Addressing Sexual and Reproductive Health

of Adolescents during COVID-19 Pandemic

Adi Nugroho, PhD

Outlines:
• Why we should invest on adolescents?
• Adolescents sexual and reproductive health
• How do Covid-19 pandemic affect
adolescents SRH?
• How can we address adolescents SRH?
Adolescent is … WHO Indonesia MoH

• the phase of life • defines

between childhood and an adolescent as
adulthood, from ages an individual in the
10 to 18 years age 10-18 years age
group and usually uses group.
the term young person
or young people to
denote those between • BKKBN defines
10 and 24 years. an adolescent as
an individual in the
• a unique stage of 10-24 years age
human development group who never
and an important time been married.
for laying the
foundations of good
health.
What is special about • is the transition from childhood
adolescents? to adulthood involves dramatic
physical, sexual, psychological
and social developmental
changes, all taking place at the
same time.

• the transition can affects how

they feel, think, make decisions,
and interact with the world
around them.

• the transition poses risks to their

health and well being.
 Adolescents population

1.2 billion adolescents in

the world, with diverse
interests, needs, and
concerns.

Around 64,19 million people

(1 out of 4 Indonesians is
Young people).
Distribution of Indonesian Youth by 2019 (BPS, 2019)

WHO. Adolescent health in the South-East Asia Region.

Why Invest In Adolescents Health?
For The Present and The Future
Promoting and protecting adolescent health will lead to great public
health, economic and demographic benefits.

Triple dividend of health benefits:

For Adolescents' Future

For Adolescents Now
Promotion of positive behaviors and prevention,
early detection and treatment of problems, can
immediately benefit adolescents.
Lives
Support for establishing healthy behaviors in
adolescents, and reduction of harmful
exposures, conditions and behaviors, will help
set a pattern of healthy lifestyles and reduce
morbidity, disability and premature mortality
later in adulthood.

For the Next Generation

Promotion of emotional well-being and healthy
practices in adolescence, and prevention of risk
factors and burdens, can help protect the health
of future offspring.
Reproductive Health
WHO:
• A state of complete physical, mental and social well-being
and not merely the absence of disease or infirmity, in all
matters relating to the reproductive system and to its
functions and processes.
• 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.
Adolescent Sexual and Reproductive Health

• Adolescent sexual and reproductive health refers to the

physical and emotional wellbeing of adolescents and
includes their ability to remain free from unwanted
pregnancy, unsafe abortion, STIs (including HIV/AIDS), and
all forms of sexual violence and coercion.

• Why we should be concerned about ASRH?

• Because these young people are tomorrow’s parents.

 The reproductive and sexual health decisions they make

today will affect the health and wellbeing of their
communities and of their countries for decades to come.
 Two issues have a profound impact on young people’s SRH
lives: Family planning and HIV/AIDS.
Common issues that affect young people health
and well being
Sexual Reproductive Health Other Key issues Specific SRH needs and other
issues affecting subgroups of
young people
 Puberty  The influence of ICT on  Young people living with HIV
 Pregnancy sexual behaviour  Young key population of HIV
 Access to modern  Poor mental/emotional  Young people living in poverty
contraception health  Young people with disabilities
 Unsafe abortion  Alcohol, tobacco, and drugs  Young people affected by
 Violence, including gender- humanitarian crisis
based violence
 HIV and AIDS
 STIs

UNESCO. 2018. International technical guidance on sexuality education - An evidence-informed approach, Revised edition.
SRH Services for young people
• Information and counselling on sexual and reproductive
health issues
• Promotion of healthy sexual behaviours
• Family planning information, counselling and methods of
contraception (including emergency contraceptive
methods)
• Condom promotion and provision
• Testing and counselling services for pregnancy, HIV and
other STIs
• Management of STIs
• Antenatal care (ANC), delivery services, postnatal care
(PNC) and pregnant mother-to-child transmission
(PMTCT)
• Abortion and post-abortion care
• Appropriate referral linkage between health facilities at
different levels.
 Many adolescents
initiate sexual activity
later than adolescents in
the past.

Positive Girls are less likely to be

trends in married and to have
children before age 18,
ASRH since use contraception and to
obtain maternal health
ICPD 1994 care.
(Liang et al, 2019)

Less likely to experience

female genital mutilation
Slow progress on adolescents SRH:

Menstruation is still HIV-related deaths The level of STI’s High proportion of Lack of good data Adolescents are
seen as a taboo are not decreasing are high proportion of on levels of unsafe still expected to
topic and limited data adolescent girls abortion among conform to specific
available have experienced adolescents, and gender norms
physical and/or the risk of mortality
sexual intimate and morbidity
partner violence resulting from it

WHO. The changing world of adolescent sexual and reproductive health and rights, 2020.
 Adolescent SRH globally
Approximately 12 million girls (15-19 years) and at least 770.000 (<15
years) give birth each year in developing regions

At least 10 million unintended pregnancies occur each year (15-19

years) in developing world

Estimated 5.6 million abortions that occur each year (15-19 years), 3.9
million are unsafe, contributing to maternal mortality, morbidity and
lasting health problems

Adolescent mothers (ages 10–19 years) face higher risks of

eclampsia, puerperal endometritis, and systemic infections and
babies face higher risks of low birth weight, preterm delivery and
severe neonatal conditions

Complications during pregnancy and childbirth are the leading cause

of death for 15–19-year-old girls globally

WHO. Maternal, newborn, child and adolescent health; Why invest in adolescent health?.
Indonesia Adolescents SRH
Where we were before COVID-19

• Premarital sexual intercourse: 8% boys & 2% girls,

most started at the age of 17 years
• Condom use: 49% girls & 27% boys
SDKI 2017 • Unwanted pregnancy: 16% of girls age 15-19 years,
Adolescents age and 8% among those age 20-24 years.
15-24 years • Abortion: 23% girls & 19% boys know if their friend had
(13,079 Boys & an abortion and 1% of them accompanied her during
10,691Girls) the process
• 45% girls and 44% boys start dating at age 15-17 years.
• 15% adolescents boys and 1% age 15-24 years ever
consumed alcohol
• 5% men and <1% women are using illegal drugs.
Indonesia Adolescents SRH

Early Adolescent’s Health in Indonesia: Evidence Base from GEAS-Indonesia Baseline 2019
Curriculum-based
• Has positive effects in increasing
sexuality education knowledge about different aspects of
programmes sexuality, behaviours and risks of
for adolescents pregnancy or HIV and other STIs.

• Improve attitudes related to SRH.

• Contribute to the following outcomes:

 Delayed initiation of sexual intercourse
 Decreased frequency of sexual intercourse
 Decreased number of sexual partners
 Reduced risk taking
 Increased use of condoms
 Increased use of contraception

UNESCO. 2016c. Review of the Evidence on Sexuality Education.

 Comprehensive
Sexuality Education
(CSE)
to equip children and young people with
the knowledge, attitudes and skills that will
empower them to
 realize their health, well-being and
dignity;
 consider the well-being of others
affected by their choices;
 understand and act upon their rights;
and
 respect the rights of others

UNESCO. 2018. International technical guidance on

sexuality education - An evidence-informed approach,
Revised edition.
Potential Impact of the COVID-19 Pandemic on SRH

• A substantial decrease in adolescents’ physical activity and increase in

screen time during the COVID-19 pandemic, which may negatively
adolescents' physical and mental health (Xiang et al, 2020)
• Decreased sexual activities and sexual satisfaction of young men and
women; rapid reduction in risky sexual behaviours of high-risk individuals
(Li et al, 2020)
• Quarantine leads to negative psychological effect, including post
traumatic stress symptoms, confusion and anger (Brooks et al, 2020)
• Quarantine might increase the risk of gender-based violence and
domestic abuse, which have been observed in other major disease
outbreaks (Chynoweth et al, 2018)
Disastrous consequences for women and their families in LMICs are possible if core
sexual and reproductive health services are reduced or deemed nonessential during the
pandemic (Riley et al, 2020)
 How has Covid-19 Pandemic affected Adolescents SRH?

 Formal education of young people has been

severely impacted
 Closures of non-formal education, which
deprives them of social engagement with their
peer and educators.
 Disruption of the normal delivery of sexual and
reproductive health services and information
 Some adolescent girls and young women may
experience even higher levels of domestic
violence and partner violence driven by
quarantine and isolation
 Protection and psychosocial issues of those
whose caregivers are infected, quarantined, or
passed away.

UNFPA. Coronavirus disease (COVID-19) preparedness and response. 2020.

COVID-19 impact on young key populations and other subgroups
 27% of young people experienced delays or
disruptions when accessing condoms, 11% when
accessing opioid substitution therapy (OTS), 17%
clean needles, 14% PrEP, and 26% HIV testing.
 30% of young people experienced delays or
disruptions in accessing psychological support and
19% in accessing mental health medications.

Asia Pasific Inter-Agency Task Team on

Young Key Populations, 2020

 Many vulnerable young people, such as young

migrants, young refugees, homeless young people,
those in detention, and young people living in crowded
areas such as townships or slums, live in conditions
that put them at greater risk of contracting COVID-19.
 They also have limited access to technology and
alternate forms of education and information,
including on how to mitigate exposure to COVID-19.

UNFPA. Coronavirus disease (COVID-19) preparedness

and response. 2020.
COVID-19 impact on young PLHIV:
Response to adolescents SRH in the time
of COVID-19 pandemic
 At individual level
• Use credible sources to get information, including
SRH related, to get the facts about your risk and how
to take precautions.
• Try to maintain a healthy routine and lifestyle
including a proper diet, sleep and exercise.
• Keep in touch with family and friends through phone
calls and making use of social media platforms.
• Don’t resort to tobacco, alcohol or other drugs to
cope with your emotions.
• If you feel overwhelmed, talk to a health worker,
social worker, similar professional, or another
trusted person in your community.
• Have a plan of where to go and seek help for any
physical and mental health and psychosocial needs,
if required.
• Decrease the time to spend on watching or listening
to upsetting media coverage and minimize the time
you spend looking for information.
At policy makers and institutional level

• Define and promote sexual and reproductive health care as essential. This will
allow people to travel for sexual and reproductive health services—even in areas
under stay- at-home orders or with travel restrictions—without fear of legal
consequences.
• Alongside private-sector actors, strengthen national and regional supply chains
to make SRH medications and supplies more accessible to providers and
patients.
• Improve access to SRH services; e.g., decentralize distribution of SRH
medications and supplies from the national to regional level (to prevent
bottlenecks); deliver services at people’s home when possible; and facilitate
multi-month dispensing of SRH pharmaceuticals.
• Adopt innovative models of care and services, such as telehealth, and as much
as possible, prevent diversion of resources and staffs away from SRH.
• Address the unique needs of vulnerable and marginalized populations, who
often face pre-existing barriers to care that are exacerbated during a crisis.
Use social media to develop and disseminate targeted,
timely and appropriate information on HIV and COVID-19
among YKP and young people living with HIV;

Adopt innovative methods to provide correct information

to the young key population who lacks access to the
digital technologies;

Promote and support digital literacy among young key

populations to equip them to make the right decisions to
prevent COVID-19 and access services and reject fake
news and misconception

Encourage young people to read information from

reliable sources such as official UN websites, Facebook
and Twitter pages, and official government website

Use friendly and simplified language for young people

and encourage translation of communication materials
into regional languages.
Promote and put in place innovative solutions to avoid
disruption to HIV-related and health services including
sexual and reproductive health services

Consider waiving restrictions (if these exist) - such as age or

marital status, parental or spousal consent and costs - to
facilitate access to SRH and HIV services by adolescents.

Ensure access to multi-month dispensing (three months or

more) of ARVs and other medicines, and preventive
commodities like condoms for young people living with HIV

Promote ARV treatment literacy interventions among young

people living with HIV

Ensure provision of mental health and counselling services

for the young key populations

Reach out to local groups/networks, vulnerable populations

and young people and encourage them to take care of
themselves and their loved ones and share information
about COVID-19 prevention
 Essential Services
Water, sanitation, and
Health
hygiene
Ensure that the COVID-19 Ensure that young people
response plan is sensitive have access to get the
to the needs of health care clean water for drink and
especially for young personal hygiene,
people, including sexual sanitation care, the facility
and reproductive health, of washing hands with
mental health, soap, and management of
and psychosocial support health menstruation to
protecting their health and
welfare and for preventing
the transmission of
infection.
Livelihoods, cash &
Education Protection
markets
Supporting of continuous Ensure that the effort of Ensure that young people
learning for young people, protection to young whose income is affected
including the group who people will always be by the crisis COVID-19 got
aged at more than 18 considered in every life support and ensure
years. Even formal and aspect of preventing and that young people with
informal education must mitigation of Covid-19. their family have money
be able to reach the access towards goods and
migrants, refugees, and services
displaced young people.
Ensure young people’s participation
• Engage community groups and youth networks to extend the provision of SRH and
HIV information and services

• Create online platform for supporting the spread of inclusive information

• Engage young people in the monitoring and evaluation process as a response for
Covid-19 and in the impact assessment through social media or online media

• Actively involve young people in COVID-19 responses as health workers,

advocates, volunteers, scientists, social entrepreneurs, and innovators

• Support young people in delivering trustworthy information on response to Covid-

19

• Prevent spreading of fake news and hoax, and fight stigma related to Covid-19

• Support access to media content which is adolescents-friendly and let the young
people to participate in developing content
References:
• Asia Pasific Inter-Agency Task Team on Young Key Poipulations. Preliminray findings; Rapid survey on the needs of Yong Key Populations and
young people living with HIV in Asia and the Pacific in the context of Covid-19, 2020. https://unaids-ap.org/2020/05/13/report-rapid-
survey-on-the-impact-of-covid-19-to-young-key-populations-and-young-people-living-with-hiv-in-indonesia/
• Badan Pusat Statistik. Statistik pemuda indonesia 2019. Jakarta: BPS, 2019.
• BKKBN, BPS, Kementerian Kesehatan. Survei demografi dan kesehatan Indonesia 2017; Buku remaja. Jakarta: BKKBN, 2018.
• Compact for Young People in Humanitarian Action. COVID-19: Bekerja dengan dan untuk anak muda. UNICEF, 2020.
• Federal Democratic Republic of Ethiopia Ministry of Health. Adolescent and youth reproductive health module: Ethiopian Federal Ministry
of Health. Ethiopian: Ethiopian Federal Ministry of Health, 2015.
• Gaidhani, Shilpa & Arora, Drlokesh & Sharma, Bhuvanesh. (2019). Understanding the attitude of generation z towards workplace.
nternational Journal of Management, Technology And Engineering; !X(1): 2804-2812.
• Kementerian Kesehatan RI. Hasil utama riskesdas 2018. Jakarta: Kemenkes, 2019.
• Office of The Secretary-General’s Envoy on Youth. #CopingWithCOVID: A webinar series on young people and mental health.
https://www.un.org/youthenvoy/2020/04/copingwithcovid-a-webinar-series-on-young-people-and-mental-health/
• UNFPA. Coronavirus disease (COVID-19) preparedness and response. UNFPA Interim Technical Brief V, 2020.
• WHO. Adolescent health in the South-East Asia Region. https://www.who.int/southeastasia/health-topics/adolescent-health.
• WHO. Key Facts: Adolescent pregnancy, 2020. https://www.who.int/news-room/fact-sheets/detail/adolescent-pregnancy.
• WHO. Maternal, newborn, child and adolescent health; Why invest in adolescent health?.
https://www.who.int/maternal_child_adolescent/topics/adolescence/why-invest/en/
• WHO. The changing world of adolescent sexual and reproductive health and rights, 2020. https://www.who.int/news-room/detail/03-02-
2020-the-changing-world-of-adolescent-sexual-and-reproductive-health-and-rights.
 Acknowledgement

• Kusnandiyah Praedevy R., SKM, M.Kes

• Anggriyani W. Pinandari, SKM, MPH
Contact:
Adi Nugroho, PhD
Dept. Promosi Kesehatan & Ilmu Perilaku
PSKM FK Universitas Lambung Mangkurat
E: adinugroho@ulm.ac.id