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Best Pract Res Clin Obstet Gynaecol ; 66: 107-118, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32527659


This article sets out the progress that has been made in reducing levels of adolescent childbearing and in meeting adolescent contraceptive needs, over the last 25 years, and also makes the public health, economic, and human rights rationale for continued attention to and investment in these areas. Using an analytic framework that covers the perspectives of both the use and the provision of contraception, it examines the factors that make it difficult for adolescents to obtain and use contraceptives to avoid unintended pregnancies, and outlines what could be done to address these factors, drawing from research evidence and programmatic experience. In doing this, the article provides concrete examples from low- and middle-countries that have made tangible progress in these areas.

Comportamento Contraceptivo , Anticoncepção/estatística & dados numéricos , Serviços de Planejamento Familiar/organização & administração , Acesso aos Serviços de Saúde , Gravidez na Adolescência/prevenção & controle , Adolescente , Serviços de Saúde do Adolescente , Anticoncepcionais/administração & dosagem , Anticoncepcionais/provisão & distribução , Dispositivos Anticoncepcionais , Feminino , Direitos Humanos , Humanos , Gravidez
Reprod Health ; 17(1): 75, 2020 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-32456657


BACKGROUND: The role of global initiatives in catalyzing change within national contexts is complex and less understood. Addressing adolescent sexual and reproductive health in Kenya requires concerted efforts of both state and non-state actors and more importantly, a supportive environment. This paper deconstructs the moral and social narratives of adolescents' and young people's sexual and reproductive health (AYSRH) in Kenya as driven by the powerful discourse and ideologies pre- and within the Millennium Development Goal (MDG) era. METHODS: Literature was systematically searched in PubMed and Medline with policy documents obtained from government agencies from the pre-MDG period (2000 and earlier) and within the MDG period (2001-2015). Literature with a substantial focus on SRH were eligible if they captured the different facets of ASRH in Kenya and sub-Saharan Africa (SSA). The results were reviewed and synthesized to disentangle the moral and social narratives of AYSRH in Kenya with an MDG lens. RESULTS: The evolution of AYSRH policies and programmes in Kenya was gradual and largely shaped by prevailing development threats and moral and social narratives. Pre-MDG period was dominated by issue-based policies of population growth and high fertility rates, with a focus on married population with strong cultural and religious barriers to AYSRH; early to mid-MDG was mainly influenced by the threat of HIV/AIDS, culminating in the first Adolescent Reproductive Health and Development Policy in 2003. However, the policies and subsequent programmes focused on abstinence only and medical narratives, with persistent religious and cultural opposition to AYSRH. Late-MDG saw more progressive policies (these are policies that refer to those that tends towards acceptance of liberal social reforms and which sometimes are contrary to entrenched social norms, beliefs and practices), high government commitment and a refocus on SRH issues due to sustained early childbearing, culminating in the revised Adolescent Sexual and Reproductive Health Policy of 2015. CONCLUSION: Debates in the translation of global goals and commitments to policy and practice at country level need to account for national level realities in AYSRH reforms. The findings contribute to critical evidence for strategic policy and programming approaches for AYSRH in Kenya and in SSA and for the realization of their rights within the context of sustainable development goals.

Sex Reprod Health Matters ; 28(1): 1741495, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32254004


This commentary is in response to a paper published in the Lancet entitled: "Progress in adolescent health and well-being: tracking 12 headline indicators for 195 countries and territories, 1990-2016" (Peter Azzopardi et al, 2019). We agree with the authors' overall conclusions that although there has been progress in some health outcomes, health risks and social determinants, the situation has worsened in other areas. Other important messages emerge from studying the data with an adolescent sexual and reproductive health and rights (ASRHR) lens. First, notable - albeit uneven - progress in all the ASRHR indicators has occurred in multi-burden countries. Second, while we cannot assign a cause-effect relationship, it is reasonable to suggest that in addition to secular trends, deliberate global and national investment and action have contributed to and/or accelerated these changes. Third, progress in ASRHR in the multi-burden countries contrasts sharply with increases in rates of tobacco use, binge drinking and overweight and obesity, in all categories of countries. Based on these observations, we submit five implications for action: the adolescent health community must recognize the progress made in ASRHR; acknowledge that increasing investment and action in ASRHR has contributed to these tangible results, which has the potential to grow; build on the gains in ASRHR through concerted action and a focus on implementation science; expand the adolescent health agenda in a progressive and strategic manner; and contribute to wider efforts to respond to adolescents' health needs within the rapidly changing context of the worlds they live in.

Saúde do Adolescente , Saúde Reprodutiva , Direitos Sexuais e Reprodutivos , Saúde Sexual , Adolescente , Saúde do Adolescente/tendências , Feminino , Humanos , Masculino , Comportamento Sexual , Determinantes Sociais da Saúde