ADOLESCENCE AND YOUTH Sexual Reproductive..

This area addresses young people's reproductive development, sexual health, and rights (including protection from STIs/HIV and unwanted pregnancy). It covers information, counseling, and accessible, youth-friendly services.

1. ADOLESCENCE AND YOUTH FRIENDLY SERVICES

2. LEARNING OUTCOMES By the end of the session, the student will be able to Understand the background and situation analysis for AYSRH Describe the strategies, approaches and service delivery models in Kenya. Describe counselling in AYSRH

3. Adolescence and Youth-Friendly Services (AYFS) Definition: Adolescence and Youth-Friendly Services (AYFS) are healthcare services designed to meet the unique needs of young people aged 10–24 years, ensuring they are accessible, acceptable, equitable, appropriate, and effective. These services promote the physical, mental, and social well-being of adolescents and youth, empowering them to make informed decisions about their health and future.

4. Youth Refers to the period between childhood and adulthood. It typically includes people aged between 15 and 24 years . This stage is marked by growth, learning, identity formation , and preparation for adulthood.  

5. 2. Adolescence Adolescence is the transitional stage of physical and psychological development that occurs between childhood and adulthood , usually between the ages of 10 and 19 . It includes puberty and is marked by rapid changes in the body, mind, and emotions.  

6. 3. Teenager A teenager is a person whose age falls within the teen years , usually from 13 to 19 years old . Teenagers are in the middle to later part of adolescence and experience social, emotional, and cognitive changes.  

7. 4. Gender Internal Identity: This is a person's deeply held internal sense of being male, female, both, neither, or somewhere else on the gender spectrum.  Social Expression: It also encompasses the social and cultural roles, behaviors, and attributes that a society associates with different genders, which can vary across cultures and time periods.   

8. Sexuality Attraction, This relates to a person's romantic, emotional, and sexual attractions to other people. Behavior: It can also include a person's sexual feelings, thoughts, desires, values, and behaviors. Gender is about identity and expression; sexuality is about attraction and relationships

9. BACKGROUND AND SITUATION ANALYSIS Young people below the age of 25 years constitute 66% of the total population(KNBS, 2009). Adolescence make up 24% of the country's total population. The adolescence and youth experience poor reproductive health outcomes. 1 in every 5 teenagers between 15-19 years have begun childbearing. Contraceptive prevalence rate among sexually active unmarried girls Aged 15-19 years is 49% 64% among age group 20-24 years.

10. BACKGROUND AND SITUATION ANALYSIS Age of first sexual experience is 12% of young women and 21% of young men aged 15-24 years having had sexual intercourse before age 15. 47% of young women and 55% of young men aged 18-24 years have had sexual intercourse by age 18 Comprehensive knowledge of HIV among youth stand at 57% for young women and 64% for young men. Rate of condom use is 61% and 75% for young men and women respectively.

11. BACKGROUND AND SITUATION ANALYSIS About 20,000 girls seek care for abortion related complications annually Unsafe abortions remain the leading cause of maternal mortality and morbidity among girls below 20 years. 29,000 youth aged between 15-24 years get infected with HIV every year, while 17% of all AIDS related deaths occur among adolescence and youth.

12. BARRIERS TO UTILIZATION OF AYFS Structural barriers Laws and policies Parental and partner consent Distance from facilities Cost/transportation Long waiting times Inconvenient hours

13. Socio-cultural barriers - Restrictive norms and barriers Stigma, inequitable or harmful gender norms Discrimination and judgment of adolescence. Individual barriers - Limited or incorrect knowledge-myths and misconception Limited information about availability of SRH services.

14. GUIDING PRINCIPLES FOR AYSRH Every young person is unique and belongs to a heterogeneous group with different needs for health information and services based on sex, gender, religion etc. RH services are the basic human rights for all people, youth and adolescents including right to information and services. Gender inequities and differences influence their health and development. Services must promote gender equality and equity.

15. GUIDING PRINCIPLES OF AYSRH The health needs of young people are best addressed by a holistic approach ( physical, mental and social wellbeing). The management of the needs of young people SRH includes the promotion of healthy sexual development, the prevention and treatment of SRH problems, as well as the response to specific SRH needs. The participation of parents, community members and other stakeholders is crucial to sustainable adolescents and youth SRH services and programs.

16. CHARACTERISTICS OF ADOLESENT AND YOUTH FRIENDLY SERVICES Equitable -All adolescent and youth, without discrimination are able to obtain the health services they need. Accessible -All adolescents and youth are able to obtain the health services that are provided. Acceptable -Health services are provided in ways that meet the diverse expectations of adolescents and youth. Appropriate -Health services needed are provided. Effective -Right services provided in the right way and make a positive contribution to health of adolescents and youth.

17. APPROACHES FOR SERVICE DELIVERY Targeted approach Services are designed and planned for adolescents and youth alone, offered in settings that meet only the needs of adolescents and youth, excluding other groups. Integrated/Mainstreamed approach Adolescents and youth receive services as part of the general public, with special arrangements being made to make the services more acceptable. Adopted in many healthcare facilities

18. ESSENTIAL PACKAGE FOR AYSRH Counselling-growth, development, sexuality. Information and education on SRH including links to reliable information. Pregnancy testing STI counselling, screening and treatment. Reproductive and UTI testing and treatment. Contraception counselling and service provision. Counselling and treatment of irregular/painful menstruation

19. ESSENTIAL PACKAGE FOR AYSRH Post abortion care. Sexual and gender-based violence(SGBV) counselling and referrals Antenatal and postnatal care. Screening services-breast, cervical cancer screening. Other RH services-prenatal counselling, HPV screening, PMTCT. HIV counselling and testing and linkage Nutritional counselling and screening services including physical activity.

20. ESSENTIAL PACKAGE FOR AYSRH Personal hygiene and sanitation. Mental health services. Counselling on drugs and substance abuse including alcohol and tobacco use Stress management. Referral, linkage and follow up.

21. SERVICE DELIVERY MODELS Community based -services and information offered in within the community/non medical settings-youth centers, outreaches, churches. Clinical based -Services and information offered within a health facility. School based -Services offered within the school setting. Virtual based -Use of digital platforms or virtual space- mhealth , telemedicine

22. SERVICE DELIVERY POINTS Static (Hospitals) Mobile outreach Digital platform Community based Others-schools, churches Streets for injection drug users.

23. SEXUAL AND REPRODUCTIVE HEALTH COUNSELLING AMONG ADOLESCENTS

24. PURPOSE Enables decision making using a rational model for decision making. Enables adolescents cope with their current situation. Helps achieve control over behavior, Understanding oneself, anticipating consequences of actions ad making long term plans

25. PRINCIPLES OF COUNSELLING Aims to help problem identification and personal decision making. Right to choose own action. Provision of accurate information. Confidentiality. Takes into account psycho-social, financial and spiritual needs of the client.

26. COUNSELLING STEPS Connect Initiate first contact Communicate appropriately Establish trust and confidentiality Reassure Be a calming influence Minimize feelings of insecurity Provide accurate information Refer appropriately

27. COUNSELLING STEPS CONT’ Stabilize Help clients understand their own actions. Recognize signs of severe distress Refer to a specialist if necessary Address needs and concerns Gather accurate information Clarify concerns Formulate possible solutions to problems Provide practical assistance

28. COUNSELLING STEPS CONT’ Provide support Help rebuild social network Encourage client to seek external support Assist in overcoming support obstacles Facilitate coping Raise awareness of positive coping skills Enable client to identify negative coping Helps client mange anger

29. COMMUNICATION WITH ADOLESCENTS Create a good, friendly first impression. Demonstrate a frank and honest willingness to understand and help Congratulate adolescent for seeking help. Eliminate barriers to good communication. Avoid judgmental responses of body or spoken language. Respond with impartiality, respecting the adolescent’s beliefs, opinion and diversity or expressions regarding his sexuality. Use appropriate tone of voice Respond simply

30. SEQUENCE OF CONVERSATION AMONG ADOLESCENTS(HEADS) Home Where do they live With whom do they live Whether they have seen recent changes in their home situation. How they perceive their home situation

31. SEQUENCE FOR CONVERSATION AMONG THE ADOLESCENTS(HEADS) Education/Employment Whether they study/work How do they perceive their performance How do they perceive their relations with teachers and colleagues Any recent change in situation What they do during their breaks

32. SEQUENCE FOR CONVERSATION AMONG THE ADOLESCENTS(HEADS) Eating patterns/habits How many meals they have on a normal day What meals they eat each day. What they think and feel about their bodies

33. SEQUENCE FOR CONVERSATION AMONG THE ADOLESCENTS(HEADS) Activity and leisure time Which activities are they involved in outside study/work What do they do in their free time during week days and on holidays Whether they spend some time with family members and friends

34. SEQUENCE FOR CONVERSATION AMONG THE ADOLESCENTS(HEADS) Drugs/substance abuses Do they use tobacco, alcohol or other substances. Whether they inject substances If they use any substances, how much do they use, where, when and with whom

35. SEQUENCE FOR CONVERSATION AMONG THE ADOLESCENTS(HEADS) Sexuality What do they know about SRH What do they know about their menstrual periods Any questions and concerns that they may have about menstrual periods. What are their thoughts and feelings about sexuality. Are they sexually active, if so, nature and context of their sexual activity

36. SEQUENCE FOR CONVERSATION AMONG THE ADOLESCENTS(HEADS) Sexuality Cont ’ Are they taking steps to avoid sexual and reproductive health problems. Have they encountered any of the problems such as unwanted pregnancy, infection, sexual coercion. If so, have they received any treatment What is their sexual orientation.

37. SEQUENCE FOR CONVERSATION AMONG THE ADOLESCENTS(HEADS) Safety Whether they feel safe at home, in the community, place of work or study. What makes them feel unsafe

38. SEQUENCE FOR CONVERSATION AMONG THE ADOLESCENTS(HEADS) Suicide/depression Is their sleep adequate Do they feel unduly tired, whether they eat well How do they feel emotionally, have they had any mental health problems(depression) If so, have they received treatment. Have they had suicidal thoughts Have they attempted suicide

39. Principles for Working Effectively With Young People Understand the cultural sensitivities surrounding the provision of information and services to young people. Create awareness to communities on the need to be realistic and to give appropriate counseling. • Identify and encourage peer leadership and communication. Have links between health and community services for appropriate treatment for problems.

40. Maintain privacy and good environment. Maintain confidentiality.

41. Life Planning Skills Life planning skills refer to the information that you impart to young people to help them cope with the life challenges they meet as they grow up. Life planning skills are very handy when counselling adolescents who are facing a dilemma and trying to make an informed choice or decision

42. Young people also need to develop certain skills to be able to make informed, responsible decisions about their sexual behavior. They need to learn how to resist pressure, be assertive, negotiate, and resolve conflict. peer counseling and peer education can be very effective in strengthening these skills and attitudes.

43. Life planning skills are divided into two components. Values and values verification, which depends on the personality of the individual • Decision making abilities, which depend on communication skills, for example: assertiveness and negotiation skills

44. Values and Values Verification They are beliefs, ideas or principles that determine who you are and how you behave. By introducing the concept of values, you help young people to identify values learned from families and communities. This helps them to explain and stand up for the values and behaviors that dictate their actions.

45. For example, a person who values their family cares about their spouse, children and home life. A person who values education will study hard and pass examinations. Values dictate the behavior of individuals. The individual learns to make decisions consistent with personal values. Values are held dear and encourage self esteem in the individual.

46. Unfortunately, some communities value practices such as wife inheritance, wife beating, female circumcision, and early girl child marriage. All of these may pose significant danger to the community in relation to reproductive health. As a healthcare provider, it is important that you discourage harmful values and advocate values that enhance good and sound health in the community.

47. some of the more common harmful practices that you need to discourage within the communities you work with Wife Inheritance Wife Beating Female Genital Mutilation Early Girl Child Marriage Polygamy Gender Violence

48. Good values you should attempt to reinforce within the communities you work with. Education of the Girl Child Abstinence Reinforcement of values and discipline in case of deviations

49. Community and Government Interventions to Improve the Health of Young People Advocating the recognition of reproductive health needs and rights of adolescents and the youth Establishing an understanding with youth advisory councils at all levels to coordinate and advise on youth and adolescent health

50. Developing specific messages for different target groups (parents, religious and other leaders, youths and adolescents) Implementing youth friendly and accessible RH services to enable the youth to seek services and receive counseling without barriers. Health providers should create a conducive environment when counseling and avoid biases that discourage youths from coming to the facility

51. Educating youths on their rights in order to help them attain the highest degree of health and self esteem. They should be sensitized to advocate against marriage at an early age, female circumcision, child abuse and so on. They should also advocate for the respect of good cultural values, access to RH services and the need for informed choice and privacy Conducting basic/applied research on youth and adolescent issues on regular basis and implementing the findings

52. Gender Issues and Reproductive Health Rights Gender inequality and discrimination refers to unequal access to power, resources and opportunities in society. Gender inequality and discrimination harms the health of young girls and women, directly and indirectly, throughout their life cycle.

53. Examples of Gender Inequalities Inequalities in education • Inequalities in the labour force • Access to medical care • Law of succession • Cultural practices (such as female genital mutilation, polygamy and wife inheritance) Preference for the Male Child

54. Female Genital Mutilation (FGM) This is also known as female circumcision. It is estimated that about 130 million girls are currently living with the effects of FGM. A further two million girls are at a risk of the practice. Societies that practice FGM believe that it is an initiation into adulthood and prevents the woman from becoming promiscuous

55. The Four Types of Female Genital Mutilation Circumcision which involves cutting of the prepuce or hood of the clitoris Excision which involves the cutting of the clitoris and all or part of the labia minora

56. Infibulation Which involves the cutting of the clitoris, labia minora, and part of labia majora. The two sides of vulva are then pinned together with silk, catgut sutures, or with thorns, thus obliterating the vaginal introitus except for a small opening, preserved by inserting a piece of wood or reed for passage of urine or menstrual blood. The girl’s legs are bound together from hip to ankle and she is kept immobile for 40 days to permit the formation of scar tissue

57. Intermediate , which involves the removal of the clitoris and some or all parts of the labia minora All of these operations present serious consequences to the reproductive health for girls and women

58. The Potential Health Consequences of FGM Medical complications such as haemorrhage , pain, pelvic infection, and painful intercourse. Complications of childbirth such as obstructed labour due to scarring of tissues Denies the woman enjoyment of sexual life as the clitoris plays a role in reaching orgasm

59. FGM also predisposes girls to early marriage since after the initiation they are considered mature and can get married. If contraception is not used, the girl may have many deliveries, which predisposes her to various risks, including cancer of the cervix