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RHO archives : Topics : Adolescent Reproductive Health

Annotated Bibliography

This is page 4 of the Adolescent Reproductive Health Annotated Bibliography. This page contains:

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Developing life skills

Advocates for Youth (formerly Center for Population Options). Life Planning Education: A Youth Development Program. Washington, DC : Advocates for Youth (1995). Copies may be ordered at: www.advocatesforyouth.org/publications/catalog.htm#lpe.

Available in English and Spanish, this curriculum is designed to help teenagers prepare for the decisions they will make about their health, sexuality, parenthood, and work. Specific chapters are dedicated to self-esteem, personal and family values, decision making and goal setting, sexuality and HIV/AIDS prevention, parenthood, and employment. Each chapter includes numerous hands-on exercises specifically geared toward adolescents, in addition to facts and information on the topic area. These experiential activities are designed to actively involve adolescents in the learning process. A specific section about life-planning education in Hispanic communities also is included.

Brady, M. Laying the foundation for girl's health futures: can sports play a role? Studies in Family Planning 29(1) (March 1998). The abstract for this article is available at www.popcouncil.org/publications/sfp/sfptoc.html.
This article discusses the potential for sports programs to assist girls in developing self-esteem, mastering new skills, and formulating a sense of bodily integrity. The author states that sports programs, which primarily are offered to boys, teach participants about teamwork, goal setting, the pursuit of excellence, and other achievement-oriented behaviors. The potential of these benefits to enhance girls' sexual decision-making skills and ability to negotiate the use of contraceptives is discussed. The author encourages youth advocates, program planners, and health services to offer programs such as sports activities that enable girls to take more control over their lives. 

Gage, A. Sexual activity and contraceptive use: the components of the decision-making process. Studies in Family Planning 29(2) (June 1998). The abstract for this article is available at www.popcouncil.org/publications/sfp/sfptoc.html.
The decision-making process involves a series of choices that are influenced by numerous factors. Among adolescents, influencing factors include education, employment history, relationship status, potential history of abuse, peer pressure, and family values. Drawing primarily on literature from sub-Saharan Africa, this article focuses on three adolescent behavioral outcomes: nonmarital sexual activity, contraceptive use, and condom use. The article explores adolescents' perceptions of the costs and benefits of engaging in these behaviors, assessments of their susceptibility to the potential consequences of their actions, and the role of family, peer, and dyadic factors in their reproductive decisions. The literature reveals that cultural values about sexuality and gender roles, the power dimensions of adolescents' lives, and economic disadvantages have a powerful influence on adolescents' decision-making processes.

Hughes, J. and McCauley, A. Improving the fit: adolescents needs and future programs for sexual and reproductive health in developing countries. Studies in Family Planning 29(2):233–245 (June 1998).
Adolescents need expanded information, skills, and services to address their sexual and reproductive health needs. This article focuses on health programming approaches for adolescents. The authors believe that programming is one of the factors most susceptible to change in the short term, and therefore able to adapt to experimentation, assessment, and a variety of approaches. The article describes the poor fit between current programs and adolescents' needs, reviews relevant behavioral theories of adolescent development, and discusses resource constraints on the provision of adolescent reproductive health programming. Six programming principles are suggested as tools for designing expanded sexual and reproductive health programs for young people. The article concludes that programs must be flexible if they are to meet the various needs of young people at a reasonable cost and in sufficient number.

Keller, S. Pressures influence contraceptive use. Network 17(3) (Spring 1997). Available online at www.fhi.org/en/fp/fppubs/network/v17-3/nt1737.html.
This article discusses the importance of health care providers' understanding of the psychological and social pressures faced by young adults. The author explores the manner in which lack of self-esteem and confidence, particularly among girls, interferes with healthy reproductive behaviors (such as saying "no" or seeking contraceptive services). Similarly, skills such as clarifying values, making decisions, and asserting rights and opinions are important, and can be taught by health care providers and counselors. Increased awareness of these issues and the ability to address them can help programs provide contraceptive services and counseling more effectively.

WHO Programme on Mental Health.The Development and Dissemination of Life Skills Education: An Overview. Geneva: WHO (1994).
This paper provides case studies of major life-skills education initiatives for children and adolescents that have been developed around the world. It also includes key observations that can be drawn from the review of program development and dissemination. Lessons learned include the following: (1) programs should avoid duplication of efforts, as life-skills education may be included in both health-promotion and prevention-education programs; (2) programs must be flexible in their design because the nature of life-skills education depends on the age group that is targeted and the setting; (3) life-skills education is most effective in long-term programs; (4) life-skills programs should start with children as young as 5 or 6 years old; (5) the involvement of parents, the community, and key religious or cultural figures can improve sustainability; and (6) ongoing teacher training is essential to long-term survival of life-skills programs. The document is oriented toward people working at a national level who wish to develop life-skills programs and learn about initiatives that have been undertaken in other countries.

WHO Programme on Mental Health. Life Skills Education in Schools. Geneva: WHO (1997).
Analysis of the life-skills field suggests that there is a core set of ten skills that children and adolescents need to master: decision making, problem solving, creative thinking, critical thinking, effective communication, interpersonal relationship skills, self-awareness, empathy, coping with emotions, and coping with stress. This publication presents conceptual and practical frameworks for life-skills program development. The materials focus on the teaching of life skills to children and adolescents in schools, but can be adapted for programs that target children who are not in schools as well as adults. Part 1 addresses the importance of life-skills education for psychosocial competence, and Part 2 presents guidelines for developing and implementing life-skills programs. An appendix includes samples of life-skills lessons.

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Reaching underserved adolescents

Alauddin, M. and MacLaren, L. Reaching newlywed and married adolescents. In Focus (July 1999). Available at: http://pf.convio.com/pf/pubs/focus/IN%20FOCUS/reach_newlywed_married.htm. Young married couples, particularly those in which the wife is still an adolescent under the age of 19, often are overlooked by family planning programs. The majority of births to adolescent women, however, occur within wedlock. This article outlines the benefits of reaching out to newlywed and married adolescents, such as decreased maternal and infant health risks. It also discusses the barriers that programs may encounter while trying to reach married adolescents with reproductive health and family planning services. Such barriers may include social and religious norms and women's lack of empowerment. Strategies that can be used to reach married adolescents include re-orienting reproductive health professionals to identify, motivate, and serve married adolescents, and raising awareness of newlyweds' needs throughout the adolescent population, their communities, and on the national level.

Barnett, B. Family planning rarely available for refugees. Network 15(3):4–8 (March 1995).
This article describes the need for and challenges of providing reproductive health services to refugees and displaced persons. Worldwide, there were an estimated 18 million refugees and 24 million displaced persons in 1995; more than 80 percent of these were women and children. Because services for refugees typically are designed to meet emergency health needs such as the provision of clean water, food, and disease treatment, reproductive health services often are limited to care for pregnant women. However, refugee women who are not pregnant, particularly adolescents, require services that address their long-term health needs. Refugees and displaced persons require access to contraceptive methods, STI prevention and treatment, training for traditional birth attendants, treatment of incomplete abortions, and family planning services. The article examines the challenges that face health workers, including limited supplies, lack of provider training, and the low status of women in refugee camps. The article concludes by discussing two key elements of successful programs: considering refugees' contraceptive use patterns and beliefs before migration, and involving refugees and displaced persons in the design and delivery of services.

Blum, R.W. Sexual health contraceptive needs of adolescents with chronic conditions. Archive of Pediatrics & Adolescent Medicine 151:290–297 (March 1997).
Except for the most severely impaired individuals, adolescents with disabilities are no less likely to be sexually active than their peers. This article states that adolescents with disabilities have the same social and sexual aspirations as their peers. Because their parents may not provide sufficient sex education, disabled adolescents need information about sexuality, reproduction, contraception, and STI/HIV prevention from their health care providers. The author states that sexual problems among disabled adolescents are more likely to result from their isolation than from physical impairment. Information about contraception for people with mental retardation and chronic physical disabilities is presented. The author concludes that clinicians should provide contraceptive guidance and sexual health information to their disabled adolescent clients.

Boyd, B. and Moore, C. Reaching young men with reproductive health programs. In Focus (December 1998). Available at: http://pf.convio.com/pf/pubs/focus/IN%20FOCUS/ReachingYoungMen.doc.
This article discusses the importance of helping men understand male and female reproductive health, and encourages them to adopt responsible sexual behaviors. Key issues related to young men's reproductive health, such as sexuality, safe sex, condoms, and other contraceptives, are discussed. Important components of reproductive health programs that target young men include a focus on young men's needs and their social and economic advancement. Specific examples of program approaches used in different countries are outlined, including multipurpose youth centers, peer education and counseling, male-friendly clinics, social marketing, and workplace programs.

Farell, M.M. et al. Reaching indigenous youth with reproductive health information and services. In Focus (February 1999). Available at: http://pf.convio.com/pf/pubs/focus/IN%20FOCUS/Indigenous.htm. This article discusses the importance of focusing on indigenous youth and their specific reproductive health needs. Indigenous youth face the same barriers to reproductive health services as other youths but they also encounter additional obstacles because of their indigenous roots. They often dwell in less accessible places, and they may speak only their native language. The problems indigenous youth typically face include marginal political and legal status, lower literacy and educational attainment rates, less access to economic opportunities and employment, less access to health services, lower knowledge about reproductive health, and earlier marriage and childbearing. The publication highlights efforts to reach this group of young people such as bilingual teacher training, services aimed at female factory workers, and specialized clinic services that include separate hours. A list of the future needs for programs and services for indigenous youth also is included.

Filgueiras, A. Needs of Rio street children. Planned Parenthood Challenges 2:22–24 (1993).
Millions of children and adolescents live on the streets of urban Brazil and are overlooked by existing social services. Many of these children are from poor, single-parent households that could not support them; others have run away from abusive or violent environments. This article states that most of these street youth engage in sexual activity at an early age, and that many are forced into prostitution as a means of survival. Street adolescents are vulnerable to pregnancy and illegal abortion, and their lack of education often prevents them from developing literacy skills or learning about sexuality and contraception. The author states that services urgently are needed to provide street children and adolescents with shelter, food, education, and health services that address their special needs. Such services should include outreach programs, educational strategies and materials, and legal advocacy resources.

Gill, K., Gryboski, T., and Murphy, E. "Reaching Married Adolescents: Implications for Health Reform and Advocacy Reform." Presentation at the International Conference on Safe Motherhood Best Practices, New Delhi, India (October 3–6, 2002).
This presentation examines what can be done to address the needs of married adolescents. It urges advocates to collect and use disaggregated data on married women, ensure representation of married adolescents in health reform, and promote their needs in reproductive health services.

Lessons from community-based distribution in Africa. Population Briefs 5(2):2 (June 1999). [Based on a longer paper by Phillips, J.F. et al. "Lessons from community-based distribution of family planning in Africa." Policy Research Division Working Paper No. 121. New York: Population Council.]
This brief article discusses the role of community-based distribution of contraceptives to people who do not have convenient access to a clinic and those who fear their family's or community's disapproval. The article emphasizes the need to tailor the type of community-based distribution used to the specific community at hand. It also characterizes three different types of community-based distribution: programs that distribute contraceptives from a fixed delivery point to clients motivated to use family planning; home-outreach efforts aimed at people who do not seek services; and programs that mobilize entire communities, rely heavily on volunteers to provide a broad range of services, and utilize guidance of leaders. Elements of successful experiences of community-based distribution include community involvement and paid (rather than volunteer) workers. The article concludes by stating that community-based distribution programs are feasible in Africa, but that they need to overcome social barriers and tailor their strategies to each setting.

Malamud, S. At risk and abandoned: street children, AIDS and human rights. AIDSLINK 31:6–7 (January–February 1995).
This article describes the experience of Covenant House in Latin America. When Covenant House was established in the late 1960s, its mission was to end the harassment and murder of homeless street children by authorities. The article provides profiles of these young people, many of whom are on the street as a result of abandonment, child abuse, and poverty. In a study of 143 street children in Guatemala between the ages of 7 and 17 years, for example, 100 percent had been sexually abused. Covenant House has broadened its focus to address the crisis of AIDS in this group of children, and street educators include information on AIDS in their outreach efforts. The organization's strategy now includes using the media and mobilizing other organizations to pressure governments to stop violence against street children.

Marques, M. et al. Gente Joven/Young People: A dialogue on sexuality with adolescents in Mexico. Quality/Calidad/Qualit No. 5 (1993).
This issue, which is available in English and Spanish, describes the experiences of Mexfam, the Mexican Family Planning Foundation, which develops programs for young people. Mexfam began its Gente Joven program by opening special centers for adolescents and offering activities to attract young people in addition to providing sex education and family planning information. After the program had grown to 13 centers, an evaluation found that the activities benefited only a limited number of adolescents who were already highly motivated, and that the cost of expanding the program to meet the growing population would be unfeasible. The evaluation also revealed that many Mexican adolescents were sexually active only sporadically and preferred barrier methods. Youth expressed a strong desire for a more active role in designing and implementing the programs. As a result of these findings, Mexfam closed the centers, revised the program, and began to reach out to adolescents where they were—in schools, colleges, sports and recreational centers, and on the streets. The article's epilogue explores the challenge of incorporating a gender perspective into this work.

Mathur S et al. Too Young to Wed: The Lives, Rights and Health of Young Married Girls. Washington, DC: ICRW; 2003.
This policy advisory gives an overview of the issues surrounding married adolescents such as early childbearing, unwanted pregnancy, and reproductive and sexually transmitted infections. It also gives a backdrop as to why early marriage could be socially and culturally accepted as well as economically necessary. The last section gives these programmatic and policy responses: ways to delay marriage, addressing the needs of married youth, and improving the education and economic options for young married women.

Mita, R. and Simmons, R. Diffusion of the culture of contraception: program effects on young women in rural Bangladesh. Studies in Family Planning 26(1):1–13 (January–February 1995).
This article explores the processes through which information about contraception is disseminated throughout communities. Prompted by one woman's story of how a community-based family planning worker affected her village, the authors conducted four focus-group sessions that examined the relationship between women's status and the availability, accessibility, and use of contraceptive methods. The discussions showed that many young, unmarried women learn about family planning from community-based family planning workers, as well as from female relatives, peers, and the media. The participants' experiences suggest that young women may be greatly interested in contraceptive use early in their married lives. The authors conclude that greater attention should be paid to the contraceptive needs of young women, particularly women who have little exposure to the outside world.

Ryan, C. and Futterman, D. Lesbian and gay youth: care and counseling. Adolescent Medicine: State of the Art Reviews 8(2):207–374 (June 1997).
This extensively researched and comprehensive issue of Adolescent Medicine addresses the primary care needs of gay and lesbian adolescents. This guide is designed to help clinicians effectively and appropriately provide quality care to lesbian, gay, and bisexual youth and their families. It provides an overview of adolescent health challenges, lesbian and gay identity development, vulnerability, and confidentiality/legal issues. It also addresses the health concerns of lesbian and gay adolescents, particularly HIV/AIDS. The authors state that, like all adolescents, lesbian and gay adolescents face many health challenges. In addition to their heterosexual peers, however, they face unique vulnerabilities, discrimination, and health risks. Gay and lesbian adolescents therefore are in need of high-quality care, confidentiality, and support. This issue includes six appendices that provide resources for adolescents, parents, and providers concerned with lesbian and gay issues.

Sikes, O.J. Approaches to adolescent reproductive health: audience-specific strategies. International Journal of Health Promotion and Education 3(3):15–17 (September 1996).
This article suggests to IEC and health services personnel that adolescents should be identified into subgroups in order to communicate effectively and respond to diverse needs. It stresses the importance of reaching married adolescents and those living together, couples who are often overlooked in reproductive health programs and have different needs from their peers.

Stevens, C. Reaching socially marginalized youth. In Focus (March 1999). Available at: http://pf.convio.com/. This article discusses the realities and challenges of reaching a group of youth characterized as "socially marginalized." These youth often have weakened or severed family ties and lack connection to institutions such as schools, youth clubs, or a formal workplace. They are vulnerable to sexual exploitation and are at disproportionately high risk of unintended pregnancies and STIs, including HIV/AIDS. They often lack access to reproductive health information, counseling, legal protection, and health and other services. Reaching these individuals requires special planning, advocacy efforts, and supplemental resources. Data on the numbers of socially marginalized youth in different countries are presented as well as mechanisms for reaching, serving, and advocating for this group of young people.

WHO. Substance abuse among street children and other children and youth in especially difficult circumstances. Fact Sheet No. 151 (March 1997).
Young people from problematic backgrounds, referred to in this article as "children and youth in especially difficult circumstances," are more vulnerable and thus more likely to begin, continue, or escalate their risk taking. This paper examines statistics associated with this group of young people, particularly street children. It states that there are between 10 and 30 million street children worldwide, with the largest populations in Latin America, Asia, Africa, and Central and Eastern Europe. The article discusses street youths' vulnerability to substance use and abuse; between 25 and 90 percent of street children use substances of one kind or another. Finally, the article describes WHO's Programme on Substance Abuse, which was developed to assess the nature and extent of the problem of street children and substance abuse in individual communities in order to develop and implement appropriate responses.

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Gender-specific issues

(Also see the Annotated Bibliography for RHO's Gender and Sexual Health section.)

Barnett, B. Gender norms affect adolescents. Network 17(3):10–13 (1997). Available online at www.fhi.org/en/fp/fppubs/network/v17-3/nt1733.html.
This article emphasizes the importance of incorporating a gender perspective into sexuality education, service delivery, and provider-training programs. The author explores the impact of gender on adolescents, particularly nutritional differences, pregnant girls dropping out of school, coerced or survival sex, female genital mutilation, and double standards for sexual behavior. Educational health programs have begun asking adolescents to rethink gender roles and stereotypes, and some reproductive health programs are trying to involve men.

Finger, W. Some cultures tolerate risky male behaviors. Network 20(3):21–23 (Fall 2000).
This article explains how cultural norms can influence young men's sexual behavior and lead them to engage in unsafe sexual behavior. The article describes efforts in several developing countries to strengthen young men's ability and motivation to adopt healthier sexual behaviors. Tapping into young men's strengths, providing accessible information and services, and encouraging appropriate media messages are discussed as important strategies for encouraging responsible male sexual behavior.

International Center for Research on Women (ICRW). Vulnerability and Opportunity: Adolescents and HIV/AIDS in the Developing World. Washington, DC : ICRW (1996).
Approximately half of all HIV infections have occurred in men and women younger than age 25, and, in many developing countries, data indicate that up to 60 percent of new HIV infections are among 15- to 24-year-olds, with females outnumbering males by a ratio of two to one. Although many factors that influence sexual risk among young people (such as lack of information and services) have been identified, this paper argues that factors are not gender-neutral. Social, cultural, and economic forces result in gender differences in sexual experience and expectation, as well as in the ability to adopt HIV/STI preventive behaviors.

Kim Y.M., Kols A., Nyakauru R., et al. Promoting sexual responsibility among young people in Zimbabwe. International Family Planning Perspectives 27(1):11–19 (March 2001).
This article highlights a 1997–98 multimedia campaign promoting sexual responsibility among young people in Zimbabwe, while strengthening their access to reproductive health services by training health care providers. Baseline and follow-up studies, each involving approximately 1,400 women and men aged 10 to 24, were conducted in five campaign and two comparison sites. The campaign reached 97 percent of the youth audience. Awareness of contraceptive methods increased in campaign areas, but general reproductive health knowledge changed little. As a result of the campaign, 80 percent of respondents had discussions about reproductive healthwith friends (72%), siblings (49%), parents (44%), teachers (34%), or partners (28%). In response to the campaign, young people in campaign areas were 2.5 times as likely as those in comparison sites to report saying no to sex, 4.7 times as likely to visit a health center, and 14 times as likely to visit a youth center. Contraceptive use at last sex rose significantly in campaign areas (from 56% to 67%); launch events, leaflets, and dramas were the most influential campaign components. The study concludes that a multimedia approach increases the reach and impact of reproductive health interventions directed to young people. Building community support for behavior change also is essential, to ensure that young people find approval for their actions and have access to services.

Singh et al. Gender differences in the timing of first intercourse: data from 14 countries. International Family Planning Perspectives 26(1):21–28, 43 (2000). Available online in English, Spanish, or French at www.agi-usa.org/pubs/journals/2602100.html.
This study analyzes data from the most recent nationally representative surveys of reproductive behavior in 14 regionally diverse countries  to assess regional variations in young people's sexual behavior. Analyses focus on adolescents age 15 to 19. The study found that, in most countries, roughly one-third or more of teen women have had intercourse; in four countries (Ghana, Mali, Jamaica, and Great Britain), approximately three in five are sexually experienced. Between approximately one-half and three-quarters of adolescent males in seven countries have ever had intercourse, but the proportion is one-third or less in Ghana, Zimbabwe, the Philippines, and Thailand. In most countries, sexual intercourse during the teenage years occurs predominantly outside marriage among men, but largely within marriage among women. Never-married young people are considerably less likely to be currently sexually active than to be sexually experienced. For example, in Ghana, 49 percent of never-married adolescent women have had intercourse, but only 23 percent have done so within the past month. The article concludes that in most of these countries, a high proportion of adolescents potentially are at risk for a range of poor reproductive health outcomes. Program planners must find ways to help sexually active adolescents consistently use effective means of protection against both pregnancy and sexually transmitted diseases.

United Nations. The World's Women 1995: Trends and Statistics. Series K, No. 12. ST/ESA/STST/SER.K/12. New York: United Nations (1995).
This 188-page statistical sourcebook presents and interprets statistics on women and men in light of the issues and objectives raised in UN-organized global forums. The six chapters cover education, population, public life, health, childbearing, and work, and provide a picture of how women fare in different parts of the world. It is a collaborative effort of the many UN bodies concerned with promoting women's equality and participating in development.

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Sexual violence and youth

Jejeebhoy S, Bott S. Non-consensual Sexual Experiences of Young People: A Review of the Evidence From Developing Countries. New Delhi: Population Council; 2003. Regional Working Papers, No. 16. Available at: www.popcouncil.org/pdfs/wp/seasia/seawp16.pdf.
The Population Council collected various studies from around the world and found that youth experience non-consensual sex often and in many ways. From physical force to manipulative behavior of the perpetrator, youth are at risk of sexual coercion due to social acceptance, silence, and denial. This booklet looks at key recommendations to ending sexual violence against youth: (1) health services to address violence against youth; (2) sexuality education that counters traditional gender stereotypes and teaches youth awareness and skills to protect themselves from violence; (3) sensitization of parents, teachers, and other adults that youth go to; and (4) training health providers to appropriately deal with victims of sexual violence.

YouthNet. Nonconsensual Sex among Youth. Arlington, VA: YouthNet/FHI; 2004. YouthLens on Reproductive Health and HIV/AIDS, No 10. Available in English, French, and Spanish at: www.fhi.org/en/Youth/YouthNet/.
This article looks at gender norms that condone sexual coercion of young girls. Gender roles are so rooted into society, that girls have be taught that they have a right to refuse and protect themselves from coercive sex. The article also explains the physical and social consequences that victims of sexual coercion experience, such as adverse reproductive health and STI-related outcomes and mental health problems.

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Meeting the needs of married adolescents

International Center for Research on Women (ICRW). Policy Advisory on Child Marriage. Washington, DC: ICRW; 2003. Available at: www.icrw.org/photoessay/pdfs/childmarriage0803.pdf.
In this policy advisory, ICRW lays out the argument that child marriage endangers the lives of young girls and their children. ICRW introduces six approaches to ending child marriage to the US government: (1) educating parents and young people about their rights, and about laws and international norms; (2) educating parents and young people about the benefits of later marriage; (3) increasing girls’ access to, enrollment in, and completion of primary and secondary education and vocational training; (4) providing safe, non-exploitative employment opportunities outside the home; (5) tailoring reproductive health services to young married people and unmarried youth in countries with high incidence of child marriage; and (6) supporting further research on child marriage, its causes, and solutions.

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