Research in Sexual and Reproductive Health in Adolescents in Nigeria
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1 Research in Sexual and Reproductive Health in Adolescents in Nigeria Morenike Oluwatoyin Folayan, Bridget Haire, SYDNEY MEDICAL SCHOOL Abigail Harrison, Brandon Brown, Morolake Odetoyingbo, Olawunmi Fatusi
2 Overview Engagement of adolescents in sexual and reproductive health research in Nigeria Definitions of adolescents Adolescence in Nigeria Current legal situation regarding research The need for adolescent-specific data Ethical issues Recommendations Acknowledgements of co-authors
3 Nigeria Highest population in Africa (170m) More than 55% of the population below 29 years Median age of sexual debut: 18 (women) 17 (men). 1 in 5 adolescents has intercourse before age 16 Less than 70% of population uses contraception
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5 What is an adolescent? People between adulthood and childhood, in the process of developing sexual maturity The Nigeria Adolescent Health policy and the World Health Organization: people in the second decade of life, years Law: person under the age of 18 is a minor The 1999 Constitution of Nigeria recognises two definitions for a person of full age: 18 years and above, or any married woman A combination of physical, psychological and social changes that manifest differently in different cultural settings Between 14 and 16, adolescent develop cognitive ability is roughly equal to that of adults, however emotionally they may be inclined to risk taking and acutely sensitive to peer influence
6 Current situation: inconsistencies Under current law, a person under 18 years is defined as a minor. Young people under the age of 18 have limited legal capacity and in many situations require a legally authorized surrogate decision maker (parent, guardian or family member) to act on their behalf. Age of consent is 18 The Child Rights Act provides that a child who has attained the age of 16 years has the right to give consent for scientific investigation without parental consent. National Health Research Ethics Code requires parental consent for minors years (unless a mature minor i.e. a married woman) Adolescents aged 15 years are regularly engaged in national surveys on HIV Adolescents below 18 can consent to medical treatment if they are assessed to be competent
7 Why engage adolescents in sexual and reproductive health research? The sexual and reproductive health needs of adolescents differ from those of adults in three critical respects: - physical immaturity that can make young women more biologically vulnerable to infection; - dependency upon parents or other careers can make health based decisionmaking more difficult; - their risk perception may be under-developed. Sexually active adolescents are at risk of: - STIs and HIV; - adverse pregnancy outcomes; - Violence; - mental health problems.
8 Why engage adolescents in sexual and reproductive health research? 64.7% of sexually active boys and 71.4% of sexually active girls had had unprotected sex with a sexual partner who was neither spouse nor co-habiting partner in the last 12 months This included instances of transactional sex
9 Sexual violence The prevalence of sexual violence ranges between 15 to 40% in sub- Saharan Africa with studies showing rates of sexual coercion and abuse among adolescents in Nigeria ranging between 11 to 55%. The report of rape ranges between 4% and 6%. Homophobic violence: Every day a Nigerian is killed, tortured by the police and/or rejected by the family. You stand higher chances of being killed, jailed or tortured as a gay man in Nigeria than in Uganda or Russia, Bisi Alimi
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11 Marriage, sex and age of consent Section 21 of the Child Rights Act (CRA) forbids the marriage of persons below 18 years with a punishment of N500, 000 or a 5 year jail term BUT Section 29(4)b recognizes any married woman (including underage) as of full age The 2008 National Population Commission survey shows that: - 23% of women age have begun childbearing, - 18% have had a child and 5% are pregnant with their first child % of male and female respondents were married by 15 years, % of women and 6.2% of men had their first sex experience by 15 years % of female and 6.8% of male year olds respondents had had sex within the last 4 weeks of the survey
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14 The argument against extrapolating from adult data Adolescent-specific health data is important to: Develop evidence-based policies and programs that support adolescent health; Increase access to and use of health services for adolescents; and Strengthen contributions from the education, media and other sectors to improve adolescent health.
15 No clear justification for excluding adolescents from research Ethics Sexual and reproductive health issues are profoundly social - issues in adolescence may be different to those experienced by adults, or be experienced differently because of the social context of adolescence Ethical duty of beneficence and justice to conduct appropriate research Adolescent health data is important to: - develop evidence-based policies and programs that support adolescent health; - increase access to and use of health services for adolescents; and - strengthen contributions from the education, media and other sectors to improve adolescent health. Vulnerability Parental consent is itself an logistical and ethical problem
16 Parental consent Nearly 1 in 5 Nigerian adolescents lives with a surrogate caregiver who is frequently not a legal guardian Cultural practices of parents may include wider discussion in the community of matters that the adolescent would consider private, violating the adolescent s privacy Adolescents are unlike to want parental involvement is issues regarding sex and sexuality if parental consent is required for the research, this creates a tension for the researchers with regard to their duty to confidentiality to the adolescent participant Has potential to compromise data quality, and introduce bias into samples In some cases, such as the diagnosis of a 12 year of with HIV, disclosure to parents may be legally required.
17 Recommendations Researchers need to develop tools to assess the competence of adolescents to provide consent Researchers need to work collaboratively with communities (including adolescents) to develop research literacy and promote shared understandings of research goals, particularly when research is on sensitive issues like HIV and sexual and reproductive health Where research is low-risk, adolescents from 14 years and below who are assessed to be competent should be allowed to provide their own consent, provided other protections are in place, including competent ethical review Where research poses slightly higher risk, research ethics committees should assess whether competent 14 year olds should be able to give their own consent without parental permission Research ethics committees need to provide training for members on the specific issues involved in adolescent sexual and reproductive health research
18 Acknowledgments Morenike Oluwatoyin Folayan, Abigail Harrison, Brandon Brown, Morolake Odetoyingbo, Olawunmi Fatusi
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