Adolescent sexual and reproductive health: The challenge for society

Within almost all countries of the world there is a growing concern about the sexual and reproductive health of adolescents. This concern has resulted from either a real or a perceived increase in adolescent sexual activity, coupled with high rates of unplanned pregnancies, early childbearing and the transmission of sexually transmitted infections, including HIV. Although many adults have difficulties in accepting young people as sexual beings, there is now a growing consensus that young people need more information and services to help them ensure their sexual and reproductive health. Many of the programmes designed to make sexual and reproductive health information and services available to young people have used ‘top down’ approaches, based on adult-led risk and lifestyle orientation. In such programmes, young people are often looked upon negatively, in terms of their problems, rather than positively, in terms of their potential and capabilities. This article argues that a focus on the negative aspects of adolescent sexual and reproductive health means that young people are seen as collections of discrete problems. Furthermore, such approaches tend to view all young people as one homogeneous group when in reality adolescents are an enormously diverse group, not only in terms of age and gender, but also in terms of ability and beliefs. Such approaches therefore fail to address the vulnerabilities of particular young people and fail to contextualize sexual health within a wider framework of young people's lives. A challenge for the next century is to move away from focusing on risks, towards embracing needs and rights, and to involve young people in identifying issues and developing solutions.     

Adolescent sexual and reproductive health: the challenge for society

Within almost all countries of the world there is a growing concern about the sexual and reproductive health of adolescents. This concern has resulted from either a real or a perceived increase in adolescent sexual activity, coupled with high rates of unplanned pregnancies, early childbearing and the transmission of sexually transmitted infections, including HIV. Although many adults have difficulties in accepting young people as sexual beings, there is now a growing consensus that young people need more information and services to help them ensure their sexual and reproductive health. Many of the programmes designed to make sexual and reproductive health information and services available to young people have used 'top down' approaches, based on adult-led risk and lifestyle orientation. In such programmes, young people are often looked upon negatively, in terms of their problems, rather than positively, in terms of their potential and capabilities. This article argues that a focus on the negative aspects of adolescent sexual and reproductive health means that young people are seen as collections of discrete problems. Furthermore, such approaches tend to view all young people as one homogeneous group when in reality adolescents are an enormously diverse group, not only in terms of age and gender, but also in terms of ability and beliefs. Such approaches therefore fail to address the vulnerabilities of particular young people and fail to contextualize sexual health within a wider framework of young people's lives. A challenge for the next century is to move away from focusing on risks, towards embracing needs and rights, and to involve young people in identifying issues and developing solutions.     

Opportunities and challenges of sexual health services among young people: a study in Nepal

IntroductionIt has been well documented that young people are more likely to engage in high-risk sexual activity. Appropriate understanding of safe sex, sexual practices, and related behaviors must recognize the importance of socioeconomic and cultural factors in prevention efforts related to HIV and other sexual transmitted infections (STIs).AimTo examine and summarize the opportunities and challenges of sexual health services among young people in Nepal.Main Outcome MeasuresReview of literature—assessing knowledge, attitudes, and understanding of sex, sexual health, and related sexual risk behaviors, among young people (15–24), in line with the current sociocultural and health service practices.MethodsMedline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Science, Cochrane database, and Google were searched. Similarly, documents published at the WHO, United Nations Population Fund, United Nations Development Program, and at national/local level—Ministry of Health, National Center for AIDS, and STD Control were also assessed to access the relevant reports and articles. Published and gray articles were also reviewed.ResultsThis study contends growing expansion of communication and transportation networks, urbanization, and urban in-migration is creating a different sociocultural environment, which is conducive to more social interactions between young girls and boys in Nepal. Rising age at marriage opens a window of opportunity for premarital and unsafe sexual activity among young people and this creates risks of unwanted pregnancy, STIs/HIV and AIDS. Socioeconomic, demographic, and cultural factors have been identified as encouraging factors for risk-taking behaviors among young people.ConclusionsUnderstanding safer sex and responsible sexual/reproductive behavior is important. Effective and appropriate interventions on sexual and reproductive health education directed at young people and the whole family, including fathers, could have significant effect on reducing risk and related risk practices in the context of Nepal. Regmi K. Opportunities and challenges of sexual health services among young people: A study in Nepal. J Sex Med 2009;6:352–361.     

Access to sexual and reproductive health care: adolescents and young people.

Obstetricians and gynecologists at the FIGO pre-congress workshop on adolescents deliberated on their role as clinicians, educators and advocates in upholding young peoples' sexual and reproductive health rights. Comprehensive services to adolescents should include emergency contraception, safe abortion and also provide care for survivors of sexual violence. Key to successful access to youth friendly services consist of providers' attitudes and addressing consent, confidentiality, evolving capacities of young people and youth participation.     

Young people's sexual and reproductive health rights

The world's population contains more young people than ever, with almost half under the age of 25 years. Millions every year enter their 'reproductive age'. Many do this in a safe and controlled way, and manage to balance life goals, education and sexual maturity as essential positive elements of human life. However, in developing countries, many young people are exposed to the increasing risks of unprotected sexual practice, such as exposure to human immunodeficiency virus/acquired immunodeficiency syndrome, other sexually transmitted diseases, unwanted or unplanned pregnancies, sexual abuse and rape, and mental health problems related to unwanted sexual exposures. Some, especially the poor and uneducated, enter into sexual activities without proper information or access to protective services. There are cultural and moral reasons for this lack of information. Worldwide, evidence demonstrates that informed young people demonstrate more protective behaviour than uninformed young people. This paper addresses how one can meet the reproductive rights of young clients, especially females, in a human rights and reproductive rights framework, as well as in clinical practice and also safeguard their health and ensure their sexual safety.     

Righting the mismatch between law,policy and the sexual and reproductive health needs of young people in the Asia-Pacific Region

The context of sexual relations is changing in the Asia-Pacific. While the age of sexual debut remains the same, young people are generally marrying later and sex outside of marriage is increasing. The first systematic review of how laws and policies govern young people’s access to sexual and reproductive health services was conducted in 2013. The study considered >400 national documents and held focus group discussions with >60 young people across three countries in the region. This paper examines the study findings in light of epidemiological data on young people’s sexual behaviour and health, exposing a critical mismatch between the onset of sexual activity and laws and policies governing consent (to sex and medical treatment), and the restriction and orientation of services to married persons. An enabling legal and policy environment is an essential foundation for efforts to improve young people’s sexual and reproductive health. This paper argues that international guidance and commitments (including the widely ratified Convention on the Rights of the Child) provide a framework for recognising young people’s evolving capacity for independent decision-making, including in the realm of sexual and reproductive health. A number of countries in the region are using these frameworks to expand access to services, providing valuable examples for others to build on.     

Access to sexual and reproductive health for young people: Bridging the disconnect between rights and reality

Of the 1.5 billion young people globally, 78% live in Asia and Africa, the poorest regions of the world. The majority of young people infected with HIV are female and adolescent girls have a significant increased risk for maternal mortality and morbidity, such as fistula. Trends to delay marriage do not decrease the age of onset of sexual activity, but highlight the need for access to sexual and reproductive information, and skills and services to learn healthy sexuality and prevent unwanted pregnancy and sexually transmitted infections. Youth-friendly services require confidentiality, privacy, and non-judgmental attitudes, and rights of adolescents include the consideration of their evolving capacities to consent to services. Denial of young people's sexuality and rights by conservative and traditional forces has lethal consequences, especially for women and girls. Countries have committed to these rights through numerous international instruments and many are making progress, but challenges at the community level are significant.     

Lost in translation: reproductive health care experiences of Somali Bantu women in Hartford, Connecticut

Introduction: Reproductive health problems are the leading cause of women's morbidity and mortality worldwide. In the United States, officially sponsored refugee women continue to face challenges in accessing reproductive health programs despite having access to health insurance. Methods: The objective of this study was to explore the reproductive health experiences of 1 such population—Somali Bantu women in Connecticut—to identify potential barriers to care experienced by marginalized populations. The study was qualitative, consisting of key informant interviews, a focus group session, and a semistructured survey. Results: Although all the women in the study reported having access to reproductive health care services, they also reported having unmet health needs resulting from barriers to care that included ethnic distinction/language barriers, passive acceptance of incorrect care, cultural discordance in family planning services, patient‐provider sex discordance, and desire but limited scope for ownership in health care outcomes. The root cause of the various types of patient‐provider discordance was the lack of recognition that the Somali Bantu are distinct in culture, language, and solidarity from ethnic Somalis, resulting in Language Line translation services being conducted in a Somali language that the Somali Bantu women did not understand. Discussion: The results of the study primarily highlight the larger issue of information asymmetry within the health care system that, if left unaddressed, will persist as new vulnerable populations of refugees arrive in the United States.     

Opportunities and limitations for using new media and mobile phones to expand access to sexual and reproductive health information and services for adolescent girls and young women in six Nigerian states

Reproductive health problems are a challenge affecting young people in Nigeria. Education as a Vaccine (EVA) implements the My Question and Answer Service, using mobile phones to provide sexual and reproductive health (SRH) information and services. Use of the service by adolescent girls and young women is low. Focus group discussions were held with 726 females to assess their access to mobile phones, as well as the barriers and limitations to the use of their phones to seek SRH information and services. Results demonstrate high mobile phone access but limited use of phones to access SRH information and services. Barriers to use of these services include cost of service for young female clients, request for socio-demographic information that could break anonymity, poor marketing and publicity, socio-cultural beliefs and expectations of young girls, individual personality and beliefs, as well as infrastructural/network quality. It is therefore recommended that these barriers be adequately addressed to increase the potential use of mobile phone for providing adolescent and young girls with SRH information and services. In addition, further initiatives and research are needed to explore the potentials of social media in meeting this need.     

Illegal female immigrants in The Netherlands have unmet needs in sexual and reproductive health

Objectives.?To determine the reproductive health problems of illegal female immigrants and what obstacles they experience when seeking help for these problems.

Methods.?One hundred illegal female immigrants in The Netherlands aged more than 18 years were provided with a structured list of common reproductive and sexual health problems. Further semi-structured interviews were conducted regarding their experiences with reproductive health facilities.

Results.?Obstacles accessing reproductive health facilities were frequently reported. Illegal female immigrants were not able to exercise control over their own reproductive and sexual health. The reasons for obstacles accessing reproductive health facilities include lack of information about reproductive health services and contraception, problems with paying for services, sexual and physical violence and fear of deportation. Obstacles accessing reproductive health facilities resulted in lacking or delayed pregnancy care (19% never received antenatal care), infrequent use of contraception and high abortion rates (64.9/1000). Of all interviewed women, 70% reported gynaecologic or sexual problems, and 28% reported past exposure to sexual violence.

Conclusions.?The reproductive health status of illegal female immigrants in The Netherlands is worrisome. There is an urgent need to empower illegal women through education. The Dutch government should make efforts to improve access to reproductive health and family planning services.     

Sexual behaviour and contraceptive use among unmarried, young women migrant workers in five cities in China

This paper reports the results of exploratory research on reproductive and sexual health knowledge and sexual behaviour of young, unmarried women who migrate to cities from rural areas for work, and their access to and needs in relation to family planning in Beijing, Guangzhou, Shanghai, Guiyang and Taiyuan, in China. Focus group discussions were conducted with 146 young women aged 16-25 and 58 in-depth interviews with key informants. Some of the young female migrant workers were sexually active and living with their boyfriends, most of whom expected to marry each other. Most of the women lacked basic information about reproduction and contraception, and did not know where or how to obtain contraception. There were social, psychological and economic barriers to accessing services. Only a small proportion of those who were unmarried were using contraception, so induced abortion was often the outcome of unprotected premarital sex. Pleasing male partners also played an important role in unprotected sex. The training, attitudes and approach of the entire family planning service system in relation to unmarried and young people in China, including this migrant population, needs to be reorientated so as to provide them with appropriate and adequate services.     

Mental health and the ageing population

The ageing population of the world presents major challenges for society and for health services. Mental health issues are extremely important, as mental disorders, notably dementia and depression, are common in old age. Mental ill health can profoundly affect the quality of people's old age and has a significant impact upon the use of health and social services. In this paper, we examine these problems from the point of view of older people as consumers, and discuss the role of health promotion, primary care, social services and specialist mental health services for older people. Certain groups within the population, including women, people from minority ethnic backgrounds, very old people, people with learning disabilities, and gay and lesbian older people face some particular issues, which are briefly discussed. Although this paper takes a mainly UK perspective, the mental health of older people is a huge global public health issue. Good epidemiology is central to understanding the needs of ageing populations and responding to them appropriately. Further research is needed in other areas, especially as to which service interventions are effective and efficient.     

The impact of cancer treatment on reproductive health in young women

The diagnosis of cancer can precipitate a re-evaluation of life at all ages. In children, adolescents and young adults, a cancer diagnosis and its treatment poses specific challenges that can affect all aspects of reproductive health resulting in considerable physical, psychological and psychosexual burden. Improved survival means that this cohort of patients is expanding and with an improving life span, the resulting morbidity is also extended. The demands of this group of patients are often not fully integrated in the operational functions of the health service with considerable variation in care. This review discusses the common reproductive morbidities amongst survivors of childhood, adolescent and young adult cancer whilst planning, delivering and following cancer treatment. This includes the current issues on the assessment of ovarian reserve and preservation of fertility.     

Neoliberal reforms and privatisation of reproductive health services in post-socialist Poland

The fall of state socialism in Poland in 1989 constituted a critical moment which redefined policies on reproductive health care and access to family planning, influenced by the renewed power of the Catholic church. Poland also embarked on neoliberal economic reforms that resulted in major cutbacks in social services and state health care coverage. The confluence of the elimination of contraceptive subsidies, privatisation of health care, and the intensification of bribes to underpaid health care providers created new challenges for women in accessing services. Furthermore, the 1993 ban on abortion resulted in a nearly total privatisation of this service, which is currently available clandestinely at a high price. Drawing on anthropological research in the Gdańsk metropolitan region in 2007, this paper examines the restrictions on access to family planning, abortion, maternity care, assisted reproduction and other gynaecological services. It draws attention to the urgent need for state-subsidised family planning and other reproductive health services, the reform of abortion law, and regulation of privatised services. Higher wages for public sector health professionals and better public health provision would curb informal payments. The state should support the legitimacy of women's health needs and reproductive and sexual autonomy.     

The sexual and reproductive health of young people in the Arab countries and Iran

This article reviews the sexual and reproductive health situation of young people aged 10-24 in the Arab states and Iran, based on published and unpublished literature and interviews with 51 key informants working mostly in NGOs and international agencies in the region. There are few national government programmes addressing young people's sexual and reproductive health, with the exceptions of Tunisia and Iran, and a lack of population-based data to guide such programmes. Although the strong emphasis on the integrity and strength of the family unit has a protective effect, young people lack access to information. Education curricula that include these topics are rare and where they do exist, relevant sections are frequently skipped over by teachers, who are unprepared. Health service providers neither recognise the needs of this age group nor make young people welcome, particularly those who are unmarried. Increased education and employment mean the age at marriage is rising, but unprotected forms of marriage are also reported. Taboos surrounding discussion of sexuality remain a key constraint, and data on unwanted pregnancy and abortion, violence against women, and STIs/HIV/AIDS are limited. Building on NGO models and existing efforts, there is a need for the development of national programmes to support the well-being of young people in this region.     

Meeting the commitments of the ICPD Programme of Action to young people

Some of the commitments nations have made in international agreements, notably in the ICPD Programme of Action (1994) and the resolution of the UN Committee on Population & Development (2012), to young people include: realisation of the right to education and attainment of a secondary school education; delaying marriage beyond childhood and ensuring free and full choice in marriage-related decisions; exercise of the right to health, including access to friendly health services and counselling; access to health-promoting information, including on sexual and reproductive matters; acquisition of protective assets and agency, particularly among girls and young women, and promotion of gender equitable roles and attitudes; protection from gender-based violence; and socialisation in a supportive environment. These are crucial for a successful transition to adulthood with reference to sexual and reproductive health outcomes. This paper assesses the extent to which these commitments have been realised, drawing from available studies conducted in the 2000s in developing countries. It concludes that while some progress has been made in most of these aspects, developing countries have a long way to go before they can be said to be helping their young people achieve a successful sexual and reproductive health-related transition to adulthood.     

Parent-child communication about sexual and reproductive health in rural Tanzania: Implications for young people's sexual health interventions

Background  

Many programmes on young people and HIV/AIDS prevention have focused on the in-school and channeled sexual and reproductive health messages through schools with limited activities for the young people's families. The assumption has been that parents in African families do not talk about sexual and reproductive health (SRH) with their children. These approach has had limited success because of failure to factor in the young person's family context, and the influence of parents. This paper explores parent-child communication about SRH in families, content, timing and reasons for their communication with their children aged 14-24 years in rural Tanzania.     

Tasting the forbidden fruit: the social context of debut sexual encounters among young persons in a rural Nigerian community

What circumstances surround the initial sexual encounters of young persons? And what are their implications for adolescent sexual and reproductive health status? These questions, although rarely raised in reproductive health discourse, appear to be critical in broadening the systematic understanding of key issues that impose themselves on adolescent sexual and reproductive health. Against this background, the present study attempts to use the circumstances surrounding the debut sexual encounters of young persons in a rural Nigerian community as an entry point to understanding their vulnerability to sexual and reproductive health problems. Data for the study were gathered using in-depth interviews of 180 persons aged 11-25 years. Emerging evidence shows that first sexual encounter took place under conditions that exposed young people to infections, disability, and even death. The study recommends that there is need to build on the clear evidence that good sex and reproductive health education for young persons delay the onset of sexual activity and makes it safer when it eventually commences.     

Reproductive health knowledge, attitude and practice among high school students in Bahir Dar, Ethiopia

This study was carried out to investigate the reproductive health knowledge, attitude and practice of high school students in Bahir Dar, Ethiopia. Data were collected using self-administered questionnaire and focus group discussions. The study revealed that the students had high level knowledge of contraceptives and where to obtain contraceptive services; however, level of use was low. Some of the reasons given for not using contraceptives include lack of access to services, carelessness, unplanned sexual intercourse and pressure from sexual partner. The study indicates that young people engage in sexual relationships at an early age without protection or with unsafe non-conventional methods. There was no significant difference between the demographic variables and contraceptive use at first intercourse. Educational level of the respondents was the only demographic variable that had significant association with sexual experience (p < 0.05). We recommend improved access to family planning information and services and family life education programmes based on the needs and experience of these young people as a potential solution to alleviate their reproductive health problems.     

Exploration of the experiences of young mothers seeking and accessing health services

Objective: The objective was to explore young mothers’ experiences of seeking and accessing health services, specifically maternity care. Study design: A phenomenological approach underpinned by the work of Husserl and guided by the framework offered by Giorgi. Participants: A purposive sample of seven young mothers took part in audio-recorded unstructured interviews in either the young mother’s home or in a private room at their GP practice. Findings: Six themes emerged from the initial thematic analysis: (1) feeling abandoned, (2) information is vital, (3) feeling judged, (4) family and friends, (5) interference, (6) younger mothers need additional support. After ‘bracketing’ the preconceptions evident in the initial analysis, essential themes describing the young mothers’ experience of accessing healthcare were identified: (1) the need for support and information; (2) fear of stigmatisation and stigmatisation of self. Conclusions: The young mothers in this study experienced a need for support and information, which reflects the findings of previous studies. This study has added to the knowledge base as it also found that these young mothers were hindered from obtaining or making use of available support and information through fear or expectation of stigmatisation and self-stigmatisation. There is a need to improve availability of support and information for young mothers, who may benefit from one-to-one education to help them gain confidence to deal with pregnancy and parenthood issues. Further research on young mothers’ perceptions of maternity service provision will advance understanding of young mothers’ help and support needs during pregnancy, birth and the postnatal period.