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. PRELUDE 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. 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. 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. REPRODUCTIVE HEALTH IS EVERYONE’S RIGHT!!! Young or Old OVERVIEW OF ADOLESCENT RIGHTS AND HEALTH IN NIGERIA 1. Introduction to Adolescent health 2. Adolescent developmental processes and behaviour 3. Factors associated with adolescent health status and key issues in programming for adolescent health and development Introduction to Adolescent Health 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. 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 The Concept of Adolescence & Chronological Definitions 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’. Adolescence… Adolescence…is a developmental stage where: Young people develop their adult identity. Move toward physical and psychological maturity, and Become (relatively) economically independent. - WHO Defining Adolescents & Other Young People.. (Nigeria & WHO) Young People 10 Youth Adolescence 24 15 10 24 19 Adolescents Adolescence can be subdivided into three periods: – Early: 10-14 years – Middle: 15-17 years – Late: 18-19 years 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 Rationale for Focusing on Adolescent Health Why Focus on Adolescent Health & Development Issues? • Demographic rationale • Health rationale • Human rights rationale • Economic rationale Adolescents constitute about 20% of global pop. Percentage distribution of the Nigerian population 35 years & above 22.6% 25-34 years 15.4% 10-14 years 11.5% Young people (10-24 31.7% years) 15-19 years 10.6% 20-24 years 9.6% 5-9 years 14.2% < 5 years 16.1% Source: National Population Commission, 2009 Population ages 10-19 (millions) Adolescent Population by Region, 2003 and 2050 800 695 700 600 600 500 400 300 300 180 200 100 110 90 35 80 80 100 90 40 0 2003 N. America Europe 2050 Latin America Arab States Sub-Saharan Africa Asia and the Pacific Reproduced from UNFPA, State of the World Population, 2003 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 Health rationale 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 • ARH status has significant implications for human reproduction and health development • Feasibility of “simple” and cost-effective interventions • Prevention of later health problems Comprehensive Knowledge of HIV among People 15-24 Percent of women and men age 15-24 with comprehensive knowledge of HIV/AIDS* 33 Women Men 40 30 28 22 18 Total Urban Rural *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. 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 condom at first sex Premarital Sex & Condom Use Among nevermarried people 15-24, percentage Women Men 50 36 31 29 Had sex in the past 12 months Used a condom at last sex Age at First Sexual Intercourse and First Marriage, Nigeria, 2008 Percent of women age 25-49 Source: NDHS, 2008 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. Teenage Childbearing in Nigeria, 2008 Percent of women age 1519 who are mothers or pregnant with their first child Source: NDHS, 2008 Teenage Childbearing by Zone, 2008 North West 45% North East 39% Nigeria 23% North Central 22% South West 9% South South South East 12% 8% Percent of women age 15-19 who are mothers or pregnant with their first child Source: NDHS, 2008 Percentage of women age 15-19 who have had a live birth or who are pregnant with their first child and percentage who have begun childbearing, by background characteristics, Nigeria 2008 Percentage who: Have had a live birth Are pregnant with first child Percentage who have begun childbearing 15 2.8 3.5 6.3 1,555 16 8.9 4.1 13.0 1,211 17 18.9 5.3 24.2 1,130 18 29.4 6.3 35.7 1,595 19 Total 33.6 18.0 4.7 4.8 38.4 22.9 1,002 6,493 Background characteristic Number of women Age 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 Women Men 9 7 7 3 15-19 20-24 OTHER HEALTH PROBLEMS School-based violence Proportion of urban & rural schoolchildren who experienced bullying in a 1-year period, Osun State, Nigeria, 2009. 100 10.8 16.2 89.2 83.8 Urban Rural % of students 80 60 40 20 0 Bullying No bullying Source: Omisore et al., 2010 Prevalence of some forms of school related violence by urban-rural location of schools in Osun state, Nigeria. [Source: Omisore et al 2010] Nutrition Nutritional status of adolescent females based on BMI, Nigeria, 2008 Moderately/ severely thin 5.9% overweight 6.0% obese 1.0% Mildly thin 13.4% Normal 73.7% Source: NPC & ICF Macro, 2009 (NDHS 2008) Substance Use and abuse Primary drug of abuse among persons treated for drug abuse problems, Nigeria, 1997 & 2004 0.7 Cocaine 9.7 Opiates 1.2 3.5 Amphe-like stimulants 2.0 2004 1997 15.3 3.7 7.0 Inhalants 3.9 0.0 depressants Cannabis 63.5 0 Sources: World Drug Report, 2004 & 2009 50 89.7 100 Key Legal & Policy Provisions about adolescents in Nigeria 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 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. Policies • Several Policies relating to the health & development of adolescents exist • Knowledge of policy poor • Implementation rate very poor Adolescent & YP’s Health Policy: Focal Areas 1. 2. 3. 4. 5. 6. 7. 8. 9. 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. 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) 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. Questions & Comments 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. Adolescent AdolescentHealth Development, Process and Behavior Adolescent Sexuality Reproductive Health Unit "hellolagos" 47 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" 48 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" 49 Adolescent Development Process Adolescent Sexuality Reproductive Health Unit "hellolagos" 50 Adolescent Development Stage Progression Biologic factors Interaction with peers & adults Socio-econ, cultural & env. factors Preadolescence Early adolescence Middle adolescence Late adolescence Youth Adolescent Sexuality Reproductive Health Unit "hellolagos" 51 Adolescent Development: Key Tasks • Moving from dependency to interdependency • Establishing a sense of identity • Acquiring a knowledge base and skills Adolescent Sexuality Reproductive Health Unit "hellolagos" 52 Adolescent Development: Key Processes • • • • • • Ongoing Uneven (within & between individuals) Complex Influenced by the environment Mediated through relationships Triggered & sustained through participation 53 Adolescent Sexuality Reproductive Health Unit "hellolagos" Tasks in adolescence Adolescent Sexuality Reproductive Health Unit "hellolagos" 54 Adolescent development: physical & physiological processes • Increase in physical size, stamina, strength • Development of reproductive capacity • Changes in sexual response system Adolescent Sexuality Reproductive Health Unit "hellolagos" 55 Female Pubertal Development ♦ Begins 8-13 years ♦ Duration: range of 2 to 5 years ♦ Menarche 2-2.5 years after. Adolescent Sexuality Reproductive Health Unit "hellolagos" 57 Compared with Females, Male Development ♦ Occurs 18-24 months later; ♦ Progresses slowly through middlelate adolescence; ♦ Early changes are not often as visible. Adolescent Sexuality Reproductive Health Unit "hellolagos" 58 Sequential Events of Puberty: Male • Growth of testicles • Pubic hair appears • Growth of penis and scrotum • Axillary hair • Facial hair • Adult height Female • Breast bud appears • Pubic hair appears • Breasts mature • Axillary hair • Menarche • Adult height Adolescent Sexuality Reproductive Health Unit "hellolagos" 59 Adolescent Brain Development Brain development now extends into the adolescent years Most of this development occurs in the frontal lobe – – – – Executive functions Planning Reasoning Impulse Control Adolescent Sexuality Reproductive Health Unit "hellolagos" 60 Emotional development • Experience a mix of emotions • Experience a change in moods • Desire to be accepted by peers • Sensitive to criticism Adolescent Sexuality Reproductive Health Unit "hellolagos" 61 Adolescent development: social • Transition from dependency to interdependency • Building social capital • Establishing identity • Exploring sexuality & relationship Adolescent Sexuality Reproductive Health Unit "hellolagos" 62 SEXUAL AND SOCIAL BEHAVIOUR OF ADOLESCENTS Adolescent Sexuality Reproductive Health Unit "hellolagos" 63 Sexual & Social Behavior Adolescent peculiar lifestyle (“youth culture”) Adolescent Sexuality Reproductive Health Unit "hellolagos" 64 Sexual & Social Behavior • • • • Social Behaviour Dating Sexual Behaviour Adolescent lifestyle (“youth culture” Adolescent Sexuality Reproductive Health Unit "hellolagos" 65 Conclusions • Adolescence is a period of physical, cognitive and emotional transformation. • Changes in adolescents are largely hormone-driven & have relationships with adolescents peculiar ways of thinking and doing things. • Adolescents’ social behavior and sexuality need to be understood within the context of these transformations. Adolescent Sexuality Reproductive Health 66 Unit "hellolagos" Questions & Comments Adolescent Sexuality Reproductive Health Unit "hellolagos" 67 Reflections/Evaluations • List the physical changes that occur in both male and female adolescents. • Describe the emotional characteristics of adolescents. • Explain the cognitive changes in adolescents and its possible influence on their behaviour. Adolescent Sexuality Reproductive Health Unit "hellolagos" 68 Factors associated with adolescent health status and Key issues in programming for adolescent health and development Objectives By the end of the session, participants will be able to: • Explain some key factors that affect adolescent development. • Describe the comprehensive approach to adolescent health and development. • Identify possible interventions to reduce or eliminate the negative factors. Factors affecting adolescent development • • • • • • Prenatal/Genetic fators Nutrition Social Environment School Environment Traditional Practices and Gender Policies Risk and Protective factors • Protective factors: they increase the likelihood of positive health behaviour or moderate and discourage behaviours that might lead to negative health outcomes. Strong connectedness between an adolescent and his parents, for example, is a protective factor. • Risk Factors: Factors are regarded as “risk” if they increase the likelihood of negative behaviours and outcomes or discourage positive behaviours that might prevent them. The green balls represents protective factors The red triangle represents the risk factors Sources: WHO, 2001. KEY ISSUES IN ADDRESSING ADOLESCENT HEALTH CHALLENGES GUIDING CONCEPTS Efforts to address adolescent health challenges must recognise that: • Adolescence is a time of opportunity and risk. • Not all adolescents are equally vulnerable. • Adolescent development underlies the prevention of health problems. • Adolescent problems often have common roots and are often inter‐related. • Social environment influences adolescent behaviour. • Gender considerations are fundamental. MAJOR INTERVENTIONS The following categories define the major programmatic approaches that are important to address adolescent health issues: • • • • • Create safe and supportive environment Provide information Build Skills Provide Counselling Improve health services SETTINGS AND KEY PLAYERS • Adolescent health interventions can be implemented in virtually all settings where young people can be found. • Various stakeholders can bring their knowledge and skills to bear positively on adolescent health development. These include: SETTINGS KEY PLAYERS Family and Social environment Family members, friends, religious leaders. Health Facilities Doctors, nurses and other health service providers Schools Teachers, Counsellors Work place Employers, employees Entertainment industry and Media Journalists, actors, musicians. Political and legal systems Police, politicians and lawmakers, lawyers Youth development and sport sectors Vocational counsellors, youth workers, sport figures. SUMMARY SEPARATE YOUR ROLE FROM THAT OF THE TEACHER!! IDENTIFY YOUR ROLE AS A COUNSELLOR and please play it!! Evaluation • Explain the concept of protective and risk factors. • Discuss factors that can affect adolescent health and development. • Describe some of the issues that should be considered in programming for adolescent health and development THANK YOU!!! • ESE, MODUPE! • NAGODE! • DAALU! MERCI BEAUCOUP!!! Eko o ni baje o!