Teenage pregnancy is one of the commonest causes of maternal and neonatal mortality. This arises as a result of immaturity of the female body at that age leading to anemia in pregnancy, obstructed labor and if it goes unsupervised could lead to vesico-vaginal or rectovaginal fistula or at worst death of the girl child. Adolescent pregnancy is also a cause of increase out of school drop-out rate amongst the girl child because of the social stigma of carrying a pregnancy out of wedlock which can lead to low self-esteem, depression, forced early in some cases where the pregnancy is not supported by the parents, this may cause her to seek for an abortion and in a country like Nigeria where abortion is not legalized she seeks such services in the hands of a quack which could lead to post- abortal sepsis and death. Drop out of school could also worsen poverty in the family, they have limited ability to get well-paying jobs following a drop out of school and not being able to complete education post-secondary school. Asides pregnancy and its complications, early sexual activity predisposes them to sexually transmitted disease including HIV and sexual dysfunction later in life.
In this locality, where sex education is being carried out by teachers in schools, it shows that intervention already taking place in this environment is limited to sex education which most likely be directed at abstinence only and not addressing other adolescent health needs.
In the light of this, an intervention using a community based approached would be carried out aimed at slowing onset of early initiation of sexual activity, reducing the incidence of adolescent pregnancy by equipping them with skills that provides them with means and confidence to protect themselves from unwanted sexual advances, unplanned pregnancy and infections. This approach builds on abstinence approach which is already in use in this community but also reducing harm in those already sexually active. The objectives of this intervention is to equip adolescents in this community with comprehensive sex education to enable them make better responsible decisions regarding her sexuality, improve parent-child communication about sex, improve clinical services making them accessible and more youth friendly, and also changing policies and cultural norms that prevent women from negotiating safer and accessing reproductive health services.
The following are the broad and specific activities that would take place under the intervention, the defined roles and responsibility and timelines over the next 3 years;
Community mobilization; this involves identifying key decision makers in the town such as the state governor, local government chairmen of all 4 communities, community chiefs, school heads, ministry of health and education, local media outlets and journalists and community influencers i.e. highly respected community members such as pastors, imams, head of youths, women leaders in the community and also the adolescents themselves. These stakeholders will need to be convinced that early onset of sexual activity, teenage pregnancy and its consequences are issues that exist and needs to be addressed and why this intervention would be important and what it hopes to achieve, identifying those who want to be actively involved as partners and active advocates for campaign programs, town hall meetings and youth forums standing as facilitators and championing the process in their cycle of influence.
There would be recurrent meetings with stakeholders to keep them updated on plans and progress made and also they would be given channels to provide the intervention team feedback on what they have done or issues raised within their cycle A needs assessment would first be conducted to know the current state of teen pregnancy and adolescent sexual health in the community via focused group discussions, interviews with residents and key stakeholders, assess what is already available to adolescents in terms of services. This will help us in drafting a strategic plan and program activities inform our direction of the mobilization. This would involve mobilizing resources, disseminating information, generating support and cooperation across public and private sectors in the community so as to enhance the community’s ability to address issues regarding teenage pregnancy and making it more sustainable even after the period of intervention.
Training on relationship and sexual health for both health and non-health professionals to develop skills and tools needed to communicate effectively to adolescents about reducing risky sexual behaviors. Sensitization of all religious leaders to incorporate adolescent sexual health issues in their sermons. All those trained can go on to be used as sex educators in schools, hospitals religious organizations and areas of influence. Adolescents can also be trained as peer educators. This kind of neighborhood initiative would ensure that most adolescents are reached with the necessary information from all quarters. SOP’s would be developed to ensure quality and detailed training and would be carried out by the implementers of the program.
