Sir,
Adolescent Reproductive and Sexual Health (ARSH) has been identified as a key strategy in the Reproductive and Child Health (RCH-II) program under the National Rural Health Mission (NRHM).(1) Providing reproductive and sex education during adolescence is an important but challenging part of ARSH. In our study area, health workers (female) posted in urban health centers provide the reproductive health education among the study population, occasionally supported by the medical officer and the team from our department. It is important to have specific information regarding the level of knowledge related to reproductive and sexual health issues among urban adolescent girls of our area, so as to target appropriate interventions among them.
In this context, we conducted a cross-sectional study among girls in the age group of 15-19 years from different educational institutes of Rohtak city to know the knowledge regarding key reproductive and sex-related issues. Three educational institutes were selected randomly from a total of seven institutes for the study. A sample size of 743 was calculated at 95% level of significance, 10% allowable error, and assuming the level of knowledge regarding reproductive health among urban adolescent girls as 35%. A total of 788 girls who consented for the participation in the study were enrolled. A pre-tested, pre-coded, close-ended questionnaire was administered by authors themselves. Prior verbal consent was taken from the participants, their parents, and teachers for the study. Anonymity was maintained by not including the names of the respondents in the questionnaire.
The mean age of menarche in the study subjects was 13.1 years. At least two or more modes of contraception were known to 636 girls (80.7%) and oral contraceptive pills (OCP) and Copper-T were the most common known methods. That menstruation is a normal physiological phenomenon was known to 626 (79.4%). The fact that sexual intercourse with an infected person and sharing needles for intravenous drug usage are the most common modes of transmission of STD/AIDS was known to 582 girls (73.9%).
Regarding abortion, 313 girls (39.7%) knew that it can be performed at government and private health facilities but none of them knew about the indications, criterion for the place where legal abortion can be performed, and person who can carry out legal abortion. Only 89 (11.3%) of the girls knew correctly about safe sexual intercourse, that was defined as “protected sex (using effective barrier methods during sexual act, e.g., condoms, etc.) with any partner having any HIV status” or “even unprotected sex (without using effective barrier methods during sexual act, e.g., condoms, etc.) with any partner with proven HIV negative status.” A total of 82 (10.4%) of the study subjects had heard of masturbation and only 18 (2.3%) considered it normal. A total of 39 (4.9%) thought masturbation is a wrong practice, 13 (1.6%) considered it as a sign of increased sexual desire, and 12 (1.5%), thought it to be a factor responsible for ill health.
Mothers were the most important source of knowledge (in 47.4%) regarding menstruation among the study subjects followed by friends/peers (23.8%), teachers (4.9%), and mass media (4.8%). Regarding contraception, friends/peers were the most important source of information (in 23.2%) followed by mass media (20.1%), mothers (14.8%), and teachers (10.4%). In relation to information regarding abortion, friends were the most important source (in 16.1%) followed by mothers (9.3%), mass media (8.7%), and teachers (5.4%) while for safe sex, friends were the most important source (in 4.0% only) followed by mass media (3.%), teachers (2.4%), and mothers (1.3%).
Thus it seems that current efforts for increasing awareness among adolescents are doing well with respect to the knowledge regarding contraception, menstruation, and prevention from HIV/AIDS. Others also reported variable knowledge regarding menstruation.(2–4) In our study, mothers followed by peers were important sources of information similar to that observed by others.(5) The study shows that we have not been able to pass effective messages regarding abortion, safe sex, and masturbation. As these three aspects are interrelated, and are ultimately linked to a high abortion rate and high maternal mortality, it is important to address these issues as well. As these issues carry high cultural sensitivity, area-specific communication strategies may help. Strengths of mass media, parent-to-adolescent communication, teacher-to-child communication, peer-to-peer communication, and health professionals-to-adolescent communication may thus need to be explored well to communicate different messages using different media of communication.
References
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