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Adolescent sexual and reproductive health - Course files

Preventing early and unwanted pregnancy and pregnancy-related mortality and morbidity in adolescents

World Health Organization

From Research to Practice: Training Course in Sexual and Reproductive Health Research 2012

September 24, 2012 - Geneva

Preventing early and unwanted pregnancy and pregnancy-related mortality and morbidity in adolescents - World Health Organization

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World Health Organization. Preventing early and unwanted pregnancy and pregnancy-related mortality and morbidity in adolescents. Paper presented at: Training Course in Sexual and Reproductive Health Research; 2012 Sep 24; Geneva. Available from: http://www.gfmer.ch/SRH-Course-2012/adolescent-health/Adolescent-pregnancy-WHO-2012.htm

Topics covered in the module

  • What is the magnitude of adolescent pregnancy?
  • What are the consequences of adolescent pregnancy?
  • What are the circumstances in which adolescent pregnancy occurs?
  • What can be done to prevent early pregnancy and poor reproductive outcomes in adolescents?

Essential reading

WHO. WHO guidelines on preventing early pregnancy and poor reproductive health outcomes. WHO. Geneva. 2011.

The Guidelines provide both a call to action and directions for future research on preventing early pregnancy: by preventing marriage before 18 years of age; by increasing knowledge and understanding of the importance of pregnancy prevention; by increasing the use of contraception; and by preventing coerced sex; and preventing poor reproductive outcomes: by reducing unsafe abortions; and by increasing the use of skilled antenatal, childbirth and postnatal care.

They are primarily intended for policy-makers, planners and programme managers from governments, nongovernmental organizations and development agencies. They are also likely to be of interest to public health researchers and practitioners, professional associations and civil society organizations.

They have been developed through a systematic review of the evidence and through consultation with policy-makers, programme managers and front-line workers from countries around the world, in partnership with many key international organizations working in this field - the Guttmacher Institute, the International Center for Research on Women (ICRW), FHI 360), the Population Council, and Centro Rosarino de Estudios Perinatales, CREP (Argentina).

Their development has been supported financially by the United Nation Population Fund (UNFPA), the United States Agency for International Development (USAID), and the International Planned Parenthood Federation. (IPPF) Similar partnerships have been forged to distribute them widely and to support their use.

Additional materials

WHO. Orientation programme on adolescent health for health-care providers. WHO. Geneva. 2006.

Module J is titled: Pregnancy prevention in adolescents.

Module H is titled: Care of adolescent pregnancy and childbirth

A range of individuals and institutions have important roles in promoting healthy development in adolescents, and in preventing and responding to health problems challenging this population group. Health-care providers (HCP) have important contributions to make in both these areas. However, situation analyses and needs assessment exercises carried out in different parts of the world point to shortcomings in their professional capabilities and in their 'human qualities' as a result of which they are unable and oftentimes unwilling to deal with adolescents in an effective and sensitive manner. To bridge this gap, the Department of Child and Adolescent Health and Development (CAH) of the World Health Organization (WHO) is developing the Orientation Programme on Adolescent Health for Health-care Providers (OP) with other partners. The OP is a joint effort of the Commonwealth Medical Association Trust, UNICEF and WHO.

The materials consist of a handout for participants and of a facilitator's guide for the overall course (course director guide) and for all the modules. It provides detailed guidance on how to run each module. In addition it contains tips for the trainers, lecturing aids such as overhead slides in electronic form with accompanying talking points and study materials. Facilitator's guide, handouts for participants, the lecturing aids and study materials are all available on a CD ROM. The Orientation programme is available in English, French and Russian.

WHO. Adolescent job aid: a handy desk reference tool for primary level health workers. WHO. Geneva. 2010.

The Adolescent Job Aid contains three algorithms on adolescent pregnancy:

  1. I do not want to get pregnant !
  2. Could I be pregnant ?
  3. I am pregnant !

The Adolescent Job Aid is a handy desk reference tool for health workers (trained and registered doctors, nurses and clinical officers) who provide services to children, adolescents and adults. It aims to help these health workers respond to their adolescent patients more effectively and with greater sensitivity. It provides precise, step-by-step guidance on how to deal with adolescents when they present with a problem or a concern about their health or development.

It comprises three main parts:

  • Part 1: The clinical interaction between the adolescent and the health worker.
  • Part 2: Algorithms, communication tips and frequently asked questions on 25 presentations related to developmental conditions, pregnancy-related conditions, genital conditions including sexually transmitted infections, HIV and other common presentations.
  • Part 3: Information for adolescents and their parents or other accompanying adults on important health and development issues.

The Adolescent Job Aid is intended to be used along with the Orientation Programme on Adolescent Health, a tool which is being used in many countries.

Assignment

  1. Read the following six stories. Identify which one/ones would be true in your country.
  2. Read the policy brief. If you were asked to identify three priority actions which ones would they be and why?

The story of Zohra

Zohra is 12 years old. She lives in a small town of Pakistan.
Her father has a low paid job in a small factory. Her mother is a home maker.
Like other girls in her community, Zohra is likely to be withdrawn from school when she starts her periods and to be married off to a man chosen by her parents.

The story of Maha

Maha is 15 years old. She is from Egypt. She studies in all girls school.
Maha is embarrassed by all the changes taking place in her body, and confused by the feelings she is having. She tried to speak to her mother about this without success.
There is no sexuality education in her school (apart from a brief discussion on anatomy and physiology in biology). But Maha has learned many things from whispered exchanges with her friends in the play ground.

The story of Galina

Galina is 15 years old. She lives in a small town of Ukraine. Galina is in secondary school and plans to go to university.
One Friday evening, after a birthday party, Galina had sex with her boyfriend Ivan. They did not have condoms, but got carried away by the passion of the moment.
It is Saturday evening now. Galina and Ivan are sick with worry. They have been trying hard to get emergency contraception. The government clinic where they could get this for a subsidised charge is closed for the weekend. The private pharmacies in town have them in stock but they are very expensive.

The story of Julie

Julie is 17 years old. She lives in Uganda.
Julie is an attractive and friendly girl. She is also a good student but has difficulties with maths. She nearly failed her mid year exam. She desperately wants to do well in her final exam and so asks her maths teacher for help. He agrees to help her and asks her to stay back at the end of the school day for special lessons.
Julie finds these lessons very useful. She says so to her parents and to her teacher.
After two weeks of these lessons, one day her teacher starts to touch her and to say things that confuse her. Julie does not know what to do…

The story of Ayleen

Ayleen is 19 years old. She lives in the Philippines.
Ayleen works in a call centre. Her boyfriend Henry – who is 23 – also works in the same call centre.
Ayleen and Henry are having sex regularly. From a friend Ayleen learned about the withdrawal method. She (or they) have been using this method to avoid a pregnancy.
Ayleen discovers that she has missed her periods. A check up shows that she is pregnant. She and her boyfriend are both shocked. This would be a big scandal and a huge shock for their staunchly Catholic parents. They want to have an abortion, but learn that it is illegal. One of Ayleen's friends tells her that she knows a place where she can have an abortion.

The story of Priya

Priya is 19 years old. She lives in a small town in Central India with her husband and his family.
Priya is pregnant. She is both happy and a little afraid because of this.
She wants to go to the local clinic for an antenatal check up, just like her elder brother's wife had done when she was pregnant.
Her mother-in-law does not believe this is necessary. She says that she had 8 children, all delivered at home, without any problems. Priya's husband agrees.