Adolescent Sexual and Reproductive Health Print E-mail

Adolescent Sexual and Reproductive Health

Sexual and reproductive behaviors during adolescence and young adulthood, whether within or outside marriage, have immediate and long-term consequences, many of which can be emotionally or physically harmful. Yet, in many countries, taboos about sexuality, and social norms such as child marriage and early sexual initiation, pose strong barriers to providing young people with the information and services they need. 

Many adolescents do not have the ability or social support to resist pressure to have sexual relations, negotiate safer sex, or protect themselves against unintended pregnancy and STIs. Young people ages 15 to 24 are the fastest rising group of new HIV cases in the world, at 6,000 new cases every day. In Sub-Saharan Africa, two-thirds of HIV-positive young adults are young women; in other developing regions the proportions female range from one third to one half.  WHO is committed to protecting the sexual and reproductive health and rights of adolescents and facilitating their healthy transition to adulthood, particularly with regard to strengthening health sector capacity to provide accurate information, high quality counseling, and adolescent-friendly, comprehensive sexual and reproductive health care.

Research and data

The years since ICPD in Cairo have witnessed a remarkable resurgence of interest in the situation of adolescents (ages 10-19) and young people (ages 10-24). Among the many organizations and agencies undertaking research in this area, WHO's contributions to the international research endeavor include the following resources.

In the mid-1990s, WHO supported research on the sexual attitudes and practices of adolescents and young adults in 20 African, Asian and Latin American countries. The results of these case studies are published in Sexual Relations among Young People in Developing Countries: Evidence from WHO Case Studies (2001). This informative collection contains chapters on the context of sexual relationships among young people (sexual debut, nature of sexual partnerships, sexual coercion); the consequences of unsafe sexual activity (STIs, unwanted pregnancy and abortion); the content and sources of information (and misinformation); and gender power imbalances influencing risky sexual behavior. The report concludes with policy, program and practice recommendations as well as proposals for additional research. 

Researchers can benefit from WHO's tools and guidelines for investigating adolescent sexuality by downloading questionnaires and other research instruments from the RHR website. Asking Young People about Sexual and Reproductive Behaviours: Illustrative Core Instruments (2000) contains an explanatory introduction; sample survey questionnaire; and guidelines and sample questions for asking adolescents about partner selection, sexual behavior and risk-taking in in-depth interviews and focus-group discussions. Although these tools can be adapted to local situations, the use of a standardized format allows direct comparisons across and within countries.

An excellent collection of articles on the socio-demographic and sexual and reproductive health situation of adolescents in South Asia has been published as Towards Adulthood: Exploring the Sexual and Reproductive Health of Adolescents in South Asia (2003). The volume is based on an international meeting held in Mumbai, India in November 2000. Topics include country case studies of the sexual and reproductive health of both married and unmarried adolescents, sexual violence and coercion, adolescents' unmet need for contraception and safe abortion, STI information and services, family life and sex education, communication skills, and access to and quality of reproductive health services. A set of policy, program and research recommendations places adolescent sexual and reproductive health in the context of other aspects of the lives of young people that must also be addressed. 

Additional reviews of research include the Annotated Bibliography of Young People's Sexual and Reproductive Health (2002) compiled for WHO by Cicely Marston, which covers theoretical approaches, substantive findings from developing countries in areas such as sexual behavior and risk taking, sexual coercion, abortion, health-seeking behaviors and quality of care; research design and methodology, and questionnaires. 

Information about special constituencies of young people who are often overlooked in research, policy making and programming can be found in the recently compiled analytic reviews on Married Adolescents: No Place of Safety (2004), which explores the issues surrounding married adolescents and outlines promising programs in countries where early marriage and childbirth are common; Very Young Adolescents: the Hidden People (2004), which reviews the evidence on health and development, risk factors, and programmatic approaches for adolescents ages 10-14; and Adolescent Pregnancy: Unmet Needs and Undone Deeds (2004), which reviews trends and variations in adolescent pregnancy and documents a variety of policies and programs designed to address the health and social risks of early pregnancy. See also, What About Boys? A Literature Review on the Development of Adolescent Boys (2000) by Gary Barker, which addresses the topics of male socialization, physical health and development, mental health and risk taking, violence, sexuality, reproductive health and fatherhood.

Guidelines for providers

Essential resources for program managers and health care providers serving adolescents and young people include Key Issues in Implementation of Adolescent Sexual and Reproductive Health Programmes (2004); Guidelines for the Provision of Quality Health Services for Young People in the Americas (2004); and Standards for HIV Services for Young People (2004), which provides a health system framework for reaching adolescents with HIV counseling, prevention and care. The UN Inter-Agency Task Team on Young People has produced a consensus document on the minimum package of information needed by young people for their health and development. Entitled Facts for Adolescents (2004), the publication is intended for use by governments, NGOs, parents, teachers, peer educators, health workers, and the media.  See also the brief report on Broadening the Horizon: Balancing Protection and Risk for Adolescents (2001). 

In addition, a useful learning package for providers, Orientation Programme on Adolescent Health for Health Care Professionals (2003), addresses the priority health problems that affect adolescents, including sexual and reproductive health (e.g., STIs), substance abuse and poor nutrition. The orientation program was created with participatory input from health care providers in developing countries in order to improve the way in which front-line health workers perceive and interact with their adolescent clients and to adapt preventive and curative health services to young people's special needs and concerns. 

A series of discussion papers called Issues in Adolescent Health and Development published in 2002 (see list Appendix, p. 19 below) is currently under revision in the Department of Child and Adolescent Health and Development (CAH). Addressed to program managers and providers, the papers address the need for special services for adolescents relating to the key areas of adolescent pregnancy and childbirth, contraception, sexually transmitted infections, and unsafe abortion.  Working with Adolescent Boys: Programme Experiences (2000) offers an array of experiences and lessons learned from selected projects in Africa, the Middle East, Asia and the Americas on how to reach adolescent males with information and services. The report is based on responses to questionnaires sent to dozens of organizations asking about their motivation for working with boys, types of interventions, sites of service delivery, needs assessment, staff training, and other issues. Stressing the importance of boys' sexual and reproductive health in their own right, the report also emphasizes sex differences in behaviors and the impact of boys' health on that of adolescent girls. A concise summary in four languages can be found in Boys in the Picture (2000), an advocacy document that stresses the importance of including boys in programming for adolescent sexual and reproductive health.

Policies and strategic plans

Intended for program planners and managers, Mapping Adolescent Programming and Measurement (MAPM) (2004) defines key concepts in adolescent programming and provides instructions for the stepwise development of a monitoring and evaluation plan. Guidance is offered for facilitators to lead workshop participants through a process of defining desired health outcomes for adolescents, identifying behaviors that need to be addressed and the risk and protective factors that are associated with these behaviors, and deciding on the specific interventions needed to implement change. 

Adolescent Friendly Health Services: An Agenda for Change (2002) is aimed at policy makers and program managers working to improve the quality and accessibility of health services (including sexual and reproductive health) to adolescents. Cases are drawn from both developed and developing countries, with examples of how to involve adolescents in program design, implementation and evaluation.  Growing in Confidence: Programming for Adolescent Health and Development.  Lessons from Eight Countries (2002) also contains helpful insights from Costa Rica, Malaysia, Mexico, The Philippines, South Africa, United Republic of Tanzania, Thailand and Tunisia on mobilizing support for adolescent programming at the national and sub-national levels together with a summary of the "common denominators" of successful programs.

Programming for Adolescent Health and Development: Report of a WHO/UNFPA/UNICEF Study Group on Programming for Adolescent Health (1999) presents a strategic framework for adolescent health programming with specific goals and guiding concepts. Interventions are assessed for providing information and health services, promoting safe environments, building decision-making skills, and counseling; contexts include homes, schools, health centers, streets, workplaces, and community organizations, the entertainment industry and political/legislative systems. Useful guidelines are presented for involving young people in programming, addressing multiple health problems, respecting cultural diversity, and building on existing interventions in various settings. Programming approaches demonstrate how to raise political commitment, decide on action priorities, maintain a strong implementation process, and track quality, coverage and impact. Reproductive health and sexuality are treated as key concerns, including providing comprehensive counseling and overcoming barriers to the use of sexual and reproductive health services. Monitoring indicators include adolescents' reproductive and sexual knowledge (including how to prevent unwanted pregnancies and STIs), condom use, capacity to make healthy decisions, and rates of adolescent pregnancy, STIs and HIV, and abortion. 

Critical policy and planning issues relating to young people and HIV/AIDS are addressed in the Global Consultation on the Health Services Response to the Prevention and Care of HIV/AIDS among Young People: Achieving the Global Goals: Access to Services (2003), a document intended for organizations working in both developed and developing countries. The report reviews the evidence for effectiveness of interventions delivered through a range of service providers, including prevention through information and counseling; risk reduction through condom use and other risk interventions; and testing, treatment and care. Protecting Young People from HIV/AIDS: the Role of Health Services (2004) is an advocacy document based on this global consultation. See also the Guide to Monitoring and Evaluating National HIV/AIDS Prevention Programmes for Young People (2004). Developed jointly by WHO, UNAIDS, UNICEF and other partners, the guide is designed for program managers at the national or sub-national level to advocate for, plan, monitor and evaluate HIV prevention policies and programs among young people; to tailor existing indicators and methods to their needs, and to introduce new measures of risk, vulnerability and protection.

 
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