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Numerous health surveys and social studies have shown that in many African countries today:
· Most teenagers (60-70%) are sexually active. As a result, in some areas as many as 70% of girls have been pregnant at least once by the time they are 18 years old;· Sexual activity at an early age is associated with several serious risks and complications;
· The majority of sexually active adolescents are unaware of these risks, or are dangerously misinformed about the potential consequences of their behaviour;
· As a group, adolescents lack access to health and social services, or are reluctant to use these services even when they are available (see Figure 21.1).
This chapter discusses some of the problems associated with sexual activity in young people, and examines why and how complications arise. It also suggests how young people, especially young women, can be helped to avoid problems related to sexual activity. Many of the health issues discussed here, such as sexually transmitted diseases and problems with pregnancy, are discussed in detail in other chapters as well.
Adolescence is the stage when a child grows and develops into an adult. In terms of age, adolescence begins at 10-12 years and continues until the age of 18-19 years. The change from childhood to adulthood is a gradual process that occurs at different ages and at different speeds in different people. It is always marked by profound changes in the individual.
· PHYSICAL CHANGES: During adolescence, both boys and girls generally grow and gain weight quickly. Their genital organs also increase in size. Other changes take place as well, such as the growth of hair in the genital area and (for boys) on the face.
Figure 21.1: Adolescent
Visiting a Health Clinic
Many teenagers do not feel comfortable in health clinics; other patients, or sometimes the health workers themselves, may make them feel unwelcome. As a consequence, they may not get the health services they need. Health workers can help by treating teenagers with sympathy and understanding, and by ensuring confidentiality.
· BIOLOGICAL MATURATION: At the same time that the body is maturing on the outside, the internal reproductive organs are also changing. In boys, the testes begin to produce sperm. In girls, the ovaries begin to release eggs, and they begin to menstruate. This usually happens between the ages of 12 and 15, although it can happen earlier or later (see Chapters 3 and 4).· PSYCHOLOGICAL CHANGES: Boys and girls become increasingly self-conscious and aware of the changes taking place in their bodies during adolescence. They also begin to be aware of their own sexuality, and feel sexual desire, sometimes quite strongly. This is nearly always a difficult period emotionally, as young people struggle to understand their own feelings and reactions. Their capacity to think in abstract terms and to empathize with others also develops during this time.
· SOCIAL ADJUSTMENT: In most African societies, becoming accepted as an adult is determined more by tradition and cultural values than by age or physical size. Adolescence can be a difficult and confusing period. Adolescents may want to be recognised as adults, but their peers, parents, and society in general may not see them that way yet. Many societies practise rituals to recognise that girls and boys are becoming adults. These rituals are important because they help the adolescent feel that everyone recognises him or her as an adult, and because they can mean new responsibilities as well as new freedoms.
Sexual activity among adolescents is both widespread and increasing, contrary to what many parents, teachers, health workers, and religious leaders may believe. The growing numbers of pregnancies and abortions among teenagers, both in and out of school, confirm that many young people are indeed sexually active.
Biologically, boys as young as 14 or 15 years old can father a child. Girls can become pregnant at an even younger age - 12-14 years - even before they have had their first menstrual period. While many African cultures favour or promote early marriage and childbearing, especially for girls, pregnancy before the age of 18-20 years may be harmful to the health and well-being of the girl. Specifically, it can involve serious obstetrical, psychological, and other health risks. For young girls, sexual activity and pregnancy may be the result of sexual abuse or exploitation, often by older men. For others, it is a reaction to the urgings of boys of their own age who are feeling sexual desires and needs. Other girls may be exploring their own sexual feelings.
Adults who talk with and counsel adolescents, whether they are parents, teachers, health workers, or others, need to understand the many different feelings and pressures that young people have, especially with regard to sexuality. First, adults need to address their own reluctance to talk about sexual issues. Next, they need to recognise that talking with young people is easier if they do not make judgments or criticise. It is more effective to be supportive and offer guidance in a way that the adolescent boy or girl will understand and accept. After all, advice is no good if it is not acted upon.
Having a child always carries a certain risk, and complications from childbearing may occur regardless of the age of the mother. However, the risk of having serious complications during pregnancy or childbirth is much higher for girls in their early teens than for women aged 20-24 years or older. The major difference between girls in their early teens and older women is that girls aged 12-16 years are still growing. The pelvis or bony birth canal of a girl can grow wider by as much as 20% between the time she begins menstruating and the time she is 16 years old. This widening of the pelvis can make the crucial difference between a safe delivery and obstructed labour. In addition, most adolescent girls are not yet capable of fulfilling all the responsibilities of an adult. In particular, they are not yet ready to have children themselves.
Because they are often inexperienced, poor, and alone, their infants are more likely to be sick and poorly fed. The major risks that young teenagers and their babies face during pregnancy and childbirth include:
· ANAEMIA: A high proportion of teenagers are anaemic before they become pregnant, usually because of poor nutrition. The anaemia tends to get worse during pregnancy unless treated (see Chapter 9).· ABORTION: The majority of teenage pregnancies are unplanned, unwanted, and come as a complete shock. Many teenagers attempt to terminate the pregnancy. Since they usually lack the funds and the information to get a safe abortion, they often resort to illegal, unskilled abortionists who operate with dirty instruments in unclean surroundings. The results of unsafe abortions can be tragic; they can include infection, injury to the reproductive organs, or even death. Other common consequences are pelvic inflammatory disease (PID) and infertility (see Chapters 18 and 19).
· PRE-ECLAMPSIA: The risk of developing high blood pressure during pregnancy is greater for teenagers. So is the danger that the condition will progress to eclampsia or fits (see Chapter 11).
· PREMATURITY AND LOW BIRTH WEIGHT: Teenagers are more likely than older women to go into labour early. Even when the pregnancy goes to term, the babies of adolescent mothers tend to weigh less than full-term babies of older women. Babies born early, and underweight babies, are more likely to get various diseases such as respiratory infections and diarrhoea. They have a higher risk of death before their first birthdays.
· PROLONGED LABOUR: Labour usually lasts longer for teenagers than for older women for two reasons:
· the contractions of the womb, although strong and painful, may be quite irregular and therefore not effective in opening up the neck of the womb or pushing the baby down;· the mother's birth canal or pelvis may be too narrow for the baby to pass through.
Whatever the cause, prolonged labour carries risks for both mother and baby. These include infection, exhaustion, injury, or even death.
Because of the risks faced by teenage mothers, they need more tender loving care than most. Pregnant teenagers should be encouraged to report early for antenatal care. They should receive supportive and sympathetic care during pregnancy, labour, and the early weeks after delivery. If they receive good care, the vast majority of them will come through safely and deliver healthy children.
Apart from pregnancy and its related risks, sexual activity among adolescents carries other dangers.
SEXUALLY TRANSMITTED DISEASES (STDs) AND HIV/AIDS: Young people are just as likely as adults to catch sexually transmitted diseases - gonorrhoea, chlamydia, syphilis, etc. - as a result of sexual intercourse with an infected person. However, young people with STDs are less likely than adults to seek help and proper treatment. This may be due to ignorance, inexperience, fear, or shyness. It can have serious consequences; when treatment is delayed, the risk of complications such as pelvic inflammatory disease or infertility is much higher.
Adolescent girls may be even more at risk of infection with HIV/AIDS than older women, for both social and physiological reasons. Socially, young women and girls are often targeted for sex by older men (sugar daddies) who believe that young teenagers are less likely to have been infected with HIV (see Figure 21.2). These youngsters may be shyer and more reluctant to say no, or to ask the man to use a condom. As a result, they find themselves at greater risk of infection. Physically, if an adolescent girl is not yet fully grown, having sexual intercourse can be painful, and may result in sores or scrapes in the genital area. These make it easier for her to get an STD, including AIDS.
PELVIC INFLAMMATORY DISEASE (PID): Any infection of the genital organs, whether following an abortion or sexually transmitted disease, can spread to other pelvic organs unless it is treated promptly and effectively. The major signs of pelvic inflammatory disease, as discussed in Chapter 18, include fever, pain in the lower part of the abdomen, pain during sexual intercourse, bad-smelling vaginal discharge, and heavy bleeding during menstruation. PID often results in damage and scarring of the fallopian tubes, and can lead to infertility or ectopic pregnancy (see Chapter 19).
Figure 21.2: "Sugar
Daddy"
Many teenage girls are tempted into sexual activity by older men, who may offer them money or presents in exchange for sexual favours.
Young people, especially young women, face other problems and disadvantages as a result of early sexual activity. Besides struggling to understand and cope with their sexual feelings, young people also have to deal with their own ignorance and confusion. They may feel a sense of guilt, fear of discovery and disapproval from parents, or outright rejection. For the young teenager this can be a major psychological trauma.
Girls who become pregnant almost invariably have to drop out of school, thereby losing their chance for a good education or missing out on opportunities for training (see Figure 21.3). This means it will be much more difficult for them to acquire useful and practical skills that could help them to earn a living and contribute economically to the welfare of their families as well as themselves.
Girls who marry young and start childbearing early tend to lack social and survival skills. They may become completely dependent on their husbands for their needs. Such women may have low self-esteem and tend to believe that the only useful contribution they can make in life is to have many children.
Figure 21.3: Consequences of
Teenage Pregnancy
Schoolgirls who become pregnant are usually forced to leave school. They may lose the chance for education and training that can provide opportunities later in life.
The health worker has two major roles to play in meeting the reproductive health needs of young people who are sexually active. The first role, of course, is to provide health care. This includes good antenatal, delivery, and postpartum care for the pregnant adolescent (see Chapters 6-13). It also includes family planning information, counselling, and services in order to prevent unwanted pregnancies (see Chapter 17). And it includes guidance on how to prevent STDs, and treatment for them when necessary (see Chapter 18). The second role of the health worker is to be an educator and a counsellor for young people themselves, their parents, and their guardians, as well as the community at large (see Figure 21.4).
Married or single, the sexually active teenager runs the risks described above. Parents, teachers, community and religious leaders, as well as teenagers themselves, need to understand that waiting until a later age - 18 or 20 years - to begin sexual activity has important health and social benefits for all. The health worker is in a unique and privileged position to provide this information and education.
Some health workers may find it difficult to provide information and services to young people because they may see it as encouraging promiscuity among the young. This is understandable, given the personal experience, religious beliefs, and principles of many health workers, and the traditional and cultural values in society.
Health workers must appreciate, however, the need for empathy and understanding in dealing with young people. For many troubled teens, the health worker is the only person they can turn to for support and help. A health worker knows the risks that sexually active teenagers are exposed to, and the potential consequences of failing to provide adequate care. Health workers should therefore strive to prevent any negative feelings or judgments from coming between them and the young person in need of help and attention. They have a responsibility to provide adolescents with information on sexual and reproductive health. They also have a responsibility for making health and family planning services available to them, or referring them to a place where they can get care.
As respected and knowledgable persons in the community, health workers can also play a role in encouraging parents and others to understand the issues involved in teenage sexual activity. They can help the community look for positive and constructive ways to deal with the issues, and help inform and reassure parents themselves. Sometimes health workers can play a valuable role in encouraging communication and understanding between teenagers and their parents.
Figure 21.4: Adolescent and
Mother Being Counselled by a Health Worker
Health workers can be an important source of information and guidance for teenagers and their parents on issues related to sexuality and reproductive health. They can encourage parents to be more understanding and communicate more openly with teenage children.
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Summary: Adolescent Health Adolescents face many physical and psychological problems related to sexual activity. Young women who become pregnant face a higher risk than older women of developing the following complications: Anaemia Because so many adolescents do not understand how their bodies work, and because they do not have access to health and family planning services, many teenage pregnancies are unplanned. As a consequence, adolescent pregnancies often end in abortions - many of which are performed incorrectly and unsafely, leading to tragic deaths or disabilities. Adolescents who are sexually active also risk getting a sexually transmitted disease. However, they are less likely to know the symptoms, and less likely to seek help. The health worker is one of the most important participants in the adolescent's life as a provider of both services and information. Sensitivity and sympathy are essential in talking with, and treating, adolescents. |
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