Righting the mismatch between law, policy and the sexual and reproductive health needs of young people in the Asia-Pacific Region

A Bioethics Framework for At-risk Child/Adolescent Access to Key Reproductive Health Services Without Parental Consent

Context: Access of adolescents to key reproductive health services (KRHS) has been emphasized; however, how to provide it has not been addressed. This study aimed to propose a bioethics framework to justify at-risk child/adolescent access to KRHS without parental consent. Evidence Acquisition: First, articles and documents were searched using the age of consent laws, reproductive health, and ethical/legal standards phrases with AND/OR separators in PubMed and Web of Science using the Google Scholar search engine in English. After a concise review of the age of consent in child/adolescent-related laws, at-risk child/adolescent access to KRHS without parental consent was justified using major ethical and legal principles and standards. Results: Given the different purposes and nature of harm preventive services, in the first part, the authors argue that considering the age of consent for at-risk adolescents’ access to KRHS is a limiting and inefficient factor, and KRHS could be provided for the at-risk adolescent with his/her own assent. In the second part, the authors argue that in decision-making for at-risk adolescents’ access to KRHS, the best interest standard is applicable on the ground of harm standard. Regarding the sociocultural context of the community, after assessing the seriousness of the harm and the threshold of intervention, practical steps are taken toward reducing or removing harm and choosing the option that best promotes adolescents’ interests. Conclusions: Regarding the existence of restrictive laws, the suggested framework can be applied in different communities as a bioethics policy guide for legislation and appropriate actions of adolescents’ healthcare professionals.

Knowledge, attitudes and peer influences related to pregnancy, sexual and reproductive health among adolescents using maternal health services in Ugu, KwaZulu-Natal, South Africa

Background

Knowledge and practices of sexual and reproductive healthcare is pivotal to the Safe Motherhood Initiative; however, only a few studies have investigated adolescent mothers’ knowledge of sexual and reproductive health in light of the above initiative. Research should thus focus on the knowledge and attitudes of adolescent girls as well as peer influences related to pregnancy and sexual and reproductive health among adolescents, as the findings may highlight vital health interventions that should be introduced. The aim of this study was thus to determine the knowledge, personal attitudes and peer influences related to pregnancy, sexual and reproductive health among adolescents who attended maternal health services in a district hospital in Ugu, KwaZulu-Natal, South Africa.

Methods

A cross sectional study was conducted. Data were collected from 326 adolescents who accessed maternal health services in a peri-urban district hospital during June 2017 and November 2017. The questionnaire surveyed the knowledge, personal attitudes and peer influences related to pregnancy, sexual and reproductive health. The questionnaire was administered by fieldworkers using mobile devices powered by the Mobenzi Researcher® technology. The completed surveys were uploaded to the Mobenzi server where it was stored and aggregated. The data was analysed using R software.

Results

Of the 326 participants, 65 (19.9%) experienced repeat pregnancies in adolescence. Overall, only 143 (43.9%) of the participants answered 50% or more of the knowledge questions on pregnancy and HIV/AIDS and STIs correctly, while 183 (56.1%) answered less than 50% of the knowledge questions correctly. There was no relationship between knowledge of pregnancy and HIV/STIs and repeat adolescent pregnancies.

Conclusion

Adolescents’ knowledge of pregnancy and sexual and reproductive health was deficient as, even with repeat pregnancies, these adolescents were evidently no better informed about pregnancy and sexual and reproductive health. This suggests that social determinants, modes and platforms regarding the delivery of adolescent sexual and reproductive health education are important. An innovative mode to the delivery of sexual and reproductive health education includes the emerging digital platform. The digital platform encompasses social media, multimedia and mobile phones which is growing popular among young people.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7242-y) contains supplementary material, which is available to authorized users.

Health policy making for street children: challenges and strategies

Background The phenomenon of street children is a bio-psychological and social issue that not only harms children, but also endangers the health of a society. In line with the national programs for the development and promotion of street children's health in Iran, health policy making and essential strategies for this group of children will be presented in this paper. This paper will discuss the main issues and challenges of street children's health and, also, health policy and guidelines for this population. Methods In this review study, the keywords; street children, health, challenges, policy, and health policy making were searched through PubMed, SID, Iranmedex, World Health Organization (WHO), Emro, the Cochran Library, Medline and Google scholar to collect data. The search resulted in 84 related resources from which 48 cases that were more relevant to this research and covered the issue more comprehensively, were used. All data published during 2002-2015 have been included in this paper. Results Key concepts including street children and their health, health policy, strategies to improve the health of street children, health policy approaches for street children, the WHO's strategies, and social support program for street children must be considered in the health policy making processes for street children, as precise identification of the relevant information makes planning more effective in health policy making for this group of children. Conclusion The phenomenon of street children is a growing problem in the world and it has turned into a serious concern in many countries including Iran. The findings of this study can be used for identifying necessary measures in order to use research outcomes more effectively in policy making processes and reforming street children's health policies in Iran.