youth friendly services notes

1. YOUTH/ADOLESCENTS AND
REPRODUCTIVE HEALTH
B.WAKO
UMMA

2. INTRODUCTION
As young people pass through puberty and adolescence, new health
concerns arise which impact on their sexual and reproductive health
Adolescents and youth represent a positive force in society
Youth account for roughly 36% of the population
Growing RH Concerns:
• High proportion of total abortion cases
• High proportion of HIV
• Youth don’t come to public RH clinics

3. Adolescent sexual and reproductive health issues
• Adolescent girls account for more than 10% of all births worldwide.
• Every year, a quarter of all unsafe abortions — approximately 5 million —
are performed on adolescent girls aged 15-19.
• Girls in sub-Saharan Africa aged 15-19 are 5 times more likely to have HIV
than boys their own age.
• Between 40% and 58% of sexual assaults are committed against girls aged
15 and younger.

4. Adolescent sexual and reproductive health
Adolescent sexual and reproductive health refers to the physical,
mental, and emotional well being of adolescents, and includes
freedom from:
• unwanted pregnancy
• unsafe abortion
• sexually transmitted infections (STIs), including HIV/AIDS
• all forms of sexual violence and coercion

5. WHO has further categorized youth people as follows;
i. Early -adolescence (10-13 years); is characterized by rapid
physical growth and the beginning of sexual maturation.
ii. Mid-adolescence (10-15 years); the main physical changes are
completed, while individuals develop a stronger sense of identity
and relate more strongly with peers
iii. Later adolescence (16-19); the body takes adult form, while the
individuals have distinct identity, more settled ideas, and opinions
iv. Young adults (20 -24 years); they are increasingly expected to
make decisions on career, marriage, and other adult responsibilities

6. Physical or Physiological Changes
• Physical characteristics are influenced by gonadotrophic hormone
from the anterior pituitary gland while other changes are marked by
the development of secondary characteristics.
• In girls, under the influence of oestrogen ,secondary characteristics
develop between the ages of 12-14 years, although they have also been
reported in younger ages of 8 to 9 years.

7. Secondary characteristic includes:
• Breasts increase in size and are spherical in shape due to enlarged
glandular tissue.
• Internal organs of reproduction that is vagina, uterus, ovaries mature
and menstruation (menarche) begins.
• Typical female shape and contour of the body develop that is broad
hips and narrow chest and shoulders.
• Hair develops in the armpits and pubic region.
• Face may become smooth or facial pimples (acne) may develop.

8. Physical or Physiological Changes
• Physical or Physiological characteristics occurring in boys are under the influence of
androgens, secondary characteristics appear from age 12-14 years.
They include:
• Enlargement of testis and penis.
• Hair develops in the face, armpit, chest, and pubis.
• First ejaculation (spermache) and nocturnal emissions (wet dreams) occur
• Gain in muscular strength and weight.
• Voice and changes by becoming deeper
• Skin problems such as acne develop and the face looks rough.
• Body shape takes on typical adult characteristics, for example, broad shoulders.
• Rapid growth in height depending on genetics

9. Sociological, Psychological and Emotional
Characteristics of Adolescents
• Changing relationships with parents, which may involve the
adolescent pulling away and becoming more independent than before.
• Changing relationships with friends whereby the adolescents often
imitate the values and behaviours of friends rather than those of
parents and other adults.

10. • Peers are an important influence and they care more about what their
friends think of them.
• The relationship with the opposite sex increases as they learn how to
cope with romantic and sexual feelings of which people can take
advantage of their innocence.
• Feelings about oneself are also affected and there is need to accept
oneself as an independent individual to enable them develop high self
esteem by reinforcing positive feelings.

11. • Values and behaviours are affected as the adolescent may attempt to
behave more as adults, resolving problems in a responsible manner
and making decisions bearing in mind the possible consequences.
• Things they like spending time doing are of interest to them.
• Increase in mood swings as they seek attention and want to belong and
be appreciated.

12. • Adolescence is accompanied by intellectual growth, being idealistic,
physical and psychological energy, creativity, marked sense of justice
and are capable of loving intensely or rejecting with equal strength.
• The psychosexual growth and development, physical, psychological,
sociologic and emotional changes are normal occurrences and the
individual should be able to adjust with minimal assistance

13. Psychosexual Growth and Developmental Changes
in Adolescents and Youths
The onset of adolescence varies from one individual to the other and
between the two sexes.
• In girls, it may begin as early as 9 years while in boys it may begin at
12 years.
• The two sexes share an approximate range marking adolescence from
10-19 and youth 15-24 years (WHO 2003).
• Most adolescents have inadequate level of knowledge about human
sexuality and most of the time indulge in risky sexual behaviours

14. Psychosexual Growth and development
They occur in stages :
Early/mid Adolescent; 10-15 years
• Still young just entering puberty and have knowledge deficit on
changes occurring (physical/psycho-social or emotional)
• Some are embarrassed by rate of growth and anxiously tries to
discover/explore on the happenings
• Highly dependent/trusting and unsuspecting hence vulnerable to
exploitation and manipulation

15. • Are obedient and no inhibitions
• Still considered ‘children’ legally not able to consent for sex or
marriage or reproduction and if marriage happens is forced
• A number have low levels of sexual activities due to censured sexual
behaviour
• Often need recognition/acceptance by peers/partners
• Have difficulties in expressing their problems/issues

16. Late Adolescents 16 – 18 years
In transitional stage
• Have conflicting SRH information which makes them prone to unwise
decision making.
• Greatly influenced by peers and often experiments with sex and drugs.
• Involves in activities of disobedience as they seek independence and
identity
• Less association with parents but more with peers
• Usually tests and check information.
• False impression of adulthood

17. Young Adults: 19 – 24 years
• Legally considered as adults.
• Mature decision making
• May be in school (dependent)
• Some may be working/salaried
• Some married, actively in sexual unions and are reproductive
• No parental consent required
• Some spousal/partner consent

18. YOUTH AND ADOLESCENTS, HEALTH NEEDS
Adolescents and youth are neglected as a group by the health system
and they need specialized reproductive health services because of:
• Specific biological and psychological needs
• High risk of STIs
• HIV/AIDS and pregnancy

19. Rationale For Focusing To The Health Of
Adolescents
• To Reduce Death and Disease in Adolescents
• To Reduce the Burden of Disease in Later Life
• To Invest In Health – Today and Tomorrow
• To Promote Human Rights
• To Protect Human Capital

20. What Reproductive Health Risks do Adolescents Face?
unprotected sex; Young women are less able to resist sexual pressure
and coercion
Poverty : Young people in disadvantaged circumstances are vulnerable to
sexual exploitation for favour and financial support
 Young women are disproportionately represented among abortion-
seekers, many of whom endure unsafe procedures; and
Young women, for biological and cultural reasons, are more susceptible to
HIV infection-Female Genital Cutting
Early Forced Marriages
Drug and Substance Abuse

21. Factors Affecting Utilization of RH Services
• Privacy : is the number one concern of youth due to the stigma
associated with youth’s RH problems
• Quality of Care: technical safety, level of infection prevention,
sufficient equipment and supplies
• Provider Attitudes and Qualifications and attitude
• Administrative Procedures: waiting time, client flow, internal referrals
• Youth appreciate quick and simple intake procedures.
• Lack of reproductive health knowledge and competency and
information

22. Definition of Youth Friendly Services
Services that are accessible, acceptable and appropriate for adolescents.
They are in the
• Right place
• Right price (free where necessary) and
• Right style to be acceptable to young people
• They are effective, safe and affordable
• They meet the individual needs of young people

23. Strategies and Actions to Make Services Youth
Friendly
Youth Friendly Service:
• Affordability and accessibility
• Safe services
• Privacy and confidentiality
• Provider competence/attitude
• Quality and consistency
• Reliability and sustainability
• Inbuilt monitoring and evaluation system

24. Challenges To Provide Youth Friendly Services
• Providers Negative Attitudes
• Very expensive program: additional training, staff time, and costs
• Poor referral mechanisms
• Lack of peer involvements

25. Sexual and reproductive health needs of
adolescents/youth:
• Contraception
• unwanted pregnancies
• Unsafe abortion
• Post abortion care
• Drug abuse
• Sexual violence
• Gender empowerment.

26. Models for Youth Friendly Services with
Recommended Essential Service Package
1) YOUTH-CENTRE BASED MODEL:
a. Counselling Services on : Relationships, Pregnancy, Abstinence, Unsafe
abortion and STIs and HIV/AIDS, Substance and Drug abuse, Contraception
b. Screening and treatment of STIs and HIV/AIDS
c. Voluntary Counseling and Testing (VCT)
d. Provision of information and Education on Reproductive Health.
e. Availability of IEC, audio/visual Materials.
f. Ante and post natal care
g. Comprehensive post rape care
h. Linkage to school based and Clinic based model

27. 2) CLINIC BASED MODEL
a. Counseling services on Sexuality Growing up ,Relationships,
Prevention of pregnancy, Abstinence, consequence of unsafe abortion
STIs and HIV/AIDS Substance and Drug abuse Contraception Careers
Rape Prevention, Unsafe abortion and abortion, Prevention, Nutrition,
Male involvement in RH, Parenting, Ante and post natal care, Skilled
attendance
b. Provision of information and Education on Reproductive health
c. Training in livelihood and life skills
d. Availability of IEC, audio/visual, Materials

28. 3) SCHOOL BASED MODEL
a. Life skill training on Goal setting * Decision making * Negotiation * Moral values*
Assertiveness * Communication skills
b. Counseling Services on, Sexuality, Growing up, Relationships, Abstinence,
Pregnancy, Abortion and, their Prevention
• STIs and HIV/AIDS
• VCT
• Substance and Drug abuse
• Contraception
• Careers
• Self esteem Nutrition
• Male involvement in RH

29. SCHOOL BASED MODEL CONT…
C. School health talks,
• Personal hygiene,
• Sexuality and growing up,
• Reproductive Health,
• STD-Prevention,
• HIV-AIDS Prevention,
• Rape Prevention,
• Communication skills
D. Post rape care
E. Linkage to clinic based and Youth center based model
F. Refer for treatment and management

30. YOUTH FRIENDLY SERVICES CHARACTERISTICS
• Convenient Hours / Special times set aside
• Acceptable Costs
• Adequate / separate space dequate / separate space and sufficient
privacy
• Services provider positive attitude and competency
• Peer counselling available
• Respectful

31. Youth friendly Services Available (One Stop Shop)
• counseling on various aspects of sexual and reproductive health,
• STD diagnosis and treatment,
• Counseling on STD prevention, and
• Voluntary Counseling and Testing (VCT)

32. Reproductive Health Problem of Adolescents
• Too Early Pregnancy
• Unwanted Pregnancy
• STD/RTI/HIV/AIDS
• Failure to negotiate for contraceptive use

33. What makes Health Services Youth-Friendly
• Service Providers
• Specially trained staff
• Respect for Young People
• Privacy/confidentiality honored
• Adequate time for client-provider interaction
• Peer-counselors available
• Health Facilities
• Convenient hours/location
• Adequate space and sufficient privacy
• Comfortable surroundings

34. HIV-related Challenges for Youth IN KENYA
• Stigma and discrimination among youth
• Acceptance and disclosure
• Adherence
• Lack of support at home
• Poverty

35. Roles of Service Providers to Youth
• Coordinator
• Educator
• Counsellor
• Community mobilization and conduct out reach services
• Prevent and treatment
• Monitoring and evaluation