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Adolescent and Youth Reproductive Health: 2. Vulnerabilities, Risk-Taking Behaviours, and Life Skills
Study Session 2 Vulnerabilities, Risk-Taking Behaviours, and Life Skills
Introduction
In this study session you will learn about some specific physical, socioeconomic and emotional vulnerabilities that adolescents have and the reasons why they are so inclined to take risks. Specifically, you will learn about risk taking behaviours such as impulsive decision-making, reckless behaviour, experimentation with substances and antisocial or even criminal activities. During the period of adolescence young people also tend to argue a lot both with peers and with people in authority (parents and other adults).They seem to be trying to find out how far they can go with this behaviour by testing the limits. As you will learn, they can become very emotional during these arguments and this may lead them to behave stupidly and sometimes violently.
You will learn about some of the important psychosocial and behavioural concerns that young people have. These include gender roles, feelings about self-worth, and relationships with family and peers, especially those of the opposite sex. We will also discuss the strategies that young people need to learn in order to negotiate with others through this period of transition when they often have confused thoughts and feelings. The skills and competencies that are needed to enable people to deal effectively with the challenges of everyday life are called life skills. By understanding the concerns of these young people and the strategies that they need to learn you will be able to help them achieve healthy development during the period of adolescence.
Learning Outcomes for Study Session 2
When you have studied this session, you should be able to:
2.1 Define and use correctly all of the key words printed in bold. (SAQs 2.1 and 2.2)
2.2 Identify the physical, socioeconomic and emotional vulnerabilities of adolescents. (SAQ 2.1)
2.3 Describe risk-taking behaviours of adolescents and young people and the consequences for their reproductive health. (SAQ 2.2)
2.4 Discuss the implications of the psychosocial and behavioural concerns that adolescents and young people have in relation to their reproductive health. (SAQs 2.1 and 2.2)
2.5 Describe life skills and explain why they are important for healthy adolescent development. (SAQs 2.1 and 2.2)
2.1 Vulnerabilities
Adolescents and young people do not always act in ways that serve their own best interests. They can make poor decisions that may put them at risk and leave them vulnerable to physical or psychological harm (see Figure 2.1). Some risk-taking behaviours lead to serious lifelong consequences (for example adolescent pregnancy); while others can be corrected (for example peer pressure to consume alcohol).
These vulnerabilities can be categorised as physical, emotional, and socioeconomic (see Box 2.1).
By understanding young people’s vulnerabilities, and the life skills that empower them, you will be in a better position to serve their needs.
Box 2.1 Vulnerabilities of adolescents
Physical Vulnerabilities:
- Adolescence is a time of rapid growth and development, creating the need for a nutritious and adequate diet.
- Adolescents often have poor eating habits which put them at risk of undernutrition as they may not be able to meet the increased demand of nutrition for growth.
- Poor health in infancy and childhood, often resulting from impoverished conditions, can persist into adolescence and beyond.
- Repeated and untreated infections and parasitic diseases, frequent diarrhoea and respiratory diseases, malnutrition, physical defects and disabilities can affect their physical and psychological development.
- Some young women may have undergone female genital cutting, which can result in significant physical and/or emotional difficulties, especially concerning sexual and reproductive matters (see Study Session 6).
Emotional Vulnerabilities:
- Mental health problems can increase during adolescence due to the hormonal and other physical changes of puberty, along with changes in adolescents’ social environment.
- Adolescents often lack assertiveness and good communication skills, thereby rendering them unable to articulate their needs and withstand pressure or coercion from their peers or adults.
- Adolescents may feel pressure to conform to stereotypical/conventional gender roles.
- Young people are more vulnerable than adults to sexual, physical, and verbal abuse because they are less able to prevent or stop such manifestations of power (see Study Session 6).
- Often there are unequal power dynamics/relationships between adolescents and adults since adults sometimes view adolescents as children.
- Young people may lack the maturity to make good, rational decisions.
Socioeconomic Vulnerabilities:
- During adolescence, young people’s need for money often increases, yet they typically have little access to money or money-making employment.
- Poverty and economic hardships can increase health risks owing to poor sanitation, lack of clean water, and the inability to afford healthcare and medications.
- Disadvantaged young people are also at a greater risk of substance abuse and may feel forced to resort to work in hazardous situations, including commercial sex work, (prostitution) which makes them likely to contract STIs, including HIV/AIDS, and have an unwanted pregnancy.
- Young women also face gender discrimination that affects access to healthcare, the ability to negotiate safer sex, and opportunities for social and economic wellbeing.
- Some young women marry very young to escape poverty, but as a result may find themselves in another difficult and challenging situation.
- Many young people are also at risk because of diverse socioeconomic and political reasons. These especially vulnerable young people include street children, child labourers, the internally displaced or refugees, those in war zones, young criminals, those orphaned because of AIDS and other circumstances, and other neglected and/or abandoned youth.
2.2 Types of risk-taking behaviour and its consequences
Adolescents can make impulsive decisions resulting in dangerous situations. For instance, reckless behaviours such as driving above speed limits or under the influence of alcohol or khat could result in motor vehicle injuries, which are quite a common problem in urban areas of Ethiopia.
Adolescents are also likely to be involved in provocative activities such as arguing and testing limits with peers and adults, resulting in emotional and physical damage (for example, unnecessary quarrelling with someone may be followed by physical violence and feelings of guilt or unhappiness). Experimentation with substances could result in short- and long-term consequences that include effects on most other risk-taking behaviour. For example, alcohol abuse can not only lead to reckless driving; it might also lead to early sexual activity, unprotected sexual activity or having non-regular sexual partners (one-night stands). All of these behaviours could have immediate and/or long-term health, emotional, psychological, social and economic consequences.
What are the possible consequences of unprotected one-night stands?
There is a very high chance that such risky behaviour will lead to multiple reproductive health problems. In the short term the adolescent might pick up a sexually transmitted infection such as gonorrhoea (which is curable if treated). However, they also carry the risk of getting infected by HIV and this is not curable, although it can be treated to slow the progression of the disease to full blown AIDs. If the girl also becomes pregnant there is a risk of transmitting the infection to the baby, which is likely to be born undernourished and prematurely. These are long-term problems which are likely to be passed on to the next generation.
In general, it is important to note that risk-taking among young people varies with cultural factors, individual personality, needs, social influences and pressures, and available opportunities. And when young people test their limits and underestimate the risks involved, you need to realise that this type of behaviour is age-appropriate, and encourage adults to help them avoid serious consequences.
2.3 Psychological and behavioural concerns
As children grow up they have concerns about their social relationships. They worry about the way others see and judge them and they often have doubts about their own self-worth. These feelings can become very strong during adolescence. These concerns, in turn, have a significant influence on sexual decision-making and reproductive health.
What might these concerns be?
Adolescents want to be accepted by their peer group and they want to be liked. So they will be concerned to behave in a way that is admired by the rest of the group. They will worry over their appearance and their speech, often feeling unsure that what they say and do is appropriate. Their feelings toward the opposite sex will be changing in a way that most find confusing.
There are a number of important issues that emerge during the adolescent period. You will probably have experienced these yourself to a greater or lesser extent so will be in a good position to be able to help younger people understand their confused feelings. Letting them talk to you and just listening in a non-judgemental way can, in itself, be a tremendous help to them. It can be a relief to them to hear from you that their feelings are not abnormal.
The following list explains some of the areas where adolescents can feel confused.
Peer relationships and peer pressure. Adolescents develop very close relationships with their peers, conforming to language, dress and customs. This helps them feel safe and secure and gives them a sense of belonging to a large group. Given the significance of peer influence, this power can sway adolescents and young people toward greater or lesser risk taking. For example, studies show that adolescents and young people tend to match their sexual behaviour, including timing of sexual debut and use of contraceptives, to what they perceive their peers are doing. Peer pressure, combined with gender inequities within a sexual relationship, can mean that males have undue power to dictate sexual decisions to females.
Relationships with parents and other adults. During adolescence relationships with parents become more confrontational as the young person tests limits and moves toward greater independence. At the same time, parents have significant influence over, and responsibility for, adolescents. Parents or other caring adults tend to strengthen adolescents’ resilience and flexibility and their ability to avoid risk-taking behaviour. Hence, when you get the opportunity, you can influence the family by encouraging communication between parents and their adolescent offspring.
Gender roles. Although boys and girls, worldwide, are treated differently from birth onward, it is during adolescence that gender role differentiation intensifies. More often than not, boys achieve more autonomy, mobility, and power, whereas girls tend to get fewer of these privileges and opportunities. Importantly, boys’ power relative to girls’ translates into dominance in sexual decision-making and expression, often leaving girls unable to fully assert their preferences and rights to protect their health.
Self-esteem. Self-esteem is the ability to feel confidence in, and respect for, oneself. It is a feeling of personal competence and self-worth. While self-esteem involves feelings about oneself, it develops to a great extent from interactions with family, friends and social circumstances throughout life. Self-esteem can be challenged during adolescence by rapid physical and social changes and the development of one’s own values and beliefs. Yet self-esteem is critically important at this stage in life.
Take a moment to think about why this might be so and what role adults might have.
Specifically for reproductive health, self-esteem influences how young people make judgements about relationships, sex and sexual responsibility. Adults can help young people to strengthen their self-esteem by showing them respect and by demonstrating confidence in these young people’s abilities.
2.4 Life skills
One of the reasons why a high number of adolescents and young people show risky behaviours is because they lack the skills necessary for adulthood: skills such as working and communicating with others, understanding themselves, and making decisions. Life skills in adolescents refer to the skills and competencies needed to build or adopt positive behaviours that enable them to deal effectively with the challenges of everyday life. The development of life skills allows adolescents to cope with their environment by making responsible decisions, having a better understanding of their values, and being better able to communicate and get along with others. Early adolescence is singled out as a critical moment of opportunity for building skills and positive habits, since at that age there is a developing ability to think abstractly, to understand consequences, and to solve problems.
What period does early adolescence cover?
Early adolescence is age 10-14. (See Study Session 1.)
Life skills translate into positive behaviours that promote health, mental wellbeing and good social relationships. Among the most important life skills are assertiveness and decision-making.
2.4.1 Types of life skills
Life skills fall into three basic categories, which complement and reinforce each other. These are social or interpersonal skills, cognitive skills and emotional coping skills (see Table 2.1).
| Social skills | Cognitive skills | Emotional coping skills |
|---|---|---|
| Communication skills | Decision-making and problem-solving | Managing stress |
| Negotiation and refusal skills | Understanding the consequences of actions | Managing feelings, including anger |
| Assertiveness skills | Determining alternative solutions to problems | Skills for increasing self-management and self-monitoring |
| Interpersonal skills (for developing healthy relationships) | Critical thinking | |
| Cooperation skills | Analysing peer and media influences | |
| Empathy/understanding and perception | Analysing one’s perceptions of social norms and beliefs | |
| Self evaluation and values clarification |
Research shows that interventions that address these specific skill areas (such as decision-making and assertiveness skills) are effective in promoting desirable behaviours, such as sociability, improved communication, effective decision-making and conflict resolution, and preventing negative or high-risk behaviours, such as use of tobacco, khat, alcohol, unsafe sex and violence.
For instance, decision-making has long been a part of pregnancy prevention; refusal skills are seen as critical to substance (e.g. khat) abuse prevention, and communication skills have been used to help aggressive or antisocial youngsters.
You are expected to explain and teach life skills to adolescents who come seeking your help. Examples of adolescents who could benefit from your messages include: a girl who is not feeling confident to end a relationship that she thinks will put her at risk of STIs, including HIV, because her partner doesn’t like to use condoms; or a boy who is about to start or has already started khat chewing just because he wants to imitate what his friends are doing. These are just two instances where you could make a difference in adolescents’ behaviours by telling them that it is perfectly OK to say ‘No’ when they have to. This could be done through individual or group counselling at your Health Post, in schools or in the community.
You need to explain the need to be assertive. Being assertive involves expressing beliefs, thoughts and feelings in a direct, clear way at an appropriate moment and does not mean imposing beliefs or views on another person. To be assertive implies the ability to say ‘yes’ or ‘no’ depending on what one wants. For example: ‘I don’t want to have sex’ or ‘Yes, I want to have sex but only if we use a condom’.
Being able to express what is truly felt or desired can have important consequences for adolescent reproductive health. Being clear and assertive can increase self-respect and help resist peer pressure to engage in sex, khat use, etc. Adolescents who are assertive can effectively negotiate safer sex to prevent unwanted pregnancy and STIs, including HIV, and resist unwanted sexual proposals from adults. They are also more likely to identify and obtain services needed for pregnancy prevention, prenatal and postpartum care, and STI/HIV diagnosis, counselling and treatment.
Decision-making skills focus on techniques involved in critical thinking and problem solving (these bold terms are defined below). Adolescents must make decisions frequently, ranging from simple and marginally consequential ones such as ‘What shall I wear today?’ to major and very consequential decisions, such as, ‘Should I have sexual relations?’ Depending on the culture, the potential to make decisions varies, as does the young person’s sense of their ability to make decisions.
For instance, in some cultures, young people believe that external factors (such as fate or luck) determine what happens to them. In others, young people believe that their own capacity or skills and efforts determine what happens to them. In general young people who think they can determine what happens, within the range of available options, will be more likely to make their own decisions and thus feel greater commitment to these decisions and get more satisfaction from them.
Before making a sensible decision it is important to weigh the good and bad sides, strengths and weaknesses, advantages and disadvantages. Critical thinking is the ability to think through situations adequately, weighing the advantages and disadvantages so as to be able to make appropriate decisions concerning other people or one’s own situation. Adolescents are confronted by multiple and contradictory issues, messages, expectations and demands of a sexual nature or otherwise. They need to be able to critically analyse the challenges that confront them. Examples in critical thinking are ability to distinguish between myths and facts; assessing the promises of a partner; and judging a situation that may be risky.
Problem solving refers to one’s capacity to identify problems, their causes and effects as well as the capability to look for possible solutions. It is the ability to identify, cope with and find solutions to difficult or challenging situations. Problem solving is related to decision-making and the two may often overlap. It is only through practice in making decisions and then solving problems that adolescents can develop the skills necessary to make the healthiest sexual choices for themselves. Examples of abilities in problem solving are skills in planning how to prevent getting STIs and unwanted pregnancy by using condoms properly and consistently.
Negotiation or conflict resolution is a ‘win-win’ or ‘no lose’ method of settling disagreements. Every relationship has conflicts. However, conflicts do not have to end with someone losing and with both parties hating each other. Many do end this way. Adolescents need to begin by understanding that they have their own way of dealing with conflicts in their lives. Knowing their own style and motives as well as the style and motives of the person they are in conflict with will help them handle the situation.
They can negotiate their position by talking about it. This needs to be strengthened, especially in situations where it has not been usual to have a dialogue. Negotiation also means that both sides will compromise. Since it may not be advisable to compromise on certain issues, agreeing to negotiate may be a dangerous strategy used by those who have selfish interests. ‘Let’s talk about it’ may actually be a dangerous invitation (Figure 2.2).
Box 2.2 shows important points that adolescents need to keep in mind when negotiating for safer sex.
Box 2.2 How to negotiate safer sex
- Be assertive, not aggressive
- Say clearly and nicely what you want (E.g. to use the condom from start to finish)
- Listen to what your partner is saying
- Use reasons for safer sex that are about you, not your partner
- Be positive
- Turn negative objection into a positive statement
- Never blame the other person for not wanting to be safe
- Practice ‘TALK’
Tell your partner that you understand what they are saying
Assert what you want in a positive way
List your reasons for wanting to be safe
Know the alternatives and what you are comfortable with.
The overall message of this study session is that in all of your activities aimed at promoting healthy adolescent behaviours, you need to focus on prevention, which means trying to build the skills of adolescents to make sound decisions that can protect their health. You should also educate the community that young people are vulnerable and need to be supported in their decisions, particularly regarding reproductive health matters.
Summary of Study Session 2
In Study Session 2, you have learned that:
- Young people have physical, socioeconomic and emotional vulnerabilities that put them at risk of engaging in many risk-taking behaviours.
- The fact that adolescence is a period of rapid growth means that their nutrition needs increase. This high demand for nutrition might be difficult to meet, particularly if they have poor eating habits. Poor nutrition can lead to poor physical and reproductive health.
- Lack of assertiveness and poor communication skills, unequal power relationships between adolescents and adults, and lack of the maturity to make good, rational decisions increase emotional vulnerability during adolescence.
- Many adolescents are socioeconomically disadvantaged. As a result, they have little negotiation power and may be engaged in more hazardous conditions such as prostitution (commercial sex work).
- Some of the risk-taking behaviours young people show include: impulsive decision-making, which could result in injuries; provoking, arguing and testing limits with peers and adults, which may result in emotional and physical damage or violence; experimentation with substances; and unprotected sexual activity, which might result in unwanted pregnancy and possibly being infected by STIs, including HIV.
- Young people are more likely to have significant concerns related to social relationships, self-perception and gender roles. For instance, boys achieve more autonomy, mobility and power, whereas girls tend to get fewer of these privileges and opportunities.
- Assertiveness and decision-making are among the most important life skills that adolescents need to develop. Assertiveness involves expressing beliefs, thoughts and feelings in a direct, clear way at an appropriate moment, while decision-making involves a group of conclusions that are followed by actions.
Self-Assessment Questions (SAQs) for Study Session 2
Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering these questions. Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module.
First read Case Study 2.1 and then answer the questions that follow it.
Case Study 2.1 Hawa’s story
Hawa is a 15-year-old girl living in a rural village. Her father and mother both died of AIDS when she was 4 years old. She was raised by neighbours until she reached 9th grade, at which time they left the area for good. Hawa then found it difficult to meet her daily expenses and married a rich 45-year-old man when she was 15. She was her husband’s second and younger wife, and he had 5 children with his older wife. For a time she thought her problems were solved; however, a year later she had a low birth-weight baby and couldn’t go to school as she had to take care of her child and do other household tasks.
SAQ 2.1 (tests Learning Outcomes 2.1, 2.2 and 2.5)
- a.Use Box 2.1 to identify Hawa’s physical, emotional and socioeconomic vulnerabilities.
- b.In your opinion, did Hawa made the right rational decision? Comment on her negotiation power.
Answer
- a.Hawa was too young to get married legally and have a child. Adolescence is a period of rapid physical growth so the fetus would have been competing for nutrients with Hawa. This resulted in poor growth, reflected by its low birth-weight. At 15 Hawa may be emotionally unprepared to take adult roles and may not be able to give proper care to her child. The fact that she lost her parents and had no income compromised her options in life so marriage seemed a way out but she thereby lost the opportunity to have a good education and find employment.
- b.Hawa could have negotiated on at least two issues even after she got married: first she could have delayed the first birth using contraceptives; and second, she could have asked to continue her education. However, since she doesn’t equal her husband in terms of age, income, and social status it was difficult for her to decide freely about these important issues in her life. Besides, it is difficult to make a mature and rational decision when only 15 years old.
First read Case Study 2.2 and then answer the questions that follow it.
Case Study 2.2 Kebede’s story
Kebede is a 16-year-old boy who recently moved from the village where he grew up to a town to pursue his education at a preparatory school. In the new school he met new friends. Some of his friends chewed khat and smoked cigarettes and told Kebede that it was normal for a modern young person to do these things. So Kebede started chewing khat, drinking alcohol and smoking. With his friends he frequently went to a nearby bar where he met a prostitute (commercial sex worker). Over time, Kebede felt that he was doing the wrong things. He decided he could no longer copy his friends’ behaviour just to get along with them. It took him a while to analyse his situation and decide to stop chewing khat, drinking alcohol, smoking cigarettes and going to prostitutes. Following his decision he was able to make friends who were free of such risky behaviours, which helped him to work towards achieving his dream, which was to perform well in his education.
SAQ 2.2 (tests Learning Outcomes 2.1, 2.3, 2.4 and 2.5)
- a.Describe Kebede’s risk-taking behaviours.
- b.What consequences could Kebede face as a result of his behaviour?
- c.What type of life skills did Kebede use to be free from risky behaviours?
Answer
- a.Kebede’s risky behaviours included having contact with a prostitute, chewing khat, drinking alcohol and smoking.
- b.His sexual behaviour put him at risk of acquiring sexually transmitted infections, including HIV/AIDS. Cigarette smoking and alcohol consumption increase his risk of acquiring many chronic diseases. Further, as he is engaged in behaviours, such as alcohol drinking and khat chewing, that can become addictive, he could have social, psychological or mental health problems in the future (e.g. being isolated and stigmatised).
- c.Kebede applied two important interrelated life skills – decision-making skills and critical thinking skills. He reflected on his own behaviour and tried to understand the consequences of his actions. He decided to stop his risky behaviours. In doing this he was able to analyse the influence that his peers were having on his behaviour and so he found new friends who were more supportive of what he was trying to achieve.