Abstract
Aims : 1) Ensuring greater availability and accessibility of services for promotion of adolescent reproductive health thereby improving the status of adolescent girls. 2) To assess the level of knowledge and attitude of adolescent girls towards menstruation, ovulation and sexual behaviour and analyze the need for a counselling centre.

Material and Methods : 1) Preparation of a structured questionnaire. 2) Focus group discussion with parents having adolescent daughters. 3) Training interviewers. 4) Pilot testing. 5) Data collection by interviewing 880 girls.

Results : 1) 93.2 % girls had attained menarche. 34.5% expressed fear and 35.1% had no reaction to the onset of menses. 2) 61.6% girls had knowledge of contraception. 3) 72.9% knew that unprotected sex would lead to pregnancy. 4) 68.65% knew about sexual intercourse and 60.2% knew that condoms could prevent HIV infection. 5) 93.2% girls wanted a counseling centre and 56% felt that it should be in a school.

Introduction
The physiological transition from childhood to adulthood during adolescence is a period of great strife. This transition has always tended to be sudden for young girls. Genetic, health and socio-economic factors have an influence on the wide variations in the age of menarche in India. There is also evidence that menarche is delayed due to poor nutritional status of the average Indian adolescent girl, thereby delaying the biological onset of adolescence. On the other hand, due to early marriage and consequently the onset of sexual activity, pregnancy and child-bearing occur relatively early, thereby propelling the girl into early adulthood even before physical maturity is attained.

Adolescents are faced with different choices in sexual behaviour – premarital sex, early marriage or abstinence. The young girl in India is primarily ‘at risk’ because of lack of information and having little or no access to sexual and reproductive health services. Communication between parents and adolescents has also greatly decreased. In addition to this, the existing health services and system have largely ignored the reproductive health needs of the adolescents. Information and services should be made available to the adolescents to help them understand their sexuality and protect them from premarital sex, unwanted pregnancies and sexually transmitted diseases (STDs).

Aims and Objectives

1. To determine and assess the level of knowledge and attitude of adolescent girls (11 – 19 years) towards menstruation, ovulation, safe sex, contraception, STDs and HIV.
2. To identify their source of knowledge and assess their health seeking potential.
3. To determine the need for a structured counselling programme and the choice of location, counsellor and the time for counselling services.

Material and Methods
The study included 880 adolescent girls from the high schools and junior colleges of Mumbai, Pune and Manipal, Karnataka. Focus group discussions were conducted with a group of parents having adolescent daughters with a pre-prepared structured questionnaire. The interviewers were trained and pilot testing was done with 25 girls following which the questionnaire was further modified. All the girls interviewed were assured that the information given would remain confidential.

Results

• Analysis of education and occupational status showed that 424 (48.2%) girls were in junior college, 193 (21.98%) were employed and only 3 (0.4%) were illiterate.
• 542 (61.6%) adolescents knew about contraception. Amongst them, 91 (16.8%) had a good knowledge and 401 (74%) had average knowledge.
• 465 (39.5%) girls knew that unprotected sex can cause Reproductive Tract Infections (RTI), STDs and HIV. 280 (60.2%) had knowledge that condoms could prevent HIV infection. Mothers [118 – 25.4%], friends [121 – 26.2%] and schools [100-21.5%] were the most important sources of information.
• 61 girls had suffered from symptoms suggestive of RTI / STDs. Of these girls, 10 had taken treatment from a Gynaecologist, 7 from a general hospital and 2 had self–medication.
• 420 (47.7%) girls knew the significance of the safe period. This was told to them mostly by mothers [130-31.7%] and schools [144- 34.3%].
• 348 (39.5%) teenagers felt the need to be educated about the physiology of menstruation and ovulation. 182 (20.7%) wanted to know more about contraception and 109 (12.4%) desired to be told about RTIs. 587 (66.7%) preferred to get the information by reading some material and 767 (87.2%) wanted sex education to be a part of the regular high school curriculum. 614 (69.8%) desired summer school camps and 501 (56.9%) wanted access to a 24 hour telephone hotline service.
• 641 (72.9%) knew that unprotected sex would lead to pregnancy. Of the 20 girls who had become pregnant, 4 opted for continuation of pregnancy and 16 underwent MTP. Only 8 girls had been counselled about contraception after undergoing MTP.

Discussion

In the present series of 880 teenage girls, 498 (56.6%) were in the 16 – 19 years age group, 39 % had attained menarche since 4 – 5 years. At menarche, the reaction of these girls varied from shock to neutral feelings – bearing a direct correlation to the extent of prior knowledge and sounding about the same. Mothers, friends and schools were the key information providers. Many mothers impart information to their daughters about menstruation, but feel shy or awkward about sex-education. In most instances, only the mechanics of menstruation related to behavioural norms (not permitted to cook or go close to the idols of Gods)⁴ are talked about, rather than the physical and physiological changes occurring in the body and their relationship to sex and reproduction.⁵ Denial of this important knowledge in this important stage of life is a major contributory factor towards ignorance about contraception, pregnancy, child-bearing and maternal morbidity and mortality. Hence, though sex education is vital for adolescents, social taboos and stigmas prevent access to such information.⁶

In the present study, 465 (52.8%) teenagers knew that unprotected sex leads to Reproductive Tract Infection (RTI). 460 (52.3%) had no idea about ‘Safe period’. 115 (13.1%) knew about the symptoms suggestive of STDs and 97 (11%) knew the symptoms of RTIs. A similar study conducted by Jasmine Prasad et al at the Community Health Department, Christian Medical College, Vellore also concluded that the knowledge on menstrual hygiene, contraception and safe sex practices was poor and stressed the importance of sex education of adolescents.9 The most significant finding in our study was that 820 girls (86.2%) strongly voiced their desire for access to a counselling centre. Recent research in western countries reveals that STDs and contraception were the subjects most frequently discussed with the nurses and doctors.

Conclusion

• Adolescents (11- 19 years) must be given due importance and must be recognised as a priority target group in terms of age, education, occupation and level of knowledge of reproductive physiology.
• A structured counselling programme could play a cardinal role in making young girls more responsible about their sexual behaviour.
• Young girls need to be encouraged and facilitated to ask questions and seek information.
• Adolescent Health Counselling centres should be developed at various places manned by trained and friendly counsellors assuring confidentiality without being moralizing.
• Mothers play an important role in shaping adolescent behaviour and values.
• 24 hour Hotline services manned by trained personnel would be beneficial.
• Adolescent reproductive health programmes should be inculcated in the National Family Planning Programme. Parents also should be offered education so that they can be sensitive to their children’s needs.

References

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