OVERVIEW OF ADOLESCENT REPRODUCTIVE RIGHTS AND HEALTH IN NIGERIA

1. OVERVIEW OF ADOLESCENT REPRODUCTIVE RIGHTS AND HEALTH IN NIGERIA BY C.I. Alakija-Ladapo (Mrs.) MPH; BSc (Ed) Health Education Deputy director/Coordinator Adolescent/Youth Sexuality & Reproductive Health Ministry of Health, Lagos, Ikeja AT A TWO-DAY TRAINING OF TRANINERS’ WORKSHOP FOR SCHOOL DISTRICT COUNSELLORS AND SCHOOL GUIDANCE COUNSELLORS Friday 21st June 2013 HDI Training room 2, Onike, Yaba.

2. PRELUDE

3. What is Health? • A state of complete physical, mental and social wellbeing; • Not merely the absence of disease. (W.H.O.) Reproductive Health: …Not merely the absence of reproductive disease or infirmity.

4. Reproductive health implies that at all stages of life… • People are able to have a satisfying and safe sex life and • That they have the capability to reproduce and • The freedom to decide if, when and how often to do so.

5. What is a Right? • Rights are fundamental normative rules about what is allowed of people or owed to people, according to some legal system, social convention or ethical theory.

6. REPRODUCTIVE HEALTH IS EVERYONE’S RIGHT!!! Young or Old

7. OVERVIEW OF ADOLESCENT RIGHTS AND HEALTH IN NIGERIA • Introduction to Adolescent health • Adolescent developmental processes and behaviour • Factors associated with adolescent health status and key issues in programming for adolescent health and development

8. Introduction to Adolescent Health

9. Objectives By the end of the session participants will be able to: • Explain the concept of adolescence; • Define adolescence, adolescent, youths, and young person; • Discuss rationale for focusing on adolescent health based on the demographic and health situation of adolescents and young people in Nigeria; • Discuss key legal and policy provisions regarding the definition of adolescents and young persons in Nigeria.

10. Session Overview • The concept of adolescence • Age definition of adolescent, youth, and young persons • Rationale for focusing on adolescent health • Key legal and policy provisions regarding the definition of adolescents and young person in Nigeria

11. The Concept of Adolescence & Chronological Definitions

12. Adolescence… A Transition Phase Adolescence is a period of transition between childhood and adulthood: it is a period in which ‘although no longer considered a child, the young person is not considered an adult either’.

13. Adolescence…

14. Adolescence…is a developmental stage where: • Young people develop their adult identity. • Move toward physical and psychological maturity, and • Become (relatively) economically independent. - WHO

15. Young People 10 24 Youth 15 24 Adolescence 19 10 Defining Adolescents & Other Young People.. (Nigeria & WHO)

16. Adolescents Adolescence can be subdivided into three periods: • Early: 10-14 years • Middle: 15-17 years • Late: 18-19 years

17. Adolescents are not homogeneous…. Needs of adolescents can differ based on… • Demographic characteristics: e.g. age & sex, • Family characteristics: e.g. family status, structure • Socio-economic: e.g. poverty, literacy • Sexual behavior: e.g. sexual orientation, sexual risk • Health status: e.g. physically-challenged • Political context • Legal context e.t.c

18. Rationale for Focusing on Adolescent Health

19. Why Focus on Adolescent Health & Development Issues? • Demographic rationale • Health rationale • Human rights rationale • Economic rationale

20. Adolescents constitute about 20% of global pop.

21. Adolescent Population by Region, 2003 and 2050 Reproduced from UNFPA, State of the World Population, 2003

22. Why Focus on Adolescent Health & Development Issues? (contd.) • Human rights rationale: rights to • Information & skills development • Safe and supportive environment • Health services • Development opportunities • Economic rationale • Averting future health costs • Cost-effective interventions • Potentials of healthy adolescents to contribute to national economy

23. Health rationale • ARH status has significant implications for human reproduction and health development • Feasibility of “simple” and cost-effective interventions • Prevention of later health problems • Leading adolescent health problems • Sexual and reproductive health problems • Intentional and unintentional injuries • Mental health problems • Substance use and abuse Nutritional problems • Endemic and chronic diseases

24. Comprehensive Knowledge of HIV among People 15-24 Percent of women and men age 15-24 with comprehensive knowledge of HIV/AIDS* *Comprehensive knowledge includes knowing that the risk of getting HIV can be reduced by using condoms and limiting sex to one uninfected partner, knowing that a healthy looking person can have HIV, and rejecting the two most common local misconceptions about HIV prevention and transmission.

25. Age at First Sex & Condom Use • 49% of women 18-24 had sex before age 18 and 16% of women 15-24 had sex before age 15 • 26% of men 18-24 had sex before age 18 • 11% of women 15-24 and 22% of men 15-24 used a condomat first sex

26. Premarital Sex & Condom Use Among never-married people 15-24, percentage

27. Age at First Sexual Intercourse and First Marriage, Nigeria, 2008 Percent of women age 25-49 Source: NDHS, 2008

28. Teenage Pregnancy and Motherhood 18.0% of women between the ages of 15-19 are already mothers and another 4.8% are pregnant with their first child in 2008.

29. Teenage Childbearing in Nigeria, 2008 Percent of women age 15-19 who are mothers or pregnant with their first child Source: NDHS, 2008

30. Teenage Childbearing by Zone, 2008 Nigeria 23% North West 45% North East 39% North Central 22% Percent of women age 15-19 who are mothers or pregnant with their first child South West 9% South South 12% South East 8% Source: NDHS, 2008

32. Recent HIV Tests among People 15-24 Percent of women and men 15-24 who have had sex in the past year and who received an HIV test in the past year

33. Other Health problems

34. School-based violence

35. Prevalence of some forms of school related violence by urban-rural location of schools in Osun state, Nigeria. [Source: Omisore et al 2010]

36. Nutrition

37. Substance Use and abuse

38. Key Legal & Policy Provisions about adolescents in Nigeria

39. Legal Provisions • The Child Rights Act: child: < 18 years. • Young People (YP)’s Law: 14-17= YP • Consent to sex (criminal code): 14 years for boys &16 years for girls unless she is married. • Rape and child prostitution are illegal. • Public display of obscene materials: punishable offence. • Minimum age for conviction by a court of law is 15 years. 15-17 years: remand homes • Work: not less than 15 years of age

40. Legal Provisions.. Key Challenge • Law enforcement agents do not adequately enforce and combat violations of sexual rights such as sexual harassment or abuse, rape and domestic violence.

41. Policies • Several Policies relating to the health & development of adolescents exist • Knowledge of policy poor • Implementation rate very poor

42. Adolescent & YP’s Health Policy: Focal Areas • Sexual and reproductive health and rights; • Nutrition; • Accidents and violence; • Mental health; • Substance use and abuse; • Education; • Career and employment; • Spirituality; • Social adjustment and parental responsibilities.

43. Other relevant policies include.. • The National Education Policy (1998) • The Child Rights Act (2004) • The National Health Policy (2004) • The National Population Policy (2004) • The National Nutrition Policy (2005) • National Policy on HIV & AIDS for the Education Sector in Nigeria (2005) • The National School Health Policy (2006) • The National Youth Policy (2009) • The National Policy on HIV/AIDS (2009)

44. Conclusions • Adolescence is a transitional stage of life, and a period of both opportunities and challenges. • With their size and energy, adolescents have great potential to contribute to national development. • As a nation, we ned to pay greater attention to adolescent’s health and development.

45. Questions & Comments

46. Reflections/Evaluations • What do we mean by Adolescence. • Describe some of the key health problems faced by adolescents in Nigeria. • List the focal areas of the National Policy on the Health and Development of Adolescents and Young People in Nigeria.

47. Adolescent Development, Process and Behavior Adolescent Sexuality Reproductive Health Unit "hellolagos"

48. Objectives By the end of the session participants will be able to: • Describe the physical, cognitive and emotional changes during the period of adolescence. • Explain adolescent’s sexual and social behaviour in the light of the changes above. • Explain adolescents’ sexual lifestyles and the effect on their health and development. Adolescent Sexuality Reproductive Health Unit "hellolagos"

49. Session Overview • Physical, cognitive & emotional changes during the period of adolescence • Adolescent’s sexual and social behaviour • Adolescents’ lifestyles Adolescent Sexuality Reproductive Health Unit "hellolagos"

50. Adolescent Development Process Adolescent Sexuality Reproductive Health Unit "hellolagos"