Medical Journal of Dr. D.Y. Patil University

ORIGINAL ARTICLE
Year
: 2017  |  Volume : 10  |  Issue : 2  |  Page : 133--137

Reproductive health awareness among adolescent girls of a government school in an urban slum of Pune City


Pooja Shankar, Puja Dudeja, Tukaram Gadekar, Sandip Mukherji 
 Department of Community Medicine, AFMC, Pune, Maharashtra, India

Correspondence Address:
Puja Dudeja
Department of Community Medicine, Armed Forces Medical College, Pune - 411  40, Maharashtra
India

Abstract

Introduction: Reproductive health of adolescent girls is crucial in determining the health of future generations. For ensuring informed decisions by adolescents regarding their sexuality and reproductive health, National AIDS Control Organisation has introduced life skills education in school curriculum. However, there exist many roadblocks in implementation from theory to practice. Hence, the present study was conducted to assess the reproductive health awareness and most preferred source of information. Materials and Methods: This was a descriptive cross-sectional study among girls of classes VI–XII of a Government High School in an urban slum of Maharashtra. Two hundred and fifty girls participated; 39 questionnaires were incomplete, hence 211 responses were analyzed. All girls were educated about reproductive health and life skills issues after the study. Results: Mean age of the participant girls was 14.9 ± 1.75 years. The level of awareness improved significantly with increase in class of respondent (P < 0.05); however, no significant association was seen with education of mother or father (P > 0.05). Eighty percent of them were unaware of the appearance of secondary sexual characteristics in both the genders. Less than 30% of the girls were aware of contraceptives. Regarding effects of premarital sex, 57% of the participants were concerned about bringing a bad name to themselves and their family, while reproductive tract infections (9%), HIV/AIDS (29%), were cited as other ill effects. Seventy percent felt comfortable discussing or confiding regarding reproductive health issues with friends rather than parents, teachers, or medical professionals. Conclusion: Knowledge and awareness about reproductive and sexual health issues among adolescent girls was dismal.



How to cite this article:
Shankar P, Dudeja P, Gadekar T, Mukherji S. Reproductive health awareness among adolescent girls of a government school in an urban slum of Pune City.Med J DY Patil Univ 2017;10:133-137


How to cite this URL:
Shankar P, Dudeja P, Gadekar T, Mukherji S. Reproductive health awareness among adolescent girls of a government school in an urban slum of Pune City. Med J DY Patil Univ [serial online] 2017 [cited 2017 Jul 28 ];10:133-137
Available from: http://www.mjdrdypu.org/text.asp?2017/10/2/133/202101


Full Text

 Introduction



The World Health Organization defines adolescents as young people aged between 10 and 19 years.[1] The National Population Policy of India 2000 recognized adolescents as a vulnerable group with specific needs.[2] They comprise nearly 20%–21% of our country's population and their numbers are expected to increase over time.[3]

Reproductive health of adolescent girls is crucial since it determines the health of future generations to come. With urbanization and liberal attitudes in contemporary Indian society, there is an increased likelihood of indulging in sexual proximity at an early age, the burden of which is usually borne by the female sex. Hence, adolescent girls are at risk of unwanted pregnancy, reproductive tract infections (RTIs) and also a spectrum of social and psychological consequences such as discontinuation of education, forced early marriages, unplanned pregnancies, unsafe abortions, and depression.[4]

Earlier millennium development goals and now the sustainable development goals, both have focused on the reduction of pregnancy rate among 15–19-year-old girls.[5]

For adolescents to make informed decisions, Government of India has incorporated the Adolescent Reproductive and Sexual Health (ARSH) services in school curriculum. However, there exist many roadblocks in providing awareness to adolescents such as patriarchal system of society, social barriers to discussing with teachers, parents, and elders. Even mothers, mostly illiterate and ill-informed themselves, restrict their communication with daughters to the topic of menstruation only and are reluctant to touch on issues of safe sex or reproductive wellness. Moreover, they feel that by addressing these topics, they will end up diluting authoritative parenting and end up promoting sexual promiscuity.

Another source of information for sexual and reproductive health education is through peers. A peer is any person with equal standing with respect to age, who also play a vital role in psychosocial development of adolescents.[6] Studies have also suggested that peer education programs positively motivate their counterparts as are they more likely to modify their behaviors and attitudes if they receive health messages from those who face similar concerns and pressures and are not authoritative figures.[7]

According to the National Family Health Survey-3 data, 2.7% boys and 8% girls in India reported sexual debut before the age of 15 years.[8] Therefore, it is imperative to find out ways of making adolescents aware about safe reproductive and sexual health practices, making them better equipped to make safe choices. The present study was hence conducted among adolescent girls to assess the existing awareness about reproductive health among them.

 Materials and Methods



This was a descriptive cross-sectional study conducted among girls of classes VI–XII of a Government High School located in an urban slum locality of Maharashtra State. The sample size calculated was 216 at 17% prevalence of reproductive health awareness among urban slum adolescents (Gupta et al.), with alpha error of 0.05 and precision of 5%.[9] However, all girls in attendance (250) were taken in for this study (convenience sampling); 39 questionnaires were returned incomplete, hence 211 respondents were analyzed. Reproductive health awareness was categorized as good (>75%), average (50%–75%), and poor (<50%) [Graph 2]. A written consent was obtained from parents/guardians of the participant adolescents. A pilot tested closed-ended questionnaire was given to all subjects. The questionnaire was initially formulated in English, translated into the local language (Marathi) and then back translated into English with the help of a medico-social worker. The questionnaire collected information on demographic characteristics, menstrual/reproductive profile and hygiene, reproductive health-seeking behavior, and life skills. Data were analyzed using SPSS 20 software (IBM SPSS Statistics for Windows, Version 20.0. IBM Corp., Armonk, NY). All girls were educated about reproductive health and life skills issues after the study.[INLINE:1][INLINE:2]

 Results



The mean age of the participant girls was 14.9 ± 1.75 years. Nearly two-third (75%) were Hindus and the remaining non-Hindus. Nearly, half (47%) of participant's fathers were educated up to 10th standard. Only 27% of the mothers were educated till primary school level.

The overall knowledge regarding reproductive health awareness was poor in 163 (77.2%), average in 29 (13.7%) and good only in 13 (9%) of the respondents. The majority (75%) were curious regarding bodily changes associated with onset of puberty/sexual maturity. The level of awareness improved significantly with increase in class of respondent (P < 0.05) [Table 1]; however no significant association was seen with the level education of mother or father (P > 0.05) [Table 1]. Although 60% of the participants were aware of menstruation as onset of puberty, a vast number (80%) of them were unaware of the appearance of secondary sexual characteristics in both the genders.{Table 1}

As far as knowledge regarding contraceptives was concerned, <30% of the girls were aware of condoms and oral contraceptive pills [Table 2]. To the question regarding harmful effects of indulging in premarital physical/sexual relationships, more than half (57%) of the participants were concerned about bringing a bad name to themselves and their family, while RTIs (9%), HIV/AIDS (29%), failure to pursue further education (30%) and unwanted pregnancy (45%) were cited as other ill effects [Table 3].{Table 2}{Table 3}

More than half (55%) the participants had access to smartphones at home. The majority (70%) felt comfortable discussing or confiding regarding reproductive health issues with friends rather than parents, teachers, or medical professionals [Graph 1].

 Discussion



According to the WHO sexual health is considered to be a state of physical, emotional, mental, and social well-being in relation to sexuality and not merely the absence of disease or infirmity.[10] Providing adolescent girls with sexual and reproductive health education is an important way of promoting healthy adolescence and sexual development and preventing unfavorable outcomes of sexual behaviors. Our study revealed that majority of the participants were unaware of the development of secondary sexual characters and use of condoms and oral contraceptive pills as means of contraception. Adolescent girls, especially those living in an urban slum locality, are vulnerable to sexual advances by not only young boys in their immediate neighborhood but also to sexual abuse and violence by men in their family or community. They are also more susceptible to RTIs. In such a scenario, lack of awareness regarding safe sexual and reproductive health practices can have disastrous consequences. The results by Shiela, et al. showed that awareness about menstrual changes was 66.1% among the girls.[11] Similarly, in another study by Ahuja and Tewari, awareness levels regarding the changes were found to be low.[12],[13] These findings about two decades back show that despite modernization in society, the adolescent awareness about reproductive health issues has not improved.

Awareness about contraceptives was present in <30% subjects. Similar finding have been reported by Gupta et al. who compared knowledge about contraceptives between girls in rural areas and urban slums in North India.[9] Another study in urban schools by Kotecha et al. in Western India also highlighted that only one-fourth of the adolescent girls had heard about contraceptives.[14] In this study, more than half (57%) stated that indulging in premarital sexual activity resulted in psychosocial disruption in the form of ostracism from the society of not only self but also one's family. This finding depicts the persistence of a strong social stigma that exists against premarital sex and pregnancy outside marriage, where family before self-predominates. The adolescents find themselves caught in a web of emotions surrounded by stigma regarding reproductive and sexual issues in the Indian society. Apart from constraints in sources of information, widespread gender inequality also makes it increasingly challenging for adolescent girls to attain the knowledge they need.[15]

Discussing sexual and reproductive health in public has always been a taboo in traditional cultures. In this context introducing life skills, education in schools has also invited objections from teachers, parents, and political groups. Studies have shown that vast majority of parents and teachers are unwilling to take up the responsibility of providing sex or reproductive health education to their daughters.[16] The existence of strong stigma and controversies handicap any adolescent health programs. In the era of smartphones, the internet has emerged as an accessible source of information, in terms of both facts and pornography. Half of our subjects had access to smartphone. Nevertheless, the participants quoted that they preferred discussing reproductive and sexual health issues with their friends rather than teachers or family members. This finding re-emphasizes the fact that adolescents have a natural tendency to resist any dominant authoritative source and look up to peers for advice on personal relationships as well as sexual and reproductive health.

Peer-led sex education programs may be defined as “teaching or sharing of (sexual health) information, values, and behaviors by members of similar age or status group.”[17] Peer educators of equal social standing may be used to bring about changes in knowledge and behavior at the individual level. Trained peers might pose as a more credible source of information for adolescents since they communicate more easily in a manner their audience is receptive to and alleviate the fear of confidentiality being compromised.

Sexual and reproductive health education, in addition to biological specifics, should also address the issues of social and moral behaviors, proper attitudes toward the opposite gender, family life, and interpersonal relations in the society. Adolescent health education should be planned for in a phased manner, starting from classes VI (>10 years) onward preferably. The initial phase could restrict itself to menstruation and knowledge on the appearance of secondary sexual characters and then gradually progress to include the concepts of sexual and reproductive health, HIV/AIDS, sexual harassment, teenage pregnancies, contraceptives, etc.

Since 2006, Government of India has launched ARSH services to providing equitable, comprehensive, accessible services such as counseling on nutrition and sexual problems, immunization, awareness on contraceptives, RTIs, and HIV/AIDS, behavioral risk factors, and services for pregnancy/abortion.[18] However, the tangible benefits of these services are yet to be realized by the beneficiaries.

 Conclusion



Knowledge and awareness about reproductive and sexual health issues among adolescent girls were dismal; parents' educational status does not play much of a role in the same. Incomplete knowledge regarding the subject gained through friends who are themselves ill-informed can lead to not only health but also psychosocial problems in these adolescent girls.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Aparna N, Raakhee A. Life skill education for adolescents: Its relevance and importance. Educ Sci Psychol 2011;2:3-7.
2Sharanya T. Reproductive health status and life skills of adolescent girls dwelling in slums in Chennai, India. Natl Med J India 2014;27:305-10.
3Mittal K, Goel M. Knowledge regarding reproductive health among urban adolescent girls of Haryana. Indian J Community Med 2010;35:529.
4Shashikumar R, Das RC, Prabhu HR, Srivastava K, Bhat PS, Prakash J, et al. A cross-sectional study of factors associated with adolescent sexual activity. Indian J Psychiatry 2012;54:138-43.
5Rasanathan K, Damji N, Atsbeha T, Brune Drisse MN, Davis A, Dora C, et al. Ensuring multisectoral action on the determinants of reproductive, maternal, newborn, child, and adolescent health in the post-2015 era. BMJ 2015;351:h4213.
6Lindberg LD, Maddow-Zimet I, Boonstra H. Changes in adolescents' receipt of sex education, 2006-2013. J Adolesc Health 2016;58:621-7.
7Abdi F, Simbar M. The peer education approach in adolescents-narrative review article. Iran J Public Health 2013;42:1200-6.
8Sivagurunathan C, Umadevi R, Rama R, Gopalakrishnan S. Adolescent health: Present status and its related programmes in India. Are we in the right direction? J Clin Diagn Res 2015;9:LE01-6.
9Gupta M, Bhatnagar N, Bahugana P. Inequity in awareness and utilization of adolescent reproductive and sexual health services in union territory, Chandigarh, North India. Indian J Public Health 2015;59:9-17.
10World Health Organization. Defining Sexual Health: Report of a Technical Consultation on Sexual Health, 28-31 January, 2002. Geneva: World Health Organization; 2006.
11Shiela W, Malathy K, Premila S. Menstrual and gynaecological disorders in 500 school girls in Madras city. J Obstet Gynaecol India 1993;43:940-5.
12Ahuja A, Tewari S. Awareness of pubertal changes among adolescent girls. J Fam Welf 1995;41:46-50.
13Gupta S, Sinha A. Awareness about reproduction and adolescent changes among school girls of different socioeconomic status. J Obstet Gynaecol India 2006;56:324-8.
14Kotecha PV, Patel SV, Mazumdar VS, Baxi RK, Misra S, Diwanji M, et al. Reproductive health awareness among urban school going adolescents in Vadodara city. Indian J Psychiatry 2012;54:344-8.
15Ismail S, Shajahan A, Sathyanarayana Rao TS, Wylie K. Adolescent sex education in India: Current perspectives. Indian J Psychiatry 2015;57:333-7.
16Nair MK, Leena ML, George B, Thankachi Y, Russell PS. ARSH 5: Reproductive health needs assessment of adolescents and young people (15-24 y): A qualitative study on 'perceptions of community stakeholders'. Indian J Pediatr 2013;80 Suppl 2:S214-21.
17Strange V, Forrest S, Oakley A; RIPPLE Study Team. Randomized Intervention of PuPil-Led sex education. What influences peer-led sex education in the classroom? A view from the peer educators. Health Educ Res 2002;17:339-49.
18Chauhan MG, Solanki HM, Patel HM, Singh MP. A study of reproductive health needs of adolescent girls of UHTC field practice area, government medical college, Bhavnagar. National Journal of Integrated Research in Medicine 2015:6;15-18. 4p.