ADOLESCENT SEXUALITY AND PREGNANCY PROBLEMS
Professor Adeyemi O. Adekunle Department of Obstetrics and Gynaecology College of Medicine, University of Ibadan University College Hospital, Ibadan, Nigeria.
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SESSION OBJECTIVES At the end of the session, participants should be able to:
Define Adolescence and related terms;
Describe the current status of adolescent sexual health in Nigeria;
Discuss the factors influencing sexual activities among adolescents;
Mention the challenges of adolescent pregnancy and parenthood. 2
DEFINITIONS
ADOLESCENCE Adolescence is the period of physical, psychological an social changes from childhood to adulthood.
It spans the ages of 10 to 19
TEENAGERS These are aged 13 to 19 years
YOUTHS Youths are aged between 15 and 24 years.
YOUNG PEOPLE These are aged between 10 and 24 years.
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ADOLESCENT SEXUAL AND REPRODUCTIVE HEALTH The adolescent years are a tumultuous period for many individuals. It is the period when an individual makes a gradual transition from childhood to adulthood. During this period:
The individual progresses from the point of initial appearance of the secondary sexual characteristics to that of sexual maturity; 4
ADOLESCENT SEXUAL AND REPRODUCTIVE HEALTH
The individual’s psychological process and patterns of identification develop from those of a child to those of an adult;
A transition is made from a state of total socio-economic dependence to one of relative independence (WHO, 1975).
This transition period is threatened b many health and social problems and thus has become a topical issue in recent times. 5
ADOLESCENT SEXUALITY
As physical maturation takes place, adolescents must acknowledge their sexuality;
Today, young people reach reproductive maturity at an earlier age than did their counterparts at the turn of the century.
On the other hand, there has been an upsurge of interest in pursuing higher education in many parts of the country which has led to a delay in marriage.
The decline in menarcheal age coupled with the delay in marriage has created a biosocial gap. 6
ADOLESCENT SEXUALITY (Contd.)
Adolescents became sexually active during this period.
Therefore, adolescents in Nigeria today, are biologically mature much before they are socially mature and independent.
The high rate of sexual activity coupled with the ambivalent attitude towards contraception has been responsible for an increased rate of pregnancies with their attendant life threatening complications.
Thus, the period is fraught with a number of medical and social consequences. 7
FACTORS INFLUENCING SEXUAL ACTIVITY AMONG ADOLESCENTS
Decline in the age of menarche
Peer-group pressure
Psychological factors
Disruption in cultural bonds and traditional restraints
Cultural interaction
Lack of parental care/guidance
Economic gains 8
SEXUALLY TRANSMITTED INFECTIONS (STIs) & HIV/AIDS
There are indications of increasing prevalence of gonorrhea, Chlamydia, syphilis and trichomoniasis among adolescents.
Similarly, there is an increasing trend of HIV prevalence in this age bracket.
The prevalence of HIV among young people between the ages of 20 and 24 years is 8.1%.
Among adolescents, girls are about twice more vulnerable than boys.
About 80% of HIV infections in Nigeria are contracted through sexual intercourse. 9
EARLY MARRIAGE
Marriage and motherhood begin early in Nigeria.
The two are closely related in the sense that culturally, Nigerians believe that the major purpose of marriage is procreation.
The median age for marriage for Nigeria is 17 years.
Adolescent nuptuality and fertility pose enormous challenges to the society and government. 10
PATTERNS OF ADOLESCENT MARRIAGE IN NIGERIA
There are considerable variations in the median age for marriage among cultural and socioeconomic groups:
17 years in urban areas and, 15 years in rural areas
Marriage is very early in the North, often taking place before menarche;
While Christianity has for a long time discouraged early marriage, the Muslim religion shows more acquiescence with the culture of early and child marriage.
Education also influences the age at marriage. 11
ADOLESCENT PREGNANCY
Early childbearing poses significant risks for both the mother and the infant.
Its adverse effects also affect the society.
In addition to bearing the costs for maternal and child health care, it may also loose the added potential of an educated person.
The reasons for adolescent pregnancy are diverse and complex.
They vary among different cultural and ethnic sub-groups and the society’s attitude toward adolescent contraception. 12
ADOLESCENT ABORTION
Abortion in the discontinuation of pregnancy when the fetus weighs less 500g. (WHO). i. e. gestational age of 24 weeks.
The cut off age of 24 weeks was chosen to indicate the period when the fetus has some reasonable chance of extra uterine life.
Spontaneous abortion (miscarriage):
occurs naturally, without willful intervention; rarely associated with death.
Induced abortion (termination): occurs with intervention; can be associated with severe morbidity and mortality. 13
COMPLICATIONS OF ILLEGAL ABORTION (UCH, Ibadan)
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Type of Complication Percentage ____________________________________ Sepsis/Infection 86.2 Haemorrhage 35.2 Uterine Perforation and Bowel injury 16.2 Lower genital tract injury 9.5 Renal Failure 0.4 Death 7.0 ____________________________________ 14
FACTORS AFFECTING THE POSSIBILITY OF COMPLICATIONS
Skill of the abortionist
The abortion method
The environment
The woman's wealth
Age of pregnancy 15
FACTORS AFFECTING INCREASED PREGNANCY/ABORTION AMONG ADOLESCENTS Adolescents are biologically more mature before they are socially mature and dependent.
Lack of factual knowledge on reproductive health.
Increased sexual activity: timing, lack of planning and frequency, multiple sexual partners,
Ambivalent attitude towards contraceptives. 16
CONSEQUENCES OF TEENAGE PREGNANCY OUTSIDE WEDLOCK Consequences
Percentage of Respondents Expulsion from school 51.8 Ashamed to return to school 19.6 Parents/guardians refuse to pay school fees 15.4 Had to get married 7.7 Future unknown 5.5 _____________________________________ Oronsaye et al. (1982) _____________________________________________________________________________________________________________________________________________________________________________
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Medical Complications of Adolescent Pregnancy
During Pregnancy
Nutritional deficiency
Anaemia
Threatened abortion
Pre-eclampsia and eclampsia
High incidence of abortion and its complications 18
Medical Complications of Adolescent Pregnancy (Contd.)
During Labour
Premature labour
Prolonged labour
Obstructed labour
High incidence of operative delivery
Obstetric neuropathies
Obstetric fistulae – vesico-vaginal and recto-vaginal 19
SOCIAL AND DEMOGRAPHIC CONSEQUENCES OF EARLY MARRIAGE AND CHILDBEARING
Many young mothers are denied the opportunity to attend school;
Those who attend terminate schooling or training to have babies; thus, reducing career chances available to women;
Women who marry early have a longer period of exposure to the risk of pregnancy; consequently, have high completed family size, 20
ADOLESCENT PARENTHOOD
It is generally believed that early childbearing certainly leads to: school dropout, subsequent unwanted births, and economic dependence.
The belief that adolescents who have children are destined to poor outcomes has been shown to be untrue.
Many young people are put in the family way, not by adolescent males but by men who are much older, some even already married.
However, many adolescent parents and their children do fare poorly over time.
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ADOLESCENT MOTHERS Maternal Educational Outcome More likely to experience a shortened education. Maternal Economic Status: This lack of education contributes to their inability to attain full economic independence.
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ADOLESCENT MOTHERS (Contd.) Repeated Pregnancy:
Young people who drop out of school, remain sexually active, and do not use effective contraception and are at highest risk for repeated pregnancy during their teenage years.
These mothers have more children than do older women. 23
ADOLESCENT FATHERS
Most adolescent males are ill-prepared for the responsibilities of fatherhood.
Recent studies have shown that academic, drug, and conduct problems were significantly more common among adolescent fathers than among adolescent males in general.
Young men also suffer educational and economic disadvantages from early fatherhood. 24
ADOLESCENT FATHERS (Contd.)
A male student, responsible for a girl's pregnancy, may be expelled from school through pressure from the girl's parents, or forced to abandon school or enter a premature marriage.
Such men are less likely to graduate from school, less likely to have a skill, and more likely to enter into low-paying occupations or jobs.
In general, men suffer less ill-effects of parenthood than young mothers. 25
CONCLUSIONS
Adolescent sexuality and reproductive health issues pose enormous challenges to the society and government.
Therefore, there is need to consider policies and programmes that could help adolescent women achieve their full potential, including:
Policies that discourage early marriage and childbearing by providing educational and employment alternatives;
Programmes to help young people stay in school, even if they have children;
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CONCLUSIONS (Contd.)
Programmes to establish or expand family-life education, for teenagers in school;
IEC programmes aimed at partners, parents, and other relatives of adolescent women;
Policies that increase access to high quality, appropriate family planning services and counseling for sexually active adolescents;
MCH programmes that seek out teenagers who may not know what health care they and their babies need or where to obtain services. 27
CONCLUSIONS (Contd.): Policies addressing ARH Issues in Nigeria
Adolescent Health Policy (1995)
Strategic Framework for Adolescent Reproductive Health Work (arising from the National conference on ARH in 1999);
Reproductive Health Policy (2001);
HIV/AIDS Emergency Action Plan (HEAP) – 2001 – 2004;
National Reproductive Health Strategic Framework and Plan (2002 – 2006) 28
CONCLUSIONS (contd.): ADOLESCENT REPRODUCTIVE HEALTH POLICY
Has a number of foci: Sexual behaviour
Reproductive health
Nutrition
Accidents
Drug abuse
Education
Career and employment
Parental responsibilities and adjustment 29
THANK YOU 30