Year : 2007 | Volume
: 32 | Issue : 2 | Page : 141--143
Perceptions and practice with regard to reproductive health among out-of-school adolescents
SS Kushwah, Anuj Mittal
Department of Community Medicine, S. S. Medical College, Rewa, MP, India
S S Kushwah
E-2, SS Medical College Campus, Rewa - 486 001, MP
|How to cite this article:|
Kushwah S S, Mittal A. Perceptions and practice with regard to reproductive health among out-of-school adolescents.Indian J Community Med 2007;32:141-143
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Kushwah S S, Mittal A. Perceptions and practice with regard to reproductive health among out-of-school adolescents. Indian J Community Med [serial online] 2007 [cited 2020 Feb 17 ];32:141-143
Available from: http://www.ijcm.org.in/text.asp?2007/32/2/141/35657
Adolescence is a period of rapid physical, emotional, cognitive, and social growth and development. Generally, adolescence begins at the age of 10 years and ends at 19 years. Most teenagers reach puberty by the age of 16-18 years. The adolescence education focuses largely, though not exclusively, on the individual's self-awareness, personal relationships, human sexual development, reproduction, and sexual behavior.  It helps people to understand their sexuality, to respect others sexuality, and to take responsible decisions with regard to their sexual behavior. In India, there are approximately 200 million adolescents (NFHS II: 1998-99). Adolescent constitute 22.8% of population in India as on March 1, 2000. Madhya Pradesh is a poor state, and a large proportion of adolescents do not even complete their primary education. This illiteracy and lack of proper reproductive education may result in problems like increasing population and higher burden of sexually transmitted diseases. Recognizing the potential for young, a reproductive health program for out-of-school adolescents has been started by the Government of Madhya Pradesh, Ministry of Health and Family Welfare with financial and technical support from Integrated Population Development Project (IPDP) funded by United Nations Population Fund (UNFPA). This program involves out-of-school adolescents of five districts of Madhya Pradesh, namely, Rewa, Satna, Sidhi, Panna, and Chhatarpur. The present study has been carried out with the following objectives in mind:
To assess the knowledge gained by adolescents who have been trained in the ARH area,To assess the attitude of adolescents toward reproductive and sexual health, andTo assess the behavior of the adolescents.
Materials and Methods
This study was conducted from April 2005 to July 2005 in rural areas of Satna and Rewa districts of Madhya Pradesh. Out of 120 centers, which impart training to out-of-school adolescents, 15 adolescent reproductive health (ARH) training centers were selected for this study. These centres were stratified based on the proportions of girls and boys, their district, their distance from district hospital or randomly selected. A total of 450 out-of-school adolescents were trained at these centers; of which, 287 (64%) adolescents (199 girls and 88 boys) were interviewed using a pre-tested and pre-designed instrument. Prior to the interview, the aims and objectives of the study were narrated to the adolescents, and confidentiality of information provided by them was confirmed.
Results and Discussion
A total of 15 centers were surveyed, 8 from Satna and 7 from Rewa district. A total of 287 adolescents were interviewed; of which, 88 (30.66%) were males and 199 (69.33%) were females. Of all the adolescents, 47.03% belonged to the age group of 14-16 yrs and 37.28% belonged to the age group of 17-19 years. Out of all adolescents interviewed, 15.68%, 10.80%, 33.80%, and 39.72% belonged to the scheduled caste (SC), scheduled tribe (ST), other backward classes (OBC), and general class, respectively.
With regard to education, 6.97% were illiterate, 21.95% had received less than or equal to primary schooling, 44.60% adolescents received upper primary schooling (grades 6-8), 19.86% reached the secondary level (grades 9-10), and 6.62% were at higher secondary levels (grades 11-12). At the time of this study, none of the adolescents were attending school. The adolescents could not attend school because of their poor economic condition (32.75%), some stayed at a distance from school (27.52%), and unavailability of school in few areas (14.98%). The other reasons for dropping out from schools were either personal or they were forced by their parents or due to marriages and lack of interest in studies. A total of 37.97% adolescents left school within 6-12 months of joining, and 24.73% adolescents did not attend school for more than 2 years. The responses of adolescents with regard to menstruation, pregnancy, and reproductive and sexual health are provided in [Table 1].
A study conducted by UNICEF in 1999  also found that 38% of girls were unaware of menstruation at the time of their first period, while in our study 45.73% girls were unaware about the menstrual cycle before training; this signifies the hesitation among parents to talk about reproductive issues with their children.
Data from an IIHMR  study shows that in Rajasthan, 46% of adolescent boys perceived that night emission was a natural process, while in our study 53.31% perceived this fact. In the IIHMR study, only 21% of boys believed that masturbation was harmless and it was a natural process, while in our study 58.19% believed in this fact; this increased number is due to the training imparted to them.
Of all interviewed adolescents, 29.62% were aware of the use of condom, while 22.65% were not. With regard to menstruation, 29.97% of adolescents were aware of its cause, while 57.49% were not. Only 17.77% were cognizant about the concept of ovulation; 31.01% of adolescents were aware of the average age of menarche, while 64.46% were aware of the average age of menopause. Approximately 72% of adolescents agreed that they gained sufficient information with regard to the mental and physical changes associated with adolescence from this program. Additionally, television also played a significant role in training these adolescents. Of all adolescents, 73.87% did not have any genital problems, while 26.12% had some problems, mainly, abnormal menstrual cycle and itching and pain during urination. Of all the adolescents, 66.55% showed interest in the program, while 17.42% were not interested in the program; whereas 4.88% of the relatives started using contraceptives, and 7.67% adolescents were bold enough to share their knowledge with their peers.
According to NFHS II,  in Rajasthan, 12.6% males and 43.1% females under the age group of 15-19 years were married in the rural areas. In our study, 17.05% males are married and 21.61% females in the age group of 11-19 years were married. The variation in these findings reflects the social custom of early girl-child marriages in Rajasthan and the increasing awareness in this area. A total of 19.51% adolescents had experienced intercourse; of these, five were unmarried (3 males and 2 females) and seven married adolescents had not experienced intercourse, since the gona ceremony, the ceremony following which the girl finally goes to the groom's house, had not taken place. A total of 41.07% adolescents had used some method of contraception; 56.52% had used condoms, 30.44% used OCP, and 12.04% were using Copper-T.
The mean age of menarche in our study population was 13.7 years, whereas it is usually 13.5 years in Madhya Pradesh and rest of India, and 13.9 years in Rajasthan.
There still exist many doubts with regard to menstruation and pregnancy among the adolescents, which needs to be clarified. The responses from the adolescents signify the fact that work has been done in this field; however, that lacunas are still not found. The responses suggest that the importance of contraception needs to be propagated and stressed upon among the adolescents.
As per our observations, the following recommendations are suggested:
ARH education should be provided to all adolescents.Reproductive health problems should be discussed among adolescents, particularly girls.Eliminate discrimination towards a girl child.Adolescent health programs should be initiated by trained staff by using authentic study material.
We are thankful to the Integrated Population Development Project, Ministry of Health and Family Welfare, Government of M.P. for providing financial support to this study. We are also thankful to UNFPA M.P. office, Bhopal for their keen interest, advice, and critical comments.
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|2||Goyal RS, Khanna A. Reproductive health of adolescents in Rajasthan: A situational analysis. IIHMR working paper. 6; Jaipur (India); 2005.|
|3||National Family Health Survey II, 1998-99; International Institute of Population Sciences; Mumbai; 2000.|