Title: DEVELOPMENT AND ASSESSMENT OF METHODS TO PROVIDE REPRODUCTIVE HEALTH
INFORMATION FOR ADOLESCENTS/YOUNG ADULTS IN URBAN TANZANIA.
A qualitative study was done to assess the methods to provide reproductive health
information for adolescents in selected Secondary schools in Moshi urban. Participants
included secondary school teachers in respective schools responsible for students’ health
matters and/or patrons/matrons in their respective schools. Different themes were
developed and detailed in responding to the questions at hand. Responses were detailed and
responded to commonly of which under some circumstances responses differed in nature.
Participants were asked if sexual and reproductive health education is important and if
reproductive health programs are necessary to in school adolescents. Participants responded
very clear that S/RH is important in health matters of adolescents as they grow, creating
awareness early will help adolescents have clear knowledge when it comes to menstrual
issues, puberty changes and knowledge on different diseases that might be caused by body
changes during growth.
“First it makes them to have a self understanding then also it makes them to
know/understand their health…. I mean for them to understand for example girls to know
their menstrual cycle, to get reproductive education so that when they get to puberty and
things like that”, MJG_CT_03.
“Yes, it’s very important to be given to adolescents because it will help them in their lives
especially at this time as they are growing, when they understand reproductive education
they will be following procedures and it will also help them in ethical issues that when they
at school what they are supposed to do, when they are at home also and they will be able to
protect themselves in high risk areas”, MWZ_T_04.
Other respondents stressed that this is very necessary because a school as a place where a
mixture of adolescents meet, different new behaviours can easily be transmitted and
therefore with this education adolescents will be equipped with knowledge on safe practices
that will further prevent risks related to poor knowledge of S/RH as a way of shaping
behaviours.
“I think it’s important because a school is a place where adolescents meets a mixture of
people, you can find he/she has come from home with a certain behaviour but getting here
finds people with different behaviour that might trigger involvement in things that are not
right at that time so when they get that education and meet such people or a different
environment it will not be a problem”, MJG_CT_01.
“Yeah i think it’s important to be given because of how adolescents are behaving these days,
it’s very important that they get that education”, MJG_CT_02
Furthermore, S/RH education is important because adolescents have goals to meet and
therefore receiving this kind of education will shape them and make them more focused and
avoid sexual relationships that might interfere with their academic endeavour and end up
failing to realise their potential by not fulfilling the goals they are aiming at.
“Reproductive health issues are important considering that adolescents have goals to meet
so if they don’t get that education they can fall astray in their life”, MJG_CT_05.
The study further wanted to see if S/RH has any importance on abortion and unwanted
pregnancies. Participants reported that this education will help to prevent unwanted
pregnancies and abortion as adolescents will be taught on the effects of such acts that will
inform adolescents to have informed decisions in engaging in sexual behaviours which intern
will promote academic progress.
“Presence of such programs can assist in preventing abortion that is how i think as i said
earlier when you talk of education you will explain to a person something in detail about
that issue, so explaining benefits, effects so if education is given that way it will touch
everywhere so it can help, when they know abortion has certain effects or death so they get
afraid”, MJG_CT_01.
“Yes, mmh i think adolescents should be given this education to help them avoid unwanted
pregnancies for example when they are at school that a girl gets pregnant at this lower level
it makes her to leave studies she cannot continue with her studies and a family gets upset
also a government gets loss”, MWZ_T_04
On the importance of S/RH on academic improvement, participants indicated that first it has
positive impact academically as examinations always ask about reproductive health/sex
education issues and therefore with such education, students will easily be able to respond
to such questions based on the education they receive.
“They have a very important contribution because academic examinations and all other
examinations including mock and our examinations normally, they ask about
reproductive/sex education, also diseases about pregnancy and things like that,
examinations normally asks and if students have received such education, they are able to
respond”, MJG_CT_03
On the other hand, they insisted t clear that knowledge on S/RH promotes academic progress
as adolescents will focus on their studies after they have been taught about the effects of
engaging in sexual activities and with that, they will devote most of their time studying and
hence improving academically.
“It can have because when a student gets sexual and reproductive health education it will
help because you find what causes a drop academically is involving in sexual activities that
can be eradicated through sexual and reproductive health education for example groups
that can make involvement in irresponsible sexual behaviours, that kind of a student if they
know the effects it means stopping such things it means most of his/her time will be used in
studies but if it happens that may be the time is used on the second side academically they
will drop, but presence of education will put things open and time will be used to study and
leaving such behaviours”, MJG_CT_01
“They have academic outcome because if a student has received that education, for example
most of the time we give examples that if you get emotions try to engage in side/extra
activities and if you are at home engage in home activities, engage yourself in reading, so
such thoughts are left, it help to lift him/her in education because already when he/she has
left such sexual thoughts for example and concentrate on studied, engage in doing other
activities it lifts academically”, MWZ_T_05
One respondent clearly stipulated that S/RH education might not have positive academic
implication as by teaching, adolescents will get open minded and end up trying practicing as
they know safe practice and prevention strategies, this might result to the negative
consequences and academic drop out leading to poor results.
“I don’t think they have importance that much, it has been that if you give them education
they go for trial such things from the education you give, some get open minded that there
are these things lets also go an try (laughing) i don’t think it has any effects academically,
no”, MJG_CT_02
Participants were also asked if there are any sexual and reproductive health education and
services for adolescent in their schools/college/university. Responses to this was different
based on the nature of the school environment and from how a respondent sees the
environment. Very few showed that S/RH education is available mostly given by female
teachers to female students who seem more in need of such education compared to male
students.
“This, mostly it is available to the more experienced teachers (women) they provider sex
education to girls also there is a counselling teacher who also provides that education when
it happens that a student has been identified to have sexual relationship while at school”,
MJG_CT_03.
However, it was very clear that such services are not available to in school adolescents and
only those subject teachers will touch into that as they teach and when they get to such topics
that have elements of sexual and reproductive health issues. This was stipulated by different
study participants that other than such topics there is no formal sexual and reproductive
education services.
“I cannot to a large percentage but they do receive education partially because they don’t
have the expert who is responsible for educating them but science teachers for example a
biology teacher they teach personal hygiene, you just sensitize them and there are topics like
reproduction, when you are teaching you inform them there is one two three, there are these
changes when you see these changes, you are supposed to do this, things like that but saying
that there is an official person who gives that education in detail”, MWZ_T_03
“For this school, there is no education only that like teachers as we are in class it’s when we
touch about that to put them aware but there is no specific department for that education”,
MJG_CT_05
“In fact, as a subject it’s not there though science teachers, we strive to deliver it especially
biology subject and also there is a department for counselling, most of the time also you find
to strive to deliver that education to children”, MWZ_T_05
Another aspect was on adolescents involvement in utilizing reproductive health services. The
question wanted to know if their involvement is high, moderate, or low. One participant
specifically showed presence of high level of involvement that was not in school explaining
how the media gets in to help adolescents in general helping parents who are unable or have
no skills talking to their children, the media comes in through plays that spreads knowledge
and involve adolescents.
“Their involvement in current years i see its good because even now i can switch on a radio
and hear students talking like a play/drama i saw it on ITV they were sensitizing parents to
talk to their girls if they have no ability to talk because there are parents...what makes many
children lack involvement it’s that parents have no ability to talk to a child so what i saw in
media is that they tell a parent you cannot talk to a child there are right people, available at
right places and health personnel are there and they will explain how to do instead of hiding
to a child at the end of the day he/she gets wasted”, MWZ_T_01.
Most of the participants honestly reported moderate level of involvement as subject teachers
teach because it’s part of the topic but not officially involving adolescents on extra time a
school. More so, teachers will involve adolescents only when they have problems that calls
for intervention and that most of those who engage are subject teachers who have no
expertise in sexual and reproductive health education.
“I think it’s moderate because like in biology subject there are topics related to such things
so it means we know biology is not an elective subject, all of them have to study it so it
means involvement is there but not hight but moderate because until you reach that topic”,
MJG_CT_01.
“Their involvement is moderate because even the education they get as i said in class its few
teachers i think they use that chance fearing to lose time of teaching that subject and also
even those counselling teachers, you find most of the time they engage more in problems
that makes that child to be like that but it’s not all problems result in reproductive health, so
if reproductive health would have been available also i would suggest if it is put in the
syllabus that we teaches children as part of the subject it would help them so much”,
MWZ_T_05.
“It’s moderate because educators have no enough education (not competent) so you find
that children get that education just normally but not from the expert responsible for health
issues so you find they get educated at a lower level that is like moderate”, MWZ_T_03.
However, the study showed that adolescents have low level of involvement due to the fact
that the schools depends on the experts to come and teach and they are not available and so
it remains on the hands of subject teachers who also teach a s a subject to cover for the
curriculum needs.
“On my side i think its low because, on the nature of students we have or on the age of
students the way they grow they need that so much, you find that most of the time we don’t
get for example here at school we don’t get people to come and talk to students”
MJG_CT_05.
“Its very low because you cannot talk about it if you are not in that topic related to that,
when we have meetings like two times in a term…personal hygiene and relationships with
adolescents to boys and girls you just get only few minutes to discuss that so you cannot get
in deep meaning that education is not enough, when we go to the issue of family planning
for example, a student is taught about family planning when they reach may be on that topic
that is in form three form four, below that they are not aware”, MJG_CT_04.
Another focus was on common reproductive health problems at school. Several were
identified by participants starting from pregnancy that if students get pregnant at school
there is a possibility of abortion that so far has not been confirmed. Adolescents involvement
is sexual matters leads to academic drop out and creates failure in the long run.
“There is the problem of pregnancy to girls, may be abortion that we don’t have much proof
but if there is pregnancy problem it means at times there is abortion, unsafe sexual
relationship among students” MJG_CT_05.
“Reproductive health problems is getting pregnant while at school, they get pregnant and
also engaging in sexual issues that causes drop out in studies, discipline becomes bad and
also at times same sex relationships are becoming common at this time in schools, another
thing is sexual relationships between girls and boys that also makes them have bad discipline
and also their studies don’t go well”, MWZ_T_04
Another problem explained was Urinary Tract Infection (UTI) that occurs mostly to adolescent
girls and it was explained that from experience that is what they come across as adolescent
girls come claiming to have UTI and teachers try to figure out what might be the cause that
include cleanliness, unprotected sexual intercourse that might affects adolescents and this
was more associated with boarding adolescent girls.
“Mmmh reproductive health we are talking about, you know mostly its STD's, i cannot say
that which problems mostly because you can find children telling you that madam i have UTI
for example those in hostels because our girls hostel has like one year and a half but because
there was a time i was close to them as an assistant to the matron, students tells you
madam i have UTI that their UTI does not end so you try to ask what are the causes of UTI,
you explain to what causes UTI may be poor cleanliness, not washing clothes well, sharing
soaps, not drying clothes well, having sex with an unsecure person so when you explain
things like that obvious she will realise that what has caused me is this but we cannot that
already that education is enough but straight we are able to assist them to tell this and that
is what causes try to avoid this or so that you get rid of UTI problem”, MJG_CT_04.
“Reproductive health that bothers them from experience i see its UTI that disturbs them that
is not related so much but related to reproductive organs, but there is no other”,
MWZ_T_03.
The study further wanted to find out how schools handle in school adolescents with
reproductive health problems given that they have happened. The first concern was on
academic related problems when participants reported that counselling is more common for
students who were initially good academically but suddenly starts dropping, they explained
that route proves to be effective as it brings an adolescent close and makes him/her free to
talk and after counselling a student will get back to normal and continue with studies. This is
made possible for those who engage in sexual activities are I formed on the effects of such
acts that makes them to change.
“You find a student was doing well or started well but later starts to drop academically of
which if you trace or even ask fellow students they will tell you madam this has a
relationship with a certain student but...you know proving relationship is a problem but what
we do we call them and try to talk to them and explain the effects of what they are doing,
though they reject because as i have said for them proving that they are in a relationship and
this is a day school, sometimes its very difficult so what we do we call them and counsel like
talking to them that what you are doing is not what brought you here, there some who listen
and their performance improves, there some we loose them that way” MJG_CT_05
“That is handled very well because every time we must check on them and see why they
have dropped academically, a reason will be searched, we sit and talk to a child in detail and
when we talk in detail most of them tell what the problem is, perhaps its a family problem,
perhaps relationship problems like that and perhaps its just a child negligence”, MWZ_T_04
And for the case of pregnancy at school, all participants agreed that several ways will be
employed like retesting to confirm pregnancy, calling parents to talk with school management
and have some kind of counselling to parents to take care an adolescent, counselling to the
adolescent herself to take it as normal and not to harm herself, but with all such measures at
the end a school girl will be discontinues from studies and they confirm that has been the only
solution so far.
“For sure if a pregnancy case is realised, i have not seen a solution or anything that teachers
do, a school management right away will test to confirm from a doctor and they suspend her
right away that you cannot continue with school because you are pregnant, that is how it is,
there is no other law”, MJG_CT_04.
“If such a case happens, administration will sit down and call parents sit and discuss that one
two three has happened, because of this situation that has happened this girl will not be
able to continue with school but don’t so any harassment and do something that is not okay
so the best thing stay with her counsel and things like that”, MWZ_T_03
Some participants went ahead and gave facts/testimonies of what happened to adolescent
girls who got pregnant and who were expelled from school. The insisted that some of these
come from home during the holidays and because students have to come to school that come
with such conditions, this was explained in a way of encouraging parents taking part in
adolescents care while at home.
“Yeah i have come across such a case, actually she was a girl and she got pregnant so i am
not sure if she knew or not because its a must she should come to school so she came just
like that and her performance was dropping and in class sleeping a lot, it gave us hard time
to figure out what the problem was, she was not studying/reading any more because she
could not sit in class and listen to a teacher she feels like vomiting so like that we realised it
was pregnancy she had to be expelled from school”, MJG_CT_02.
“i remember like two years back we interrogated one she said who impregnated her was a
houseboy, another one said it was a university student who impregnated her and its last
year it was a form six girl she would have finished form six this year very bad that she had to
leave but such conditions they came with from home during the holiday”, MJG_CT_04.
Handling Sexual Transmitted Infections (STI’s) has different approaches in which when an
adolescent claim to have that he/she will be retested to confirm and a school will take the
person to the hospital for further treatment.
“In case of STI's most of the time a school if there is a nurse like this time, a nurse will be
assigned a student for testing to prove if its STI and after treatment will be given, a school
can take him/her to the hospital and informing parents as well”, MWZ_T_04.
On the other hand, most of the participant claimed to have never see, heard such a case and
if it has happened then it was kept undisclosed, this shows that such cases are rare and/or
most of the teachers are not aware of.
“On that case, we have not experienced any or hearing that a student has STI's, if its there
we have never experienced”, MJG_CT_05.
“On that question, i have never heard, i have never come across a case like that like there is
a child with such a problem, on my side i have never heard”, MWZ_T_03.
Another scenario that participants had was the fact that detecting such a problem is very hard
as adolescents might not disclose it and therefore it remains personal with their health care
providers or they might claim to have a different disease that is difficult for a teacher to know
if they don’t disclose such a situation.
“On that, first that is known by a patient himself (student), if he/she says feels sick they will
go to the hospital that now will be between a student and a doctor, coming back he/she will
say i have been found with a certain problem even if they report back it will be a lie they will
not report STI so its hard for teachers to realise he/she had such a problem”, MJG_CT_02.
“On STI's there is a little challenge because a disease is a secret between a doctor and a
patient so its hard for a teacher to understand that this person has STI's may be only if
he/she has been found in such a situation at school and a nurse has been involved but still
we cannot so much judge him/her so it remains to be a secret between a patient and a
school management (laughing), MWZ_T_02.
The study further wanted to know on how the school deliver S/RHS to adolescents during the
course of their training, on this delivery is mainly as part of subject teaching n class and this
process is made almost blinded to avoid adolescents get a full understanding of issues that
may trigger their curiosity to try practicing.
“To be honest, may be if a teacher tries to put like a point in explaining and it is mostly said
blinded and i think it is put that way to avoid those who are not yet in such things not to
imitate because as they might realise like ooh so there are students with sexual relationships
at school why don’t i have, so it is normally said but blindly so whoever understands will
continue”, MJG_CT_02.
In some very few cases heath care providers used to visit schools for provision of such
education but it appeared like it was mostly on projects and not an official timetable that
adolescents have to be taught, this lows down provision of sexual and reproductive health
education to in school adolescents.
“There was a time they came, they came from Mawenzi i think, for advance (A level) were
allowed on Fridays to go and explain themselves there but after corona i have not heard that
thing again, but there is a day experts came and talked to A level girls, they were allowed on
Fridays to whoever has a reproductive health problem, they used to go and explain
themselves there but after corona i am not sure if that thing existed or got over”,
MWZ_T_03.
However, most of the participants clearly showed that there is no such education provided to
students, this pint showed that most of the adolescents lack this kind of education and only
depend on the curriculum that only teaches following the need and not a full package of
sexual and reproductive health education.
“No, i have not seen them ever since i came here like the whole year”, MJG_CT_03
“For sure there is no official process, may be if it happens that we have invited motivation
speakers to talk in parts about sexual issues”, MWZ_T_02
It was clear that schools don’t have trained teachers on sexual and reproductive health
education who can be assisting on delivery of such education to in school adolescents, most
of the teachers available teach based on the needs of the curriculum and the knowledge
acquired from colleges and the expertise they have on science subjects but not purely sexual
and reproductive health education provision expertise.
“Here at school i have no experience if there are those who got that education but what i
know there are caregivers/teachers they use that chance to educate them though they have
no official education but there are people who help them”, MWZ_T_02.
“No, i have not seen that”, MJG_CT_01.
All participants were willing and comfortability in teaching sexual and reproductive health
education among in-school adolescent, all of the participants were concerned by the life
goals, academic progress of the adolescents and that engaging in sexual relationships before
time contributes so much in poor performance, early pregnancy and spread of diseases,
although they insist on having more expertise in dealing with such issues.
“I am very ready because i like to see students to get achievement on what has brought
them to school based on that if i see a student not performing well or something has
happened because he/she lacked a certain education i normally feel very bad” MJG_CT_05.
“I am truly ready to save this generation because this problem has become big and if we got
more education, we could help them more because we deal with such cases but there is
expertise needed in such cases because they are hard to disclose, for example another one
you find a real relative doing such a thing so a child is hard to explain but there is expertise
to click that child to the point to explain, then to give him/her ways to stop so getting that
education would help a lot”, MWZ_T_04.
The study revealed that all participants were not aware of the available S/RHS clinics to
adolescents and even the ones mentioned they were not sure if they provide S/RHS and
clearly they showed that they were fully not aware of the available services, participants
skeptically mentioned some centers not knowing if they has services or not.
“I know Majengo clinic but i have never asked if they provide that service, but if its being
close there is Majengo clinic close”, MJG_CT_05.
“Mmh there is one called UMATI but i am not sure if only adolescents go there or its all
people”, MWZ_T_03.
“No, i am not aware of any”, MJG_CT_02.
“No”, MWZ_T_02.
Participants explained that mode of delivery for S/RHS should consider age as some of the
adolescents have not reached puberty and so their mode of delivery should consider that to
avoid them being exposed to more bigger things, participants added that age consideration
could be because while delivering there could be a need to touch private parts as examples
and therefore sometimes boys d=should be separated from girls t make it easy. They also
insisted that delivery should involve experts from outside that can make students more kin in
listening rather that using the same teachers that students are used to.
“This service should focus all boys and girls but should consider age, for example children
from form one and form two can be mixed perhaps they have not gone to puberty and some
are and some are close and if its possible because as you are teaching you have to touch
their body parts girls should be alone and boys alone then when we get to form three, four,
five and six those can be mixed and talk about family planning, but a form one or form two
child you cannot teach contraceptive issues but you can teach other classes and tell its
effects because biologically we say there is no contraceptive with no effects so we must tell
then, the effects of practicing while at school”, MJG_CT_04.
“When this service is provided by outside experts children do listen more, they have freedom
to explain without fear like they are afraid of us as teachers that we teach them, a fear that
may be a teacher will know i am like that, so its having guest speakers for that but also we
should have exchange programs for teachers it can make these children to be free and open
to ask many questions for example a child can ask questions on how to prevent, something
that we cannot hide we should teach them how to prevent and their effects because they do
engage without our knowledge”, MWZ_T_05.
“I think they should take experts and take them to secondary schools (O level & A level) also
and mid colleges it can help as well”, MJG_CT_04.
A big challenge that was expressed by participants was that teachers find that most of the
reproductive health issues taught by teachers are new to adolescents which shows that
parents either have no time or they have jo expertise to talk and teach their children and also
it makes t hard for teachers to full teach S/RHS to adolescents and therefore it becomes a
hard work for teachers, on the other hand teachers find it challenging that when adolescents
are taught its like telling them what to do and that they may start practicing what has been
aught in class, a practice that makes teachers teach by not disclosing some of the contents.
The study revealed that some adolescents find it that by teaching the effects of engaging in
sexual relations they feel like they are denied on some things limiting their participation in
such acts.
“The first challenge is when you teach form two students may be a sub topic on family
planning, a child doesn’t know something called female condom, doesn’t know loop, gel so
you get a challenge first of all you cannot use those teaching aid, some children see it as
funny, i also get worried that if this child used to hear today i am giving a way by teaching
she might go to practice, when you get to natural methods like calendar you get worried,
you can teach it but not draw because you are afraid she might go to count the safe days
some are still young and those who have understanding in class they will go and lie to form
one children that if you follow this and this you wont get pregnant lets do this that’s the first
challenge i get, the second challenge is we teach for them to win examinations to apply the
knowledge you have given on the questions to be asked to be able to respond but if i was not
open to a student because i was worried h/she going a wrong way how will they be able to
respond to such questions if they come in exams?, so that is a challenge”, MJG_CT_04.
“The first challenge many adolescents see like adults are lying to them, like there is
something good that they don’t want adolescents to get, they deny them that freedom that
is the biggest challenge, and at times the language used as an educator especially when you
are old you will not use a language that adolescents are used to currently, so they look at
you as outdated, things like that (laughing)”, MWZ_T_02.
On the other hand participants expressed that faith related challenges hinder in teaching
sexual and reproductive health education as teaching this appears to some religions as a sin,
betraying God and that religion does not allow such teachings and with that mentality such
education may be not of any use as its against their faith.
“Challenges that we face, if we talk of the issue of faith there are students who believe that
talking about such issues its a sin though they are few, so you find that if he/she has that
faith such education cannot be taken, so he/she stands with faith not knowing the effects
they will come across”, MWZ_T_05.
“First as i teach them i see many of them are very shy so when you mention that word they
get even close to cover their ears, another challenge that is available is the issue of religion,
like some see when you teach that you are betraying God, that it is said you should not do
that, you should not insult, that see like you are talking insults another challenge that we
face, their understanding on these issues is hard i am the one starting so a parent was
suppose to start at home, there are things that parents had to sit with their children and talk
to them, there are few things they would have talked to them”, MWZ_T_04.
They all recommended that sexual and reproductive health education should be set as a
special program for in school adolescents and should be provided by the health care providers
who have specialised in such matters. Also they insisted that because currently its not fully
integrated, the content should be part of the curriculum for in school adolescents to receive
S/RH and that teachers will be able to touch into every aspect that will benefit in school
adolescents, generally they recommended that there should be a special day for S/RH
education for adolescents that will add on the in school programs for adolescents that are
existing together with what visiting experts will come with.
“My recommendation is that at least that program be official meaning that experts coming
for education at least once a month so that to make adolescents aware, to be honest most
adolescents sometimes you can talk to a student and realise you are opening something that
he/she did not know so it should be like a special program that should be considered, that
health care providers come to school once a month to talk to students”, MJG_CT_05.
“Sexual and reproductive health, because its not in schools like in subjects, it should be in
subjects if its biology or civics it should be there and if possible involving a health personnel
from health facilities because we have plenty of them especially urban schools, why should
children not be taught by experts?, if a teacher thinks he/she will feel shy has no enough
knowledge, they should call in a health expert”, MJG_CT_04.
“Seminars should be given, if there are people who are able to do that work should help us
for sure because adolescents now days have focused so much on that because many cases at
a school are not theft issues its relationship cases so if there will a department or people
responsible with that issue or who have been given that education it will help a generation”,
MWZ_T_03.
“As i said there should be a department that will be a able to coordinate well by putting a
plan to visit schools even if its not every month at least once per term there should be a
special day that adolescents will be taught by experts who are not their teachers about
sexual issues and mostly when they are taught by nurses i know their language is different
from teachers, they will explain in detail, they (students) can be free to explain what they
have but also i think many adolescents need counselling about such things so that to
recognise and decide that whenever they do anything related to sexual issues to know why
they have decided, and to whose benefits”, MWZ_T_02.