Sexual and Reproductive Health Assessment

The Reproductive and Sexual Health focuses on adolescent growth and development, menstruation cycle and key disorders, sex and sexuality, Reproductive Tract Infection, contraceptives and safe abortion as well as adolescence pregnancy.

Sexual and Reproductive Health?

Sexual health

The term sexual health is used to describe the absence of illness and injury associated with sexual behaviour, and a sense of sexual well-being.

Sexuality influences thoughts, feelings, interactions and actions among individuals, and motivates people to find love, contact, warmth and intimacy. It can be expressed in many different ways and is closely linked to the environment in which people live.

Reproductive health

Reproductive health is 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.

Therefore 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 when and how often to do so. Implicit in this last condition 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, as well as other methods of their choice for regulation of fertility which are not against the law, and the right to access appropriate health-care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant.

Sex and Sexuality

Sex : Sex is the biological difference between women and men

Sexuality : Sexuality includes perception, thinking, personality and behaviour of any individual. Sometimes it is related to individual or specific type of community or group of people.

How to Counsel on Sexuality?

Sexuality means different things to different people. Many people equate mating, being able to reproduce and common sexual behaviour (romance, kissing, physical relations, provocative behaviour, marriage) with sexuality.

Sexuality is a very broad term, which includes the sum total of a person’s personality, thinking and behaviour towards sex. It includes the identity, emotions, thoughts, actions, relationships, affection, feelings that a person has and displays. The negative aspects of sexuality also exist and include sexual coersion, eve teasing, sexual harassment, rape and prostitution.

Communicating and counselling with adolescents about sexuality can be challenging because it is a sensitive topic about which adolescents often feel emotional, defensive, and insecure.

What can health-care providers do to improve adolescents’ access to sexual and reproductive health information and services?

Adolescents seek information and clues about sexual life from a variety of sources - parents, siblings, peers, magazines, books, the mass media, etc. Whilst they receive a great deal of information from diverse sources, not all of it is correct and complete. Many adolescents lack information concerning the physical changes that occur during adolescence, their implications, and how to take care of themselves. This is often because the subject of sexuality is a sensitive one in many societies. As a healthcare provider, you can be a valuable source of accurate information and support to the adolescents you serve. You can present them with facts, respond to their questions, and provide reassurance.

In many societies, parents and other community members are concerned that the provision of information on sexuality can do more harm than good. As a health-care provider, it is important that you are very well aware that this is not true. Failure to provide adolescents with appropriate and timely information represents a missed opportunity for reducing the incidence of unwanted pregnancy and STIs, HIV and their negative consequences.

Involving gatekeepers, teachers, AWW and peers for counselling adolescents

• Considering the adolescent’s age and sexual experience.
• Demonstrating patience and understanding of the difficulty adolescents have in talking about sex.
• Assuring privacy and confidentiality.
• Respecting the adolescent and her/his feelings, choices, and decisions.
• Ensuring a comfort level for the adolescent to ask questions and communicate concerns and needs.
• Responding to expressed needs for information in understandable and honest ways.
• Exploring feelings as well as facts.
• Encouraging the adolescent to identify possible alternatives.
• Leading an analytical discussion of consequences, advantages, and disadvantages of options.
• Assisting the client to make an informed decision.
• Helping the adolescent plan how to implement her/his choice.

Adolescents must often make significant decisions on the following sexual and/ or reproductive health matters:

• How to discourage and prevent unwanted sexual advances?
• Whether to engage in sexual relations or not. If yes, when?
• How to prevent pregnancy and STI/HIV.
• Whether to conceive a child or not? If yes, when?
• Whether to continue or terminate a pregnancy?
• What kind of antenatal care to seek and where to go?
• How to deal with sexual abuse and/or violence?

Most of these decisions can be worked through during counselling sessions that follow suitable approaches. Sexual abuse and violence are more difficult and require additional help.

Counselling in Cases of Sexual Abuse and/or Violence

• Sexual abuse is any sexual activity carried out against a person’s will.
• Often, sexual abuse is perpetrated by an adult, whether by deceit, black mail, or force, against a child or someone not mentally or physically mature enough to understand or prevent what is happening. Sexual abuse has a significant impact on an adolescent’s health, mental state and life in general. It can cause serious future sexual and reproductive health problems.

Promoting the Sexual and Reproductive Health of Adolescents

Adolescent concerns tend to revolve around the immediate future, while the concerns of adults are for the longer term.

• The concerns of different groups of adolescents may not be the same. For instance, boys and girls, married and unmarried adolescents, urban and rural adolescents may have different issues of interest and concern.
• Understanding what their interests and concerns are, and the underlying reasons for this, may help adults deal with them more effectively.
• Information helps adolescents understand how their bodies work and what the consequences of their actions are likely to be. It dispels myths and correct inaccuracies.
• Adolescents need social skills that will enable them to say no to sex with confidence and to negotiate safer sex, if they wish to. If they are sexually active, they also need physical skills such as how to use condoms.
• Counselling can help adolescents make informed choices, giving them more confidence and helping them feel in more control of their lives.
• Health services can help healthy adolescents stay healthy, and ill adolescents get back to good health.
• As adolescents undergo physical, psychological and social change and development, a safe and supportive environment in their families and communities can enable them to undergo these changes in safety, with confidence and with the best prospects for health and productive adulthood.

It is worth stressing that adolescents are a diverse group. For example, a boy of 12 is at a very different stage of personal development than a boy of 18. Similarly, he is different in psychological and social terms from a girl of 12, in addition to obvious physical differences. Social circumstances can influence personal development; for example, the health and development of a boy of 12 who is part of a caring family is likely to be very different from those of a boy of the same age who is working and earning or himself and his family. Finally, even two boys of the same age, growing up in very similar circumstances, may proceed through adolescence in different ways, and at different “speeds”. The sexual and reproductive health service needs of adolescents are correspondingly heterogeneous. Adolescents who are not yet sexually active have different needs from those who are; sexually active adolescents in stable, monogamous relationships may have different needs from those in more casual relationships. Quite different needs characterise those faced with unwanted pregnancies or infection, or those who have been coerced into sex. It is important therefore to be aware of the diversity of sexual and reproductive health needs of adolescents, and to tailor our responses to their specific needs.

Sources :

1. Rashtriya Kishor Swasthya Karyakram - Resource Book by Ministry of Health and Family Welfare
2. Menstrual Hygiene, Reading Material for ASHA - By National Rural Health Mission