Adolescent reproductive health interventions
- Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, London, UK; frances@uz-ucsf.co.zw
Must be a priority if the next generation is not to be decimated by HIV
The broad aim of adolescent reproductive health interventions (ARHI) is both to reduce the adverse consequences of sexual behaviour and to improve the quality of sexual relationships for young people, both as young people today and also in their future life as adults. This article aims to describe the different approaches that have been employed and to review the methodological issues that face both those developing and implementing these interventions and the researchers trying to evaluate their effectiveness. It makes no attempt to systematically review all the relevant literature.
BACKGROUND
Young people are particularly vulnerable to the adverse consequences of early sexual behaviour1 and as such are widely recognised to be one of the most important groups for reproductive health interventions.2 This increased vulnerability is caused by a number of biological, behavioural, and psychological factors3 including hormonal changes at puberty, cervical anatomy, immunological naivety, inability to recognise symptoms of infection, sexual experimentation including experimentation with same sex partners, non-consensual sex, imperception of risk, immaturity of communication skills, contraception choice, poor health seeking behaviour, and alcohol or illicit substance use. In addition, structural (societal) factors that facilitate HIV and STI spread are also well documented.4 Economic deprivation, sex inequalities and mobility, including social disruption, are all important determinants of HIV /STI spread.
The consequences of sexually transmitted infection (STI) and unplanned pregnancy can be devastating. Young women are at the start of their reproductive life and risk compromising their future fertility through tubal occlusion or ectopic pregnancy. In many areas, young women who get pregnant are withdrawn from school, further disadvantaging them. In countries where access to abortion is limited, the gynaecological consequences of “back street” abortion can be dire. While young men …
