UNIT 3 : SEXUAL & REPRODUCTIVE HEALTH OF THE ADOLESCENT

Facilitator:
MUJAWIMANA PATRICIE:PGTLHE, MScN, BcSM,
RM
Assistant Lecturer

General Nursing Department

Rwamagana Campus

SoNM/CMHS/UR
 CONTENT TO BE COVERED

 Global Youth Today

 Reproductive Health Risks and consequences for
adolescents
 Causes for early unprotected sexual intercourse
in adolescents
 Effects of gender roles
 Adolescents’ contraceptive use
 Adolescent Reproductive Health Services
 Pre-nuptial counseling and preconception
Adolescent
 Definition:
 The period of life when a child develops into an
adult : the period from puberty to maturity.
 It is the transitional phase of growth and
development between childhood and adulthood.
 (WHO) defines an adolescent as any person
between ages 10 and 19.
WHO Classify:
Adolescent :10-19 years old
Youth:15-24 years old

3 Stages of adolescent:
 Early adolescence: 11age-14 age
 Middle adolescence: 15 age-17 age
 Late adolescence: 18 age-21age

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Adolescent sexual and reproductive
health

 Adolescent sexual and reproductive health

refers to the physical and emotional wellbeing
of adolescents and includes their ability to
remain free from unwanted pregnancy, unsafe
abortion, STIs (including HIV/AIDS), and all
forms of sexual violence.
 I. GLOBAL YOUTH TODAY
 Today, globally, there are 1.2 billion young people who

are 15 to 24 years of age, accounting for 16 percent of

the global population.

 By 2030, the number of young people is projected to

reach nearly 1.3 billion.

 Two thirds of premature deaths and one third of disease burden in the
adults are associated with conditions or behaviors that began in youth.
 Risk of dying from pregnancy related cause is much more high for
adolescents than older women.
 GLOBAL YOUTH TODAY
 Globally, one in seven 10-19-year-olds experiences a mental
disorder, accounting for 13% of the global burden of disease in
this age group.
 Depression, anxiety and behavioral disorders are among
the leading causes of illness and disability among adolescents.
 Suicide is the fourth leading cause of death among 15-29
year-olds.
 The consequences of failing to address adolescent mental
health conditions extend to adulthood, impairing both physical
and mental health and limiting opportunities to lead fulfilling
lives as adults.
 GLOBAL YOUTH TODAY
 Each year, about 15 million adolescents aged
15-19 years give birth,
 4 million obtain an abortion,
 up to 100 million become infected with a
curable sexually transmitted disease (STI).
 40% of all new human immunodeficiency
virus (HIV) infections occur among 15-24 year
olds;
 Where 7,000 are infected each day.
GLOBAL YOUTH TODAY
These health risks are influenced by many factors:
 Access to education and employment,
 Early marriage and sexual relationships,
 gender inequities,
 Sexual violence,
 Influence of mass media
 Culture.
GLOBAL YOUTH TODAY
 Challenges:
 Adolescents often lack basic reproductive
health information,
 Skills in negotiating sexual relationships,
 Confidential reproductive health service.
 Incompetent of healthcare providers
 Many adolescents lack strong stable
relationships with parents
YOUTH IN RWANDA
 Republic of Rwanda’s minister of youth, culture and
sport defines youth as those from of 14 to 30 years
old.
 Over 50% of the Rwandan population is under 20
years old and the median age of the population is
22.7 years old.
 Urban areas of Rwanda have a higher percentage of
youth than rural areas,
 Youth constitute over 53% of the population within
the Kigali capital.
Characteristics of the adolescence period

 There are several characteristics of

adolescence. Five characteristics are:
1.Rapid growth both physically and mentally,
2.Sexual attraction,
3.Cognitive development,
4.Interests in new hobbies and self discovery,
5. importance of acceptance by peer groups
Effects of social environment on adolescent
RH behavior

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Effects of social environment on
adolescent RH behavior, cont,……..

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 REPRODUCTIVE HEALTH RISKS AND
CONSEQUENCES FOR ADOLESCENTS
Adolescent reproductive health is affected
by:
 Pregnancy,
 Abortion,
 STIs,
 Sexual violence,
 Limit access to information and Clinical services.
 Nutrition,
 Psychological well-being,
 Economic
 Gender inequities that can make it difficult to

avoid forced, coerced, or commercial sex.

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REPRODUCTIVE HEALTH RISKS AND CONSEQUENCES FOR ADOLESCENTS ,CONT,
…

 Girls younger than 18 age face two to five times the

risk of maternal mortality as women aged 18-25 due
to:
 Prolonged and obstructed labor,
 Hemorrhage,
 Hypertension and anemia also are more common
among adolescent mothers,
 One in every 10 births worldwide and 1 in 6 births in
developing countries is to women aged 15-19 years.
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 REPRODUCTIVE HEALTH RISKS AND CONSEQUENCES
FOR ADOLESCENTS ,CONT,…

Unsafe abortion:
 1 in 10 abortions worldwide occurs among women age
15-19 years.
 Each year one million to 4.4 million adolescents in
developing countries suffer abortion,
 Most of these procedures are performed under unsafe
conditions due to:
- Lack of access to safe services.
- Self-induced methods
- Unskilled or non-medical providers
- Delay in seeking procedure
 In developing countries, up to 60% of pregnancies to
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CAUSES FOR EARLY UNPROTECTED SEXUAL
INTERCOURSE IN ADOLESCENTS
Lack of knowledge on physiology of the
reproductive system and human sexuality
 Decreasing age of menarche
 Early marriage
 Urbanization, migration,
 Sexual violence and coercion
 Peer influence
 Lack of knowledge on family planning
 Unavailability and inaccessibility of ARH services

 Negative attitude of the society (including

service providers)
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THE CONSEQUENCES OF ADOLESCENT SEXUALITY AND PREGNANCY :

Psychological impact:
 Poor psychological development
 Lack of confidence
 Isolation
 Stigmatization
 Socio-economic impact:
 School dropouts
 commercial sex workers
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 EFFECTS OF GENDER ROLES
 Gender roles: Are the social and cultural
expectations for how people should behave
according to their assigned gender.
 These roles shape the behaviors, attitudes and
responsibilities considered appropriate for men
and women.
 Are expectations of sexual activity of boys and
girls.

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EFFECTS OF GENDER ROLES
 “Gender roles are not biologically
determined,” “Gender roles are socially
constructed and can vary widely between
different societies and cultures.”
4 Sources of gender roles:
 Socialization:
 Family,
 Education,
 Peers and media.
Negative effects of gender roles

Poor mental health in young people,

Higher male suicide rates,
Low self-esteem in girls
Limiting ability to express themselves
Sexual violence
Inequality and discrimination.
Limiting opportunities
ADOLESCENTS’ CONTRACEPTIVE USE
 Few married adolescents use contraception
before first pregnancy.
 After becoming sexually active, unmarried
adolescents delay to use the contraceptives for
about a year.
 Two common reasons for non-use of
contraceptives among youth are:
• Did not expect to have sex
• Lacked knowledge about contraception Sunday, September 22, 20 23
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BARRIERS TO CONTRACEPTIVE
USE
 Adolescents’ contraceptive use is limited due to:
• Do not plan ahead or expect the consequences
• Think they are not at risk
• Lack of confidence to use the contraception
• Cultural beliefs,
Fear of side effects
Peer influence,
Religion,
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 ADOLESCENT REPRODUCTIVE HEALTH SERVICES

Services
Components covered nearly the full range of
reproductive health care services.
 Covered routine gynecologic care
 screening and testing for the full range of STDs:
 gonorrhea, chlamydia,
 syphilis, human papillomavirus,
 genital herpes and HIV);
 contraceptive methods
 abortion, rape or pregnancy testing; and

obstetric care.
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 Services con’t
Inadequate access to ARH services exposes adolescent girls
to unwanted pregnancies and, as a result of:
 Dropping out of school,
 Unsafe abortion,
 Sexually transmitted infections,
 Maternal and/or child death,
 Newborn abandonment,
 Many kinds of physical and psychological violence.

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 Services con’t
 TRAC(Treatment and Research AIDS Center)
offers HIV counseling and testing services to the
entire population, including the youth.
 Some NGOs and projects participate actively in
ARH by establishing youth centers and carrying
out training and awareness-raising activities.
 Anti-AIDS clubs in the schools

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Services con’t
Lack of integration of ARH services within health
facilities,
Absence of clinical ARH services in most of the
working youth centers.
Insufficient technical skills of ARH healthcare
providers.
Insufficient coordination of IEC/ARH activities.
The adolescent client has different needs and
problems than an adult client due to physical and
emotional immaturity.
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Strategies of ARH

 Meeting their Reproductive health needs include;

◦ Confidentiality
◦ Convenient location and time
◦ Strong counseling component
◦ Trained professionals
◦ Availability of ARH services

◦ Community based adolescent RH centers

◦ Peer group education
◦ ARH clubs at schools
◦ ARH Youth center Sunday, September 22, 20
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2
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Participants

Involve the young in ARH program and design its

evaluation
Parents should improve interaction with their
children, guide them in the right way.
Support process of maturation of their children in
the area of sexual and RH
Health care providers should not be judgmental
not to make things worse (trust, confidentiality,
privacy, helpful)
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 Targets

Direct:
 In school adolescents
 Out of school adolescent
 Street adolescent

Indirect:
 Parents
 School teachers
 Policy makers
 Community leaders
 Religious leaders.

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PRE-NUPTIAL COUNSELING AND
PRECONCEPTION
Pre-nuptial counselling:
Is a type of therapy that helps couples to take
the next step in their relationship, resolve issues
in their relationship before they commit to
marriage, or set relationship goals.
Couples can openly discuss their expectations,
desires, and concerns, enabling them to build a
strong emotional connection and maintain a
fulfilling intimate relationship over time.
Importance of pre-nuptial counselling
 Enhancing communication skills
 Understanding expectations and roles
 Building conflict resolution skills
 Exploring financial management
 Navigating family dynamics
 Addressing intimacy and expectations
Establishing shared goals and values:
challenges of pre-nuptial
counselling

 Common issues which couples bring to a

session of pre-marriage counselling include:
 Stress around wedding plans,
 Different approaches to financial
management,
 Cultural differences
 Impact of families.
Preconception counseling
 Is an appointment with the healthcare provider
that helps the couple to plan for a future
pregnancy.
 The discussion must be focused on the family
history, risk factors, medical conditions and
lifestyle.
 This appointment is an important part of a
planned and healthy pregnancy.
4 Components of preconception care

The main components of preconception care

under four categories of interventions:
1. Maternal assessment (e.g., family history,
behaviors, obstetric history,general physical
exam);
2. vaccinations (e.g., rubella, varicella and
hepatitis B);
3. screening (e.g., HIV, STD, genetic ..
Benefits of preconception counseling
 Reduced child and maternal mortality.
 Preventing complications during pregnancy.
 Preventing complications during delivery.
 Preventing stillbirths, preterm labor, and
preterm birth.
 Preventing low birth weight.
 Reducing neonatal infections.
 Preventing the transmission of STDs/HIV.
 The barriers to preconception
 Lack of knowledge and awareness,
 Financial barriers,
 Inadequate or too many sources of
information,
 Unplanned pregnancies,
 Perception of being healthy were common
barriers in developed and developing
 END