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Adolescence Seminar Presentation

SA492 Seminar Presentation on Adolescence by Emilie Shore and Honor Mishcon
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Honor Mishcon

on 20 November 2014

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Transcript of Adolescence Seminar Presentation

UNFPA, https://www.unfpa.org/public/home/adolescents/pid/6486
Vulnerabilities
Biological factors specific to Adolescence e.g. ability to access risk, immature bodies etc.
Access to services
Economic Dependance
Peer Pressure/Family Pressure
Inadequate or no education
Rights and Agency
Gender & Adolescence
Girls

Pregnancy and Abortion
Pregnancy and Abortion
Rates of induced abortion are greatest in the younger and older age groups.
In 27 countries, abortion rates are highest among women in their 20s
Worldwide, 46 million pregnancies are voluntarily terminated every year, 27 million are legal and 19 million are outside legal system
All but 3% of 19 million unsafe abortions per year happen in developing countries
Unsafe abortion accounts for more than 30% of maternal deaths and 14% of all unsafe abortions in developing countries are among women younger than 20 years old

HIV/AIDS
Young women worldwide make up more than 60 per cent of young people living with HIV; in sub-Saharan Africa, their share jumps to 72 per cent
What is Adolescence?
What makes this group unique?

Boys & Men
Unequal power structures underlying society/family life
Specific Treatment needed to cater for Adolescents
Adolescence
How do we classify it?

Why do we need a separate category from children or youth?
"Today's adolescents and youth are 1.8 billion strong and make up one quarter of the world's population."
- UNFPA, https://www.unfpa.org/public/home/adolescents
Definitions
According to the United Nations....

Young People: 10-24 years of age

Youth: 15-24 years of age

Adolescents: 10-19 years of age

- WHO, The second decade: improving adolescent health and development. Geneva: World Health Organization, 2001: 1–20.
More likely to be coerced into sexual relations (in and outside marriage)
Less likely to be able to negociate sex/safe sex
Increased Risk of Violence
Early Marriage
Poorer Education Outcomes
Pregnancy
More likely to contact STIs (due to sexual partners being more promiscuous and older [both increasing risk of STIs/HIV] and also immaturity of the vaginal cannal that can habour more infection by tearing etc.)
More at risk from HTPs such as FGM (the prevalence of FGM ranges from 0.6% to 98% of the female population in sub-Saharan Africa) which can increase chances of maternal morbidity as well as psychological issues and painful intercourse.
Contraception
Seminar Exercise - ON YOUR FEET!
Role Play
Researches and Policy Makers: What's Next?
Issues....
- UNICEF, 2011, Opportunity in crisis: Preventing HIV from early adolescence to young adulthood, p. 4.
Violence against women and girls increases their risk of acquiring HIV. A 2010 longitudinal study conducted in South Africa showed that power inequity in relationships and intimate partner violence were associated with increasing the risk by 11.9 per cent and 13.9 per cent, respectively, among young South African women.
http://www.unwomen.org/en/what-we-do/hiv-and-aids/facts-and-figures, cited from: R. Jewkes et al., 2006, “Factors Associated with HIV Sero-Status in Young Rural South African Women: Connections between Intimate Partner Violence and HIV,” International Journal of Epidemiology, 35, pp. 1461-1468; R. Jewkes, 2010, "HIV/AIDS. Gender inequities must be addressed in HIV prevention," Science 329(5988), pp. 145-147; J. Silverman et al., 2008. “Intimate Partner Violence and HIV Infection among Married Indian Women,” JAMA 300(6), pp. 703-710; R. Stephenson, 2007, “Human Immunodeficiency Virus and Domestic Violence: The Sleeping Giants of Indian Health?” Indian Journal of Medical Sciences, 61(5), pp. 251-252; K. L. Dunkle et al., 2004. "Gender-Based Violence, Relationship Power, and Risk of HIV Infection in Women Attending Antenatal Clinics in South Africa," Lancet, 363 (9419), pp. 1415-1421; and L. Manfrin-Ledet and D. Porche, 2003. “The State of Science: Violence and HIV Infection in Women,” Journal of the Association of Nurses in AIDS Care, 14(6), pp. 56-68.
Too many 15-24 year olds do not know how to prevent HIV infections and hold misconceptions about how the virus is transmitted: in 2010, only 34% of young people held comprehensive and correct knowledge about HIV.
Three groups to consider:
1. Adolescents that are at risk from HIV
2.Those born with HIV that have recieved ART treatment and survived into Adolescence
3. Adolescents who contract HIV through sexual intercourse or high risk behaviours
Specially trained non-judgemental staff
Adolescent friendly clinics
Adolescent support groups
Easy access (transport, cost, hours)
Education to improve peer knowledge and reduce stigma

There are initiatives targeted more and more at young men and children that aim to tackle HIV prevention such as male circumcision which lowers chances of contraction via heterosexual incourse by 60%
WHO, http://www.who.int/hiv/topics/malecircumcision/fact_sheet/en/
More likely to have multiple partners and contract/transmit STIs
ICRW, http://www.icrw.org/what-we-do/engaging-men-boys
Preventing HIV/AIDS and Promoting Sexual Health: among especially vulnerable young people, http://www.who.int/hiv/pub/prev_care/en/vulnerableyp.pdf
Moore, Ann et al., Coerced First Sex among Adolescent Girls in Sub-Saharan Africa: Prevalence and Context, 2007.
Wood, K., et al., "HE FORCED ME TO LOVE HIM'': PUTTING VIOLENCE ON ADOLESCENT SEXUAL HEALTH AGENDAS, Soc. Sci. Med. Vol. 47, No. 2, p. 233-242, 1998.
UNAIDS. Report on the Global HIV/AIDS Epidemic: June 2000. Geneva: UNAIDS, 2000, http://data.unaids.org/topics/gender/youngpeople_en.pdf
In many developing countries, more people are becoming sexually active before marriage
For young boys, most of their sexual experiences are occurring during their teenage years in a non marital context
In most countries, more than 40% of unmarried adolescent boys have had intercourse
It is more likely for girls to be engaging in intercourse within marriage
Bearinger L, Sieving R, Ferguson J, Sharma V. Global perspective on sexual and reproductive health of adolescents: patterns, prevention and potential. Lancet 2007; 369: 1231-1220.

Singh S, Wulf D, Samara R, Cuca YP. Gender differences in the timing of first intercourse: data from 14 countries. Int Fam Plan Perspect 2000; 26: 21–28.

Blanc AK, Way AA. Sexual behavior and contraceptive knowledge and use among adolescents in developing countries. Stud Fam Plan 1998; 29: 106–16.
Developed Countries & contraceptive prevalence
42% of adolescents in USA reported use of a contraceptive method at most recent sex
64% in Canada
50% in France
69% in UK

Developing Countries & Contraceptive Prevalence
In developing countries, marriage is an indicator for increased risky sexual intercourse in adolescent girls.
Married adolescent girls have increased unprotected intercourse, sex more frequently, and are less likely to use protection than unmarried adolescent girls
Over the next 10 years, about 1/3 of adolescent girls in developing countries will marry before their 18th birthday
With the exception of male and female sterilization, all contraceptive methods recommended and used for adults are potentially appropriate for post pubertal adolescents.

Bearinger L, Sieving R, Ferguson J, Sharma V. Global perspective on sexual and reproductive health of adolescents: patterns, prevention and potential. Lancet 2007; 369: 1231-1220.

Wellings K, Collumbien M, Slaymaker E, et al. Sexual behaviour in context: a global perspective. Lancet 2006; 368: 1706–28.

Barriers to Contraception in Low & Middle Income Countries
Barriers:
Obtaining contraceptives
Unavailable to both adults and adolescents
Policy and laws preventing distribution to unmarried adolescents
Limited method of contraceptive choice to mainly condoms

Using contraceptives
- Social pressure to bear children
- Stigma
Lack of knowledge
- Incorrect use
- Problem with consistent use
- Adolescents in most countries are more likely to discontinue their method of contraception more than adults

Chandra-Mouli et al.: Contraception for adolescents in low and middle income countries: needs, barriers, and access. Reproductive Health 2014 11:1.

Oringanje C, Meremikwu MM, Eko H, et al. Interventions for preventing unintended pregnancies among adolescents. Cochrane Database of Systematic
Reviews; 2009.
Magnani R, Gaffkin L, de Aquino EM, et al. Impact of an integrated adolescent reproductive health program in Brazil. Stud Fam Plan 2001;32:230e43.

Pulerwitz J, Barker G. Promoting healthy relationships and HIV/STI prevention for young men: Positive findings from an intervention study in Brazil. New York: Population Council; 2004.

an Rossem R, Meekers D. An evaluation of the effectiveness of targeted social marketing to promote adolescent and young adult reproductive health in Cameroon. AIDS Educ Prevent 2000;12:383e404.

Murray N, et al. An evaluation of an integrated adolescent development program for urban teenagers in Santiago, Chile. March 5, 2000 (unpublished).

Adolescents' Views of Sexual and Reproductive Health in Sub-Saharan Africa
Qualitative study to gain insight into adolescents’ views on sexual and reproductive health issues
Data collected from 55 focus group discussions in Burkin Faso, Ghana, Malawi and Uganda in 2003
Focus groups were sampled from youth aged 14-19, coming from in and out of school, living in both rural and urban areas

M. Amuyunzu-Myamongo, A. Briddlecom, C. Ouedraogo, V. Wong. Qualitative evidence on adolescents' views of sexual and reproductive health in sub-Saharan Africa" : Occasional Report No.16. The Alan Guttmacher Institute: 2005.


Sexual Discussion :
Discussions were focused around relationships with boyfriends or girlfriends, older married men or women and occasional sex partners
Young women were described as dressing and acting provocatively and engaging in sex for money or with sex outside of their relationship
Young men were described as pursuing sex or “conning” young women into having sex
Female and male adolescents discussed sexual relationships with older (married) men or women involving a material exchange

Findings
M. Amuyunzu-Myamongo, A. Briddlecom, C. Ouedraogo, V. Wong. Qualitative evidence on adolescents' views of sexual and reproductive health in sub-Saharan Africa" : Occasional Report No.16. The Alan Guttmacher Institute: 2005.

Premarital pregnancy
Young men who have a child before marriage are pitied, teased or talked about
Young women who become pregnant have consequences of having to drop out of school or getting kicked out of their home
HIV/AIDS & other STI'S
Young people are aware of the risk, but misconceptions about symptoms and knowledge are prevalent


Findings
Abstinence:
Regarded as a way to prevent HIV, STI's and pregnancy, and less as a preservation for marriage
Condoms / Negotiating use:
Way to protect against HIV and other STI's, less about protecting against pregnancy
Values attached to adolescents’ engaging in sexual behaviour: more enjoyable without a condom, trust, love anxiety and excitement
Generally recognized condom use as the women’s responsibility
Dependent on money / gifts
Information:
High value on confidential and accurate information
Mainly getting information from mass media, health care providers, schools, performances, family members and adults

Services:
Hospitals, public health centers and traditional healers were discussed for problems concerning STI's
Cited home remedies, hospitals, and traditional healers for abortion services
Low levels of awareness, due to low levels of availability, were associated with Voluntary Counseling and Testing (VCT) services

M. Amuyunzu-Myamongo, A. Briddlecom, C. Ouedraogo, V. Wong. Qualitative evidence on adolescents' views of sexual and reproductive health in sub-Saharan Africa" : Occasional Report No.16. The Alan Guttmacher Institute: 2005.

In sub-Saharan Africa, the average birth rate per 1000 adolescent girls aged 15-19 is 143, compared with the worldwide average of 65
In some sub-Saharan African countries, 1 in 5 adolescent girls give birth each year
In USA, rates of adolescent pregnancy and birth are some of the highest in developed world
Rates have dropped substantially since 1990s

Bearinger L, Sieving R, Ferguson J, Sharma V. Global perspective on sexual and reproductive health of adolescents: patterns, prevention and potential. Lancet 2007; 369: 1231-1220.

WHO. Adolescent pregnancy: issues in adolescent health and development. Geneva: World Health Organization, 2004: 1–86.

United Nations Statistics Division. Demographic year book, 2003. http://unstats.un.org/unsd/demographic/products/dyb/dyb2.htm (accessed July 30, 2006).

Singh S. Adolescent childbearing in developing countries: a global review. Stud Fam Plann 1998; 29: 117–36.

Pregnancy and Abortion

Complications from pregnancy and childbirth are the leading cause of death among adolescent girls
Perinatal deaths are 50% higher among babies born to mothers under the age of 20 years
In developing countries, maternal death rates for adolescents are twice that compared to adult rates
Antenatal care should begin in the first trimester of pregnancy or early in the second
Adolescents are more prone to entering pregnancy with reduced nutritional stores
Iron and nutritional supplements should be taken during pregnancy
Special attention is needed for pregnant adolescents below the age of 15 years
Postpartum care is needed to be proactive in diagnosing and treating complications such as hemorrhage or infection, provide contraceptives, promote and support breastfeeding and to give nutritional advice

Bearinger L, Sieving R, Ferguson J, Sharma V. Global perspective on sexual and reproductive health of adolescents: patterns, prevention and potential. Lancet 2007; 369: 1231-1220.

Reynolds H, Wright K. Maternal care among adolescents. Arlington: YouthNet, 2004.

WHO. Adolescent pregnancy: unmet needs and undone deeds. A review of the literature and programmes. Geneva: World Health Organization, 2006.

WHO. Preventing early pregnancy and poor reproductive outcomes among adolescents in developing countries: what the evidence says. Geneva: World Health Organization,

Bearinger L, Sieving R, Ferguson J, Sharma V. Global perspective on sexual and reproductive health of adolescents: patterns, prevention and potential. Lancet 2007; 369: 1231-1220.

WHO's Recommendations for Preventing Early Pregnancy and Poor Reproductive Outcomes
Reduce marriage before the age of 18 years
Create understanding and support to reduce pregnancy before the age of 20 years
Increase use of contraception
Reduce coerced sex
Reduce unsafe abortion
Increase the use of skilled antenatal childbirth and postpartum care

WHO. Preventing early pregnancy and poor reproductive outcomes among adolescents in developing countries: what the evidence says. Geneva: World Health Organization

WHO's Recommendations for preventing early pregnancy and poor reproductive outcomes
In the US young men who have sex with men account for almost 60 percent of HIV diagnoses among all young people and represent twice as many diagnoses as young women across all risk categories. However, in adolescents aged 10-14 girls have a higher burden of HIV.
CDC. Sexual and reproductive health of persons aged 10–24 years, United States, 2002–2007. 2009, 17/07/2009, http://www​.cdc.gov/mmwr​/preview/mmwrhtml/ss5806a1.htm.
Key to changing cycles of violence
LGBT
Very under researched and vulnerable community
At risk from from violence and risky sexual health practice
Face judgement and prejudice in clinic settings
Lack of education in schools or parental support
Rebeccah, a young woman living with HIV from Zimbabwe, was treated badly the first time she went to a clinic to receive counselling about contraception. She said: “The nurse said she was surprised I was still having sex considering my ‘condition’. And she told me I should abstain from sex since I am HIV positive. I cried a lot in her office and decided not to go to that clinic anymore.”
Why are well trained clinic staff so important especially for adolescents?
KOUASSI, N., StayingAliveFoundation, YOUNG PEOPLE DEMAND SEXUAL AND REPRODUCTIVE HEALTH RIGHTS, http://stayingalivefoundation.org/blog/2014/07/young-people-demand-their-sexual-and-reproductive-health-rights/
Institute of Medicine (US) Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities.
Washington (DC): National Academies Press (US); 2011.
Very little research has been conducted on the relationship between teen pregnancy and sexual orientation, although there is some indication that lesbian and bisexual adolescents may have at least the same and possibly an increased likelihood of pregnancy compared with heterosexual adolescents.
There is also research to suggest that LGBT groups are more likely to contract STIs/HIV due to risky sexual behaviours
Lukale, N., Okondo, H., Racherla, .S. J., YWCA, SUB-SAHARAN AFRICA REGION FACT SHEET: reclaiming and redefining rights: setting the adolescent and young people SRHR agenda beyond icpd+20, Arrow, 17/12/2012
Regionally [In Sub-Saharan Africa], 36 countries have laws criminalizing homosexuality. Punishments include imprisonment and the death penalty. The laws on homosexuality are rooted in colonial era laws, religious extremism, political climates, cultural beliefs, heterosexual family values and patriarchy.
Therefore, many LGBT adolescences have to negotiate not only their SRH but also the Law and stigma within their societies leading to difficulties accessing health care and education
Further implications
Lukale, N., et al, YWCA, Sub-Saharan Africa Fact Sheet, 17/12/2012
Full transcript