This includes information on ARSH.

1. Adolescent Reproductive And
Sexual Health
Dr. Ramya S

3. Outline
1. Health risks of Adolescents
2. Global and Indian scenario
3. Determinants of adolescent health
4. Health services & interventions - WHO guidelines
5. ARSH in RCH II
6. RMNCH+A
7. Sexual & Reproductive health concerns
8. Role of health system - Adolescent friendly health services
9. Government initiatives in other sectors

4. Introduction
• Adolescence- 10-19 yrs
GOI in National Youth Policy: 13-19 yrs
Early 10-13
Mid 14-16
Late 17-19
• Youth: 15-24y GOI:15-35y
• Young people: 10-24y
• Young adults: 20-24y

5. Adolescents profile in India
1) Adolescents: 253 million -Census 2011
2) Adverse sex ratio- 898
3) Early marriage
4) Female mortality rates higher
5) Rural adolescents and girls are disadvantaged
6) Economic compulsions force many to work
7) Malnutrition affects development
8) Drug abuse
9) Crime
10) Unmet need for contraceptives
11) Trafficking and prostitution
12) Premarital sexual relations
13) HIV/ AIDS

6. Early
pregnancy and
childbirth
HIV
Other
infectious
diseases
Mental health Violence
Alcohol,
tobacco use &
drugs
Injuries
Malnutrition
& obesity
Exercise &
nutrition
Adolescents : health risks and solutions

7. Health for the world’s adolescents- WHO 2014 for the year 2012

8. Health for the world’s adolescents- WHO 2014 for the year 2012

11. Health for the world’s adolescents
Extending
improvements in
MCH to
adolescents
Universal health
coverage for
adolescents
Combining forces
for adolescent
health
Health during
adolescence:
impact across life-
course
Policies play a key
role in protecting
adolescents’ health
Adolescents need
to be involved in
decisions and
actions
Moving beyond
the status quo

12. Providing health services
Collecting and using the data
needed to advocate, plan
and monitor health sector
interventions
Developing and implementing
health-promoting and health-
protecting policies
Mobilizing and supporting
other sectors
State-of-the-art overview of
four core areas for health
sector action
Health for the world’s adolescents

13. ARSH in RCH II
1. Two-pronged strategy
2. Policy & institutional framework
3. Coverage
4. Operational framework
5. Key interventions for operationalising ARSH
6. Evaluation & operations research
7. Logical framework

14. RMNCH+A: Why invest in adolescent health?
A healthy adolescent becomes a healthy adult
• Strong foundation
• Builds self-esteem
• Capacity building
• Preparation for adult life
• Improves productivity
• Averts future health cost
• Not just an investment but also a basic human right

15. ACROSS LIFESTAGES
ACROSS LEVELS OF CARE
Health facilities
at various
levels : PHCs,
FRUs, DH
Outreach
services
Family /
home and
community
care
Appropriate Referral & Follow up
RMNCH+A …a new approach

16. Heath Systems strengthening :
Infrastructure, Human
resources, drugs &
commodities, referral transport
Five high impact interventions
across five key life stages
Prioritisation of investments :
High Priority Districts, tribal
blocks, marginalised
populations in underserved
areas …also urban slums
Integrated monitoring and
accountability through good
governance, use of data,
communitisation & grievance
redressal
Convergence & partnerships
with other Ministries/
departments, development
partners, civil society
organisations & other
stakeholders
RMNCH+A approach… key features

18. • Normal growing up
• Breast development
• Oily skin
• Desire to be thin
Physical
development
• Development of identity
• Very curious
• Peer pressure
Emotional &
social
development
• Desire to have sex
• Ejaculation
• Menstruation
Sexual
development
Adolescent growth and development

19. Nutritional needs and anaemia
1. Balanced diet
2. RDA of nutrients for adolescence
3. Eating right & nutritious food
4. Factors influencing adolescents’ nutrition
5. Nutritional anaemia
6. Other deficiency states

20. Special attention
groups of
adolescents
“Out of
school” &
street
adolescents
Sexually
abused
Commercial
sex workers
Those in
conflict with
law
Working
adolescents
Orphans,
those in
foster care
&
institutions
Physically &
mentally
disabled

21. Implications of early
sexual involvement
• More likely to have
sex with high risk
partners/ multiple
partners
• Less likely to use
condoms
• Contraceptive usage
likely to be low
Consequences of
unsafe sexual
behaviour
• Early pregnancy &
parenthood
• LBW babies,
increased infant
mortality &
morbidity
• Abortions & related
complications
• RTI/STI including
HIV/AIDS
• Emotional, social and
economic impact
Negative impact due to
lack of awareness and
skills related to
sexuality and HIV
• More in case of
adolescents even if it
is safe sex as they are
not mature enough
to handle these
consequences
Adolescent sexual behaviour and health implications

22. Provide accurate
information
Provide needed
services in a
friendly manner
Address adolescent
groups, teachers,
parents, schools,
colleges, clubs
Facilitate the provision
of ‘LSE’, help postpone
early marriage & early
pregnancy
Utilize the
media
Role of health system

23. • GATHER approach
• Counselling on
sexuality, sexual
abuse and/or
violence
• Tips for effective
communication
• Barriers to
communication
Feelings of
an
adolescent
Establishing
trust
Verbal vs non-
verbal
communication
Counselling
Communicating with adolescent client

24. Adolescent friendly health services
1. Adolescent friendly programmes/ policies
2. Adolescent friendly service providers
3. Adolescent friendly health centre
4. Needs of adolescents and barriers that prevent their service
utilization
5. Best delivery of services to adolescents

25. Life skills
1. Core life skills
2. Relevance of Life Skills Education to adolescents
3. Impact of LSE interventions
4. Role of health sector in promoting LSE

26. Broad areas of life skills
Social skills
Thinking/
reflective
skills
Negotiation
skills

27. Sexual health
Reproductive
health
Sexual &
reproductive
health promotion
Common
concerns and
problems
Genital hygiene
and cleanliness
Sexual & Reproductive health concerns

28. Adolescent pregnancy
• Magnitude of problem
• Factors influencing adolescent pregnancy
• Pregnancy related complications
– Antenatal period
– During labour & delivery
– Postpartum period
– Problems affecting baby
• Care of adolescents during pregnancy

29. Abortions
Legal abortion
Illegal abortion
Unsafe abortion
MTP Act 1972

30. Contributing factors to post- abortion
complications
1. Delay in seeking care
2. Negative attitudes of trained providers
3. Resorting to untrained providers
4. Use of dangerous methods
5. Laws relating to abortion
6. Service delivery factors
7. Complications following spontaneous abortions

31. Medical
• Major short
term
• Major long
term
Psychological
• Guilt
• Depression
Socio-
economic
• Disapproval,
rejection
• Economic
burden
Complications and consequences

32. Unsafe abortions
• Diagnosis & Management
– H/O missed menstrual period followed by an attempt to
terminate pregnancy or spontaneous
– Emergency resuscitation
– Evacuation of uterus
– Prevention of further complications
– Post-abortion care
– Post-abortion contraception counselling
• Prevention of unsafe abortions

33. Contraceptive use
Barriers to contraceptive use
Effectiveness
Providing adolescents information and education
Contraceptive services and counselling
Contraception

34. RTI &
STI
Factors
that
increase
risk
Consequen
-ces
Prevention
Factors
hindering
prompt
and correct
diagnosis
Why
adolescent
s more
prone
HIV/ AIDS
Voluntary
counselling
and testing
Symptoms

35. Teen clinics

36. To make the clinics adolescent friendly,
states have branded the clinics as:
Maitry in Maharashtra
UDDAN in Uttrakhand
Sneha in Karnataka and so on
Teen clinics

37. Services provided

39. Government initiatives
• RGSEAG- SABLA
• RKSK
• WIFS

40. SABLA

42. Strategies for promotion of adolescent health
A :Adoption of healthy life style
D :Develop appropriate strategy
O :Organize adolescent friendly clinic
L :Life skill training, legal support
E :Educate
S :Safe, secure & supportive environment
C :Counselling, curriculum inclusive of family life skills
E :Enable & empower
N :Networking
T :Training

43. Thank you