Adolescents' reproductive health promotion policy in Lithuania

     Research project proposal

Lina Jaruseviciene

 Medical University of Kaunas

Introduction

The document "Health 21 - the health for all in the 21st century" of the World Health Organization provides that by the year 2020 young people in the European region should be healthier and could be able to fulfill their roles in society better. In the task "Health of Young People" there is noted a very important aspect of the adolescent's reproductive health - the number of pregnancies among adolescents should be lowered by one third.
Adolescents’ sexual behavior and its consequence – teen pregnancy and STD have been identified as a serious problem in Lithuania and in the other countries. Sex education and reproductive health services for adolescents are essential elements in different comprehensive preventive strategies. But “the reproductive health needs of adolescents as a group have been largely ignored to date by existing reproductive health services ... In particular, information and services should be made available to adolescents that can help them understand their sexuality and protect them from unwanted pregnancies, sexually transmitted diseases and subsequent risk of infertility...“ (1994 UN Cairo Program for action).
It is necessary to refer to the scientific research data in order to choose public health problem solving strategy. Adolescents’ reproductive health promotion policy issues and obstacles are not investigated thoroughly in Lithuania. Without sufficient information it is difficult to plan and realize the effective preventive strategies.

Project aim

This project aims to examine adolescents reproductive health promotion issues in Lithuania in order to develop policy recommendations that will meet adolescent’s need for sex education and reproductive health care services provision more appropriately and effectively.

Project goals

1. To analyze historical background of adolescents’ reproductive health promotion policy in Lithuania
2. To investigate legislation frameworks which affect sex education and adolescents reproductive health care;
3. To make an assessment of implication of the 1994 UN Cairo Program on adolescent reproductive health promotion policy
4. To identify current status of sex education and adolescents reproductive health care in Lithuania
5. To evaluate reproductive health promotions needs, perceived by adolescents
6. To develop a research and policy paper with guidelines for the Ministry of Education and the Ministry of Health
 

Project description

As was mentioned above sex education and reproductive health services for adolescents are essential elements in different comprehensive preventive strategies. Therefore this research will focus on these aspects.

Sexual education in Lithuania

Historical background of policy on sex education in Lithuania will be analysed in order to understand the steps of formal intervention by the government in this subject. The changes in aims, curriculum and provision of sex education in Lithuania will be reviewed.
Legislation of sex education of the latest decade (period of Lithuanian independency from Soviet Union) will be studied in particularly as well as policy implications of the 1994 UN Cairo Program for action.
Examining sex education practice in Lithuania special attention will be paid to:
• Curriculum makers (committees, experts, community representatives, non governmental organizations, etc.);
• Criteria used to include (or exclude) different topics in sex education curriculum (experience from other countries, data of research conducted in Lithuania or in foreign countries, national peculiarities, lobbying of powerhouse organizations, etc.);
• Analysis of separate programs, implemented in schools by the agreement of Ministry of Education (monitoring of programs, measurement of effectiveness, spreading of experience, etc.);
• Sex education providers (training, continuing education, specific needs and expectations, etc.). Possibilities for participation of religious or family planning organizations, pharmaceutical companies in sex education at schools will be studied as well;
• Success and failures of sex education at schools (identification of fortes and difficulties, related with daily sex education practice).

Researchers argue that sex education fails in part because the adolescents’ own concerns are not sufficiently considered by those who create the programs. As underlined in 1994 UN Cairo Program for Action “in conducting sexual and reproductive health research, special attention should be given to the needs of adolescents in order to develop suitable policies and programs … to meet their health needs”. Consequently analysis of teenagers expectations toward sex education, their needs for different sort of information, styles of conducting sex education lessons, possibilities to obtain individual consultation and others issues are essential.

Reproductive health care services for adolescents in Lithuania

Review of reproductive health care services for adolescents in the period of Soviet Union - accessibility of services, reasons for attending health care settings, the diversity of reproductive health care providers and settings, etc. will be made.
Legislation that defines delivering of reproductive health care to adolescents will be studied. Special emphasis will be paid on policy implications of health care reform as well as 1994 UN Cairo Program for Action.
Concepts of adolescent health care in generally and adolescent’s reproductive health care in particularly are recent in Lithuania. Despite that recommendations for adolescent reproductive health care services from different medical associations of Lithuania (Society of Pediatricians, Society of Obstetricians and Gynecologists, College of General Practitioners, etc.) will be studied carefully.
Reproductive health care services which should be included in the primary health care are described in 1994 UN Cairo Program for Action: „family-planning counselling, information, education, … education and services for prenatal care, safe delivery,... abortion,… treatment of reproductive tract infections; sexually transmitted diseases… “. Based on this analysis of reproductive health care services accessible for adolescents’ in the primary health care level in Lithuania will be accomplished. Content of adolescents’ preventive services (detection of sexually actives adolescents, contraceptive counseling, clinical curricula in STDs, etc.) provided by family physicians will be studied as well.
Possibilities of primary care providers to ensure adolescents reproductive health care (professional training, continuing medical education, material resources for examination of patients, etc.), their contribution to adolescents’ reproductive health promotion (providing confidence family planning services and sex education for their patients, working at family planning clinics, collaborating with schools in the field of sex education etc.) will be explored.
1994 UN Cairo Program for Action indicates availability of referral for „family-planning services and further diagnosis and treatment for complications of pregnancy, delivery and abortion ... treatment of sexually transmitted diseases and HIV/AIDS“. Because of that possibilities for adolescents to get needed reproductive health care services in secondary and tertiary health care level as well as in wide net of private health-care providers or non - governmental organizations will be searched. Possibilities of all types of non- governmental organizations to be involved in the promotion of better reproductive health will be overlooked.
Young people who need reproductive health care services often meet barriers in health care facilities. Identification of these barriers and clarification of quality criteria and priorities for reproductive health care perceived by teens would very helpful for establishing guidelines.

Procedures for fulfilling the project

The sources of information will include local library databases, information in the Internet, interviews with the policy makers, professionals, adolescents etc.
A systematic search and review of literature will be carried out to determine what is being done on adolescent reproductive health care promotion and to gather evidence of interventions that are effective. Keywords and text words will be combined to search for studies on adolescent sex education as well as reproductive health care in primary, secondary or tertiary health care.
This research will also incorporate both qualitative and quantitave strategies. Qualitative approaches will be utilized for sensitive areas of adolescent attitudes and experience.
Selected sex education programs will be examined in order to analyze their effectiveness and limitations. Participant observation of sex education programs will be followed up by unstructured or semi-structured interviews with teenagers, sex educators, health care providers in schools and health care settings.
Interviews will be applicable in meetings with policy makers, sex educators, physicians, administrators, representatives of non-governmental organizations.
While conducting the more detailed evaluations quantitative techniques are planed to use.

Usage of the results of research

This project will provide understanding of historical and national peculiarities to be considered while developing more appropriate reproductive health promotion strategies for adolescents.
Outcomes of this work could stress the need for government to listen and to take into account expectations of young people and perspectives of sex educators and adolescents’ reproductive health care providers and then to create policies and legislation.
Results of this study will emphasize ways that will positively affect sex education and adolescents’ reproductive health care issues in Lithuania. Based on the outcomes of this study the policy guidelines of sex education and adolescents’ reproductive health care delivery in governmental and municipality level will be proposed. Recommendations for training of sex educators and health care providers in adolescent reproductive health promotion issues will be suggested.
The results of this study will be presented at the national and international conferences, disseminated in mass media and published in a form of scientific publications in journals. The benefit of gained experience through the project will be given to students of Faculty of Public Health of Kaunas Medical University.
 
 

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