| Abstract|| |
Background: Sex education should be an integral part of the learning process, beginning in childhood and continuing into the adult life. The 1994 international conference on population and 1995 fourth world conference on women held in Beijing recommended educational services for adolescents in a friendly environment. Objectives: 1. To know about the reproductive health awareness, like adolescent reproductive health by a pre-test, among pre-university girls (XI and XII standard). 2. To study the change in knowledge after the educational intervention by post-test. Materials and Methods: The study was conducted in pre-university colleges present in Davangere city. A pre-structured proforma was used to assess the existing knowledge, which consists of both open-ended and close-ended questions on growth and development during adolescence, pregnancy, and Sexually Transmitted Infections (STI) including HIV/AIDS. Educational intervention was done on the second day with the help of posters, printed materials, flip charts, Overhead Projectors (OHPs), and black board. One week after the educational intervention, post-test was conducted to know the change in the knowledge. Results: For a majority of them, the source of information about the above-mentioned aspects was television, followed by magazines. About 98% of them preferred doctors for getting sex education. There was overall significant change in knowledge (P<0.001, HS) after educational intervention. Conclusion: There were substantial lacunae in the knowledge about reproductive health among the study group. After educational intervention, there was significant change in the knowledge. Students felt that sex education is necessary in school and should be introduced in the school syllabus.
Keywords: Educational intervention, pre-university girls, sex education
|How to cite this article:|
Manjula R, Kashinakunti SV, Geethalakshmi R G, Sangam D K. An educational intervention study on adolescent reproductive health among pre-university girls in Davangere district, South India. Ann Trop Med Public Health 2012;5:185-9
|How to cite this URL:|
Manjula R, Kashinakunti SV, Geethalakshmi R G, Sangam D K. An educational intervention study on adolescent reproductive health among pre-university girls in Davangere district, South India. Ann Trop Med Public Health [serial online] 2012 [cited 2018 May 23];5:185-9. Available from: http://www.atmph.org/text.asp?2012/5/3/185/98612
| Introduction|| |
Comprehensive sexuality education is a program that starts in kindergarten and continues through high school. It brings up age-appropriate topics on sexuality and covers the broad spectrum of sex education including safe sex, Sexually Transmitted Diseases (STDs), and contraceptives.
The World Health Organization (WHO) defines 'Adolescence' as the age group of 10-19 years-a time of transition from childhood to adulthood.  The period varies in duration from one individual to another with differences in growth patterns, potentialities, and limitations. The adolescent is subjected to profound biological, morphological, and psychological changes all of which lead to full maturity and eventual fertility.
The reproductive health needs of adolescents have long been neglected, but in the last 10 years, the importance of information on reproduction and sexuality is being increasingly emphasized. The 1994 international conference on population and 1995 fourth world conference on women held in Beijing recommended educational services for adolescents in a friendly environment. 
Sex education should be a lifelong learning process based on the acquisition of knowledge and skills and development of positive values and attitude. It should help young people to enjoy sex and relationships that are based on qualities such as mutual respect, trust, negotiation, and enjoyment. Empowering youth with age appropriate knowledge about the development of the body, sexuality, modes of transmission and prevention of Sexually Transmitted Infections (STIs), and the means of maintaining a healthy and safe sexual life is important for the health and welfare and further generation, but is also a key to fighting the spread of HIV/AIDS. 
The WHO believes that education for health is a fundamental right of every child. Education can help to increase self-esteem, develop effective communication skills, and encourage each person to respect his or her own body as well as understand their responsibilities to others. In 1993, a survey of 35 sex education project conducted by the WHO showed that sex education in schools did not encourage young people to have sex at an earlier age or more frequently. Rather, importantly, the survey showed that early sex education helps delay the start of sexual activity, reduces sexual activity among young people, and encourages those already sexually active to have safer sex. Furthermore, WHO published a review of 1,050 scientific articles on sex education programs. 
Unfortunately, in our country, one of the most neglected age group is the adolescent age group, even though we are aware that 10-15% of our population is of growing adolescents. It is only recently that we have acknowledged the need for a separate specialty for adolescents to manage their medical, social, psychological, sexual problems, or ailments, whether they are about menstrual disorders, contraceptive advice, pregnancy/abortion counseling, or the more serious matter of malignancy. They need to be heard and understood patiently and given friendly practical advices. 
In India, According to National Family Health Survey-III (NFHS-III), overall 12% of women aged 15-19 years have become mothers and 4% of women aged 15-19 years are currently pregnant with their first child. In urban areas, the teenage pregnancy rate is 8.7% and in rural areas, it is 19.1%. The pregnancy rate among unmarried women aged 15-19 years is reported to be less than 0.05%. Almost 96% of adolescent girls knew about at least one method of contraception. They are most likely to know about pills. Both urban and rural girls had some level of knowledge in the above aspect. About 78% knew about pills, 65% about condoms, and 48% about Intrauterine Devices (IUDs) in the age group of 15-19 years. Among unmarried adolescents in the 15- to 19-year age group reported to have had sexual intercourse. About 17.8% of them used any method and 14.7% used modern methods of contraception. Further, 3.0% of them used pills, 0.2% used IUDs, and 0.6% used injectables. 
Empowering youth with age-appropriate knowledge about the development of the body, sexuality, modes of transmission and prevention of STIs, and the means of maintaining a healthy and safe sexual life is important for the health and welfare of future generations, and is also a key to fighting the spread of HIV/AIDS. Accordingly, working with Non-Governmental Organisations (NGOs), National AIDS Control Organization (NACO) is implementing a school AIDS education program, in which HIV/AIDS education, integrated within a broader framework of building family life skills, is provided to students in classes IX-XI and also through extracurricular activities. 
In a study of 811 adolescent students (average age, 16 years), as many as one-third-both male and female-reported some form of sexual abuse in the previous 12 months, and 6% reported forced sexual intercourse. Older students and friends were the most commonly reported perpetrators, followed by strangers, neighbors, and others; abuse by parents and teachers was also reported. Hence, authors' are of the opinion that these children should be given adequate and scientific knowledge about safe sex in their schools, which must be appropriate to their age. This involves the knowledge about growth and development, puberty, pregnancy, safe sex, emergency contraceptives, STDs, and HIV/AIDS. 
Against this background, the present study was under taken among pre-university girls (XI and XII standard), who have experienced the adolescent changes, in order to find out the existing knowledge and change in knowledge after education intervention regarding normal changes that take place in the adolescent period as well as the aspects of pregnancy and STDs including HIV/AIDS.
| Materials and Methods|| |
Study design: An educational intervention study.
Methodology: A pilot study was conducted among 50 students and analyzed. Based on the percentage of student who had correct knowledge about the safe period was considered for the calculation of the sample size in the finite population of 2,500 pre-university college girls who are studying in various colleges in Davangere city.
The sample size calculated for the study was 310, which was rounded off to 350 considering 10% of non-responses. The sampling units of our study were colleges, includes the government and private colleges, which were listed and selected by systematic random sampling technique. Required sample was selected randomly from the colleges proportional to the total number of students in the college.
A total of 362 students were included in the study, of which 114 students were from two government colleges and 248 students from four private colleges. A pre-structured proforma was prepared to assess the existing knowledge, which consists of both open-ended and close-ended questions on growth and development during adolescent period, pregnancy, and STIs including HIV/AIDS.
Educational intervention was done on the second day with the help of posters, printed materials, flip charts, Overhead Projectors (OHPs), and black board. Some of the methods given in Stepping stones-a manual for training on HIV/AIDS-communication and relationship skills, an Indian adoption developed by United States Agency for International Development (USAID), NACO, and Karnataka Health Promotion Trust (KHPT) was used for HIV/AIDS session.
Students participated in discussion with great enthusiasm. One week after the educational intervention, post test was conducted for the same batch analyzed.
- Post-educational intervention changes in knowledge scores (The total study girls are converted to quintiles based on the score of the pre-test and post-test. A low score is given when they scored less than 3 marks; similarly, average score for those who got 4-7 marks, and high score for more than 8 marks.) were analyzed by McNemar test.
- Chi-square test was used for qualitative data and Z scores for proportions.
| Results|| |
A total of 362 girls were included in the study. Almost equal number of girls, ie, 38.1% and 36.7% was from commerce and arts groups, respectively, and the lowest number (25.2%) of girls was from the science group.
There is significant change in knowledge about the age at the appearance and complete formation of breast and height gain in the adolescent period (P<0.001) after applying McNemar Chi-square test. There is a highly significant change in knowledge in the remaining aspects, eg, about adrenarche, menstruation, pregnancies, and HIV/AIDS (P<0.0001) [Table 1].
|Table 1: Distribution of study group according to change in knowledge about various aspects of adolescent health after educational intervention|
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The change in knowledge about STIs after educational intervention is found to be statistically significant. The Z-score for change in knowledge is the highest for chancroid, ie, 29.5 [Table 2].
It was observed that about 75.9% of them who were in low quintile in the pretest and none with a high score, there was significant change in knowledge about growth and development during adolescent period in post-test, ie, the maximum (64.4%) had high scores in post-test. The maximum (98.4%) number of girls had an average score in pre-test; 91.1% of them got high scores in post-intervention about aspects of pregnancy.
The maximum (98%) number of girls prefer doctors should give them the adolescent health education followed by female teachers, ie, 42.8%. The least (5.8%) number of girls opined to get education from their parents [Table 3].
|Table 3: Opinion about appropriate age and preference for getting sex education|
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About 29.8% of girls had low score in pre-test, followed by 70.2% with an average score. In post-educational intervention regarding STIs including HIV/AIDS, about (95%) of them got high scores. The change in knowledge is statistically highly significant, with P<0.0001 [Table 4].
|Table 4: Change in knowledge scores on adolescent reproductive health after educational intervention among study groups|
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| Discussion|| |
The present study revealed that poor knowledge existed among students before the educational intervention. After intervention, a significant change was noted in the knowledge in various domains of adolescent reproductive health. Similar study was conducted by Pratinidi et al,  in Pune city (India). They observed that the change in knowledge was 8 marks and 19.05% increase in percentage between pre and post-test was observed with P value < 0.001. The peer educators secured about 12 marks and change in knowledge was 12 marks with 28.57% percentage with P < 0.001. They observed that the change in knowledge about AIDS was 5 marks and 17.86% increase in percentage following intervention. Among the peer educators there was about 7 marks (25%) increase after intervention.
Gupta et al.,  conducted a study among school going unmarried, rural adolescents to know about their reproductive health awareness. Mean age of adolescents was 14.3±34 years. The study showed tremendous lacunae in the awareness level of all reproductive health matters. The correct knowledge among girls (15-19 years) was present in 56.1% of them with regard to the legal age at marriage.
Adolescents represent approximately one-fifth of the total population, of which 85% are living in developing countries. This large group is not adequately prepared for reproductive and sexual life, since these group of people lack basic information about their body, sexuality, contraception, and STDs.  In societies like India, where talking about sex is a taboo, the adolescents really find it difficult to acquire correct scientific knowledge in this regard, both in formal and non-formal setting.
A majority of the victims of HIV/AIDS are young and under the age of 30 years, of which about 30% are in the sexually active phase of life. It is, therefore, essential to 'catch them young', impart them knowledge on adolescent sexual health, STDs, HIV/AIDS before they indulge in any high-risk behavior. They are vulnerable to practicing unsafe sex. Hence, this group should be the target group for imparting health education on safe sex. 
In our study, the study group had reasonably good knowledge about HIV/AIDS, and at the same time, they had few misconceptions that were clarified in the educational intervention [Table 3] and [Table 4]. Another study was conducted by Bhasin et al. in East Delhi to study the impact of educational intervention about AIDS. They observed significant change in knowledge following intervention, with P<0.001.
Cheng et al. conducted a study to evaluate the feasibility and effectiveness of a life planning skills training program by using participatory method among rural senior high school students in Shanghai Country, Henan Province, China. The interaction effects in ordinal logistic regression analysis were found on HIV/AIDS-related knowledge (P<0.0001), attitude towards daily contacts with HIV-positive individuals (P<0.0001) and subjects protection self-efficacy (P<0.001) suggesting the intervention increased subjects knowledge significantly, changed attitudes positively, and improved their protection self-efficacy. The intervention also significantly improved subject's communication with teachers and individuals with HIV/AIDS issues (P<0.0001).
Rusakenikos et al. carried out a study with the objective to determine the impact of an intervention package on knowledge levels of various reproductive health issues through trend analysis. The students from the intervention schools were more likely to have correct knowledge over time on aspects of reproductive biology. A significant linear trend (P=0.017) was observed in the area of family planning and contraception. The general trend of knowledge levels in old areas of reproductive health pregnancy risk, STDs, and HIV/AIDS showed an upward trend from 20% to 96%.
One of the most popular arguments against sex education is that it encourages early sexual activity. Yet in 1993 WHO review of 35 sex education studies in the US, Europe, Australia, Mexico, and Thailand found no evidence that sex education leads to earlier or increased sexual activity. The survey showed that sex education programs can actually encourage young people to postpone penetrative sexual intercourse, or if they are already sexually active, to reduce their number of partners or have safer sex. 
The sex education should be an integral part of the learning process beginning in childhood and continuing into adult life. It should be for all children, young people, and adults, including those with physical learning or emotional difficulties. It should encourage exploration of values and moral values, consideration of sexuality and personnel relationships, and development of communication and decision-making skills. It should foster self-esteem, self-awareness, a sense of moral responsibility, and the skills to avoid and resist sexual experience. 
Often, adolescent pregnancies occur outside the wedlock and about half of legitimate pregnancies in young age (<18 years) are unwanted; further, even safe abortions have far reaching physical, emotional, and psychological consequences. About 1-4.4 million illegal abortions occur every year in developing countries like India. Ironically, conservancies of teenage pregnancy fall upon young girls, and they are two times more prone to STDs, including HIV, when compared to boys. Moreover, there is a risk of transmission of STDs, including HIV, to the fetus if they become pregnant. Hence, giving information to adolescent girls about contraception, emergency contraception, and safe sex is vital for their own safety and development.
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C/O SS Belagal, 8th Main, Pratiksha, Vidyagiri, Bagalkot - 587 102, Karnataka
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4]