Training Resource Package for Pre-Service Education in FP & AYSRH AYSRH Module

Pre-Service Education (PSE)on Family Planning and Adolescent Youth Sexual and Reproductive Health (AYSRH)

Session III: Adolescent Youth Sexual and Reproductive Health

Introduction

Youth represent a large, significant and growing demographic globally. With generally

low knowledge about reproductive health,low contraceptive use rates and high risk of maternal mortality and morbidity- youth represents a relatively high proportion of the country’s unmet reproductive health needs. Promotingcomprehensive youth friendly services is essential in assisting youth to make responsiblesexual and reproductive decisions and empowering them to enforce these decisions.The AYSRH module is aimed at developing the competencies of students to provide youth friendly reproductive health services upon deployment from pre-service education. This session’s goal and general objectives are:

Training Goal:

Introduce students to basic concepts related to adolescent sexual and reproductive health (SRH) and rights and build their understanding of the SRH situation of young peopleto provide basic youth friendly sexual and reproductive health services upon graduation from PSE.

Notes to Tutor:

The slides and session plans provide presentation support for conveying- technical information and for conducting the interactive learning activities.

To use this presentation most effectively, please:

  • Read the Pre-service Education on FP and AYSRH Instructor’s Guide, on the Using the Training Resource Package tab, for guidance on selecting and adapting TRP materials for the learning needs of your audience
  • Next read this session plans, which includes detailed learning objectives for this module and describes how to use this presentation and other materials required to prepare for and conduct the learning activities
  • Session plans on adolescentyouth sexual and reproductive health focus on family planning will take a total of 22 hours, including the pre-test and post-test.
  • The session plans are presented for use individually for ease of use by different instructors

Training Process / Resources
Session III
Adolescent Youth Sexual and Reproductive Health Module
Total Time: 22Hours (including pre-and post-test)
Introduction to Section III: AYSRH Module
Discussion(5 min)
Greet students.
Explain that the next topics will cover AYSRH and will apply a lot of what they have learned from the family planning sessions and other sessions on reproductive health. Explain that as young people, students are also expected to bring a lot of their own experiences and perspectives.
Pre-Test
Individual Written Exercise (45 min)
Administer pre-test to check students’ prior knowledge on AYSRH
Specific Objectives for the AYSRH Module:
1. Clarify student’s values related to adolescents.
2. Explain the terms used by the World Health Organization (WHO) to differentiate age groups of young people.
3. Discuss the sexual and reproductive rights of adolescents.
4. Describe the Sexual Reproductive Health (SRH) situation of adolescents in the country, including key policies that protect their health and well-being.
5. Identify physical, cognitive, social, and emotional changes that occur during adolescence.
6. Discuss vulnerabilities, social and cultural pressures, adolescent risk-taking behavior and its consequences.
7. Summarize the elements that should be included in screening: history taking and physical examination for adolescent sexual and reproductive health service provision.
8. Demonstrate counseling techniques for all adolescents.
9. Identify safer sex messages and techniques in the prevention of STIs and unintended pregnancy, including contraceptive options available to adolescents.
10. Explain the importance of establishing a positive service environment that is welcoming to the adolescent client.
11. Describe how to create reproductive health services that are adolescent friendly.
Notes to the Educator:
The topics under the AYSRH Session were developed to build on the previous Family Planning Sessions I and II. In preparation for topics under this session, ask your students to review their notes/handouts on counseling and contraceptive technology as well as sessions on sexually transmitted infections (STI) or HIV that have already been covered.
Administer Pre-Test
Session III Topic 1: Overview of the SRH Situation of Adolescents (1 hour 30 min) / Slide 1: Introduction
Objectives:
By the end of this topic, students should be able to:
  1. Defineage groups key concepts related to AYSRH
  2. Explain the dynamics that shape the unique experience and situation of adolescents.
  3. Understand personal values, attitudes and beliefs related to AYSRH.
Introduction
Discussion (5 min)
  • Introduce topic objectives
  • Explain that:
It is important that students have a clear and common understanding of the terms and concepts related to adolescents and SRH. This session provides simple definitions of the basic terms related to adolescent and youth populations used globally as well as those that are applicable in the country.
Defining Age Groups and Key Concepts Related to Adolescents and Youth
Brainstorming (10 min)
  • Ask student what they understand by the terms adolescents,youth, and children by age?
  • Explain the World Health Organization’s distinction between different age groups.
  • Use slides 2 and 3 to define key Adolescent Youth Sexual and Reproductive Health (AYSRH) terms.
Dynamics that shape the unique experiences and situation of adolescents
Lecturette (15 min)
  • Explain that while adolescents are defined by age, multiple dynamics shape the lives of each individual adolescent. Being able to understand and respond to these complex dynamics is a critical element of quality, adolescent-friendly SRH services.
  • Ask students what are some of the dynamics and situations that shape and influence adolescents. Explain that because adolescence is a transitional age where young people transition and go through changes physically, emotionally and psychologically- there are also social changes that occur when maturing from being a child to an adult. It is also a period with changing emotions, thoughts, behaviors and exploration which builds capacity for making decisions and trying out what they consider as “adult” practices and behaviors.
  • This period is therefore influenced by different experiences, people, social pressures, gender roles and situations and the following dynamics have an effect the experiences of adolescents on their sexual, reproductive and wellbeing. Providers need this understanding to be able to provide client focused services to adolescents.
  • Use slides 4, 5, 6, 7 to go through the dynamics asking students to clarify and give examples where possible to check their understanding.
/ Slide 2: WHO Definitions of Different Age Groups
Slide 3: Definition of Key AYSRH Terms
Slides 4, 5, 6, 7: Dynamics that shape the unique experience and situation of youth.
Values Clarification Exercise: Agree or Disagree?
(50 min)
The tutors should:
•Explain that the purpose of this first exercise is to explore feelings, attitudes and values regarding adolescents and how those feelings might influence how providers care for adolescent clients.
  • Put up signs reading “Agree” and “Disagree” on either side of the room.
  • Explain that you will read statements one at a time. After each statement, students should move to the side of the room based on whether they agree or disagree with the statement. Ask students to be honest about their feelings and resist being influenced by where other students move.
  • Begin the exercise using the following Value Clarification Statements. Read the statements aloud and ask students to move to the side of the room based on whether they agree or disagree with the statement.
  • Ask volunteer students from each side of the room to explain the reasons for their responses.
1. Adolescents should not have sex.
2. Adolescents should never have an abortion for any reason.
3. Parents of an adolescent who is receiving treatment for an STI should be informed that the adolescent has contracted an STI and is receiving treatment.
4. Providers should get parent’s permission before offering contraceptives to adolescents.
5. Providers working with adolescents should focus on ensuring that the adolescent abstains from sexual activity.
6. Providing contraceptives to adolescents encourages the adolescent to have sex repeatedly.
7. Only married adolescents should be allowed to use contraceptives.
  • 8. Adolescents should not use any of the long-acting FP methods.Once all the statements have been read, ask students to return to their seats. Facilitate a discussion by asking the following questions:
  • Which statements, if any, did you find challenging to form an opinion about? Why?
  • How did you feel expressing an opinion that was different from that of some of the other students?
  • How do you think people’s attitudes about some of the statements might affect their interactions with young clients or their ability to provide reproductive health services to adolescents?
  • Emphasize that it is normal to have strong feelings and values about these topics. Tell students that learning to be aware of their own values will help them be more open to listening to different points of view. When adolescents notice that service providers are more accepting of differences, they will more openly and honestly assess and express their own values. This, in turn, can help young people assess the attitudes and beliefs that lead to high-risk behavior.
Summary and Closure
Discussion (10 min)
Finish by allowing time for discussion on AYSRH terms and concepts. As many students are recent adolescents, themselves, encourage them to share additional ideas or perspectives.
Conclude that the AYSRH module within their broader RH training will delve into the specific needs and situation of adolescent clients and build their own ability to service this critical population.
Session III Topic 2 Sexual and Reproductive Rights of Adolescents (1 hour 15 min) / Slide 1: Introduction
Note to Tutors:
Compile the Adolescent Sexual and Reproductive Health laws, policies, strategies, acts etc. in the country and add a slide on thistopic section on Sexual Reproductive Health Situation of Adolescents in the Country.
Objectives
By the end of this topic, students should be able to:
  • Describe the sexual and reproductive health rights of adolescents
  • Identify the AYSRH rights granted globally through different, acts policies and initiatives
Discuss the role of health care providers in ensuring the rights of adolescents.
Introduction to the Topic:
Lecturette (5 min)
  • Introduce topic objectives.
  • Explain that it is important that providers understand global and country -specific rights given to adolescents and youth regarding their sexual and reproductive health, as often, they will be called upon to meet and protect those rights during their service,

Sexual and Reproductive Rights of Adolescents
Discussion/Group Work (35 min)
The tutor should:
  • Remind students that in the family planning session they learned about the rights of clients and that reproductive Rights arelegal rightsand freedoms relating to reproductionandreproductive healththat vary amongst countries around the world.
  • Explain that reproductive rights arelegal rightsand freedoms relating toreproductionandreproductive healththat vary amongst countries around the world. They may include things such as the right to use contraception; freedom from coerced sterilization; the right to access good-quality reproductive healthcare; the right to receive education about sexually transmitted infections, etc.
  • Ask students as young people what are sexual and reproductive rights that apply to adolescents and write answers on a flipchart.
  • Use the slide to discuss sexual and reproductive rights of adolescents.
  • Divide students into groups or pairs.
  • Provide each pair or group with Handout1 on Sexual and Reproductive Rights of Adolescents. Explain that the handout includes the sexual and reproductive rights defined by many different organizations, including the United Nations.
  • Go around the room and assign each group or pair 2-3 rights listed on the Handout.
  • Ask each pair or group first to identify the obstacles or barriers that might prevent each of the assigned rights from being fulfilled.
  • Ask students to list specific steps they can take in a clinic to remove each barrier or obstacle. Allow 20 minutes for the work.
  • Reconvene the larger group and ask each small group to present their list.
/ Slide 2: Sexual and Reproductive Rights
Of Adolescents
Handout 1: Sexual and Reproductive Rights of Adolescents
Sexual Reproductive Health Situation of Adolescents in the Country
Discussion (20 min)
  • Explain that adolescents’ rights to reproductive health care were first recognized internationally in the 1989 Convention on the Rights of the Child. Governments around the world have moved to promote adolescents’ rights through international instruments and documents, such as the International Convention on Population and Development.
  • Explain that different countries have different laws that affect the Sexual and Reproductive Rights of Adolescents. Discuss the situation in your own country pertaining to topics that affect these rights such as:
  • The legal age of marriage
  • Legal age of consent
  • Laws pertaining to contraception for adolescents
  • Laws related to abortion
  • The availability of sex education in schools
  • Government reproductive health services for adolescents
  • Laws that protect adolescents from sexual violence
The governments approach toward the elimination of female genital mutilation (FGM)
  • Population of young people
  • Incidence of HIV, STI and maternal mortality if known
  • Incidence of sexual and gender based violence if known
  • Contraceptive use.
  • Strategies to reach youth with SRH services and messages.
Role of health care providers in ensuring the rights of reproductive health adolescents
Small Group Work (30 min)
  1. Distribute participant Handout 1A: Adolescent Sexual and Reproductive Rights and ask students to divide into small groups. Divide the rights listed on the handout, so that each group has a different set to discuss. In the small groups, ask students to take 15 minutes to look at their selected rights and discuss the following questions:
  2. What are the obstacles or barriers that might prevent each of the assigned rights from being fulfilled?What are some specific steps health providers can take in their clinic/service location to remove these barriers and obstacles?
Plenary
Report-out (5 min)
Ask the small groups report their ideas in plenary, and discuss common or unique ideas with each other.
Summary
Emphasize that providers should not discriminate against young people and deny services because of their age, gender, sexual preference, marital status, level of education etc. Explain that when providing services, they should always be guided by the rights of young people.
Topic Closure (5 mi)
Review the objectives and ask students which rights were they not aware of that they learned today.
Acknowledge responses, thank students and explain that the next topic is also on providing background knowledge necessary for provision of services to young people. / Handout 1: Sexual and Reproductive Rights of Adolescents
Session III Topic 3 Developmental Characteristics of Adolescence and Young Adulthood
(3 hours) / Slide 1: Introduction
Objectives:
By the end of this topic should be able to:
  1. Describe the physical, cognitive, social and emotional changes that occur during adolescence.
  2. Explain adolescent risk-taking behaviors and other age and genderrelated factors that create SRH vulnerabilities.
  3. Explore how gender and family relationships shape the perceptions and actions, choice, decision-making and power in terms of SRHhealth of adolescents. Discuss the qualities and characteristics of a sexually healthy adolescent

Developmental Characteristics of Adolescence and Young Adulthood
Discussion (45 min)
  • Introduce the activity to students by explaining that they will work in groups to brainstorm the changes that adolescents go through as they mature. Explain that it is important to understand adolescent development to work with adolescents in a positive manner.
  • Divide students into small groups, assign 2 groups a stage of adolescence (very young adolescence, 10-14; and older adolescence, 15-19), and give each group a flipchart.
  • 1 group will discuss 10-14 years and list the physical and cognitive changes. Second group will list the social changes.
  • 1 Group will discuss 15-19 years’and list physical and cognitive changes
  • Second group will discuss 15-19 years and list the social and emotional changes
  • Ask groups to think about when they were adolescents, or to think about a child or adolescent they are close to. Give 15 minutes for groups to list the physical, cognitive (reasoning or thinking), and social and emotional changes they remember experiencing on a flipchart. For example, a physical change may be growth of body hair, a cognitive change might be an interest in moral reasoning, and social and/or emotional changes might include feeling awkward about themselves and their body.
  • Bring groups back together to present to each other and add to each other’s lists.
  • Pass out Participant Handout 1: Developmental Characteristics of Adolescence and Young Adulthood and present the slides 4 to 8 on the changes that occur during adolescence. Tell students they can follow along on the handout.
  • After you have shown the slides, ask students if any of this sounds familiar or lines up with their experience, especially since most of them are young adults. If there is time, invite students to share stories with each other or the group about their memories of experiencing these changes in their own lives.
/ Slides 2 and 3: Physical Changes
Slides 4 and 5: Cognitive Changes
Slides 6-8: Social and Emotional Changes
Handout 1: Developmental Characteristics of Adolescence and Young Adulthood
Risk Taking Behavior and Vulnerabilities
Brainstorming (20 min)
Explain to students that while they address the physical needs of adolescent clients, psychosocial factors such as gender, self-esteem and relationships are as, important to their ability to seek and receive health care. They also can impact the client’s ability to follow-through with the recommended treatment or behavior, especially if that action should ideally be sustained or repeated over time. It is important for students to understand these factors and how they can have different effects on different adolescent clients, or even on the same client as s/he ages goes through different life experiences.