An Introduction to Adolescent Health Issues

INTRODUCTION TO HEALTH ISSUES IN PERU

Peru has been recognized for making strides to curb maternal and infant mortality, and increase life expectancy.  Peru’s economy has been growing at an impressive rate and generous funds have been allocated to improve health care delivery and organize interventions to address urgent issues at a local level.  Peru’s national Ministry of Health recognizes its critical role in increasing access to health care services and addressing the health issues plaguing children which prevent them from becoming productive adults.

The Ministry of Health has outlined a plan of action to address a range of health issues across several target populations, and has partnered with Peace Corps Peru to carry out critical interventions to ensure adequate development of children under three years of age and adolescents aged 12-17.  Adolescents are generally lacking in reproductive health education and access to resources for the prevention of unintented pregnancy, HIV and sexually transmitted infections.  The teen pregnancy rate nationally hovers around 13% (for girls aged 15-19) but is slowly creeping upwards.  Locally, in the Piura region, statistics from 2012 show the rate has risen above 16%, a dramatic increase from 9% in 2000.

 COMMUNITY DIAGNOSTIC

The district of El Tallán is comprised of four neighborhoods, with about 2,500 residents (not including the annexes).  The main neighborhood of Sinchao Grande hosts the municipal building, the health center and the only high school serving the district.  Among the 2,000 residents of the community of Sinchao Grande, just over 600 are adolescents.  Students attend high school for five years and graduate high school around age 16.

To determine the most pressing social issues impacting adolescents in the community of Sinchao Grande, I interviewed two community leaders who operate a church-affiliated youth group for teens, plus several parents and teachers.  In addition, I surveyed a group of high school students on their knowledge of pregnancy prevention and transmission of HIV and sexually transmitted infections (STIs).  Lastly, I conducted a SWOT analysis to record perceptions of the resources available to youth in the community.

According to statistics provided by the Ministry of Health RED Bajo Piura, 21 teenagers visited the El Tallan health center in 2012.  One-third of these patients (7) sought attention for an existing pregnancy, and six received services to treat a sexually transmitted infection. Only three teenagers sought family planning services last year at the health center.

The statistics show that among the 612 adolescents between the ages of 12 and 17 living in the district of El Tallán, the prevalence of sexually-transmitted infections (STIs, including HIV) and teen pregnancy rates are remarkably low.  STI rates are at 0.98 % and the pregnancy rate for teens is at 1.14%.  If the data correctly reflect the true incidence of adolescent pregnancies in the district, the rate for the district is 14 times lower than for the region as a whole, which is unlikely given the lack of adequate pregnancy prevention and STI-focused public health interventions in the district.

We should bear in mind that these statistics represent the number of cases reported to the local health facility.  There is a good possibility that more cases of teen pregnancy and sexually transmitted infections existed among adolescents in El Tallan in 2012 which were not reported to authorities.  An unfortunate aspect of the health facility is its visibility and the lack of privacy afforded to patients seeking services, which was reported to me by community members and noted through casual observation.  Even if a woman or girl sought reproductive health services under the guise of a different (less controversial) issue, there would be no assurance to her that the health workers would maintain her confidentiality, given the existence of a legal obligation to obtain consent from her parents.

Adolescents who participated in the Community Diagnostic survey indicated no current or past sexual activity, even though one of the participants admitted to being in a dating relationship.  Less than half of the participants indicated having received instruction on sexual and reproductive health.  Among those who had received instruction in school, several mentioned that they felt that the instruction was insufficient.  Only one had received instruction on a sexual health topic at the health facility.

Key points from the Community Diagnosis and SWOT Analysis:

• 30% of adolescents could not name one method to prevent unwanted pregnancy and sexually transmitted infections.

• Only one person was able to describe the steps to use a condom correctly.

• Less than half of the participants could name at least one method of preventing transmission of HIV.

• Adolescents mentioned a lack of opportunities to develop leadership skills and job skills.

• Adolescents expressed the desire to improve communication with parents.

With respect to adolescents, there is clearly a lack of understanding of the methods to protect against unwanted pregnancy and sexually transmitted infections. Given the reportedly low teen pregnancy rate, it will be important to reinforce healthy behaviors among this generation of young adults who are serving (willingly or not) as role models to influence the next generation of youth.

Furthermore, the lack of opportunities to acquire leadership skills and job training may leave youth unprepared for the demands of a career, or full contribution to the community. These opportunities can give legitimacy to the decisions that teens make with respect to the delay of initiation of sexual activity, as placing a value on activities that expand the possibilities for the future can reduce the desire to engage in risky activities that could derail future plans.

The ideal program will incorporate life planning as one component in a comprehensive reproductive and sexual health curriculum with a peer education component.  Please continue reading to find out how we addressed these issues by utilizing best practices in Peru and adapting them for the particular needs of the community.

Please continue reading about the Pasos Adelante project to improve the health of adolescents.