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!