A STUDY OF SEXUAL & REPRODUCTIVE KNOWLEDGE, ATTITUDE & BEHAVIOUR AMONG ADOLESCENT SCHOOL CHILDREN
Dr. Hosenara Begum*, Dr. Rina Das**
Associate Professor Dept. of Pediatrics, MCH *, Adolescent Health Clinic Medical College & Hospital, Kolkata **
There is an estimated 300 million young people (aged 10-24) including youth (aged 15-24) in India today representing almost one third of the population. Specifically, 22% of the population falls into the adolescent age group (aged 10-19) (IIPS and ORC Macro 2000;UN 2001).

Young people in India are healthier, more urbanized and better educated than earlier generations. They experience puberty at younger ages but marry and have children later than in the past. At the same time, they face significant risks related to sexual and reproductive health and many lack the power to make informed sexual and reproductive choices. These vulnerabilities remain poorly understood and served and it is only over the last decade that researchers and policy makers have begun to shed their traditional ambivalence to these issues. Even so, there is little evidence that identifies the factors that protect young people's ability to ensure safe sexual and reproductive health and their autonomy to make informed and wanted decisions.

The objective of the study was to assess the sexual and reproductive health status of school children, which includes their views and attitude towards reproductive life, knowledge of HIV & STI, source of knowledge about sexuality, contraceptive and pregnancy.
Materials and Methods
The survey was done by administering a questionnaire proforma to students of six Government Schools (3 boys & 3 girls Schools) of Kolkata. The survey was carried out individually on all the students in the section of a class in the school (each class has 2-3 sections with 45-50 students in each sections). This ensured that all students of varying capacity, skills and socio economic background had a choice of being equally represented among the respondents of the survey. The students from Class V to XII (age 10-18 yrs) were included. The students were encouraged to give their frank opinion as their identity was kept confidential. Results were analyzed according to age group and among boys and girls

The study involved 1465 respondents aged 10-18 yrs
    Early adolescents 488 (10-13 yrs, Boys 47.6%; Girls 52.4%)
    Mid adolescents 557 (14-16 yrs, Boys 54.2%; Girls 45.8%)
    Late adolescents 420 (17-18 yrs, Boys 45.2%; Girls 54.8%)
Study Findings
Knowledge about pubertal changes among early adolescents is poor. It is 21.2% in boys and 17.5% in girls. In mid adolescents it is 35.6% and 42.4% in boys and girls, where as in late adolescents it is 88% and 90% respectively.

Knowledge about pregnancy in relation to menstruation is less among boys. It is only 10.2% among early adolescent boys, 29.3% in mid adolescent boys and 40.4% in late adolescent boys. This knowledge is little more among girls. In 10 to 13 yrs age group girls it is 22%, among 14 to 16 yrs aged girls it is 48.8% and in 17 to 18 yrs age group this knowledge is reported as 65.4%.

TABLE I. Knowledge about Pregnancy in relation to Menstruation

Early adolescents (10-13 yrs)

Mid adolescents (14-16 yrs)

Late adolescents (17-18 yrs)

Boys

Girls

Boys

Girls

Boys

Girls

21.2%

17.5%

35.6%

42.4%

88%

90%


Knowledge about contraceptive method is poor among early adolescents
Early adolescents (10-13 yrs)

TABLE II. Knowledge about contraceptive methods

Early adolescents
(10-13 yrs)

Mid adolescents
(14-16 yrs)

Late adolescents
(17-18 yrs)

Boys

Girls

Boys

Girls

Boys

Girls

10.2%

22%

29.3%

48.8%

40.4%

65.4%


Among mid adolescents, condom is better known contraceptive than oral pill.
Awareness on ligation is < 50% in both the sexes.
Mid adolescents (14-16 yrs).

TABLE III. Knowledge of different Contraceptive methods

Boys Girls
Condom Oral pill Cu - T Ligation Condom Oral pill Cu - T Ligation
73.2% 58.5% 23.3% 42.5% 66.2% 59.6% 32.5% 48.2%

Condom and oral pill are better known contraceptives among late adolescent boys and girls. Cu - T is least known by them whereas, more than 50% boys and girls are aware of ligation.

TABLE IV. Knowledge of different contraceptive methods in late adolescents (17-18 yrs)

Boys

Girls

Condom

Oral pill

Cu - T

Ligation

Condom

Oral pill

Cu - T

Ligation

81% 72.2% 40.1% 50.4% 79.7% 78% 45.2% 55.3%

Awareness on birth control and safe sex among early adolescents are poor. It is 19.2% in boys and 22% in girls. Among mid adolescents (14-16 yrs), 39.3% boys and 36.4% girls are aware of this. But in late adolescents (17-18 yrs) the awareness is 52.5% in boys and 55.2% in girls respectively.

TABLE V. Awareness on Birth control and Safe sex

Early adolescents

(10-13 yrs)

Mid adolescents

(14-16 yrs)

Late adolescents

(17-18 yrs)

Boys Girls Boys Girls Boys Girls
19.2% 22% 39.3% 36.4% 52.5% 55.2%

Knowledge about other STIs apart from HIV / AIDS are very limited among early adolescents. Among mid adolescents the knowledge is 22.6% in boys and 25.2% in girls. Among late adolescents, it is little more ie 31.6% in boys and 34.7% in girls.

TABLE VI. Knowledge about STIs apart from HIV/AIDS

Early adolescents

(10-13 yrs)

Mid adolescents

(14-16 yrs)

Late adolescents

(17-18 yrs)

Boys Girls Boys Girls Boys Girls
3.2% 1.7% 22.6% 25.2% 31.6% 34.7%

Awareness on AIDS is better among school children. Transmission by sexual route is known by 69.3% girls and 62.5% boys of 17-18 yrs age group. This knowledge is 61.2% in girls and 57.6% in boys of 14-16 yrs age group. But it is poor among early adolescents. Only 22.4% girls of 13 yrs age and 16.3% boys of the same age are aware of this.

Transmission through used needle and blades are known by 18.6% girls and 14.3% boys of early adolescent age group. Among mid adolescents, this knowledge is 50.2% in girls and 42.5% in boys. Among late adolescents, 65.2% girls and 58.3% boys are aware of this.

TABLE VII a. Knowledge about AIDS Transmission

Knowledge
onAIDS
Transmission
Early adolescents (10-13 yrs) Boys Girls Mid adolescents
(14-16 yrs)
Boys Girls
Late adolescents (17-18 yrs) Boys Girls
Transmission by Sexual route 16.3% 22.4% 57.6% 61.2% 62.5% 69.3%
Transmission by Used needles & blades 14.3% 18.6% 42.5% 50.2% 58.3% 65.2%

Monogamous relationship for prevention of AIDS is known by 59% boys and 61.2% girls of late adolescents age group (17-18 yrs). This knowledge is 42.1% in boys and 44.3% in girls of mid adolescents age group. Whereas among early adolescents, it is only 16.5% in boys and 21.1% in girls respectively.

74% girls and 71.8% boys of 17 to 18 yrs age group are aware of using condom for prevention of AIDS. This knowledge is 52.4% among boys and 58.3% among girls of 14-16 yrs of age group. Among early adolescents, it is only 22.5% among boys and 18.2% among girls.

TABLE VII b. Knowledge about AIDS Transmission

Knowledge
onAIDS
Transmission
Early adolescents (10-13 yrs) Boys Girls Mid adolescents
(14-16 yrs)
Boys Girls
Late adolescents (17-18 yrs) Boys Girls
Monogamous Relationship 16.5% 21.6% 42.1% 44.3% 59% 61.2%
Use of condom 22.5% 18.2% 52.4% 58.3% 71.8% 74%

Friends (76.8%), Television (70%) and books (66%) are the commonest sources of information on reproductive and sexual health issues. Parents, teachers, relatives play minor role.

TABLE VIII. Source of Information on SRH

Source of information About sexuality, contraception, pregnancy
Friends 76.8%
Television, Radio 70%
Books, Magazines, News paper 66%
Parents 23.4%
Teachers 15.5%
Other relatives 10.8%

More than 70% adolescents like to receive more information on sexual and reproductive health issues.

Analyzing sexual behaviour among mid and late adolescents, it is observed that reading pornography and viewing blue films are more common in boys than girls. It is more common among 15-16 yrs boys. Pornography (34.2%) is more popular than blue films (25.2%) among them.

Sexual exposure is reported by 1.2% boys of late adolescents age group (17-18 yrs).

Nocturnal emission is experienced by 51.8% boys of 14-16 yrs age group and 42.2% boys of 17-18 yrs age group.

Incidence of self stimulation (masturbation) was reported by 12.5% boys of late adolescents and 16.8% boys of mid adolescent age group. Among girls, it is 1.2% in mid adolescents and 3.6% in late adolescents age group.

TABLE IX. Sexual behaviors in adolescents

Sexual behaviour among Boys Mid adolescents (14-16 yrs) Late adolescents (17-18 yrs)
Reading pornography 34.2% 30.5%
Viewing blue films 25.2% 22.9%
Sexual exposure - 1.2%
Nocturnal emission 42.2% 51.8%
Self stimulation (masturbation) 16.8% 12.5%


Sexual behaviour among Girls Mid adolescents (14-16 yrs) Late adolescents (17-18 yrs)
Reading pornography 4.2% 6.8%
Viewing blue films - -
Sexual exposure - -
Self stimulation (masturbation) 3.6% 1.5%

Conclusion
The study reveals that most girls and boys become oriented about sexual and reproductive health in their adolescence period. Knowledge about pubertal changes developed more in late adolescence and is generally adequate.

The school children of Kolkata are aware of HIV-AIDS, but remain vulnerable to infection in large part. At the same time the knowledge of STI is poor. It is a well known fact that they have a rather inadequate knowledge in these matters and many misconceptions exists among them.

Adolescents are curious about sex. But they are worried about sexual involvement. The inadequate level of knowledge of reproduction among young adolescents and increasing rate of sexual activity among them suggests that family life education program should be introduced to children before they enter puberty. Youngsters need to be well informed about reproductive health concerns before they face decision-making about becoming sexually active.

The study suggests that communication between parents and children about sex and sexuality is little. In the past, many parents relied on grand parents, aunts or elders to discuss sexual matters with their children, but the sources are falling out of practice. As traditional sources of information are weakening and adolescents get more information from their friends and media, they are more likely to be misinformed about sexuality and reproduction.

It is important as well as highly desirable to provide correct scientific knowledge to the adolescents on the issues related to sexuality, contraceptives, etc.
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