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The Importance of Addressing Adolescent Reproductive Health Issues

The Importance of Addressing Adolescent Reproductive Health Issues. Barthélemy Kuate Defo, PhD, MPH Professeur Titulaire, Université de Montréal Professeur-Chercheur, Centre de Recherche du CHUM

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The Importance of Addressing Adolescent Reproductive Health Issues

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  1. The Importance of Addressing Adolescent Reproductive Health Issues Barthélemy Kuate Defo, PhD, MPH Professeur Titulaire, Université de Montréal Professeur-Chercheur, Centre de Recherche du CHUM Fifth Annual Conference of the African Science Academy Development Initiative on “Improving Maternal, Newborn, and Child Health in Sub-Saharan Africa”, Accra (Ghana), 10-11 November 2009

  2. What is at stake? Maternal mortality: greatest divide [developed vs. developing world] = average lifetime risk of pregnancy/childbirth-related death of 1/300. Our societies, communities and families have failed women/young women vs. their children. 15/01/2008: new target (5.B) to have universal access to reproductive health by 2015 to MDG 5 “Improve maternal health”. Sex (for married/unmarried people) and pregnancy per se, should be joyful not deadly.

  3. 2005 NRC + 2007 World Development Report Growing Up Healthy for Adolescents: Give them the knowledge to help them make informed choices about their sexual behavior and life options for successful transitions Create an environment for young people to practice healthful behavior For those harmed by poor health decisions or environments, provide them with good quality health services, treatment and rehabilitation

  4. Interconnections between Adolescent Reproductive Health and Maternal, Newborn and Child Health Framework matters to understand, intervene and improve the health of girls and women in Africa. Review of evidence in studies and impacts of interventions on adolescent reproductive health, focusing on evidence which is informative for improving maternal/newborn/child health. Population-based epidemiological investigation with 95 DHSs (1988-2008) in 40 African countries.

  5. Framework matters Good intentions, eclectic list of “risk factors” and “protective factors”, policy prescriptions, even if dressed up in notions of “gender” are not enough! Articulate frameworks explicitly and use them systematically in order to uncover gaps in CURRENT AND ACCURATEknowledge and action and set up the grounds for documentation/intervention research and policy. Address the interconnected & overlapping concerns (health, social, etc.) about women in the life course.

  6. Review of Existing Evidence 1/2 Contraceptive use low and pregnancy risk high for women, especially adolescent women. Healthy pregnancy, childbirth, motherhood and life transitions for childbearing women are strongly influenced by care and opportunity structures (education, health, transportation, technology, etc.). Girls and mothers = most vulnerable/disadvantaged. Basic and reproductive (prenatal/postnatal) healthcare during the pre-reproductive and reproductive years of women reduce maternal morbidity/disability/mortality (80% for mortality).

  7. Review of Existing Evidence 2/2 Successful programs have targeted key entry points during women’s entire life cycle and her offspring: Mother: pre-adolescence, adolescence, before/during/after pregnancy Child: conception to birth + during childhood years. Need for sustainable (ecosocial, costs, coverage, up-scaling. ...) programs and initiatives that : Can prevent at-risk behavior and adolescent pregnancy Can address health and safety of pregnant adolescents Have a country-driven spin, and not ideology/stereotype.

  8. Epidemiology of Adolescent Reproductive Health - Relevance to Maternal/child Health 40 African countries and 95 DHSs from 1988 to 2008: latest and comparable data for SSA Assessing levels, trends and changes over time in key indicators of reproductive health for adolescents vs. older women Situating the pivotal role of adolescent reproductive health issues in maternal health Lessons for current and emerging interventions

  9. Fertility: Contribution of Adolescents Fertility rates remain highest in Africa – only Timor-Leste (6.5) and Afganistan (5.7) have TFR> 5 outside of Africa (Niger highest = 7.4). Reversals in fertility decline in several countries (e.g., Kenya, Mozambique, Nigeria, Cameroon). Countries with reversals in fertility decline have highest (>10%) contribution of adolescents to TFR: Mozambique (16%), Cameroon (14%). Fertility-Mortality linkages: high fertility impacts levels of maternal, neonatal & under-5 mortality.

  10. 2005 Egypt Source: Macro International Inc, 2009. MEASURE DHS STATcompiler. http://www.measuredhs.com.

  11. Source: Macro International Inc, 2009. MEASURE DHS STATcompiler. http://www.measuredhs.com.

  12. Source: Macro International Inc, 2009. MEASURE DHS STATcompiler. http://www.measuredhs.com.

  13. Source: Macro International Inc, 2009. MEASURE DHS STATcompiler. http://www.measuredhs.com.

  14. Medical maternity care Association between antenatal/delivery care and maternal and child health BUT adolescents at disadvantage (e.g., rate of neonatal mortality: 130.8 for South Africa). Inconsistent pattern (i.e., NNM for women with both antenatal and delivery care vs. none): e.g., Togo (1988,1998), Cameroon. High levels of maternal and child mortality: multilevel approach/coordination of action.

  15. Cameroon Source: Macro International Inc, 2009. MEASURE DHS STATcompiler. http://www.measuredhs.com.

  16. Delaying child marriage and sexual activity Association between delayed marriage, longer period of exposure to the risk of initiating sexual activity and history of sexual activity among unmarried sexually active women: variability. Robust delays in marriage and postponing of sexual debut by adolescents: e.g., in Cameroon (1991, 1998 and 2004): never married (55.8%, 64.2%, and 66.8%) and never had sex (31.5%, 34.9% and 45.3%); and idem for Uganda (50.1%, 67.7%, 77.6%; 38.4%, 47.9%, 57.0%).

  17. Source: Macro International Inc, 2009. MEASURE DHS STATcompiler. http://www.measuredhs.com.

  18. Contraception Use among sexually active and unmarried men and women Modern contraceptive use has increased but remains low among sexually active young women in African countries: <30% in Uganda. Condom is the preferred method of contraception among adolescents. Significantly more men than women who use modern contraceptive method, over time and across countries.

  19. CONCLUSION AND IMPLICATIONS Bad news : Adolescent pregnancy/fertility constant Home delivery still preponderant Highest prevalence of anemia Good news : Delaying simultaneously marriage and sexual debut works among adolescents. Unmarried sexually active: adolescents use condom preferably more than older women. Progress in medical maternity care: quality & coverage issues remain stumbling blocks!

  20. Thank You for Your Attention...

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