Meeting the needs of young adults.

As they mature and become sexually active, more young people face serious health risks. Most face these risks with too little factual information, too little guidance about sexual responsibility, and too little access to health care. Meeting young adults' diverse needs challenges parents, communities, health care providers, and educators. Despite urgent needs, program efforts have been slight and slowed by controversy.

PIP: The overview of this report, illustrated with tables, discusses the size and proportion of the population ages 10-19; the definition of young adult; the falling age of puberty; sexual activity among young adults (including premarital sexual activity); the rising age at marriage; fertility patterns; contraceptive usage (including factors that inhibit usage, such as a lack of information, of access, of decision-making ability, and/or of power); and unmet contraceptive needs. The report's essay on growth, change, and risk behavior associated with youth deals with the specific topics of sexually transmitted diseases, sexual violence and coercion, the health risks of early pregnancy, unintended pregnancy and the complications of unsafe abortion, the social and economic consequences of early childbearing, and ways to meet needs and, thus, prevent problems. This last subject leads into an overview of programs available for young adults, including large school programs, small health programs, and European youth programs and social norms. A table gives types of reproductive health programs for young adults that defines the audience/activities, extent of the program, special issues addressed, and research findings for 1) family life education programs, 2) clinic-based programs, 3) AIDS prevention programs, 4) condom distribution programs, 5) school clinics, 6) communication through the entertainment media, and 7) peer education. In the next major section of the report, evaluations of the various types of programs for youth are reviewed to determine whether the programs lead to a delay in initiation of sexual intercourse, an increase in sexual intercourse, and/or an increase in contraceptive usage. Consideration is then given to what makes programs work and how to win support for programs from the community and from young adults. These major essays are punctuated with short highlights on such topics as whether adults and youth have differing views about sex behavior, whether young people are different today than they were in the past, reaching boys with services, where young people learn about sex, contraceptive choices for youth, and lessons learned from youth programs.

Are adolescents good candidates for RU 486 as an abortion method?

PIP: No published reports exist on and clinicians have limited experience with RU-486 use to terminate pregnancy among teenagers. We need to learn how they respond to RU-486 differently from older women psychologically and physiologically, how clinicians should respond to their special needs, and how they would accept drug-induced abortion. We can look at related attitudinal and behavioral patterns to determine the potential for teenagers' use of RU-486, however. US adolescents have the lowest contraceptive use rates in the developed world. They deny that pregnancy can happen to them, so they do not use contraception. Other reasons for not using contraception are the belief that contraceptives are dangerous, partner issues, and ignorance of choices. Pregnant teenagers tend to delay undergoing an abortion, mainly because they fear telling their parents or partner. Fear of an invasive procedure is another reason. RU-486 addresses this fear and could be a viable option. This delay behavior is the biggest obstacle to overcome if teenagers are to use RU-486. The younger the pregnant teenager, the more likely she is to behave in a moral or absolute manner after the abortion option. They are also more likely to perceive that their decision needs to be determined externally. This need for external decision-making may keep them from using RU-486 since a drug-induced abortion is a personal matter. 14 year olds are as capable as 18 and 21 year olds of making decisions, but teenagers still are not competent to implement decisions. Adolescents' perceptions of their sexuality and their needs and their ability to manage sexuality pose an indecisive and confused method to obtaining services. Barriers to services, implemented by anti-abortion groups, exacerbate the considerable confusion adolescents face. Public health professionals must reach adolescents early to help them use protective measures. They need to practice and preach confidentiality well to gain teenagers trust.^ieng

Adolescent fertility: worldwide concerns.

PIP: There is growing concern over the adverse health, social, economic, and demographic effects of adolescent fertility. Morbidity and mortality rates ar significantly higher for teenage mothers and their infants, and early initiation of childbearing generally means truncated education, lower future family income, and larger completed family size. Adolescent fertility rates, which largely reflect marriage patterns, range from 4/1000 in Mauritania; in sub-Saharan Africa, virtually all rates are over 100. In most countries, adolescent fertility rates are declining due to rising age at marriage, increased educational and economic opportunities for young women, changes in social customs, increased use of contraception, and access to abortion. However, even if fertility rates were to decline dramatically among adolescent women in developing countries, their sheer numbers imply that their fertility will have a major impact on world population growth in the years ahead. The number of women in the world ages 15-19 years is expected to increase from 245 million in 1985 to over 320 million in the years 2020; 82% of these women live in developing countries. As a result of more and earlier premarital sexual activity, fostered by the lengthening gap between puberty and marriage, diminished parental and social controls, and increasing peer and media pressure to be sexually active, abortion and out-of-wedlock childbearing are increasing among teenagers in many developed and rapidly urbanizing developing countries. Laws and policies regarding sex education in the schools and access to family planning services by adolescents can either inhibit or support efforts to reduce adolescent fertility. Since contraceptive use is often sporadic and ineffective among adolescents, family planning services are crucial. Such programs should aim to reduce adolescents' dependence on abortion through preventive measures and increase awareness of the benefits of delayed sexual activity. Similarly, sex education should seek to provide a basis for intelligent, informed decision making. Programs tailored to reach teenagers in schools, recreational centers, and the workplace have particular potential.^ieng