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Adolescent and Youth Health Program (AYHP)

A Situationer on Adolescents Health Non-communicable diseases account for more than 40% of the deaths in young people (10-24 years old) and injuries are the causes of death in almost one third of people in this age group. Assault and transport accidents are the leading causes of mortality among young people with a mortality rate of 9.7 and 5.8 deaths per 100,000 populations, respectively (Philippine Health Statistics, 2003). Other significant causes of death among the 10-24 years old Filipinos include complications related to pregnancy, labor and puerperium; epilepsy; chronic rheumatic heart disease; intentional self harm; and accidental drowning and submersion (Philippine Health Statistics, 2003).Of the 1.67 M live births registered in 2003, 35.7% (596, 076 LB) were by women 24 years old. Teenage pregnancy accounted for 8% of all births (National Demographic Health Survey, 2003). Of the 1,798 maternal deaths registered for the same year, 22.3% were women 24 years old. The proportion of malnutrition among those 11 19 years of age (underweight and overweight) were noted to increase from 1993 to 2003 (FNRI Survey 1993, 1998 and 2003).About 4% of Filipinos 10 24 years of age have some form of disability. The most common of this are speaking and hearing disabilities.

MOST COMMON CAUSES OF DEATH AMONG 10-24 YEARS OLD PER 10,000 POPULATION. Philippine Health Statistics, 2003 Male Rank 1 2 3 Asssault Transport Accidents Event of undetermined intent Cause of Death No. Female Both Rate

Rate No. Rate No.

2,240 17.6 183 1.5 2,423 9.7 1,146 9.0 303 2.5 1,449 5.8 570 5.3 300 2.5 970 3.9

4 5 6 7 8 9 10

Symptoms, signs & abnormal clinical 602 4.7 352 2.9 findings not elsewhere classified Pneumonia Tuberculosis of the Respiratory System Chronic Rheumatic Heart Disease Accidental drowning and submersion Nephritis, nephrotic syndrome and nephrosis Other accidents & late effects of transport/other accidents 527 4.1 355 2.9 537 4.2 340 2.8 447 3.5 426 3.5 596 4.7 215 1.7 385 3.0 332 2.7 518 4.1 113 0.9

954 3.8 882 3.5 877 3.5 873 3.5 811 3.2 717 2.9 631 2.5

Leading Threats to Adolescents Health Accidents and other inflicted injuries Among 10- 24 age groups, this threat caused 27% of the total deaths (2003 data). Young males always exlusively succumb to injuries and females have the increasing mortality due to complications of pregrancy, labor delivery and puerperium. These data have been on the uptrend, a challenge to community-based or DOH-led programs. The threat is caused by the adolescents exposure to poorly maintained roads and poorly managed traffic systems. Adolescents increased mobility to urban areas needs a correspondidng physical and infrastructre support in their quest for better opportunities and education pursuits. Another is the inability of the state to provide adequate number of police personnel leading to an increasing number of assault and transport accidents among the young males. Tubercolusis, Pneumonia, and Accidental drowning Close to 6% of young Filipinos who died in 2003 died of various forms of tuberculosis, followed by pneumonia that caused 4% of deaths. This health issue among the young has been declining through the years due to sustained nationwide programs that began in 1987 and has somehow caused to keep deaths down, hence efforts to continue sustaining becomes the challenge. The threat of HIV and other sexually related diseases Reported cases increased substantially increased over the past year.Among the 15-24 year olds, reported HIV infections nearly tripled between 2007 and 2008 from 41 cases to 110 per year, which is substantial cause for alarm. In 2009, 15-24 year olds make 29% of all new infections; in 2009, the number of new infections among 20-24 equals the number of new infections among 25-29; with 10 cases see July DoH AIDS Registry Report. The substantial increase from the past year can be traced from the adolescents early engagement in health risk behaviour, due to serious gaps of the knowledge on the dangers of drugs, as well as the cause as well as causes on the transmission of STD and HIV AIDS , dangers of

indiscriminate tattooing and body- piercing and inadequate population education. Under this threat, young males are prone to engaging in health risk behaviour and more young fermales are also doing the same without protection and are prone to aggressive or coercive behaviours of others in the community such that it often results to significant number of unwanted pregrancies,septic abortion and poor self-care practices. In addition, there are also other less common but significant causes of disease and deaths namely; Intentional self- harm the 9th leading cause of death among 20-24 years old. In this age group, seven out of 10 who died of suicide were males. In age group of 10-24 years old took up 34% of all deaths from suicide in 2003 Substance Abuse - 15-19 years old group has the claim of drug use; more males than females who are drug users and drug rehabilitaiton centers claim that majority of clients belong to age group of 25-29 years old. According to the SWS survey, 1996- 1.5M youth Filipinos and 1997- grew into 2.1M youth Filipinos are into substance abuse Nutritional Deficiencies there are no specific rates for adolescent and youth, but there is the prevalence of anemia and vitamin A deficiency which may be also high for the adolescents and youth as those known for the younger and pregnant women. Disability Filipinos aged 10-24 years old has an overall disability prevalence of 4%. The most common disability among this age group affected are speaking (35%), hearing (33%) and moving and mobility (22%)

There are also vulnerable Filipino adolescents which can be classified in their respective areas of vulnerability VULNERABLE YOUNG FILIPINOS Sub-groups Young among the street-dwellers Out- ofschool adolescents and youth Urban based male youth Female adolescents Vulnerability areas Common infections, physical abuse or assault, sexual exploitation, drug use, road accidents High risk behaviour; smoking, alcohol use, drug abuse, high risk sexual behaviour, risky work conditions leading to injuries and diseases High risk behaviour; transport accidents , other inflicted injuries Sexual abuse, sexual exploitation , unwanted pregranancies, abortion, unsafe pregnancy and insecure motherhood

Not living with parents Nutritional disorders, substance use and risky or family sexual behaviour, other inflcited injuries

Factors Causing Threats to Adolescents Health The alarming patterns of health issues affecting adolescents health is caused by the following factors operating in a systemic manner reinforcing further complexities in the health issues affecting adolescents .

Socio-Cultural Factors Demographic Factors Continuing Rapid Population Growth The rapid population growth of the youth creates pressure to the state to expand education, health and employment FO rhtis age group. The pressure creates an imbalance to the distribution and allocation of resources to various sectors especially the youth. The imbalance reinforces deeper the marginalization and deprivation of some sectors to basic services. A viscious cycle is created and more are having difficulties to access provision on health service delivery.

Increased population movement The scarctiy of local employment has triggered the participation of the youth in overseas work. The movemente of the sector has caused displacement from families and love ones increase youths vulnerability to exploitation, low paying jobs. According to a study in 2001, there were more tha 6,000 workers in the teenage group overseas workers and it is most likely that they would land in overseas low paying work.

Attitudes, Lifestyles, Sense of Values, Norms and Behaviours of Adolescents Health Risk Behaviors A significant proportion of young people engage in high-risk behaviors 23% ever had premarital sex, 57% of first sex experience was unplanned and unplanned. About 70% - 80% of their most recent sexual experiences were unprotected (YAFS, 2002). The 2002 Young Adult Fertility and Sexuality Survey showed that the proportion of 15-24 year olds who were currently smoking, drinking and using drugs were 20.9%, 41.4% and 2.4%, respectively. The proportion is higher among males compared to females. A comparative data (1994 and 2003) showed that among 15 24 year olds, smoking increased by 23%; drinking

increased by 10%; drug use increased by 85%; and pre martial sex increased by 30% (YAFSS, 2003). The likelihood of engaging in pre-marital sex is higher among those who smoke, drink alcohol or take drugs. As a consequence of substance and alcohol abuse, some have mental and neurological disorders; others spend the productive years of their life behind bars with hardcore lawless adults. Health Seeking Behavior Adolescents are more likely to consult the health center (45%) or government physician (19%) for their health needs (Baseline Survey for the National Objectives for Health, 2000). The most common reasons for not consulting were the lack of money, lack of time, fear of diagnosis, distance and disapproval of parents. Dental examination and BP monitoring were the most common reasons for consultation (62.4% and 37.8%, respectively).Similalry, Conditions relating to pregnancy, childbirth and post partum were among the leading reasons for utilization of inpatient, emergency room and out patient health services at DOH-Retained Tertiary General Hospitals. Low Contraceptive Use The overall use of contraception among sexually active adolescents is at 20%. Non- desire for pregnancy and high awareness of contraceptive methods were not enough to encourage adolescents to use contraceptives. Among the reasons cited for the low contraceptive use were:

Contraceptives were given only to married individuals of reproductive age Even if they were made available to adolescents, the culture says that it is taboo for young unmarried individuals to avail of contraceptive services and commodities. Condom use is perceived mainly for STIs, HIV/AIDS prevention rather than contraception

The practice Abortion and Unmet need for Contraception In 2000, induced abortion among adolescents reached 319,000. This is due to the inadequate knowledge on preventing unwanted pregnancies. Consequences of teen-age pregnancies among young mothers include not being able to finish school and reduced employment options and opportunities. In addtion, the social stigma and fear brought about by unwanted pregrancy pushes the young mother to resort to abortion. Although the disapproval rating for abortion remains to be high, there is an increasing trend among those who approve of it (from 4% to 6% in males and 3.5% to 4% in females).On contraceptive use , adolescents also don't use condoms for prevention of HIV,it's not only that they don't use them for contraception.

Risk of HIV/AIDS due to Unprotected Sex

Adolescents including children living in exteme conditons and great exposure to sexual exploitation and abuse belong to high-risk categories threatened by unprotected sex. Latest data on these shows that majority of people engaged in sex work are young and 70 % of HIV infections involve male-to-male sex. The proportion of young people reported to have STDs/HIV and AIDS is increasing. The YAFS survey showed that although awareness about STDs is increasing, misconceptions about AIDS appear to have the same trend. The proportion of those who think AIDS is curable more than doubled (from 12% in 1994 to 28% in 2002). Many adolescents also resort to services of unqualified traditional healers, obtain antibiotics from pharmacies or drug hawkers or resort to advices from friends (e.g. drinking detergent dissolved in water) without proper diagnosis to address problems of STDs. Improper or incomplete treatment may mask the symptoms without curing the disease increasing the risk of transmission and development of complications. The limited use of condoms to protect adolescents from risk of HIV is an issue to reflection for condom use is not only to prevent pregranancy but also preventing sexually transmitetd disease. r The YAFS 2002 survey showed that Filipino males and females are at risk of STIs, HIV/AIDS. It was reported that 62 % of sexually transmitted infections affect the adolescents while 29 % of HIV positive Filipino cases are young people. In addition, it was revealed that thirty seven percent (37%) of Filipino males 25 years of age have had sex before they marry with women other than their wives. Some will have paid for sex while others will have had five or more partners.

Political and Economic Factors Marginalization and Poverty The disturbing poverty situation of households and families where majority of the adolescents belong brings in difficulties to meet adolescents.needs. Poverty is closely link to adolescent health issues. It reinforces to the situation of adolescents vulnerability to health risks due to the lack of access to various services and unsupportive social, political and economic environment. The following are some of the consequences of poverty faced by the youth.

Limited Access to Information -among the greatest challenges for Filipino youth is access to correct and meaningful information on sexual and reproductive issues. Limited access to services and commodities-The lack of access to contraceptive services and supplies was among the most frequently articulated concerns with regard to adolescent SRH. Programs such as the AYHDP do recognize adolescents need for access to contraception. Limited awareness of pertinent policies-While the AYHP Administrative order was issued in 2000, few key informants knew of its existence. In fact, many key informants said that no ARH policy existed at the time they were interviewed

Technological Factors Rapid Advancement of Communication

The value of technological advancement could never be discounted. However, to the curious and adventurous adolescents various modes of communications are oftentimes abused and misused such as the use of internet and mobile phones. Adolescents then become vulnerable to exploitation, in cybersex and pornography exposing them deeper into risky behaviour. In addtion the digital dependence and addiction causes alienation of adolescetns to personal and closer mode of communciation resulting to a distorted image of the adoelscents relationships to the social environment. This also deprives the adolescents from productive activities where they can develop themselves fully grown up and mature e conomic and socail being Moreover, communcation advantcement has also produced adverstisements and television commercials whose image are not adoelsent- friendly are paving the way for so much consumerism, distorted personal and family values

THE ADOLESCENTS HEALTH PROGRAM IN THE PHILIPPINES 8. International Policies, Passages and Laws as anchors In International Laws

UN Convention on the Rights of Children UN Convention the Action for the Promotion and Protection of the health of adolescents Convention on the Elimination of all forms of discrimination againts women 1994 International Conference on Populaiton and Development ( ICPD) 1995 Fourth World Conference on Women World Programme of Action for Youth 2000 MDG Goals : Goal 2:Achieve Universal Primary Education Goal 3:Promote Gender Equality Goal 4 : Reduce Child Mortality Goal 5: Improve Maternal Health Goal 6:Combat HIV/AIDS, Malaria and other diseases National Laws and Policies o National Objectives for Health o Fourmula One for Health o Adolescent and Youth Health Policy (AYH) o Adolescent and Youth Health and Develoment Program o National Directional Plan for reaching the Un reahced Youth Population o Reproductive Health Program AO#1 s1998

o Local Government Code WHO, together with countries and areas in the Region and partner agencies, are working to promote healthy development of adolescents and reduce mortality and morbidity. In the Western Pacific Region, several technical units are working to implement interventions that improve adolescent health in the Region. The Philippines belong to the Western Pacific Region and is committed to: Recognize adolescents as vulnerable and a group in need o Address Issues that have an evidence base o Socio- Cultural perspectives o Develop Innovative mechanisms to reach out to adolescents. o Encourage collaboration and partnerships o Program implementation is monitored and evaluated. The Adolescent Health Program The Adolescents Youth and Heath Development Programs was established in 2001 under the oversight of the Department of Health in partnership with other government agencies with adolescent concerns and other stakeholdres. The program is targeting youth ages 1024, and the program provides comprehensive implementation guidelines for youth-friendly comprehensive health care and services on multiple levelsnational, regional, provincial/city, and municipal. The program is solidly achored on International and laws, passages and polices meant to address adolescents health concerns. It is operating then within the facets and adolescents and youth health that includes disability, mental and environmental health, reproductive and sexuality, violence and injury prevention and among others. It employed strategies to ensure integration of the program intothe health care system in addition, broader society such as building a supportive policy environment, intensifying IEC and advocacy particularly among teachers, families, and peers, building the technical capacity of providers of care, and support for youth; improving accessibility and availability of quality health services, strengthening multi-sectoral partnerships, resource mobilization, allocation and improved data collection and management. The program to address sexual and reproductive health issues likewise adopts gender-sensitive approaches. The primary responsibility for implementation of the AYHDP, and its mainstreaming into the health system, falls to regional and provincial/city sectors. Guidelines cover service delivery, IEC, training, research and information collection, monitoring and evaluation, and quality assurance.

Introduction: Adolescent Reproductive Health

Worldwide, young women and men suffer a disproportionate share of unplanned pregnancies, sexually transmitted diseases, including HIV, and other serious reproductive health problems. About one half of all HIV infections worldwide occur among people age 25 and under, according to the World Health Organization (WHO). In industrialized countries, two of every three STD infections occur among people under 24 years of age, and the proportion of infected youth in developing countries is believed to be even higher.1 More than 10 percent of all births each year are to women ages 15 to 19, according to the Washington-based Population Reference Bureau (PRB). Even when pregnancy among young married women is planned, the health risks for teenage mothers and their babies can be serious. Because their bodies are not fully mature, the risk of maternal mortality is two to four times higher for pregnant adolescents than for pregnant women over 20. Infant mortality also is greater among adolescent mothers -- typically 30 percent higher for infants born to women ages 15 to 19 than for those born to women 20 or older.2 Approximately 2 million adolescent women in developing countries undergo unsafe abortions each year,3 and a third of all women seeking hospital care for abortion complications are under age 20. For young women who undergo unsafe abortion, short-term health problems can include infection or injuries from the procedure itself, such as a perforated uterus, cervical lacerations or hemorrhage. Long-term complications include increased risk of ectopic pregnancy, chronic pelvic infection and possible infertility. In the following articles, Network examines several issues that influence the quality of reproductive health services for this vulnerable age group:

Gender perspectives, which are largely defined by social and cultural conditions, shape the way adolescents view sexuality and play an important role in gaining access to information and services. Sexual health education typically delays the initiation of sexual activity among youth, and helps them to avoid risky behaviors when activity begins. Youth programs that succeed tend to share certain traits, such as involving young adults, parents and community leaders during planning. Psychological and social pressures that youth often face are important considerations when providing reproductive health services. Media, including posters, drama, broadcasting and publications, can inform young people about important reproductive health concerns and where to obtain services.

Also included in this issue is a chart of contraceptive methods, with considerations for the use of each method by adolescents. Defining the ages of "adolescence" and "adulthood" often varies from one culture to another. Adolescence typically begins with puberty in most cultures, but the age when people are considered adults varies. A young woman attending school may still be considered an adolescent in one country, while her counterpart of the same age in another may be married, beginning a family and considered an adult. In this issue of Network, the term "young adults" is often used to

embrace both adolescents and people who are in the early years of their adulthood -- people in their late teens in some cultures, or early 20s in others. References 1. Cates W, McPheeters M. Adolescents and sexually transmitted diseases, current risks and future consequences. Presented at the Workshop on Adolescent Sexuality and Reproductive Health in Developing Countries: Trends and Innovations, National Research Council, March 25, 1997, Washington. 2. Risks and Realities of Early Childbearing Worldwide: Issues in Brief. New York: The Alan Guttmacher Institute, 1997. 3. The World's Youth 1996. Chart. Washington: Population Reference Bureau, 1996.

Reproductive Health Defined by WHO Reproductive health, as defined by the World Health Organization, is a state of physical, mental, and social well-being in all matters relating to the reproductive system at all stages of life. Reproductive health implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when, and how often to do so. Implicit in this definition are the rights of men and women to be informed and to have access to safe, effective, affordable, and acceptable methods of family planning of their choice, and the right to appropriate health-care

Reproductive health care is the constellation of information and services designed to help individuals attain and maintain the state of reproductive health by preventing and solving reproductive health problems. Reproductive health care includes a variety of prevention, wellness and family planning services as well as diagnosis and treatment of reproductive health concerns. Positive reproductive health means that individuals can manage their own sexuality and have unrestricted access to the full range of reproductive health care options. Implicit in this understanding of reproductive health is the right of all women and men to be informed, to have access to safe, effective, affordable, and acceptable methods of family planning of their choice, and to have access to appropriate health care services that enable women to safely go through pregnancy and childbirth. Reproductive health is a critical component of womens general health. Reproductive health care is a prerequisite for womens social, economic and human development. When women lack access to safe, comprehensive reproductive health care, the consequences can be damaging. services that enable women to safely go through pregnancy and childbirth.