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Adolescent sexual and reproductive care
The media often sensationalises adolescent sexuality by providing us with tabloid information on adolescents using emergency contraception repeatedly, having high rates of teenage pregnancy and being the centre of tile HIV epidemic. Currently it is women in the age group 25-29 who are the worst infected. It has been shown that the infection rate of those under 20 years of age is declining.
It is important to be correctly informed and to actually explore and unpack these issues. While it is true that young women make up the bulk of HIV infections in the country, teenage pregnancy is also actually declining, as evidenced by the comparisons of the 1998 and 2003 SA Demographic Household sUrvey 1998-2003, Rachel Jewkes. This could indicate that we are managing contraception services better.
Of serious concern is the reality of sexual abuse. Some 40 percent of women experienced some form of contact sexual abuse before tile age of 18. The young girls that we see in our clinics are under attack and live in contexts where their ability to negotiate safer sex is not a given. As adults we know how difflcult it is for ourselves at times to negotiate safer sex and it is important to be sensitive to the environments in which young women are groWing up.
We have a role to play in communicating to young boys that they need to negotiate safer sex with their partners in an effort to address sexual violence. Sexual abuse can result in Post Traumatic Stress Disorder, which may have a numbing effect and lead to dissociated sexual behaviours. This would be where young girls look for greater connection in order to deal with their emotional losses and devastation of abuse.
Concerns have been expressed in the media regarding the repeated use of emergency contraception. This is a strange concern - if women are accessing this as an emergency to prevent pregnancy, why is that a bad thing? It could be viewed as concerning in that young women are repeatedly in this emergency situation. But given the reality of sexual abuse, is it appropriate to be concerned about the repeated use or just grateful that young girls are accessing this emergency service?
It is understood that repeated use of emergency contraception has no disadvantages in that there are no contraindications or known side effects. These methods are not so hazardous that women should be prohibited from deciding whether and when to use them. It is clear that no method is infallible. Of course, routine contraception and barrier methods should be encouraged when appropriate. Similarly, post-exposure prophylaxis (PEP) needs to be provided to reduce HIV transmission.
As nurses we should take courage from providing services that have enabled the rates of teen pregnancy and HIV infections to decline. Our role also needs to be that we encourage girls to go to schools and encourage schools to keep girls in schools - whatever their HIV or pregnancy status. It is known that young girls out of school have a higher HIV rate and are more vulnerable.
We need to listen to our children and welcome them into our clinics, given the epidemic of sexual violence. We need to watch out for this and deal with it with appropriate treatment and referral. It is also good practice that we are not judgmental and stigmatising - this is the last thing young girls need when they come to clinics for help they need to be cared for and supported.