Meeting the Needs of Young Clients:
A Guide to Providing Reproductive Health Services to Adolescents

Chapter 1:  Adolescents: An Underserved Population

See Also:

Network 20.3: Adolescent Reproductive Health

We believe that information should be given as early as age 10 to 12 because they are practicing sex at an early age." ­ ---Peer health educator in Ethiopia

Adolescence is the transition from childhood to adulthood, marked by profound physical, emotional, mental and social changes.

In this manual, we define adolescence as the time period from ages 10 to 24. We use the terms "adolescents," "youth," "young adults" and "young people" interchangeably. In such a broad age range, reproductive health needs can vary greatly. The needs of a 10-year-old who has not yet reached puberty and who is not sexually active will be considerably different from those of an 18-year-old who is newly married, or a 24-year-old with two children. As a health-care provider, you should individually assess the reproductive health status, goals and needs of each adolescent.

Change is the hallmark of adolescence. Physical changes, such as growth of facial hair for boys and onset of menstruation for girls, take place during puberty, which occurs mostly from ages nine to 14 for boys and ages eight to 13 for girls. Emotionally, young people move toward independence from their parents or elders and establish new interests and relationships.

As adolescents become adults, they consider sexual relations, marriage and parenthood as signs of maturity. They seek information and clues about sexual life from a variety of sources ­ parents, peers, religious leaders, health providers, teachers, magazines, books and mass media. While youth receive a wealth of information from diverse sources, a good deal of that information is incorrect, incomplete or misleading.

Adolescents obtain information and make decisions within the context of the culture in which they live. Decisions and actions may be affected by violence, drug and alcohol use, school attendance, work, economic opportunities, self-image and autonomy in decision-making.

As a service provider, you can be a valuable source of accurate information for young women and men. You can offer facts and reassurance, answer questions and provide a variety of health services.

There are two main reasons reproductive health programs should offer information and services to adolescents:

• Young people have a right to quality reproductive health services.
• Young people need reproductive health services.

Adolescents' needs for reproductive health services are often misunderstood, unrecognized or underestimated. Consider:

• Nearly half the world's population is under age 25.
• Adolescents account for approximately 10 percent of all births worldwide. Each year 15 million girls ages 15 to 19 have babies.
• Girls under 16 years old are twice as likely to die in childbirth as women in their early twenties.
• Two to four million adolescents in developing countries have unsafe abortions each year.
• Eleven percent of young women ages 15 to 19 have an unmet need for contraception.
• Nearly half of all HIV infections worldwide occur in people under age 25.
• Seven in 10 new STIs occur among individuals 15 to 24 years old.

Young people's reproductive health needs vary. Depending on their individual situation, they may need:

• Skills and motivation to help them postpone sex.
• Information, skills and contraceptives to protect themselves against STIs and unplanned pregnancies.
• Counseling to encourage them to change risky behaviors.
• Information to help them delay and space pregnancies.
• Information about and support for prenatal care, child nutrition and breastfeeding.
• Information and support during labor and delivery.
• Protection from violence, forced sex or sexual coercion.

Health services can help adolescents:

• Protect and improve their current health.
• Understand their sexuality and reproductive health needs.
• Learn to take active responsibility for their reproductive health.
• Prevent unplanned pregnancies.
• Prevent serious health problems and premature deaths due to complications from a too-early pregnancy or an unsafe abortion.
• Avoid STIs.
• Make informed choices about reproductive health.
• Ensure a healthy future.

Questions for Providers and Program Managers about Underserved Adolescents

? How is adolescence defined in your community? ? Where do adolescents in your community obtain information about sexuality and reproductive health? Who are the most credible sources of information? Do adolescents receive most of their information from these credible sources? ? What percentage of your clients are adolescents? ? What percentage of adolescent clients are married? What percentage are unmarried? ? What reproductive health services do you think adolescents in your community need? ? What types of services do you offer for adolescents? Do you offer education, services or both?

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