1. Pre-service Education on FP and AYSRH
Session III Topic 3 Developmental Characteristics of Adolescence and Young Adulthood

2. Physical Changes Early Adolescence: Puberty; growth of body hair;
increased perspiration and oil production in hair and skin;
physical growth (both height and weight);
breast and hip development and onset of menstruation (girls);
growth of testicles and penis, wet dreams, and deepening of voice (boys).
Late Adolescence:
physical growth slows for girls;
physical growth continues for boys.
• Late Adolescence:
o physical growth slows for girls;
o physical growth continues for boys.
Slides 2-8
Introduce the activity to students by explaining that they will work in two groups to brainstorm the changes that adolescents go through as they age. Explain that it is important to understand adolescent development in order to work with adolescents in a positive manner.
Divide students into two groups, assign each group a stage of adolescence (very young adolescence, 10-14; and older adolescence, 15-19), and give each group a flipchart.
Ask groups to spend 3-5 minutes thinking about when they were adolescents, or to think about a child or adolescent they are close to. Give 20 minutes for groups to list the physical, cognitive (reasoning or thinking), and social and emotional changes they remember experiencing on a flipchart. For example a physical change may be growth of body hair, a cognitive change might be an interest in moral reasoning and social and/or emotional changes might include feeling awkward about themselves and their body.
Bring groups back together to present to each other and add to each other’s lists.
Pass out Participant Handout #1: Developmental Characteristics of Adolescence and Young Adulthood and present the slides on the changes that occur during adolescence. Tell students they can follow along on the handout.
After you have shown the slides, ask students if any of this sounds familiar or lines up with their experience, especially since most of them are young adults. If there is time, invite students to share stories with each other or the group about their memories of experiencing these changes in their own lives.

3. Physical Changes (continued)
Young Adulthood
Young women are typically fully physically developed
young men continue to gain height, weight, muscle mass, and body hair.

4. Cognitive Changes Early Adolescence:
growth in capacity for abstract thought;
mostly interested in present with little thought for future;
expansion of and increased importance placed on intellectual interests;
deepening of moral thought.
Late Adolescence:
continued growth in capacity for abstract thought;
increased and evolving capacity for goal-setting and decision-making;
interest in moral reasoning;
growth in connection to peer group, community;
questioning of faith, beliefs, and meaning of life;
growing interest in social justice, equity, and fairness.

5. Cognitive Changes (continued)
Young Adulthood
ability to plan ideas from beginning to end
increased ability to delay gratification
examination of inner experiences
increased concern for the future
deepening of moral reasoning.

6. Social and Emotional Changes
Early Adolescence:
struggle with sense of identity;
feel awkward about themselves and their body;
worry about being ‘normal’;
developing critical lens of and heightened conflict with parents;
increasing identification with peer group;
increase in desire for independence;
prone to mood swings;
beginning to test rules and boundaries;
increased interest in privacy;
increased awareness of sexual desire.

7. Social and Emotional Changes (continued)
heightened sense of justice and fairness;
increased drive for independence with resultant distance from parents or other authority figures;
increasing awareness of responsibilities to family and community;
greater reliance on friendship networks and peer group;
heightened capacity for emotional regulation;
experience feelings of love and passion;
increasing interest in sex.

8. Social and Emotional Changes (continued)
Young Adulthood
firmer sense of independent identity
including sexual identity
increased emotional stability and self-reliance
deeper connection to peers
community and family relationships
regrowth of interest in social and cultural traditions
development of serious romantic relationships

9. Types of Risk-Taking Behavior
Impulsive decision-making
Failure to consider consequences, or lack of information about risk
Social, sexual, or other experimentation
Provoking or testing limits through argument
Reckless behavior
Experimentation with substances, such as
alcohol or drugs
Slides 5-6
Ask students to revisit their handout from the previous unit, Handout #1: Developmental Characteristics of Adolescence and Young Adulthood. Draw their attention to the language under “Social and Emotional Development” about pushing boundaries, taking risks, and increasing independence.
Ask students to brainstorm some examples of risk-taking behavior.
Note their answers on a flip chart.
Explain that the major physical, cognitive, emotional, sexual and social changes that occur during adolescence affect young people’s behavior:
Ask students to brainstorm some of the reasons for adolescent risk-taking behavior.

10. Reasons for Risk-taking
New social relationships, especially with peers, begin to gain greater influence as family influence decreases. The need to identify or “fit in” with a peer group can sometimes lead to increased risk.
Curiosity combined with sexual maturity create a natural inclination toward experimentation, which also serves a developmental role in helping the adolescent learn more about their body and sexual response.
Questioning authority and established “rules” helps adolescents create an independent identity and personality, but can also lead to impulsive decision-making and lack of future-planning.
Adolescents test their limits and underestimate the risks involved, though the amount of risk and vulnerability they face varies with cultural factors, individual personality, needs, social influences and pressures, and available opportunities.

11. Consequences of Adolescent Risk-Taking
Development of sense of independence, resiliency
Potential for unintended pregnancy, infection with HIV/STIs
Growth in and failure of social and family relationships
Early child-bearing, complications in childbirth and/or unsafe abortion
Risk of sexual or interpersonal violence
Loss of access to educational or economic opportunities
Poor nutrition or other health outcomes
After showing the slide on consequences of risk-taking behavior, facilitate further discussion on risks and consequences, using the following questions to probe further into key gender and age issues:
Looking at the SRH-related consequences, which are experienced by female adolescents, male adolescents or both?
Who took the initial risk – the female, the male or both? What does this say about the gender-disparity in who/how adolescents experience SRH consequences?
How does adolescent risk-taking and consequences differ from those experienced by adults? How are they similar?
What does adolescent risk-taking behaviors and consequences mean for you as a provider – in terms of your understanding, the SRH needs of your client, and helping your client navigate risk?
Can you give examples of how you can work as providers to help adolescents navigate risk.

12. Gender Roles
Gender roles are the social and cultural expectations about how men and women are “supposed” to behave on the basis of their gender or physical sex.
Gender roles are:
Learned: from families, from peers and friends, from media and stories and from our societies.
Varied: what it means to “act like a woman” or “act like a man” can be different from culture to culture, or can change over time and at different points in our lives.
Stereotypical: built on assumptions about how “all women” or “all men” should naturally behave, rather than on an understanding of the individual’s character and inclinations.
Explain that while health providers must address the physical needs of adolescent clients, psycho-social factors such as gender, self-esteem and relationships are often as, if not more, critical to their client being able to seek and receive health care. They also can impact on the client’s ability to follow-through with the recommended treatment or behavior, especially if that action should ideally be sustained or repeated over time.
Explain that certain psychosocial factors - social relationships and pressures, along with concerns of self-perceptions - become very strong during adolescence. These, in turn, have a significant influence on sexual decision-making and sexual and reproductive health.
Previous sessions have explored some of the vulnerabilities and factors that adolescents face due to their age. In addition, gender norms and roles are critical factors in shaping adolescent lives. Show the slide on gender roles.
Conduct an activity to explore gender and age stereotypes. Ask students if they have ever been told to “act like a man” or “act like a woman” based on their sex. Ask them to share some experiences in which someone has said this or something similar to them. Why did the individual say this? How did it make the student feel? Tell the students that we are going to look more closely at these two phrases. By looking at them, we can begin to see how society can make it very difficult to be either male or female.
See next slide to continue

13. Gender Roles (continued)
Gender roles are intensely differentiated during later childhood, puberty and adolescence. While experiences vary from culture to culture, for many people, adolescence is a time when options expand for young men and restrict for young women.
Boys are allowed more autonomy, mobility and power.
Girls are expected to remain home more, take on household responsibilities and be differential to male figures.
Boys are expected to take on more dominance in social and sexual relationships, sometimes translating to interpersonal or sexual violence.
Boys are expected to take and give more power in sexual relationships
Girls are expected to control better their sexual desire and take on the responsibility for sexual health (FP and STI prevention)
Divide students into groups of 6-8 people. Assign one of the following to each group (expend or repeat categories as needed):
female child under 10 years
male child under 10 years
adolescent girl, years
adolescent boy, years
woman over 24 years
man over 24 years
Give each group a piece of flipchart and ask them to title the paper “Act like a ____,” writing in the category assigned. Give the groups 20 minutes to brainstorm and list out their ideas on what society’s expectations are for this type of individual, based on age and gender.
While groups can brainstorm on any stereotype, they should be sure to address factors related to sexual and reproductive health issues, such as:
Expectations about engaging in sexual activity
Expectations about taking risks
Expectations about what to do when they are in pain or need help
Expectations about violence
See next slide to continue

14. Why Adolescents May Have Unprotected Sex
Lack of Information
Often think they are not vulnerable to pregnancy or STIs/HIV. “It can’t happen to me” or "I don't have sex often enough to get pregnant or contract a STI/HIV."
May not have adequate or accurate information about protection.
School sex education is often non-existent or inadequate.
Parents and others are reluctant to provide practical information. Some believe that providing information encourages sexual activity, though this has been proven to be untrue.
Media gives unrealistic notions of sexuality and usually omit any mention of protection.
Don’t know that methods are available
Don’t know where, how, or when to get methods
Pass out 5 index cards to each participant. Tell them that first we’re going to try to put ourselves in the mind of an adolescent, because we can better plan for counseling adolescents if we understand the context in which they are making decisions about sexual behavior.
Have students write one reason why adolescents have unprotected sex on each of their index cards. Give them 5 minutes to complete their cards.
Collect the cards and group them according to similar responses.
Once a good list has been developed, go through the responses and circle those that are more relevant for adolescents vs. adults. Discuss why and the implications for providers in working with younger clients vs. older.
Present Slides # 8-14, noting those reasons for unprotected sex already raised by the students in their list.

15. Why Adolescents May Have Unprotected Sex (continued)
May not be aware of the need for protection during every sex act (i.e. may think that oral or anal sex are “safe” alternatives to vaginal sex)
Believe their peers are not using contraception or protection.
Misinformation or Misconceptions
May have misinformation or myths about methods and their side effects.
Myths about dangers of contraception are common and difficult to defuse.
May not believe that protection is needed with a regular partner.
May not believe that protection is needed if their partner looks healthy.
May be under social pressure to “prove” their fertility.

16. Why Adolescents May Have Unprotected Sex (continued)
May think that STI/HIV transmission only occurs among "certain people" (for example, commercial sex workers, poor people, "other" ethnic groups).
Social norms that associate use of contraceptives with “planning for sex” and promiscuity.
May be using ineffective or potential harmful traditional remedies for pregnancy or STIs.
Believe that sexual desire is uncontrollable or could result in injury if not fulfilled.
Denial
"Sex just happened.“ "I only had sex once."
They believe "sex should be spontaneous" or are under social pressure to behave as though sex is/was spontaneous
They don't think they will get pregnant or contract a STI.

17. Why Adolescents May Have Unprotected Sex (continued)
Lack of Access
Access to contraceptive services (including protection) for adolescents is limited by law, custom, or clinic/institutional policy.
Availability and cost of different methods may restrict access.
Irregular supply of methods available.
Social pressure associating contraceptives with promiscuity and for adolescents to believe/behave as though sex is spontaneous means that methods are not available when sex happens.
Attitude or beliefs of the provider may prevent them from distributing protective methods to adolescents.

18. Why Adolescents May Have Unprotected Sex (continued)
Coercion
Partner or family wants pregnancy.
Partner won't let her/him use protection or insists that use of contraceptives is a sign of mistrust.
Sex is forced or coerced.
Believe that condoms ruin sex or are unromantic.
Partner agrees to use contraceptives or protection but then refuses to follow through.
Embarrassment
Service providers are sometimes judgmental and/or moralistic about adolescent sexual activity.
Embarrassed to buy condoms.
Retail outlets often place protective methods behind the counters so that customers must request it.
May be embarrassed to use a method at the time of intercourse.

19. Why Adolescents May Have Unprotected Sex (continued)
Fear
Fear of rejection by partner
Fear of the lack of confidentiality at the place where they obtain methods.
Fear of using something that they have never used before-fear of the unknown.
Fear of side effects.
Fear about the proper use of protective methods.
Fear of where to keep protective methods so that no one sees them.
Fear something may go wrong if they start using certain methods or products too early in life.
Fear that their parents will find out they are having/planning to have sex.

20. Why Adolescents May Have Unprotected Sex (continued)
Fear that their parents will find out they are having/planning to have sex.
Fear that their peers will know they are sexually active.
Fear of physical examination, especially pelvic exam.
Fear of being asked questions by medical staff.
Fear of being labeled as "cheap" or "loose" or “bad.”
Fear of being seen accessing services.

21. Healthy Adolescents Appreciate their own body
Practice health-promoting behaviors, such as having regular checkups, doing breast and/or testicular self-exams, and seeking early identification of potential problems
Avoid exploitative or manipulative relationships
Identify and live according to their own values
Take responsibility for their own behavior
Communicate effectively with family, peers, and partners
Negotiate sexual limits
Accept refusals for sex
If having sexual intercourse, practice safer sex to prevent sexually transmitted infections (STIs) and unintended pregnancy
Seek new information and resources to enhance their sexuality as needed
Have each group present their key points to the full class. Allow for clarifications and changes or additions for each group (these should be made on the flipchart). When finished, facilitate a discussion on what students have seen, using the following questions:
What are some of the key differences in what society expects of females and males at different ages?
How do these expectations for males and females change as they age? Which norms change? Which do not? What does this tell us about the different gender and age roles people are assigned at different points in their lives?
What feelings and emotions are ‘assigned’ to different groups? How does this limit them?
How do gender and age norms affect the types of sexual and other relationships that people have?
How can social norms and expectations have a negative impact on a person’s sexual and reproductive health?
What happens when someone tries to act in a different way from society’s expectations? How are they treated? What does this mean for an adolescent’s SRH situation?
Summarize the activity by sharing the slide #17: Healthy Adolescents, noting how these points echo or differ from the findings that the students shared during their activity. Highlight again how these age and gender stereotypes affect how adolescents address their SRH needs and have implications for quality service provision.