between ages 10 and 14
for girls and ages 12 and 16 for boys.
• It causes physical changes, and affects boys and girls
differently.

11. Puberty
In girls:
• The first sign of puberty is usually breast development.
• Then hair grows in the pubic area and armpits.
• Menstruation (or a period) .
In boys:
• Puberty usually begins with the testicles and penis getting bigger.
• Then hair grows in the pubic area and armpits.
• Muscles grow, the voice deepens, and facial hair develops as
puberty continues.
Both boys and girls may get acne. They also usually have a growth
spurt (a rapid increase in height) that lasts for about 2 or 3 years. This
brings them closer to their adult height, which they reach after
puberty.

12. Stages of Puberty
Stage of Puberty in Female:
• Stage one: Between the ages 8 and 11
– The ovaries enlarge and hormone production starts, but external
development is not yet visible.
• Stage two: Ages of 8 and 14
– The first external sign of puberty usually develops.
– The aureole will increase in size.
– The first stage of pubic hair may also be present
– Height and weight increase .
• Stage Three: Age 9 and 15
– Breast growth continues
– pubic hair gets coarser and darker.
– first menstrual period begins.

13. Stages of Puberty
Stage of Puberty in Female:
• Stage Four: Age 10 to 16
– If menarche did not happen in Stage Three, it should start now.
– Ovulation also occur in this period, But it will not necessarily occur on a
regular basis. (It is possible to have regular periods even if ovulation
does not occur every month.)
• Stage Five: Ages 12 and 19
–Full height is reached
–ovulating regularly.
–Breasts are developed fully for the body.

14. Stages of Puberty
Stage of Puberty in Male:
• Stage One: Age 9 and 12
– No visible signs of development occur, but, internally, male
hormones become more active.
• Stage Two: Ages 9 to 15
– Height increases and the shape of the body changes.
– Muscle tissue and fat develop
– The aureole, the dark skin around the nipple, darkens and
increases in size.
– The testicles and scrotum grow,
– little bit of pubic hair begins to grow

15. Stages of Puberty
Stage of Puberty in Male:
• Stage Three: Ages 11 and 16
– Pubic hair is getting darker and coarser
– Grow in height, and even their faces begin to appear more
mature.
– The shoulders broaden, making the hips look smaller.
Muscle tissue increases and the voice starts to change and
deepen.
– Finally, facial hair begins to develop on the upper lip.

16. Stages of Puberty
Stage of Puberty in Male:
• Stage Four: Ages 11 to 17
– Hair may begin to grow in pubic area.
– Underarm and facial hair increases as well
– Skin gets oilier, and the voice continues to deepen.
• Stage Five: Age 14 to 18
– Boys reach their full adult height
– Pubic hair and the genitals look like an adult man's.

17. Changes During Puberty
• Puberty is a time of great change and growth
• During puberty one grow in many areas.

18. Physical changes
• As a result of rising hormone levels, physical changes are
triggered in the body and the reproductive organs begin to
work.
Physical change in girls:
• A rapid growth in height and breasts beginning to grow
• Hair growth under the arms and between legs
• Hips becoming wider
• A curvier appearance to the body outline due to fat being laid
down under the skin
• A slightly deeper voice
• The menstrual cycle beginning with their first period.
• These changes happen over 2-3 years.

19. Physical changes
Physical change in boys:
• A rapid growth in height
• Hair growth under arms, between legs and on the face
• A widening of the shoulders
• Muscles becoming more developed creating an angular
outline to the body
• A much deeper voice – called ‘breaking’
• The enlarging of the reproductive organs and beginning of the
sperm production

20. Emotional Changes
The huge changes that take place in the body can make puberty
an emotional rollercoaster.
These teenage mood swings can be caused by:
• The brain still developing – especially the area in charge of
impulse control and managing risks and consequence
• Hormonal fluctuations of estrogen and testosterone
• The frustration of changing from a child to an adult
• Wanting independence and control
• Peer influences and the desire to belong to peer group
• The beginning of sexual responses to others
• Awareness of body image
• Self-esteem

21. Spiritual Changes
• We begin to question values instilled at home due to exposure
to other value systems in our peers.
• We begin to look outside the immediate family for guidance
about our beliefs, values and purpose in life.
• Influence of and approval from peers can begin to matter
more than parental influence.

22. Social Changes
• We spend more time with peers than family.
• There is more opportunity and likelihood of risk-taking
behavior when outside adult supervision.
• We begin to experiment with behavior associated with
becoming an adult.

23. Cognitive Changes
• Our brain development and gender differences can impact on
learning styles and problem solving approaches.
• Maturity levels and hormonal changes can begin to impact on
behavior in classroom.
• Subjects, teachers and learning preferences can begin to
shape interests, skills and abilities.
• We become aware that there are many ways to be smart and
many pathways through education.

25. Why pay attention to health of adolescents?
• Adolescence is a period of rapid development when young
people acquire new capacities and are faced with new
challenges.
• It is a time of opportunity but also of vulnerability to risky
behaviors which can have lifelong consequences, especially
for health.
• There are many interrelated reasons why we need to pay
attention to the health of adolescents: for this age group, for
later life and for the next generation.

26. Why pay attention to health of adolescents?
To Reduce Death And Disease In Adolescents Now:
• An estimated 1.7 million young people aged from 10 to 19 die
each year — mainly from accidents, violence and pregnancy
related problems.
• Many more develop chronic illness that damage their chances
of personal fulfillment.
To Reduce The Burden Of Disease In Later Life:
• Many diseases of late middle age, such as lung cancer,
bronchitis and heart disease, are strongly associated with a
smoking habit that begins in adolescence.
• Some of the highest infection rates for sexually transmitted
infections are in adolescents.

27. Why pay attention to health of adolescents?
To Protect Human Capital:
• Economic development, as well as personal fulfillment, is strongly
related to the health and education levels of the population.
• If they are no longer able to fulfill these roles because of injury,
illness or psychological damage, the cost is primarily a human one,
but there is also a cost to society.
To Invest In Health — Today And Tomorrow:
• Many of the behavioral patterns acquired during adolescence will
last lifelong. These can affect the health and well-being of future
children.
• Adolescence provides an opportunities to prevent the onset of
health-damaging behaviors and their future repercussions.
• Furthermore, engaging in positive and constructive activities
provides occasions to build relationships with adults and peers as
well as acquire behaviors that are crucial to health.

29. Adolescent Reproductive Health Problems
• Menstrual Problem: Girls need support as they begin to menstruate.
Without the support of a more knowledgeable person, an adolescent girl
may not know what is ‘normal’ or how to recognize menstrual problems.
• Compelled to Undergo Female Genital Mutilation: Despite efforts to
eradicate female genital mutilation, this harmful practice still persists in
some countries in North and West Africa, the Middle East and South-East
Asia.
• Early and Unprotected Sex: The high number of unwanted pregnancies,
unsafe abortions and the steep rise in HIV infection are all evidence that,
despite taboos or cultural disapproval, sexual activity in adolescents is
more common than reported.
• Sexually Transmitted Infections: Affect one in 20 young people every year,
and although most are curable, many infections are left untreated. Girls
are five times more likely than boys of their age to become infected.

30. Adolescent Reproductive Health Problems
Risk Factors: Adolescents are exposed and affected by the risks
associated with early and unprotected sex.
• The rapid growth of cities and the breakdown of traditional family
structures erode a protective cultural layer.
• Adolescents are exposed to mass media that challenge cultural
values.
• Conflict and forced migration put many young people at risk,
sometimes from the very people who are supposed to protect
them.
• In war or extreme economic hardship, girls, and sometimes boys,
may be forced into sex for survival.

31. Adolescent Reproductive Health Problems
Violence:
• Violence - including rape, family abuse and war - is among the top ten
causes of death among adolescents globally.
• Many survivors are left with significant physical and psychological
problems.
Sexual Violence:
• For millions of adolescents, sex is linked with force, violence and abuse –
sometimes even by family members or adults with privileged access.

32. Adolescent Reproductive Health Problems
People At Risk:
 Across the world, a huge number of children and adolescents are abused
sexually. Most at risk are girls, aged 11-16, but boys are at risk too.
 Young people are especially vulnerable when they are unprotected by
families, homeless perhaps living on city streets, or who are displaced from
their homes by conflict or by natural disaster, are at high risk.
 Young women may trade sex for the protection of their families, or for
essential material goods to keep their families alive.
 In the case of refugees, there is evidence that some sexual exploitation is by
soldiers acting as peacekeepers or by workers employed by international
agencies.
 Children in all institutions are at risk, including adolescents in prison, and
adolescents with disabilities in institutional care.

33. Adolescent Reproductive Health Problems
• There is an increasing world trade in the sexual exploitation of
young people, usually girls but also boys.
• This includes ‘sex tourism’ and organized child abuse
including child prostitution and child pornography.
• UNICEF estimates that a million children and adolescents a
year are recruited into the commercial sex trade.
• There is a high demand for children aged 12-16, and this
market is growing wherever tourism operates or economies
grow and men have money to spend.

34. Adolescent Reproductive Health Problems
Early Marriage:
• Often involving the union of a young woman to a much older man,
contributes to the large number of teenage pregnancies.
Early Pregnancy And Childbirth:
• About 16 million girls aged 15 to 19 give birth every year - roughly 11% of
all births worldwide.
• The vast majority of births to adolescents occur in developing countries.
• Young adolescents are more likely to die or experience complications in
pregnancy and childbirth than adult women.
• Girls aged 15-20 are twice as likely to die in childbirth as those in their
twenties, while girls under the age of 15 are five times as likely to die in
childbirth.
• A child born to an adolescent mother have a higher risk of morbidity and
mortality. An infant’s risk of dying is 60% higher when the mother is
under age 18 than when the mother is 18 or older.

35. Adolescent Reproductive Health Problems
Unsafe Abortion:
• Many pregnancies are terminated at great risk to the young women,
including pelvic infection, infertility or even death.
• Majority of abortions for adolescents are carried out by unskilled staff
under unhygienic conditions.
Addictive Behavior
• is often referred to as ‘risk behavior’, but it is a risk that adolescents are
not good at assessing, since they do not understand the long-term
consequences of adopting what they may regard as being only a temporary
habit.
• Habits that are expensive and illegal make it more likely that adolescents
will be drawn into crime

36. Adolescent Reproductive Health Problems
Mental Health Problems:
• Frequently start to make themselves felt in this age group.
• Depression is common, especially for young people who have low self-
esteem. They may feel that they have no future or are ‘useless’.
• Depression reduces the quality of a young person’s life at a time when he
or she should be full of optimism and hope.
• Depression can also lead to the ultimate tragedy — almost 90,000
young people commit suicide each year across the world

37. Adolescent Reproductive Health Problems
Eating Disorders:
• In a growing number of developing countries, obesity and eating disorders
exist alongside malnutrition.
•
• From an early age adolescents are under pressure from mass media to have
ultra thin body shapes and have a poor self image as a result.
• Obesity itself is a major problem in some societies. A failure to deal with
this at a young age, can lead to serious health consequences and an early
death.
• In extreme cases eating disorders like bulimia and anorexia can
permanently damage physical and mental health.

38. Adolescent Reproductive Health Protective
Factors
Adolescents whose environment includes:
– positive relationships with adults at home & in the broader
community,
– positive school environment, and
– peers who have positive attitudes and behaviors,
– who have spiritual beliefs
are less likely to initiate sexual activity early, less likely to use
substances, and less likely to experience depression and other
Reproductive Health Problems.

39. Promoting Protective Factors
• So far, programming for adolescent health and development has focused
mainly on providing information and services to reduce risk behaviors and
reduce their consequences. But this is not enough.
• The evidence now shows that there is a link between the social
environment & health outcomes; and enhancing protective factors, in
addition to reducing risk, is equally important.

40. What needs to be done?
Multi Sectorial Coordinated Approach:
• Various government sectors – health, education, social welfare, justice, etc.
need to work together to address the needs and problems of adolescents.
Ministry of health has a central role to do.
• For a start, all the facts and figures needed to be collected to define a clear
national/local picture of the sexual and reproductive health of adolescents.
• Second, the Ministry should bring together different stakeholders and help
them develop a common understanding of this sensitive area based on the
available facts and figures.
• Once this is achieved, appropriate evidence-based policies should be
developed to guide the work of the health and other sectors.

41. What needs to be done?
Providing Information, Education And Support:
• Parents and teachers, with the support of the community, have the main
responsibility for providing adolescents with the information they need to
protect themselves from sexual and reproductive ill-health.
• Once informed, adolescents too can play an important role in passing on
the information to their peers.
• Providing adolescents with age-appropriate sexual and reproductive health
information empowers them to make responsible decisions regarding
sexuality, thereby reducing the number of unintended pregnancies and STI
incidence.
• Educating adolescents about sexual health and/or HIV/AIDS does not
encourage them to increase sexual activity.

42. What needs to be done?
Providing appropriate sexual and reproductive health services:
• Efforts should be made to overcome the barriers, ensuring especially that
adolescents have access to condoms and emergency contraception.
• The utilization of services by adolescents can be greatly increased by
training health workers to be non-judgmental and empathetic, making
health facilities user-friendly and obtaining the support of community
leaders for the provision of health services to adolescents.

43. What needs to be done?
Breaking the silence about sexual coercion and violence:
• Adolescents must be protected against sexual coercion and empowered to
fight it – either on their own or, when required, with the help of others.
• At the wider societal level, laws against coercion should be passed and
energetically enforced.
• At the community level, steps should be taken to protect young people
(especially girls and women) against sexual harassment and coercion in
educational institutions, work places and in other community settings.
• Other key government departments (e.g. criminal justice and education)
and community-based organizations should be engaged in these effort to
challenge and change the norms that overlook non-consensual sex.

44. What needs to be done?
Stepping up the fight against female genital mutilation:
• Advocate for the formulation (and enforcement) of laws to ban this harmful
practice.
• In addition, community mobilization programs should help families to
understand how it damages the health and well-being of girls and women,
and what they need to do to put an end to it.
• Efforts should also be made to mobilize community leaders against the
practice.

45. What needs to be done?
Preventing early pregnancy and making pregnancy as safe as possible:
• Efforts should be made to;
• Educate the public on the hazards of early marriage and early pregnancy.
• Advocate for the formulation and enforcement of laws that specify a
minimum age for marriage, and
• Develop initiatives aimed at providing girls and young women with
opportunities to learn skills needed to earn a living.

46. What needs to be done?
• These measures should be backed by the provision of fertility regulation
information and services (including emergency contraception).
• Adolescents who are pregnant should receive proper health information and
services they need to prevent mortality and morbidity during pregnancy and
childbearing.
• Where abortion is permitted by law, pregnant adolescents should be able to
access safe abortion services if they so desire.

47. CONCLUSION

48. REFERENCES
• Broadening the horizon - Balancing protection and risk for
adolescents. Department of Child and Adolescent Health and
Development. Family and Community Health. World Health
Organization, Geneva.
• Policy brief 4. Promoting and safeguarding the sexual and
reproductive health of adolescents. Reproductive Health and
Research. World Health Organization, 2006. Available at;
• www.who.int/reproductive-health
• www.who.int/child-adolescent-health

49. Thank you