Adolescent Health problems & Health risks of adolescent sexuality

Lecture 1
by:
Sadat Mohammed (BSc in PH,MPH/Rh)
Adolescent Health problems & Health
risks of adolescent sexuality
May 2020
Debre Birhan University

Causes and Determinants ofAdolescent
andYouth Reproductive Health Problems

Adolescent andYouth Reproductive
Problems
 Common understanding is that
adolescence is from ill-health
Health
free
 It is considered as the healthiest period of
person’s life due to low mortality rate

Adolescent Sexual and
Reproductive
Health Problems
Many behaviors that are established
during adolescence lead to health
problems later in
life
◦ Example: Smoking, alcohol drinking, drug use
(Risky behaviors)

Adolescent andYouth Reproductive
Health Problems
Leading health challenges of young
people globally are
–Sexual and reproductive health issues
–Accidental and intentional injuries
–Mental health problems
–Substance use and abuse
–Disorders related to eating behaviors
•

Adolescent andYouth
Reproductive
Health Problems
• There is a pronounced rise in mortality
rates from early adolescents (10-14yrs) to
young adult (20-24 yrs) with higher
concentration in developing countries
Mortality in young adult in developing
countries
was about 2.4 times higher than
mortality in young adolescents
•

What are the major health problems of
adolescents and
youths?
• Problems
related
–
Adolescent/Teen
–Abortion and
its
to sexual
behaviors
age
pregnancy
complication
s
–Rape/Sexual
violence/coercion
–HTPs ( FGM, EM,
abduction)
–SexuallyTransmitted
Infections
(STIs
)

What are the major health problems
of
adolescents and
youths?
• SubstanceAbuse
– Alcohol,Tobacco, other drugs – Marijuana,
Cocaine, KhatInjuries
(intentional/unintentional)
– RTAs, fighting, recreations, sport
Medical
problems
•
•

• Why do young people engage
in health
risking behaviors?
6/11/2020Lecture by Sadat Mohammed9

Why do young people engage in
health
risking
behaviors?
There are two basic assumptions about
why young people engage in health
risking behaviors – implications for
programs

1. Young people take
risks
knowledge
because they
lack
2. Young people engage
in
because they think
they
health risking
behaviors
are not vulnerable

Factors contributing toAYRH
Problems
• Immediate factors
–Inadequate information, knowledge
and skills
• Lack of knowledge on physiology of
the reproductive system and human
sexuality
• Lack of negotiation skill for safe sex
• Lack of knowledge on
contraceptive methods and use

Immediate factors…
• Knowledge of contraception is a
prerequisite to gaining access to and
eventually adopting a FP method
• More than 9 in 10 women ages 15-24 years
know
at least one contraceptive method
• Most sexually active adolescents do not
use
modern contraception

Immediate factors….
• Unavailability
and
services,
–Lack of access
to
contraceptives
inaccessibility
of
and/or
utilization
of
–Poor access to RH services
–Sense of guilt, fear of
discovery, disapproval or
rejection

Immediate factors…
Societal factors
–Attitude of the society
including service providers
towards use of services by
adolescents
–Unsafe environment
–Peer influence/pressure
•
F
P

Factors contributing toARH
Problems
• Underlying factors
–Poverty
–Rapid social changes and urbanization,
Migration, Globalization, cultural
influences
–Gender discrimination
–Lack/inadequate Education
–Unemployment/Limited work
opportunities

Factors contributing toARH
Problems
• Underlying factors
–– Social values and norms (EM)
– Civil unrest: war, disaster, earthquake,
flooding
(natural or man-made)
– Sexual and Gender basedViolence (GBV)
and
Coercion

Cause of ARH Problems
• The major contributing factor toARH problem
is early initiation of sexual intercourse
pregnancies
Early Initiation of Sexual intercourse
STI/HIV/AIDS Unwanted/unplanned
Abortion and its
complications

Sexual
Initiation
and
marriage• Early marriage and early sexual exercise are
some of the key millstones influencing the RH
of young people.
• The adverse effect of early marriage and
early sexual activity are not just health
related – but also curtail educational and
employment aspirations of young women.

Percentag
e
of women who had first sexual
intercourse
at the ag
eof 15, EDHS 2016

0

1

Early
Sexual
initiation
• When entering into
sexual relations for
the first time,
adolescents:
– Do not use any form
of contraception
– Encounter difficulties
in negotiating for safer
sex
– Unplanned parenthood
– More susceptible than
adult women to
STIs/HIV

Adolescent pregnancy
• Adolescents are not prepared
biologically, psychologically,
economically or socially to
bear rear a child
an
d
Associated with higher morbidity
and
mortality (mothers and children.)
Affect educational
attainment
•
•

Consequences of
Adolescent
pregnanc
y
• Physical complications
– Physical growth not completed
• Height
• Pelvic size
– Greater risk of obstructed labor with risk of
fistula
– Injury to the infant (cranial palsy)
– Maternal Morbidity, Mortality and Disability

Maternal morbidity, mortality or disabilit
y
• MMR in this age
group is twice
that women in
their twenties.
of
More girls aged
15
19 years die
from pregnancy-
related
-
causes than from
any
other causes.
•

Consequences ofAdolescent
pregnancy
• Psychological and social
consequences of pregnancy
– Social stigmas for unmarried mothers and
children
– Limited education (No schooling, school drop
out
– Fewer career or job opportunities
– Heavy economic burden to rear child
particularly for single mother
– Depression, loss of self-confidence, self-
esteem and lack of hope

Consequences
of
Adolescent
pregnancy
• High Neonatal
and
Infant mortality
rate
Children of teenage mothers have poorer
survival
prospects than children whose mothers
are in their twenties or thirties
• LBW
• Pre-term
• Still birth
–

Abortion in Adolescents
Each year at least 2 million young women
worldwide have unsafe abortions mainly due to
inaccessibility
or costs of safe services
95% of the world unsafe abortions took
place in developing countries
About 13% of maternal deaths worldwide are
due to complications related to unsafe abortion
•
•
•

• Reasons for
abortion
– Mistimed pregnancy
– Fear of being expelled from school
– Anxiety about having a child out of
wedlock
– Financial problems
– Uncertainty regarding their partner

• Consequences of unsafe abortion
– Infection
– Hemorrhage
– Injury to RH organs
– Intestinal perforations
– Infertility
– Psychological trauma and negative social
reactions
– Death…

Unsafe abortion Ethiopia
– Ethiopia’s adolescent fertility
rate in EDHS 2016 was 80
per 1,000 women ages 15-19.
– Much higher in rural than in
urban areas
– Ethiopian teenage mothers
have children at shorter birth
intervals than older women.
– Too early and too close
pregnancy among adolescents
2

Malnutrition
• Many boys and girls in developing countries enter adolescence
undernourished, making them more vulnerable to disease and early death.
• Most adolescents are not doing physical activity.
– Less than1 in every 4 adolescents meets the recommended guidelines
for physical activity - 60 minutes of moderate to vigorous physical
activity daily.
• Anaemia resulting from a lack of iron affects girls and boys, and is the
third cause of years lost to death and disability.
3

Violence
• Globally an estimated 180 adolescents die every day
as a result of interpersonal violence.
• Around 1 of every 3 deaths among adolescent males in
the low- and middle-income countries is due to
violence.
• Globally, some 30% of girls aged 15 to 19 experience
violence by a partner.
4

Substances use
• Harmful drinking among adolescents is a major concern in
many countries.
• It reduces self-control and increases risky behaviours, such as
unsafe sex.
• It is a primary cause of injuries (including those due to road
traffic accidents), violence (especially by a partner) and
premature deaths.
5

Depressions and mental disorders
• Depression is the top cause of illness and disability
among adolescents and suicide is the third cause of
death globally.
• Violence, poverty, humiliation and feeling devalued
can increase the risk of developing mental health
problems.
• Wide practice substance uses may also be among the
causes
6

Intervention options
• Appropriate age and context specific IEC/BCC on
– Risky sexual behaviours
– Contraceptive use to avoid early pregnancy and
abortions
– HIV/AIDS prevention
– Nutrition and exercise
– Violence prevention
– Reducing alcohol and other substance use
– Mental health
– Injury prevention 6/11/2020Lecture by Sadat Mohammed3
7

Interventions....
• Equipping girls with education, knowledge and skills to
prevent early and unintended pregnancy
• Support adolescents by providing services to support both
female and male teenagers who find themselves struggles to
cope with an unexpected pregnancy.
• Age-appropriate, comprehensive education on sexuality,
stating that this is especially important to empower young
women to decide when and if they wish to become mothers.
• Providing comprehensive SRH services based on need of
adolescents 6/11/2020Lecture by Sadat Mohammed3
8

• Reviewing and revising policies to protect young people from
early child-bearing;
• Young people need to know how to protect themselves and
have the means to do so.
• Promoting nurturing relationships between parents and
children early in life, providing training in life skills, and
reducing access to alcohol and firearms can help to prevent
violence.
• Effective and empathetic care for adolescent survivors of
violence and ongoing support can help deal with the physical
and the psychological
Interventions....
9

• Iron and folic acid supplements help to promote health
before adolescents become parents.
• Developing healthy eating and exercise habits at this
age are foundations for good health in adulthood.
• Reducing the marketing of foods high in saturated
fats, trans-fatty acids, free sugars, or salt and
providing access to healthy foods and opportunities to
engage in physical activity are important for all but
especially children and adolescents.
Interventions....
0

• Setting a minimum age for buying and consuming alcohol
• Regulating how alcoholic drinks are targeted at the younger market are
among the strategies for reducing harmful drinking.
• Building life skills among adolescents and providing them with
psychosocial support in schools and other community settings can help
promote good mental health.
• Programmes to help strengthen ties between adolescents and their families
are also important.
• If problems arise, they should be detected and managed by competent and
caring health workers.
Interventions....
1

THANK
YOU
2

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