Op t imi s i n g a d o l e s c e n t s e x u a l a n d r e p r o d u c t i v e h e a l t h i n t h e S A D C r e g i o n Commonwealth Health Partnerships 2015 55 either being denied access because of their age, misinformed, threatened or not treated in confidence (SAGPA, 2014). HIVinfected adolescent mothers are less likely to receive the recommended PMTCT regimen than adult mothers (76.7 per cent vs 81.2 per cent), and infants born to adolescent mothers are more likely to be HIV-infected than those born to adults (Horwood et al., 2013). Mathews et al. (2009) showed that, although adolescents had better access to HIV testing at adolescent-friendly clinics, their overall experience at the clinic (HCW attitude and confidentiality) was poor. Research done by Geary et al. (2015) corroborates these findings and highlights several service provision gaps during HCW–adolescent consultations: sexual history was not taken; counselling and testing for HIV/sexually transmitted infections (STIs) was not offered; condom usage was not demonstrated; HCWs’ attitudes were negative; and implementation of national family planning guidelines was sub-optimal. Unsafe sexual behaviour: Age of sexual debut, number of partners and condom use influences acquisition of STIs. Research among adolescent males in Malawi and Lesotho found increased risk of early sexual debut (less than 15 years), compared to females. Furthermore, males aged 15–24 years in Lesotho, Madagascar and Mozambique were more likely to have multiple partners. Adolescent females in most SSA countries report lower use of condoms compared to males, raising questions around gender inequality, sexual violence and coercion (UNFPA, 2012). Early sexual debut with limited family planning availability resulting in teenage pregnancy: Of the 16 million annual births to adolescent girls globally, 95 per cent occur in developing countries (WHO, 2011). The adolescent birth rates in SADC countries are amongst the highest in SSA. The Democratic Republic of the Congo, Swaziland, Zambia, Tanzania and Madagascar are within the top 20 SADC countries with the highest prevalence of early childbearing (Unicef, 2012). Early pregnancy is associated with negative pregnancy outcomes for mother and infant: in developing countries, adolescents below 15 years of age are five times more likely (and two times in the 15–19 age group) to die during childbirth compared to women aged 20 years and over (UNFPA, 2012). Next steps Kågesten et al. (2014), in a review on the impact of adolescentfocused interventions, 1998–2013, found only ten publications and concluded that the long-term impacts of adolescent health programmes, including SRH services, are not known. Research in Mongolia found that the most important determinant of youthfriendly service success was adolescent acceptability/privacy of the health service (Sovd et al., 2006). Research in South Africa found that, despite scale up of youth-friendly services, implementation was less than optimal, resulting in no significant impact of youthfriendly services on utilisation (Geary et al., 2014). Notwithstanding this, Sutton et al. (2014) highlighted the importance of the following: • Parents’ education • Health care provider education • Parent–child interaction • In-school and out-of-school adolescent programmes • The use of popular media to promote adolescent health We recommend that SADC countries prioritise seven areas to improve adolescent SRH in the region (see Box: ‘Priorities for improving adolescent SRH’). We also propose that mobile/outreach health services should play a bigger role in adolescent health care. This should be supplemented by an essential fixed service run by respectful, friendly health care providers. Conclusion Adolescent health is a global priority (WHO, 2014). Adolescent health services should focus on SRH as part of a comprehensive life-course approach with emphasis on risky behaviours to prevent injuries, maintain physical and mental health, and prevent chronic non-communicable adult diseases. Fixed and mobile adolescent services by formal and community health care providers should be explored for acceptability and impact. The demand for adolescent health services should be created by advocacy within communities and through community or faith-based organisations. References Bearinger, L. H., Sieving, R. E., Ferguson, J. et al., 2007. ‘Global perspectives on the sexual and reproductive health of adolescents: Patterns, prevention and potential’. The Lancet, 369, pp. 1220–1231. CRC (Committee on the Rights of the Child), 2003. General Comment No. 4: Adolescent Health and Development in the Context of the Convention on the Rights of the Child. Geneva: United Nations High Commissioner for Human Rights. Duvall, S., Thurston, S., Weinberger, M. et al., 2014. ‘Scaling up delivery of contraceptive implants in Sub-Saharan Africa: Operational experiences of Marie Stopes International’. Global Health: Science and Practice, 2 (1), pp. 72–92. Geary, R. S., Webb, E. L., Clarke, L. and Norris, S. A., 2014. ‘Evaluating youth-friendly health services: Young people’s perspectives from a simulated client study in urban South Africa’. Global Health Action, 8. Horwood, C., Butler, L. M., Haskins, L. et al., 2013. ‘HIV-infected adolescent mothers and their infants: Low coverage of HIV services and high risk of HIV transmission in KwaZulu-Natal, South Africa’. PLos ONE, 8 (9), e74568. Kågesten, A., Parekh, J., Tunçalp, Ö. et al., 2014. ‘Comprehensive adolescent health programs that include sexual and reproductive health services: A systematic review’. American Journal of Public Health, 104 (12), pp. 23–36. Koon, A. D., Goudge, J. and Norris S. A., 2013. ‘A review of generalist and specialist community health workers for delivering adolescent health services in Sub-Saharan Africa’. Human Resources for Health, 11, p. 54. Mathews, C., Guttmacher, S. J., Flisher, A. J. et al., 2009. ‘The quality of HIV testing services for adolescents in Cape Town, South Africa: Do adolescent-friendly services make a difference?’. Journal of Adolescent Health, 44, pp. 188–190. Morse, J., Chipato, T, Blanchard, K. et al., 2013. ‘Provision of longacting reversible contraception in HIV-prevalent countries: Results from nationally representativesurveys in southern Africa’. BJOG, 120 (11), pp. 1386–1394. SAGPA (Southern Africa Gender Protocol Alliance), 2014. SADC Gender Protocol 2014 Barometer, chapter 6: Health webpage Gender Links. Available at: www.genderlinks.org.za/attachment. php?aa_id=19383 Accessed 20 Feb 2015 Sovd, T., Mmari, K., Lipovsek, V. and Manaseki-Holland, S., 2006. ‘Acceptability as a key determinant of client satisfaction: Lessons
Commonwealth Health Partnerships 2015
To see the actual publication please follow the link above