raghavan-gilbert/vw-99 1

gSocial factors shape and interact

with biology.

gLearn how to act out sexual feelings
on the basis of social attitudes,
extracted from cultural contexts.
Sexuality & Adolescent
Development
raghavan-gilbert/vw-99 2
Social Influences on Adolescent
Sexuality


A. Proximal Social Influences
Parents
Attitudes initially formed at home and so
parental models and Teachings are
important.
Peers
Later children are influenced by peer
groups and the wider social arena.

raghavan-gilbert/vw-99 3
I. Parents
O Psychological literature reveals the
profound influence that parents have
on the lives of their children.
Parents are the primary socializers
of their children.


raghavan-gilbert/vw-99 4
Parents influence Adolescent
Sexual Behaviour through four
different avenues:

Parental attitudes towards adolescent
behaviour influence adolescent
attitudes.

Marital and child rearing behaviour of
parents provide and support role models
for young people.
raghavan-gilbert/vw-99 5
The Religious environment influence
sexual attitudes and sexual guilt.

The education level and work
experience of the parents may
influence attitudes and present
opportunities for sexual activity if
parents are away.

raghavan-gilbert/vw-99 6
Theories on Adolescent
Sexual Development
Psychosexual Theorists such as FREUD,
BLOS attach great significance to the
impact of sexual drives on the
psychological functioning of the person.

raghavan-gilbert/vw-99 7
Psychosocial Theorists like Erikson,
Marcia, Adams, take the position that
anatomy is destiny but takes into
account social context and their
cultural factors that mediate sexual
conflict.

raghavan-gilbert/vw-99 8
Erickson places a great emphasis on establishing
a sense of identity and a coherent sense of self
in adolescent sexual development.

Difficulty in parent-adolescent particularly
parent-daughter conversation regarding
Sexuality seems to have a negative effect in
delaying sexual activity. i.e. Greater the
difficulty, the earlier the initiation of sexual
activity.
raghavan-gilbert/vw-99 9
Non virginity in youth is associated with
non-authoritative parenting.

Girls from single parent-families repeat
this cycle. It is unclear whether this is
related to role modeling or lack of
parental supervision or to parental
absence.

raghavan-gilbert/vw-99 10
O Parents also influence via socialization of the
child to coping strategies in their personal life.
Learned Restraint was a factor in adolescent
sexual expression for boys. This was the
ability by parents to delay gratification, inhibit
aggression, exercise impulse control, display
consideration of others and to act responsibly.
raghavan-gilbert/vw-99 11
II. Peers (& Friends)
O Behaviour of peers have little impact on
young children - but importance of peers
shifts at adolescence.

O Peer influence and positive or negative
pressure can be through:
peer information
peer attitudes
peer behaviour

raghavan-gilbert/vw-99 12
Studies show in Adolescent sexual
activity and FP use



Peers have 70-73% of influence,
Mothers have 33-37% influence
Fathers have 15% influence

raghavan-gilbert/vw-99 13
OTheory of reasoned action:


Perceived attitudes and values of
significant others have important
effect on shaping intention.

Young women more than men were
influenced by attitudes of their
peers about pre-marital sex,
contraception and safer sex
practices.
raghavan-gilbert/vw-99 14
B. Distant Social Influences
1. The Youth Culture
(a) Sets of beliefs
(b) Adult models of sexual behaviour
(c) Media models of sexual behaviour

2. Social Institutions
(a) School
(b) Religion
(c) The Law


raghavan-gilbert/vw-99 15
1. The Youth Culture

(a) Sets of beliefs: fashions, leisure,
music influenced by:

Eprint, media, definitions of female femininity
and desirability, definitions of maleness, lyrics,
etc.
EPerceptions of peers about sexual experiences.

raghavan-gilbert/vw-99 16


(b) Adult models of sexual behaviour

E Parents are not the only role models;
other adults in society
E How changing adult sexual norms
affect the youth is unknown

raghavan-gilbert/vw-99 17
(c) Media models of sexual behaviour

Movies and videos reinforcing roles and
messages -
E women as passive victims
E women as sexual beings
E women as play things

raghavan-gilbert/vw-99 18
2. Social Institutions
(a) School

have an important role to play in informing young
people and providing a forum for values
exploration and clarification about sex

school based sex education policy and
implementation

whether sex education per se without supportive
services translates to behaviour change is less clear
prefer to turn to peers for info
do not trust teachers knowledge or discretion
raghavan-gilbert/vw-99 19
(b) Religion



Religiosity is negatively related to
premarital sexual behaviour. Sexual
conservation is greater among
religious youth
4consequence of religious values
4association of youth with similar values
4may be other sources of values
raghavan-gilbert/vw-99 20
(c) The Law



Laws that deal with adolescent sexual
expression relate mainly to:

4age of consent laws for sexual intercourse
and medical interventions such as FP and
abortions

4laws on homosexuality

raghavan-gilbert/vw-99 21
Arguments about adolescent sexuality
revolve around 4 central themes:

Morality and responsibility (parents
and religions, especially related to
sexuality education)

Desire - media representation
(responsibility vs. gratification)

raghavan-gilbert/vw-99 22
Danger - public health approach and
medical models (fear related to
pregnancy, disease, HIV/AIDS)

Victimization - power of women in
sexual encounters is limited and so
is responsibility

raghavan-gilbert/vw-99 23
Rationale for Addressing Adolescent
Sexual and Reproductive Health




E Number of Adolescents
adolescents aged 10-19 constitute approximately 20% of the
world population
half of all individuals are younger than 25
E The fertility level for this age group is decreasing but
decreasing more slowly than for other age groups
resulting in an increasing proportion of births being to
adolescent mothers
E Pregnant adolescents resort to abortion more often
than pregnant women of other age groups
raghavan-gilbert/vw-99 24
+ Risk Factors in of Adolescence:
Psychosocial Risks




the period during which sexual and reproductive
health issues are added to the health concerns of the
individual
adolescents not knowledgeable about sexuality and
reproduction
abstinence not encouraged
gender equality not promoted
healthy and responsible sexual and reproductive
behaviour not discussed
sexual and reproductive risk-taking not discussed

raghavan-gilbert/vw-99 25
s Early Pregnancy Risks




C neo-natal mortality levels are higher
C infant mortality are higher
C an increase in the age of marriage
C a fall in the age of menarche
C no decrease in sexual activity
C a greater risk of adolescent girls becoming pregnant
outside of marriage
C social stigma prevent pregnant adolescent girls from
obtaining early prenatal care
raghavan-gilbert/vw-99 26
L Abortion Risks




lack of information on contraception
the cost of health services
lack of confidentiality
limited access to safe services
delay in realising or admitting to the pregnancy

raghavan-gilbert/vw-99 27

E most susceptible to STDs due to
physiological and social factors
E 5% of all adolescents contract an STD
E half of those infected with HIV are
younger than 25
E less developed physiological barriers
towards infection
E young womens low decision-making power
STD Risks
raghavan-gilbert/vw-99 28


Contraceptive Use
level of contraceptive use is often very
low among adolescents
due to insufficient or incorrect
information
to limited access to contraception
because of location, cost or social and
cultural barriers
to the low social status and decision-
making power
raghavan-gilbert/vw-99 29

= The Sexual and Reproductive Rights of
Adolescents




Economic Benefits
the cost of contraceptive use is significantly lower
than the cost of medical care related to unwanted
pregnancies and treatment of STDs
is a cost-saving strategy
educational options limited
economic opportunities curtailed


raghavan-gilbert/vw-99 30
O Meeting Adolescents Needs




The primary goal of ASRH programming and policy is
to enable adolescents to enjoy their sexual and
reproductive rights
provide adolescents with knowledge and services
sexual and reproductive health care for all
adolescents
create an enabling environment to reinforce
preventive interventions and services

raghavan-gilbert/vw-99 31

_ Preventive Interventions



to promote responsible and healthy reproductive
and sexual behaviour, including voluntary abstinence
to provide services and counselling
to educate and counsel in the areas of gender
relations on equality
to reduce violence against adolescents
to promote responsible sexual behaviour
to promote responsible family planning practice
to promote family life and reproductive and sexual
health, including STD prevention
raghavan-gilbert/vw-99 32
+ IEC





+ IEC initiated before adolescents have
engaged in sexual activity give adolescents the
skills
to postpone the onset of sexual activity and
to engage in safer sexual practices once
sexual activity begins

+ For sexually active adolescents, IEC and services
raise the level of contraceptive use
increase condom use

raghavan-gilbert/vw-99 33
O Sexual and Reproductive Health
Care



E access to services for treatment and
care
E treatment of complications of self-
induced or clandestine abortions
E pre-and post-natal care
E counselling and contraceptive service
provision
raghavan-gilbert/vw-99 34
= Service Provision





the provision of adolescent-friendly
preventive services is a key element
in enabling adolescents to engage in healthy
responsible sexual practices
E special hours
E special centres,
E peer distribution of condoms
raghavan-gilbert/vw-99 35
Enabling Environment





EGender
enhance gender equity and equality
eliminate discriminatory practices, laws
and policies against women and girls
introduce appropriate laws for legal age of
consent and minimum age of marriage
promote a focus on mens role by inclusion
promote concept of shared responsibility

raghavan-gilbert/vw-99 36
L Significant Adults




IEC and advocacy initiatives should address

parents, teachers and local leaders
religious leaders
national level policy-makers
raghavan-gilbert/vw-99 37

+ Research





Research is important to understand
adolescent sexual and reproductive health
problems and the underlying socio-cultural,
economic and other development factors



raghavan-gilbert/vw-99 38
Limitations of
Evaluation in ARH Studies
Self report techniques (problematic areas
in research):
verification of validity
gap behaviour between knowledge and
behaviour

Conscious and unconscious distinction of
respondents (pressure, privacy, confidence
and anonymity issues)
raghavan-gilbert/vw-99 39





O Unreliable measures (test - retest the
reliability)

O Memory (recall)

O Inadequate definition of the construct
under consideration e.g. in utilization of FP
knowing the methods is as important as
knowing where to receive services


raghavan-gilbert/vw-99 40
) Using qualitative methodologies
may produce richer data
(thought harder to interpret)

) Triangulation is important


raghavan-gilbert/vw-99 41
Inappropriately worded questions (no
formal terminology, no ambiguities, no
double negatives)

Differences across survey
presentation mode: mail out, surveys,
self-administered, etc.

raghavan-gilbert/vw-99 42



Types of Studies:

Surveys and correlation studies (describe
and compare group)
Experiments to establish causality
Case materials - ethnographic studies
through participant or non-participant
observer techniques:
individuals
groups
Generalizability is extremely limited
raghavan-gilbert/vw-99 43

+ Networking






^ Involvement of all stakeholders

^ networking at all levels

^Involving Adolescents in programming
raghavan-gilbert/vw-99 44
p Advocacy



+ National Capacity-Building in Advocacy
+ Innovative approaches in Advocacy
+ Advocacy against Sexual Violence
+ Advocacy for Adolescent Sexual and
Reproductive Rights
+ Advocacy to Establish an Enabling
Environment
+ Advocacy to Promote Gender Equality and
Equity

raghavan-gilbert/vw-99 45
O Information, Education and
Communication



4 Needs Assessment and IEC Content
4 Peer Education and Peer counsellors
4 Parent Education
4 Gender Training
4 Innovative approaches
4 Involvement of Professionals
4 National Curriculum
4 Strategies for Implementation
raghavan-gilbert/vw-99 46
) Training



4 Health Care Providers

4 Teachers

4 Strategies for Training

4 Institutionalisation of Training

4 Sustainability of Training
raghavan-gilbert/vw-99 47
Lessons Learned by Youth for Youth


Execution by youths at the national level was a
successful approach;
Youths preferred topics which affected them
directly such as human sexuality, STDs,
including AIDS, and contraception over
general issues such as population;
Its difficult to decide at the global level what
will happen at the national level;

raghavan-gilbert/vw-99 48
Lessons Learned by Youth for Youth (CONTD)




Networking is easier at the peripheral level;
The involvement of stakeholders in project
design triggers positive attitudes and deep
commitment to the project;
Governmental institutions and NGOs can
successfully be involved in the same project;
It is important to build trust among youths
and their organisations;
Youth learn better from other youth.
raghavan-gilbert/vw-99 49
the Youth Perspective




[Youth] tell us they want information on
reproductive health and sexuality education,
preferably from their parents. They want this
information early and in a form appropriate to their
psychological and physical development. They want
accurate information so they can empower
themselves to make choices and take responsibility
for those choices.
raghavan-gilbert/vw-99 50
the Youth Perspective (contd)




They also say they want to have at their disposal -
and this does not mean they will automatically use
those services - family planning information and
supplies that will allow them to avoid early and
unwanted pregnancy, and abortion, and to protect
themselves from sexually transmitted diseases,
including HIV/AIDS.

raghavan-gilbert/vw-99 51
+ Challenges for the Future




Advocacy
Research
Evaluation
Indicators
Upscaling of programmes
Gender awareness
Segmentation of Target Group
Management
Sustainability
raghavan-gilbert/vw-99 52

Key References: Adolescent Sexuality



1. S. Moore & D. Rosenthal, 1993 Sexuality in Adolescence.
Routledge London & N.Y.

2. UNFPA Technical Report No. 43 1998 The Sexual &
Reproductive Health of Adolescents: A Review of UNFPA
Assistance