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Reproductive Health Services for Adolescents Comprehensive Reproductive Health and Family Planning Training Curriculum MODULE 16: REPRODUCTIVE HEALTH SERVICES FOR ADOLESCENTS Judith Senderowitz, Cathy Solter, and Gwyn Hainsworth Pathfinder International March 2002 Revised 2004 © 2002 Pathfinder International. Any part of this document may be reproduced or adapted to meet local needs without prior permission from Pathfinder International provided Pathfinder International is acknowledged, and the material is made available free of charge or at cost. Please send a copy of all adaptations from this manual to: Technical Services Group Pathfinder International 9 Galen Street, Suite 217 Watertown, MA 02472 Funds for the development and production of this Comprehensive Reproductive Health and Family Planning Training Curriculum were provided by the United States Agency for International Development (USAID) and the Melinda and Bill Gates Foundation under the African Youth Alliance (AYA) project. The views expressed are those of Pathfinder International and do not necessarily reflect those of USAID. ACKNOWLEDGEMENTS The development of the Comprehensive Family Planning and Reproductive Health Training Curriculum, including this module, is an ongoing process and the result of collaboration between many individuals. The development process of this Comprehensive Curriculum began with the privately funded Reproductive Health Program (RHP) in Viet Nam. This module is a new module based on Pathfinder's experience in providing reproductive health services to adolescents. The module's design is based on the Family Planning Course Modules, produced by the Indian Medical Association in collaboration with Development Associates, Inc. Parts of this curriculum are adapted from Improving Interpersonal Communications Skills for Counseling Adolescents on Sexual and Reproductive Health by Dorina Vereau, Pathfinder International, Peru. The module was pre-tested in India and then underwent a technical review in Tanzania by colleagues involved in the African Youth Alliance (AYA) project, other programs in Tanzania, and the Ministry of Health. Feedback from this pre-test and technical review was incorporated into the training module to improve its content, training methodologies, and ease of use. With the help of colleagues at Pathfinder International, this curriculum has been improved, expanded, and updated to its present form. Many thanks to: Nelson Keyonzo and Pamela Onduso for assisting in the planning of this module; Ellen Israel, who provided technical support and input; Rekha Masilamani and Annie Mathew for arranging the pre-test of this module; Nelson Keyonzo and Naomy Achimpota for arranging the technical review of this module; Gwyn Hainsworth, who provided technical editing and guidance on publication; Rachael Morgan who provided copyedit, Yasmeen Khan, who designed and formatted the document, and coordinated the printing process; and Anne Read, who designed the cover. Colleagues in the field of adolescent reproductive health reviewed this training material and provided invaluable comments and suggestions. These reviewers included: Naomy Achimpota Pathfinder/AYA, Tanzania Erol Alexis Margaret Sanger Center International Lucy Asaba Pathfinder/AYA, Uganda Dr. Babbar FPAI, Delhi Barbara Barnett FHI Joy Bategereza RCHS-MOH, Tanzania Rajiv Bhatt CASP, Delhi Dr. Raj Brahmbhatt SCERT, FPAI, Mumbai Sharon Epstein Pathfinder/FOCUS Anneth Gerald Youth Action Volunteers, Tanzania Anna Gutapaka Morogoro Hospital, Tanzania Lucy M. Ikamba GTZ – REPRO Esther Jackson Youth Action Volunteers, Tanzania Aleyamma John PSS, Delhi Kiran Kalwaye FPAI, Jabalpur Dr. J. R. Kanama UMATI, Mbeya Nelson Keyonzo Pathfinder, Tanzania Irenei Kiria Youth Action Volunteers, Tanzania Bernard Kiyenze Red Cross Society Amod Kumar St. Stephen's Hospital, India Donath P. Lasway Youth Action Volunteers, Tanzania Deborah Lwecenja Mogoro Hospital, Tanzania Venancia Lyapembile Morogoro Hospital, Tanzania Flora Lymo Morogoro Hospital, Tanzania Cuthbert Maendaenda AYA, Tanzania Rekha Masilamani Pathfinder, India Annie Mathew Pathfinder, India Elah M. Matshedisa UNFPA Hassara Maulid RCHS-MOH, Tanzania Joan J. Mngodo IDC STD Clinic, Tanzania Mr. Moinuddin Salaam Balak Trust, India Scholastica Mokake AMREF Tanzania Neo Mokgautsi Pathfinder/AYA, Botswana Omary Mrisho Youth Action Volunteers, Tanzania Dr. Mrosso Meta Hospital, Mbeya Hawa Y. Mshana Marie Stopes Tanzania Agness Mtawa Muhimbili National Hospital, Tanzania Dr. Lopa Mudra CASP, Delhi Joy Mukaire Pathfinder, Uganda Adella Mvulla Meta Hospital, Mbeya Mary Nchimbi Public Health School, Morogoro Illuminata Ndile UMATI, Tanzania Dr. Oscar Nkatilo Meta Hospital, Mbeya Pamela Onduso Pathfinder/AYA, Kenya Dr. K.K. Panda PSS, Orissa Dr. Kamala Ram Parivar Seva Sansthan (PSS), Delhi Sara Rwiza Muhimbili Nursing School, Tanzania Dr. Mnaliwe Sabina MOH, Tanzania Generose Salila UMATI, Tanzania Hadija Sayombo Morogoro Hospital, Tanzania Mridula Seth UNFPA, New Delhi Asha Singh FPAI, Lucknow Suman Srivastava PSS, Lucknow Tijuana James-Traore Pathfinder/FOCUS Dr. Joyce Vaghela St. Stephen's Hospital, India Special thanks to Betty Farrell for writing portions of the unit on Pregnancy, Birth, and Post-Partum Issues, and thanks to UNICEF and Where There is No Artist, by Petra Röhr-Rouendaal for some of the graphics included in this module. Table of Contents Notes to the Trainer ......................................................................................i • Purpose................................................................................................i • Design..................................................................................................i • Participant selection .............................................................................i • Using the modules ...............................................................................ii • Guide to symbols .................................................................................iii • Informed choice....................................................................................iii • Client rights during clinical training.......................................................iv • Do’s and don’ts of training....................................................................v TRAINING GUIDE Introduction...................................................................................................1 Unit 1: The Nature of Adolescence..............................................................9 • Special training for ARH.......................................................................12 • Biological and psychological changes..................................................15 • Desirable health status.........................................................................17 • Reproductive rights of adolescents ......................................................18 Unit 2: Adolescent Vulnerabilities, Risk-Taking Behaviors, and Their Consequences ..............................................................................................23 • Vulnerabilities of adolescents...............................................................25 • Risk-taking behaviors...........................................................................28 • Consequences of risk-taking behaviors and vulnerabilities..................30 Unit 3: Adolescent Behavior and Life Skills ...............................................33 • Psychological and behavioral concerns ...............................................36 • Life skills necessary for healthy development ......................................39 Unit 4: Communicating with the Adolescent Client ...................................43 • Establishing trust with the adolescent ..................................................46 • Behaviors conducive to counseling adolescents..................................48 • Counseling techniques to be used with adolescents............................52 Unit 5: The RH Visit and the Adolescent Client..........................................65 • Screening and history taking for ARH service provision.......................67 • The physical exam and how it can be tailored for adolescents ............72 Unit 6: Safer Sex and Protection for Adolescents .....................................77 • Safer sex messages and techniques for prevention.............................79 • Reasons why adolescents may not practice safe sex ..........................82 Unit 7: Contraceptive Options for Adolescents .........................................87 • Importance of delaying childbearing.....................................................90 • Contraceptive options ..........................................................................93 • Common side effects and their impact on adolescents ........................95 • Responding to misconceptions and rumors .........................................97 Unit 8: STI/HIV and Adolescents..................................................................101 • Impact of STI/HIV on adolescents........................................................104 • Syndromic and clinical management of STIs .......................................110 Unit 9: Counseling the Adolescent on Safer Sex.......................................115 • RH counseling and factors influencing counseling outcomes...............118 • How to counsel adolescents about safer sex and protection................123 • Ways to counsel young men ................................................................126 Unit 10: Sexual
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