THE role of family planning in improving Adolescent Sexual and Reproductive Health (ASRH), cannot be over-emphasised. Before delving into the topic proper let us first of all take a cursory look at the meaning of adolescent.
According to the book – Adolescent Sexual and Reproductive Health Toolkit for humanitarian settings (2009), “Adolescence is defined as the period between 10 and 19 years of age. It is a continuum of physical, cognitive, behavioural and psychosocial change that is characterized by increasing levels of individual autonomy, a growing sense of identity and self-esteem and progressive independence from adults”.
The book also added that adolescents are learning to think abstractly, which allows them to plan their futures. Experimentation and risk taking are normal during adolescence and are part of the process of developing decision-making skills. Adolescents are both positively and negatively influenced by their peers whom they respect and admire. Adults play an important role in this regard and can help adolescents weigh the consequences of their behaviours (particularly risky behaviours) and help them to identify options. The influence of at least one positive adult and a nurturing family are protective factors during this period of development and can help adolescents cope with stress and develop resilience.
At one end of the continuum are very young adolescents (10-14 years of age), who may be physically, cognitively, emotionally and behaviourally closer to children than adults. Very young adolescents are just beginning to form their identities, which are shaped by internal and external influences. Signs of physical maturation begin to appear during this period. Public and auxiliary hair appear, girls develop breast buds and may begin to menstruate, in boys, the penis and testicles grow, facial hair develops and the voice deepens. As young adolescents become aware of their sexuality, they may begin to experiment with sex. They also may experiment with substances such as alcohol, tobacco or drugs. Adolescent Sexual and Reproductive Health (ASRH) programs should develop strategies that specifically target very young adolescents tailoring interventions that are appropriate to their level of maturity experience and development.
During middle adolescence (15-16 years of age), according to the above quoted book, adolescents begin to develop ideals and select role models. Peers are very important to adolescents in this age group and they are strongly influenced by them. Sexual orientation develops progressively and non-heterosexual individuals may begin to experience internal conflict particularly during middle adolescence.
At the other end of the spetrum, the book continues, are older adolescents (17 to 19 years of age) who may look and act like adults but who have still not reached cognitive, behavioural and emotional maturity. While older adolescents may make decisions independently they may be employed, their sexual identitied are solidified and they may even marry and start families – they still benefit from the influence of adult role models as well as family and social structures to help them complete the transition into adulthood.
Coming to the topic proper
In any setting, adolescents have the right to receive accurate and complete information about Sexual Reproductive Health (SRH), including Family Planning (FP). Unfortunately parents and other adult role models commonly don’t want to discuss issues such as FP with adolescents because of cultural or religious norms, which prohibit sexual relations before marriage. In addition, health workers may be unwillingly to provide FP information or services to adolescents (particularly those who are unmarried) because of their own personal beliefs or cultural pressures.
Access to FP is particularly important in crisis settings, when adolescents are affected by the loss of normal family and social support structures and when facility and community based systems for providing FP information and services may be disrupted. During emergencies, adolescents may be sexually exploited or may engage in high-risk sexual behaviours. This can lead to unwanted pregnancy, which may lead to other negative consequences such as death of the mother and/or the child, unsafe abortion, and social stigmatization of the young mother.
What FP interventions should ASRH programs implement in emergencies?
While comprehensive FP programming is not considered part of the Minimum Initial Service Package (MISP) for reproductive health in crisis situations, contraceptives should be available during the acute phase of an emergency to respond to request for FP. Later when the situation has stabilized, it is important to consider ways to reach adolescents with FP information and comprehensive services.
Provide adolescent friendly services: Facility based services should be “adolescent friendly”, meaning that the facility has been set up in such a way that ensures privacy and confidentiality, and makes adolescents feel comfortable accessing services. To provide adolescent friendly services health providers should be aware of the vulnerability of adolescents to early pregnancy and the dangers of pregnancy in adolescence. They must treat adolescent clients with a positive attitude and respect the right of an adolescent to receive confidential FP information and services regardless of age or marital status and without the consent of a parent or guardian.
Offer a broad method mix: ASRH programs should include information and access to a broad mix of FP methods, including Emergency Contraception (EC). EC can be used by adolescents to prevent pregnancy after wither consensual or forced unprotected sexual intercourse. EC can also be used when a regular FP method fails (for example, when a condom breaks, when the adolescent has not taken her Oral Contraceptive Pills (OPCs) properly, etc). It is important to emphasize to the young FP client that she may choose whatever method(s) she profers, without fee living as if she has been coerced into choosing any specific methods.
Provide quality counseling: Provide complete information about all of the methods available and their effectiveness and allow the adolescent to make a choice. Quality FP counseling includes explanation (and demonstration when appropriate) of how to correctly use each method.
Some considerations for FP counseling include (WHO, 2007).
All methods of FP are safe for use by adolescents although permanent methods such as tubal ligation and vasectomy should be discouraged for adolescents without children.
Young women may be less tolerant of side effects. It is important to explain possible reactions during FP counseling in order to increase the likelihood that they will continue FP and seek alternative methods if the side effects persist.
Adolescents have less control when and with whom they have sex and over contraception than older women, which increases their need for EC. Any adolescent who requests EC should receive counseling on all methods of FP and should be allowed to take EC with her.
Adolescents may profer more discrect methods (such as injectables or intra-interine devices) that can be used without drawing attention and would require fewer visits to the health facility.
Encourage the use of condom for dual protection: Since they may engage in unsafe sexual practices that put them at risk for STIs or HIV/AIDS, adolescents should be strongly encouraged to use condoms for dual protection against pregnancy and STI/HIV.
Look for alternative ways to reach adolescents:
Because of the barriers to accessing Reproductive Health (RH) information and services faced by adolescents, it is important that ASRH programs look for alternative ways to reach out to this group.
Community-based services may be the best way to reach particularly at risk sub-groups of adolescents, such as married girls, child heads of household and girl-mother. Training adolescents in Community-Based Distribution (CBD) can be great resources to the ASRH program by providing community – or home – based FP counseling distribution of certain methods, (typically condoms and Oral Contraceptive Pills – (OCPS) and referrals to health facilities for other methods. Adolescents may be more likely to access FP services from adolescents trained in CBD because they feel more comfortable in the home setting and because they feel less intimidated about discussing SRH issues with a peer than they would with an adult.
In situation where schools are functional, teachers can provide RH orientation sessions, which include discussions.
