Note: make sure that your discussions are arranged logically.

For your intro, provide

a brief discussion of what is an adolescent including their characteritics then focus
on reproductive health. Discuss about the reproductive health, characteristics or
changes experienced by the adolescent and then present and discuss briefly
common reproductive health issues. Remember that what you are writing about and
the focus of your output are not the reproductive health issues or problems but
rather, the adolescent health program of the municipality

Adolescent Health

I. Introduction

Adolescence came from the Latin word – adolecere – to grow into maturity. It is the
phase of human development encompassing the transition from childhood to adulthood,
ranges between 10-19 years for both sexes, married and unmarried people. During this
transition, biologic changes and sexual maturation occurs. At this period, the society no
longer views him as a child but does not as yet concede him either the roles or the function
inherent in the status of adult. Further, it is considered as the best part of someone's life yet
it is also a part where nothing seems to go smoothly so adolescent health is therefore an
important component of global health. Republic Act (RA) 10354 also known as the
Responsible Parenthood and Reproductive Health (RPRH) Act of 2012 uses the term
adolescents for people aged 10-19 years. This distinguishes the term from youth for those
aged 15–24 years and young people for that aged 10-24 years. In the Philippines,
adolescents comprise 21.5% of the country’s population.

In the Philippines, adolescents comprise 21.5% of the country's population. The

Department of Health and Philippine Pediatric Society(PPS) divides this period into :
1.) Early Adolescence (10-13y/o)
2.) Middle Adolescence (14-16y/o)
3.) Late Adolescence (17-19y/o).

Further, in 2000 statistic shows that majority of the adolescents were Asians with
62% of worldwide youth population. This was followed by African adolescents(15%) and the
least are from North America(4%). A decline in percentage in Asia is expected as seen on
the projected youth population percentage by the year 2025. However, an increase of 7% of
the youth population is expected in African countries and North American youths will still
have the least percentage worldwide. While in the Ilocos Region, majority of the population
in 2020, according to PSA are aged 10-19y/o.

Meanwhile, statistic also shows that in 2015, about 103 adolescent died mostly from
preventable or treatable diseases. In addition, it was estimated that 330 adolescents die
everyday due to road traffic injuries. It was seen that half of all mental diseases in
adulthood start at age 14 which are undetectable and untreatable. Further, 11% of
 worldwide births accounts to girls aged 15-19y/o and complications linked to pregnancy and
childbirth are the second cause of adolescent pregnancy.

Philippine Adolescent Health is no exempt to difficulties that they are facing.

Problems ranges from physical violence and sexual violence(4.4%), smoking (6.8%) to
newly reported HIV antibody positive individuals(30%). These percentages were based on
the country's population.

As statistic shows that the most common culprit in adolescent health are
reproductive problems and mental health problems.

Turning to reproductive health problems, the most common issues include Teenage
pregnancy, abortion related problems, reproductive tract infections and irregular menstrual
cycle.

Early onset of pregnancy is a global issue commonly occur in power and

marginalized communities in the Philippines 6% of Filipino girls are affected by teenage
pregnancy. Early pregnancy is one of the pressing issues Filipino youths are facing today.
The Philippines has one of the highest teenage pregnancy rates among the ASEAN
member states despite the decrease of total live births of teenage mothers (aged 10-19) in
2016 (203,085) to 183,000 in 2019. According to the Commission on Population and
Development (PopCom), the Philippines has recorded a 7% increase in births among girls
aged 15 and below in 2019. Filipino minors who gave birth in 2019 increased to 62,510
from 62,341 in 2018. In 2019, 2,411 very young adolescents aged 10 to 14 gave birth, or
almost seven every day. One in three births among minors occurred in the three regions of
Calabarzon with 8,008, National Capital Region with 7,546, and Central Luzon with 7,523
births. Outside Luzon, the highest number of minors who gave birth were in Northern
Mindanao with 4,747 cases, Davao Region with 4,551, and Central Visayas with 4,541.
This increases when girls are denied the night to make decisions about their sexual and
reproductive health and well-being. Every teenager needs to know the effects and
consequences of risk behaviors that will lead to teenage pregnancy.

Factors causing teen pregnancy

Though there is no single cause for the rate of teen pregnancy in the Philippines, there is a
combination of biological, social, and cultural factors that can be noted:
 Biological. Teenagers become curious about sex and their sexuality.
 Social. This includes lack of sex education and how to effectively protect themselves from
getting pregnant and contracting sexually transmitted infections. The lack of access to
family planning services is also a big problem.
 Cultural. Parents in the Philippines are not comfortable with discussing sex with their
teenagers. There is also the culture of encouraging teens to get married early as a means
to become more financially stable.
Filipinas should be given the right to make decisions about their own reproductive health, in
order to protect their wellbeing and to reduce the risk of teen pregnancy in the Philippines.
Women should be able to have access to the right healthcare services, sex education, and
ways and means to protect themselves from unwanted pregnancies as well as STIs.

Short term impact:

When teenage pregnancy occurs, the entire family will be affected which lead to
stress that will affect family relationships. Pregnant teenager may encounter many
problems which will affect relationship and society. Pregnancy during teenage years is also
associated with a higher risk of health problems such as preeclampsia, anemia, contracting
STDs (sexually transmitted diseases), premature delivery, postpartum hemorrhage, and
poor mental health outcomes.

Long term impact:

Early childbearing may result in poor health outcomes and may be a threat to the
country’s economic growth. Pregnant adolescents are less likely to complete higher
education and have lesser ability to earn more income over the course of a lifetime, causing
economic losses to the country. Due to stigma and shame pregnant teenager are often
forced to stop schooling and this will reduces their chance to hold a decent job and have a
good income which will limits the opportunities to build a better life in the future. Teenage
mothers are more likely to experience violence and depression that can increase the risk of
mental disorders.

Further, other issues is abortion. This term is the termination of pregnancy by

removal or expulsion of an embryo on pelvis. This occur approximately 30-40% of all
pregnancies. It was noted between year 2000 and 2017 that there is a large number of
abortion among adolescents due to non use of contraception. A pregnancy that result in
induced abortion can result in long-term psychological effects on adolescent which include
depression, post-traumatic stress disorder, guilt feelings, sleep problems and anxiety
disorder.

One of the most important issue in Reproductive Health among adolescent is

reproductive tract infection(RTI's). This infection are caused by organism normally present
in the reproductive tract or introduced from the outside during sexual contact or medical
procedure. STD's are spread thru vaginal, anal or oral sex with an infected person. It was
estimated that more than 1 million STD's are acquired everyday.

Adolescent are at greater risk for getting an STD due to several reasons:
1.) Biologically young bodies are more prone to STD's.
2.) They don't get the recommended STD test;
3.) They are hesitant to talk openly and honestly about their sex lives and
4.) They have multiple sex partners.
 Further, the most common STD's are HIV( Human Immunodeficiency Virus),
HPV( Human Papillomavirus), Clamydia, Gonorrhea, Genital Herpes, Syphillis and
PID( Pelvic Inflammatory Disease). There are some advised by the expert to help reduce
the teen's risk of getting and STI. They include use of condoms even for oral sex, learn the
symptoms of STIs, don't have sex during menstruation, don't have anal intercourse and
have a regular checkup for HIV and STIs.

In addition, irregular menstruation cycle is also on of the major problems of teenage

girls, irregular cycle examples include, fewer than 21 days or more than 35 days apart
periods; missing 3 or more periods in a row; heavy or lighter than usual bleeding periods
longer than 7 days; period accompanied by severe pain, cramping, nausea and vomiting
and bleeding/ spotting between periods.

Some of the conditions related to irregular menstruation includes;

a.) Amenorrhea, a condition where your periods have stopped completely. If you haven't
started menstruating by the age of 15 or 16 or within three years of your breasts
developing, you may also have amenorrhea;
b.) Oligomenorrhea, a condition where your periods occur infrequently. You may go 35
days between periods or have six to eight periods a year;
c.) Dysmenorrhea, a medical term for painful and severe menstrual cramps;
d.) Abnormal uterine bleeding, is bleeding between monthly periods, prolonged bleeding or
an extremely heavy period.

Causes

Most of the time, irregular periods are part of the normal changes that can happen
when you're a teen. As you get older, your cycle will probably settle into a recognizable
pattern. Sometimes, irregular periods can be caused by some medicines, exercising too
much, having a very low or high body weight, or not eating enough calories.

Hormone imbalances can also cause irregular periods. For example, thyroid
hormone levels that are too low or too high can cause problems with periods. Some girls
have extra androgen, a hormone that can cause hair growth on the face, chin, chest, and
abdomen. Extra androgen can also makes girls gain weight and have irregular periods.

When you are stressed, your body releases a stress hormone known as cortisol that
can affect the levels of other hormones such as estrogen and progesterone. The changes
in your hormones cause abnormalities in your menstrual cycle, such as the color of your
menstrual blood, the amount of blood you eliminate, and the consistency of your bleeding
patterns.

Signs and symptom

Irregular periods often occur with many other symptoms. Side effects of irregular periods
might include:

 Heavy bleeding
  Light bleeding

 Intense pain or cramping

 Nausea or vomiting

 Bleeding or spotting between menstruation

 Bleeding or spotting after sex

Short term impact

Female students face many problems that challenge their quality of life and academic

performance. Of the problems that affect the quality of life of female students, menstrual

cycle irregularity is a foremost gynecological problem and a cause of anxiety to students

and those close to them . It affects the different day-to-day events of students .

Long term impact

Different studies revealed that menstrual irregularities can also affect issues later on in life,

such as osteoporosis, infertility, future diabetes mellitus, and cardiovascular disease .

The problem can be diagnosed through pelvic ultrasound, endometrial biopsy and
Hysteroscopy (a procedure that allows your provider to look inside your uterus in order to
diagnose and treat certain causes of abnormal bleeding). Medications are often the first
treatment for irregular periods. If medication doesn't help, your provoder may recommend
surgery. Possible medications include hormonal birth control, tranexamic acid, pain
relievers, hormonal therapy, antibiotics and Gonadotropin-releasing hormone agonist.

Turning to mental health problems, 13% of this age group experiences a mental
disorder globally. Depression, psychosis and anxiety disorder are the most common.

Depression is common yet serious mood disorder. It affects one's feelings, thinking
and handles daily activities like sleeping, eating and working. There are several types
including major depression, persistent depression disorder and depression with symptoms
of psychosis. Signs and symptoms are felt everyday for 2 weeks. These includes but are
not limited to, persistent sadness, feelings of hopelessness, irritability, frustration, feeling of
guilt, worthlessness, loss of interest in hobbies and activities, decrease energy, difficulty
concentrating or making decisions, difficulty of sleeping, changes in appetite or unplanned
weight changes and thoughts of death and suicide attempts. The condition can be treated
with medication and psychotherapy.

Moreover, the next mental health issue is psychosis, wherein a person loses touch
with reality. Symptoms includes; withdrawing from friends/ feeling suspicious of others,
changes in sleeping or eating patterns, less concern with appearance, difficulty organizing
thoughts or loss of usual interest in activity, feeling like thing are unreal, changes in
personality and feeling of grandiosity. Regardless of severity of the symptoms, the child's
outcome can be improved by making sure your kid sticks to a routine that includes; eating
well, getting regular exercise, adhering to a regular sleep schedule, reducing stress as
much as possible, staying away from drugs particularly marijuana. Treatments are psycho-
education, therapy, particularly behavioral therapy, lifestyle adjustment and reducing stress.

Lastly anxiety disorder, it is a normal part of life and can be anyone. Anxiety
disorders are when fears and worries cause distress and interfere with your teenager doing
the things they want, or should be doing. Symptoms includes feeling constantly agitated,
being sensitive to criticism, always worrying about things that aren't likely to happen,
avoiding difficult or new situations, being withdrawn, having trouble concentrating and
starting or finishing schoolwork, having trouble sleeping and changed eating habits.
Treatment option includes psychological therapy and medicines, other options that can
alleviate anxiety includes getting a regular physical activity, eat well, reduce their caffeine
get enough sleep, deal with any issues causing anxiety, reduce their stress levels through
mindfulness and do breathing exercises.

There are also other major adolescent problems that includes nutritional adolescent
problem that includes undernutrition, iron deficiency anemia, obesity and eating disorder.
Physical growth is a key indicator of child health, and this holds true for adolescents. It
leads to impaired growth, anemia, iodine deficiency. Under-nutrition may contribute to
underweight, poor performance at school, poor general health, pregnancy and birth
complications, and less economic productivity. Nutrition is one of the most important factors
affecting pubertal development. Increasing demands of energy proteins and micronutrients
are necessary to cope with the rapid linear pubertal growth and development, changes in
body composition, and increase physical activity. Eating disorders, such as anorexia
nervosa and bulimia nervosa, commonly emerge during adolescence and young adulthood.
Eating disorders involve abnormal eating behaviour and preoccupation with food,
accompanied in most instances by concerns about body weight and shape. Anorexia
nervosa can lead to premature death, often due to medical complications or suicide, and
has higher mortality than any other mental disorder. Malnutrition is a double burden with
12.4% of adolescents wasted and 8.3% overweight or obese. The latter is somewhat
expected given that 42.2% consume soft drinks one or more times per day while only
13.9% were physically active for a total of at least 60 minutes daily on five or more days
during the past week. On the other hand, one in three (37.2%) pregnant adolescents are
nutritionally at risk (based on weight for-height classification.

II. DISCUSSION
Adolescent and youth-friendly health services (AYFHS) (also called youth-friendly services,
YFS) are designed to address the barriers faced by youth in accessing high-quality sexual
and reproductive health (SRH) services. The adolescent- friendly health services have to be
paired with an adolescent-friendly health facility. An adolescent- friendly health facility
should have an accessible location, offers confidential services, and a wide range of other
services.

This wide range of services include information and services that will improve the
reproductive health, nutrition, immunity from common illness, psychosocial health, oral
health, sexual health, and environmental safety of the adolescents. Comprehensive
program include intervention to address the social, cultural, spiritual, and economic aspects
of health care. Special services for special health problems and conditions such as
disability and rape and for abuse victims should also be made available. These shall
include medical, legal, and rehabilitation services as well as social and support services.

The facility also have a friendly and open atmosphere, sufficient space with comfortable
seats, private area for consultation and examination, and posters and decors that are age
appropriate. In order for a facility to be adolescent friendly, it also has to operate at
convenient hours. In other words, health services should be available to all adolescents
during times of the day that are convenient to them.

Program Purpose

To improve the health status of the adolescent of Magsingal, Ilocos Sur and its other
catchments namely: Municipality of San Juan, Municipality of Sto. Domingo, and
Municipality of San Ildefonso Ilocos Sur through delivery of quality and efficient health care
services particularly on the promotion of health and prevention of illnesses.

Program Objectives

A model Adolescent-Friendly Health Facility that provides cost-effective, patient- centered

primary health care experience made possible by a vibrant and collaborative team of
nurturing outcomes- driven professionals, local government leaders, and community for the
adolescents of Magsingal, San Juan, Sto. Domingo, and San Ildefonso.

Program Components or Services

General Health Assessment – History and Physical Exam
Dental Assessment
Psychosocial Risk Assessment and Management
Nutrition Assessment & Counselling
Micronutrient Supplementation
Immunization
Basic Diagnostic Tests
Reproductive Health Assessment and Counselling
Fertility awareness, menstrual health issues, sexual and reproductive health counselling
including contraceptive
Counselling
Pap smear and pelvic exam if sexually active
Adolescent male reproductive health issues
Gender issues (VAWC Desk)
Voluntary Counselling and Testing for STIs and HIV
Risk Assessment (HEEADSSS)
Prevention of Adolescent Pregnancy
Health education sessions
Counselling
Prenatal
History and Physical Examination
Immunization – Tetanus toxoid
Micronutrient supplementation with iron, folate
Laboratory – CBC, blood typing (if not available, refer), pregnancy test, urinalysis
Pregnancy counselling
Nutrition counselling
Birth plan including exclusive breastfeeding counselling
Family planning counselling
HBsAg test for pregnant mothers
Natal (Birthing Homes)
Safe delivery by skilled health worker at a mother-and baby friendly health facility
Essential Newborn Care Protocol
Newborn package:, Vitamin K, Hepatitis B – birth dose, BCG, eye prophylaxis, Newborn
Screening
Postnatal
Micronutrient Iron supplementation
Counselling services: Family planning, Nutrition counselling, Exclusive Breastfeeding,
Parenting
Provision of FP services and commodities (with parental consent)
Sexually Transmitted Infections/HIV Packages
STI and HIV Risk Assessment
Diagnostics: Gram Stain, RPR, C/S, HIV Counselling and or Testing
Risk Reduction Counselling
Voluntary Counselling and Testing for HIV/STIs
Health Education
Conduct of Adolescent Health sessions among in-school and out of school adolescents
Conduct of Parent Education sessions among parents of adolescents

Target Population
There are around 17, 000 adolescents among the four targeted municipalities. This includes
the municipalities of San Juan at around 4,700, Magsingal with 5,800 teenagers, Sto.
Domingo with 5,000, and San Ildefonso with 1570 adolescents. The above population is
based on the statistical report of PSA in 2022.

Program Resources
The hospital provided a room to serve as a clinic/ counselling clinic. Physiological history
and assessment is given to the adolescent to answer the questions. Logbook is also
provided to monitor and serve as a record of the adolescent health.
Because there is no adolescent friendly clinic in the hospital, the staff started from and little
by little with the resources they have they were able to put up the clinic and other needed
tools and equipment to provide quality care for the adolescent.

Financial
With regarding to the funding of the said program, there is an allocated budget which is
incorporated in the training fund. If it is consumed, it is said that re-allocation can be done,
just to supplement the needs of the adolescent program in the hospital.

Human Resources
The chief nurse of Ilocos Sur District Hospital- Magsingal appointed a focal person for the
Adolescent friendly health facility, approved by the Chief of Hospital I. The adolescent
health focal person of the hospital is the only person who is responsible for safe handling
and upkeep of documents/ records of the clinic. The focal person also attended seminars
and trainings regarding adolescent in preparation to the program given to her.

Statistics
There are several reasons why teenagers are seeking health care services. Mainly, due to
involvement in Vehicular accidents, followed by problems in the urinary system, drinking
problem, smoking, STDs, Sexual problems, and lastly due to early pregnancy. Statistics
shows that majority of adolescents seeking healthcare are those involved in vehicular
accidents(207) 21.9%, smoker (110)11.6%, drinker(186)19.7%, sexual(75) 7.9%,
STD(95)10%, UTI(195)20.6% and Early pregnancy(77)8.15%.

The plan of the program is at least 2% Adolescent birth rate reduction by year 2024 to
improve health outcomes among 109-19 years old. The output of the said plan is to
improved the health services and increase in logistics for adolescents health care needs
through our accredited adolescent friendly health facility.

The problem encounter by the program is the privacy. It is important that we protect privacy
when discussing sensitive issues. One way to do this is through providing scenario to use
as the basis for our discussion. The purpose of these is to have people develop their skills
and confident to talk about sexuality and gender issue. While we do need to talk freely and
openly, we also need to respect privacy. We ask people not to tell stories about other
people that those people may wish to keep private.

An interview was conducted with Mrs. Camille Vera Cruz, adolescent nurse at Ilocos
Sur District Hospital Magsingal dated last November 7,2023 . It was noted that it was
started last December 2022 and was accredited last April 2023. According to Mrs. Vera
Cruz , the most common illness was due to cough and cold and urinary tract infection. She
also emphasized the importance of perineal care/hygiene. In addition, the institution have
catered early pregnancies (12-17years of age), and they were glad to have visiting OB-
gyne physicianS. Further there was one (1) recorded case of STI infection, gladly he is
now well. Ad to the number of early pregnancies they have about (10) ten cases. All were
given health education. Finally, as to the progress of adolescent programs, she claimed that
a youth summit was conducted last July 2023 with the students of Magsingal National High
School. Wherein the adolescent were taught to do basic life support and educated on
reproductive health. Continues health education among adolescent were conducted in the
hospital too. According to Mrs. Vera Cruz the main problem of the program is the
scheduling due to lack of trained staff they cannot cater all the adolescent that in the
hospital. Only one nurse that is trained to cater the program. The program is only catering
adolescent Monday to Friday at 8am to 5pm that is the only time allotted for the program
but most cases of adolescent health happens at night which the clinic is close.

III. Conclusion

In conclusion, adolescents comprise most of the population worldwide. Like among other
age groups, they are facing a lot of problems too. These include but are not limited to
reproductive health issues, and mental health. Unfortunately, some of these concerns are
not addressed accordingly, due to unavailability of facilities that can cater the needs of the
adolescents.

In ilocos Sur, there is a newly established adolescent clinic, located in ISDH Magsingal. In
the interview conducted, the most common cause of consultantion of teenagers are due to
cough, colds and urinary problems. It was also noted the increased number of adolescents
involved in vehicular accidents.

Slowly, this age group seems to be noticed by the local units. Wherein, a health youth
summit was conducted to increase their awareness of health and safety. The government
is making sure that this program is funded, and well disseminated in order to meet the goal
to have a healthy, educated and safe adolescents.

Compromised adolescent health will negatively affect a country's economy. Failure

to invest in the health care of adolescents will further increase in the number of dependents
in coming generations and negatively influence the health of future generations. It is
therefore imperative to work toward improving adolescent health in order to ensure a
brighter future for coming generations. Sustainable development goals provide an
opportunity for renewed attention to meeting the health care needs of adolescents through
the strengthening of health systems. This requires a specific focus on modes and channels
of delivering targeted interventions via specialized health services (such as clinics, health
posts, health centers, and district hospitals), school-based delivery, youth organizations,
community-based delivery, information communication technology, and mass media. To
make progress toward universal health coverage, ministries of health and the health sector
more generally will need to transform how health systems respond to the health needs of
adolescents. A number of transitions in service delivery, workforce capacity, and financing
will be needed. Three types of interventions have been stated to be required for increasing
the utilization of services by adolescents—some changes in the health facilities (or spot of
service delivery), some changes in the attitudes of providers, and sensitization of the
community gatekeepers (such as parents, teachers, and community opinion leaders) as to
how access to services can help adolescents.

IV. Appendix

Appendix A: Interview Transcript Format