Reproductive Health Series

1. Reproductive Health of Young Adults:Contraception, Pregnancy and Sexually Transmitted Infections/HIV Reproductive Health Series

2. Reproductive Health Issues of Young Adults Topics to be covered • Why focus on young adults • Defining young adults • Characteristics of young adults • Reproductive health risks and consequences • STI/HIV risks and consequences

3. Why Focus on the Reproductive Health of Young Adults? More than 1 of every 4 persons worldwide is between ages 10 and 24 years

4. Youth Are Assets Youth are a great potential resource

5. Risks: Unintended and too-early pregnancy STIs, including HIV/AIDS Unsafe abortion Sexual violence and unwanted sexual activity Reproductive Health Risks and Consequences for Young Adults Consequences: • Medical • Psychological • Social • Economic

6. HIV/AIDS Risk for Youth About half of all new HIV infections are among youth • HIV/AIDS epidemic among youth remains largely invisible to adults • Stopping HIV/AIDS requires working with youth in a comprehensive way • Young women are several times more likely to get infected than young men Today’s young people are the AIDS generation

7. Transition from Childhood to Adulthood Involves physiological, psychological, cognitive, social and economic changes Universal process that varies by individual and culture

8. Defining Young Adults Terms used: adolescents, young people, young adults, teenagers, youth Age Range: 10-24 years

9. Factors Affecting the Reproductive Health Needs of Young Adults • Age • Marital status • Gender norms • Sexual activity • School status • Childbearing status • Economic/social status • Rural/urban • Peer pressure • Political/cultural

10. Married and Unmarried Youth Common Characteristics: • Biological • Need for accurate information Differences: • Access to services • Contraceptive needs

11. Gender Affects the Reproductive Health of Youth • Expectations of sexual activity of boys and girls • Views regarding responsibility for contraception • Social consequences of pregnancy • Degree of risk for HIV/AIDS infection • Cultural acceptance of harmful behaviors and practices • Client-provider interactions Gender involves roles and relationships that are determined by society and culture. Gender affects:

12. Gender Affects HIV/AIDS, Other Risks • Males have more ability to use a condom than females, for cultural reasons • Culture accepts harmful behaviors and practices against females

13. Fertile Years Prior to Marriage Increasing 1890 Marriage Menarche 7.2 years 10 30 14.8 22.0 14.8 22.0 Age 1988 Menarche Marriage 11.8 years 24.3 12.5 10 30 Age Source: U.S. data: adapted from Alan Guttmacher Institute, 1995.

14. Average age 25 20 15 10 Latin America Asia North America Age at first intercourse, males Age at first intercourse, females Age at marriage females Average Age at First Intercourse for Unmarried, Sexually Active Youth Source: CDC Surveys; WHO, 1997; AGI, 1995.

15. Young Adults and Contraceptive Use • Few married youth use contraceptives before first birth • After becoming sexually active, unmarried youth delay use of contraceptives about a year • Common reasons for non-use of contraceptives among unmarried youth: • did not expect to have sex • lacked information about contraception • lacked access to contraceptives

16. Limited Contraceptive Use: Characteristics of Youth • Tend not to plan ahead or anticipate consequences • Think they are not at risk • Feel invulnerable • Lack confidence or motivation to use • Embarrassed or not assertive • Lack power and skill to negotiate use • Social or cultural expectations or beliefs

17. Lack of access to services or methods: Clinics not designed to be inviting to youth Providers reluctant to serve unmarried youth Laws/policy may prohibit provision to unmarried youth Youth may: Lack transportation to clinic or money for contraceptives or services Fear judgment or discovery Be concerned about having pelvic exam Limited Contraceptive Use: Barriers to Access

18. High Proportion of Births are Unintended Sub-Saharan Africa Latin America 3 out of 6 2 out of 6 Percent of last births that were unintended to all women under age 20, average for regions Source: Adapted from Population Reports, 1995.

19. Psychological and Social Consequencesof Pregnancy for Unmarried Youth • Social stigmas for unmarried mothers and children • Limited education • Fewer career or job opportunities • Heavy economic burden • Depression, loss of self-confidence and lack of hope • Consequences more severe for young women than men • Children of young parents may face psychological, social and economic obstacles

20. Maternal Mortality Higher for Young Women Maternal mortality rate per 1000 live births 28 24 20 16 12 8 4 0 Nigeria Bangladesh Ethiopia  15 years 30-34 years 20-24 years 30-34 years Source: Studies in Family Planning, 1986; British Journal of Ob/Gyn, 1985.

21. Medical Risks of Pregnancy in Young Women Under age 16: May result in: Small pelvis Obstructed or prolonged labor First births: Hypertensive disorders of Hemorrhage, eclampsia pregnancy Can be fatal for both mother and child

22. Maternity Care Prenatal Care: • To educate young women on proper pregnancy care and assess risk for complications Delivery: • To monitor for possible complications Prenatal and postpartum: • To provide information on contraception, breastfeeding, child-care skills and child health

23. Risk of Unsafe Abortion Each year at least 2 million young women worldwide have unsafe abortions mainly due to: • Inaccessibility or costs of safe services • Self-induced methods • Unskilled or non-medical providers • Delay in seeking procedure past first 3 months of pregnancy Family planning can reduce unsafe abortion

24. Consequences of Unsafe Abortion 3 out of 5 women seeking hospital care for unsafe abortion complications in Africa, Asia and Latin America are under age 20 • Complications: • Infection • Hemorrhage • Injury to reproductive organs • Intestinal perforations • Toxic reactions to drugs • Can result in: • Infertility • Death • Psychological trauma • Negative social reactions

25. Youth at High Risk for STIs/HIV Primary factors are behavioral: • Non-use or incorrect use of condoms • Little knowledge of STIs • Failure to seek treatment • Multiple partners or partners with multiple partners High STI risk

26. Consequences of STIs, Including HIV Curable STIs: • Mostly bacterial • Can lead to PID and infertility Harmful medical, psychological, and social consequences Incurable STIs: • Viral • Can lead to chronic disease or death (HIV/AIDS)

27. Risks and Consequences of Sexual Abuse Rape, sexual assault, involuntary prostitution can result in: • Physical injury • Unintended pregnancy • STIs • Psychological trauma • Increased likelihood of high-risk sexual behavior

28. Summary and Next Steps Young adults face high risks of pregnancy and STIs To address this: Young adults need information, skills, and access to services Policy-makers and providers need to know how and where to reach youth, and what contraceptive and STI/HIV services are needed

29. How to Reach Young Adults Topics to be covered • Who provides information and services to young adults • What reproductive health information is needed by young adults • Where services for young adults are best provided • Who provides information and services to young adults • What reproductive health information is needed by young adults • Where services for young adults are best provided

30. Youth Involvement Is Critical • Involve perspective of target audience • Work with youth, rather than for youth • Draw on youth’s energy, hope, eagerness to learn and resilience Youth “should be involved from the start as full partners….” • World Health Organization, 2001

31. Who Provides Information and Services to Youth? Teachers To offer a range of services, various providers need to be involved Doctors Peer Educators Nurses Community Workers

32. I don't want I wouldn't Anyone that to talk about want my child age who is sexuality; it to get sexually active may contraception. must be a bad encourage person. them... Provider Attitudes Often Negative Toward Young Adults

33. Difficult topic to discuss openly for both youth and adults Includes a wide range of issues, such as peer pressure, sexual identity, sexual orientation, sexual capability, sexual coercion Helps youth understand and express their feelings Promotes responsible sexual behavior, helps prevent unintended pregnancy and STIs Sexuality: Open DiscussionsAre Important

34. Reflective listening Open-ended questions Positive body language Characteristics that help communication: sincerity, honesty, non-judgment, respect, sense of humor Communication Skills Needed by Providers Confidentiality is critical in serving youth

35. Technical knowledge Knowledge of issues facing young adults Gender awareness Counseling skills For some: how to train young people in communication skills Provider Training Needed

36. Young adults need information and skills to be able to take responsibility for their sexuality. Risks and consequences of sexual activity Contraceptives and STIs Sex education Fertility issues for men and women Gender issues What Reproductive Health Information and Education Do Youth Need? Information and education should be age-specific

37. Sex education: Does not lead to earlier or increased sexual activity Can give young people skills to delay sexual activity Can increase contraceptive use Research Shows Sex Education Helps It is important to begin sex education early Source: WHO, 1993.

38. Elements of Effective Sex Education Programs • Content: • Provides basic, accurate information • Focuses on reducing sexual risk-taking • Addresses peer pressures • Strengthens individual and group values against unprotected intercourse • Teaching methods/ program design: • Provides modeling and practice of communication and negotiation skills • Trains instructors • Involves students in teaching methods • Lasts at least 14 hours or has intensive small-group work Effective Programs Source: U.S. National Technical Information Services, 1995.

39. Includes issues of identity, societal roles, human relationships, biological development Youth need to learn: How their bodies, minds and feelings are changing How to communicate about sexuality How to handle societal and peer pressures How to make responsible decisions about sexual activity, including abstinence Sexuality: What Youth Need to Know

40. Young people need to knowalternatives to risky sexual behavior Holding hands Hugging Dry kissing Body rubbing Masturbation Mutual masturbation Sexual intercourse with a condom Ways of Expressing Sexuality

41. Involves education about: The reproductive system Fertility The menstrual cycle How pregnancy occurs Attitudes and cultural norms about fertility, the use of contraception and childbearing Fertility Awareness Important for both males and females

42. Males are fertile all the time after beginning sperm production Females are fertile for a period of time during each cycle Menstrual cycle: begins with menstrual bleeding ovulation occurs if egg is not fertilized, cycle begins again in about 2 weeks Fertile time can begin about 6 days before ovulation Fertility of Men and Women

43. Important to emphasize communication and shared responsibility between boys and girls Gender Awareness for Youth

44. Home Health clinics School-based programs Community-based youth organizations Mass media Where Can Information and Services for Youth Be Provided?

45. Effective Programs for Young Adults Identify target group, analyze assets and needs Involve youth Work with community, including family members Incorporate evaluation Make services accessible, as identified by youth Use materials designed by and for youth

46. Youth-Adult Partnerships Elements of good partnerships: • Organizational commitment and capacity • Attitude shifts among adults and youth • Selection, recruitment and retention of youth • Substantive levels of youth participation

47. Many youth want to talk to family members about sexuality Crucial elements: availability of family members attitudes and knowledge communications skills Programs needed to help parents learn necessary skills and information Family members can support youth in seeking services and information Family Involvement

48. Separate units for youth Outreach clinics with specially trained staff Mobile clinics Special hours Convenient and safe locations Youth-to-youth promotion Low or no-cost services Health Clinics Designed for Youth

49. Providers can take advantage of existing opportunities for providing information to young adults With every client, the provider should ask: Referrals to other services and providers Traditional Health Clinics: An Opportunity to Reach Youth “If you are sexually active, what are you doing to prevent pregnancy and STIs?”

50. Large numbers of youth can be reached efficiently at schools Family life education curricula School-based or linked clinical services Training of instructors and administrators Involvement of families and community Elements of School-Based Programs