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Laura Fonseca

on 6 February 2014

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Transcript of Adolescents

Why are adolescents a special group? Facts from the World Health Organization* million adolescent girls between 15 and 19 give birth each year 16 babies born to adolescent mothers of all births worldwide 11% 95% in developing countries This generation of adolescents is the largest in history "Adolescents are the greatest hope for turning the tide against STIs, AIDS and early pregnancy" (p. 1220). More people are sexually active before marriage than in the past Most sexual relationships during the teenage years are non-marital Most sexual relationships occur within marriage Singh, S., Wulf D, Samara, R, Cuca, YP (2000) Gender in differences in the timing of first intercourse: data from 14 countries. Int Fam Plan Perspect, 26: 21-28 14 countries study 60%

of new HIV infections occur among 15-24 year-olds (Kim & Free, 2008) Risks Teen Pregnancy What do we do? Youth Development Sex Education Programs Bearinger, Sieving, Ferguson and Sharma (2007) “Sexual intercourse prior to a girl’s full maturation can be extremely painful—especially when forced—due to the small diameter, short length, inelasticity, and lack of lubrication of the vagina, quite apart from the emotional shock it may cause when violence is used. Abrasions and tearing increase the risk that a girl will acquire STIs such as syphilis or the human papilloma virus (HPV) and HIV from an infected partner.”
- “Overlooked and uniformed”
Dixon-Mueller et al (2007) 2.5 Million of unsafe abortions a year in developing countries by women under 20 (Bearinger 2007, p1224) - Higher risk for maternal death for those aged 15-19 twice that of older women - In low and middle income countries leading cause of death among 15-19 year olds - Less likely to seek ante- peri- and postnatal care - Reduced nutritional scores - Heightened risk for miscarriage and fistula - Medical interventions designed for older women Maternal Mortality and Morbidity Health care Economic - Reduced schooling - Less employment opportunities - Additional expenses associated with child rearing - Most births are unattended because the cost of care high Child Marriage Social Physical Economic - High risk for early pregnancy and poor health outcomes
- More likely to have forced or coerced sex
- Vulnerable to HIV and STIs - Perpetuates cycle of under-education and poverty
- Limits opportunity for employment - Not mentally, emotionally prepared for marriage

- Limits right to choose partner

- Often married to older men, higher risk of widowhood and economic vulnerability

- Lack of education and empowerment

- Human Rights issue HIV/STIs - Worldwide largest proportion of STIs occur in people under 25
- Incidence of STIs rising
- 6000 young people infected with HIV each day
- Higher risk of cervical cancer – lack of Pap Smears
- Girls with sexual partners 10 yrs or more older are 2-4x more likely to be infected with HIV Physical Economic - Economic barriers to access medical treatment
- Disruption of school, impacts opportunities for employment
- Less resources means young girls are more susceptible to sex work, putting them at greater risk - Double standards regarding multiple partners
- Lack of skill in negotiating condom use and/or against coerced sex
- Insufficient knowledge
- Limited access to services
- Gender discrimination and sexual violence put girls at greater risk Social Clinical Services Youth Development Program Knowledge improvements Attitude improvements Intentions Improvement Prevention, diagnosis and treatment of STIs and HIV, prevention of cervical cancer and prevention and care during pregnancy and childbirth Information about their body functions , sex, safer sex, reproduction, and sexual negotiation and refusal skills Health Facilities Information and counseling Provision of contraception Antenatal, postnatal and perinatal care Special attention is needed for pregnant adolescents aged 14 years or younger Build life skills for interpersonal communication and decision making (Bearinger, Sieving, Ferguson & Sharma, 2007, p. 1226) IMPLEMENTATION Schools Clinics Juvenile detention centers Youth-oriented community agencies Kirby, Laris and Rolleri (2005) Evaluations of curriculum based programs reviewed. 83 Curriculum Based Programs 18 in developing countries Focus on: HIV/STIs Pregnancy Encouraging specific sexual risk reduction and protective behaviors Vast majority encouraged abstinence but also discussed or promoted the use of condoms or contraception if young people chose to be sexually active Areas of focus Initiation of sex Frequency of sex Number of sexual partners Condom use Contraceptive use in general STI rates Sexual risk taking Pregnancy rates significant positive impact on one or more of the areas significant negative impact 28% neither positive or negative impact 65% 7% Mediating factors Perceived peer behavior and norms Knowledge Perceived Risk Perceived security Personal values and attitudes Self efficacy and skills Changes in these factors contribute to to the changes in sexual risk taking behaviors. Implementation of the curriculum Content of the Curriculum Developing the curriculum Effective programs Including experts from different areas in the design Use a Logic Model Assess needs and resources of the target group Context-based Create safe spaces Clear goals Focus on specific and preventive behaviors Focus on mediating factors Multiple activities to each of target risks and protective factors Interactive methods Topics in a logical sequence Training of selected educators Partnership with authorities Incentives to recruit youth Implementation of all the activities proposed Research Programmatic efforts Address protective factors Application and development of skills and knowledge in daily lives Embed youth in supportive networks and provide them opportunities Enhancing the capacity to be happy, healthy and successful. Peer led Approach Millennium Development Goals 4 5 6 Reduce child mortality Improve maternal health Combat HIV/AIDS, Malaria and other diseases Colombia Los Andes University 2 Phases I decide my life
I decide to promote a healthy sexuality Trained teachers
Curriculum-based program
Adolescents as active participants (peer-led approach) Radio Program Data collection Surveys pre-post
Audience ratings
In depth interviews Results Strengths Adolescents and teachers empowered. Weaknesses Radio station targeted adults and had not a high adolescent audience. Willingness to include the program into the pre-existing curriculum. Strengths
Applicable to heterogeneous community of girls
SRH embedded in larger youth development program, provides skills to make the most of RH health knowledge
Good buy-in from local districts and schools
Site visits – real world experience
Mentors often left to own devices to create activities around materials
Parents needed to be more involved
Did not reach most vulnerable girls Strengths and Weaknesses RWANDA Ministry of Health
Population Services International
Nike/Girl Hub
L’Association du Guides du Rwanda Curriculum based youth development program for girls aged 10-12 Girls met weekly in schools and youth centers to participate in trainings, activities and site visits which focused on topics related to health and finance and were led by mentors (young women aged 18-20) Affect knowledge, attitudes and intentions regarding SRH by sharing information and developing self-esteem and life skills
Measured health, self-efficacy, self-esteem/leadership, health intentions and access to social capital Base-line surveys
Pre and post-test knowledge around HIV, STIs, Pregnancy
Surveys and interviews post-program Largest impact on knowledge with health test scores improving 118% and finance scores improving by 105%
Greatest impact with less urban and lower income girls Aims and Measurements Data Collection Similar proportion of adolescent pregnancies are associated with poor social outcomes - Stigma

- Less chance to develop skills to manage child rearing

- Less chance to develop skills to prevent additional pregnancies

- Low income means high dependency Social Physical Results Not all programs engaged community at same level
They focused on the professional services, did not integrate traditional medicine
Assumed if they just made professional services youth friendly that would be enough
Youth still prefer clinics least – need to find different environments to supply services Lusaka, Zambia Lusaka Health Management Team
UNICEF/Zambia Family Life Movement
John Snow International Youth-friendly service projects (YFS) Trained health care providers and peer educators to communicate with youth about RH
Different levels of community engagement
Some peer educators chosen from same community
Some peer educators chosen by the youth in community
Some had participatory learning action (PLA) in community Aims and Measurements Youth-friendliness of services Community acceptance of youth RHS Service use In-depth interviews with Clinic Managers, Nurses and Clinic Staff
Focus Groups with youth that had never received RH services
Client exit interviews
Focus Group Discussion with Neighborhood Health Council members and Adults in the community
Focus Group Discussion with Peer Educators
Service Statistics Data Collection Results Improved clinic experience for youth
Some increase in service use
Community acceptance had largest impact on health-seeking behaviors of adolescents Strengths Engaging the youth in the choice of peer educators
Accessing the level of acceptance for adolescent RH
Engaging the community in the program
Providing information about services and risks
Specific YHS training Weaknesses Activities... Programs around the world Why do you think adolescents are a special group? What are the physical, economic and social risks associated with Based on what you learned design your own program for adolescents addressing:
- Teen pregnancy
- Child marriage
- HIV/ STIs - Teen pregnancy
- Child marriage
- HIV/ STIs Any Questions? Bearinger, L.H., Sieving, R.E., Ferguson, J, & Sharma, V. (2007). Global perspectives on the sexual and reproductive health of adolescents:Patterns, prevention, and potential. Lancet. 2007 Apr 7; 369 (9568) :1220-1231

Dixon-Mueller R; Germain A; Fredrick B; Bourne K; Kidwell J. (2007). Overlooked and uninformed: Young adolescents' sexual and reproductive health and rights. New York, International Women's Health Coalition [IWHC]

Gavin, L.E, Catalano, R.F, & Markham, C.M. (2010). Positive youth development as a strategy to promote adolescent sexual and reproductive health. Journal of adolescent health, 46, 1-6

Kim, C.R & Free, K. (2008) Recent Evaluations of the Peer-Led Approach in Adolescent Sexual Health Education: A Systematic Review Perspectives on Sexual and Reproductive Health, 40, 3, 89-96

Kirby D, Laris B.A, Rolleri L. (2005). Impact of sex and HIV education programs on sexual behaviors of youth in developing and developed countries. Youth Research Working Paper No. 2. Research Triangle Park: YouthNet/Family Health International

Mmari, K., Magnani, R. J. (2003). Does making clinic-based reproductive health services more youth-friendly increase service use by adolescents? Evidence from Lusaka, Zambia. The Journal of adolescent health : official publication of the Society for Adolescent Medicine (1054-139X), 33, 4, 259 - 270

Resnick, M.D. (2005). Healthy youth development: getting our priorities right. Medical journal of Australia, 183, 398-400

Ross, D. (2009). Long-term impact of a behavioral change intervention on HIV, STI, knowledge, attitudes, and reported sexual behaviors among young people in rural Mwanza, Tanzania: Results of a community randomized trial. 16th Conference on eetroviruses and opportunistic infections, Montreal.

World Health Organisation, Technical Policy Brief: Preventing early pregnancy and poor reproductive outcomes among adolescents in developing countries: What the evidence says References Tanzania MEMA kwa Vijana Who? How? Evaluation Results - Impact on sexual and reproductive knowledge
- Males reported different attitudes to sex
- Impact on condom use
- Followed a logic model - No impact on biological outcomes
- Adults weren't involved (family)
- Didn't take into account gender specifically Strengths Weaknesses Adolescents and reproductive health Colleen LaFontaine
Laura Fonseca
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