Perception of Adolescents Reproductive Health Problems Amongs Mothers

Introduction:

Quality of our lives is changing day by day. The world in recent years has been undergoing momentous changes that have influenced our lives and our thinking in many ways. The world is fast moving from fragmented countries and culture towards becoming a global village. It’s also urbanizing rapidly, the value systems are changing. No one has been left untouched by the economic liberalization, media explosion and technological advances taking place in most countries.

The adolescents are caught in the web of transition from childhood to adulthood, and often unmanageable, changes. The swiftly-changing global conditions are placing a great strain on the young people, modifying their behavior and relationships and exacerbating their health problems.

WHO defined adolescents as the period of life spanning the ages between (10-19 years). Adolescence is an important formative period of human life between the age of 10 to 19 years which shapes the future of a person. Adolescence is a crossroad in the development of life through which a child gradually walks to reach the maturity of adults.³

Adolescence is a period of transition from childhood to adulthood. It is characterized by rapid physical, biological and hormonal changes resulting   in psychosocial, behavioral and sexual maturation between the ages of 10-19 years in an individual. Physical and biological changes are universal and take place due to maturation but the psychosocial and behavioral manifestations are determined by the meaning given to these changes within a cultural system.

Adolescents-include both boys and girls but in Bangladesh context the cultural differences are vast with regard to their conduct and are based on traditional adult roles stereotypes. For a girl, the onset of puberty implies more restrictions on her movement, fewer interactions with boys and men, and more active participation in household chores. Boys begin to exercise greater freedom to move about, expected to seek educational and vocational pursuits as a priority and to take adult roles. Besides there are variations arise from factors such as urban, rural and tribal residence ethnicity and socio economic levels of the family.

The population of Bangladesh has grown from 42 million in 1943 to 123-million in 2001, 25 percent of which are adolescents, with 39.2 percent under 15 years. A significant high percentage of young adolescent girls are married. The legal minimum age of marriage is 18 for girls and 21 for boys.

Healthy development of adolescents is dependent on several complex factors: their socio-economic circumstances, the environment in which they live and grow the quality of relationships with their families, communities and peer groups and the opportunities for education and employment, among others. The health problems of adolescents and youth are very different from those of younger children or older adults.

The concept of RH is comprehensive, which includes all health events related to reproduction in the life cycle of a person. Initially during the year 1970, a special program was undertaken by world Health organization (WHO) to address the issues of “Human Reproduction”.¹ At that time its objectives were limited 10 the research and development of safe, acceptable and effective methods for fertility regulation and development of safe, acceptable and effective methods for fertility regulation and thus population control. Later the scope of the program was gradually broaden to include infertility, sexually transmitted disease, HIV/AIDS and maternal and child health issue still later, it was realized that human reproduction problems cannot be addressed as a separate entity. In fact, it is inextricably linked lo reproductive rights, freedom and development of women status and also health needs and problems of adolescents, as because adolescent constitute considerable proportion of the whole population.

The importance of adolescent RH was farther realized because RH of present generation has an impact on the health of the next generation and also has crucial importance for socio-economic development. These realizations and discussions are reached up to WHO and they achieved formal global acknowledgement of reproductive health as a concept and ideology at the international conference on population and development (1CPD) in Cairo in September 1994. According to ICPD program of action document, Reproductive Health Care is defined as “The constellation of methods, techniques and services that contribute to reproductive health and well being through preventing and solving reproductive health problems”.

The reproductive health situation in Bangladesh still remains unsatisfactory despite some improvement in some aspects of health. The high rates of MMR, IMR, RTI, STDs arc the indicators of RH condition in the country. The HIV, AIDS situation is still under control but there exists potential threat of spreading the fatal disease rapidly. In this context adolescent health is a major concern.

However the government of Bangladesh has officially adopted the ICPD (International Conference on Population and development, Cairo, 1994) definition of RH and developed a comprehensive plan of action in the light of th~ recommendation’s of the conference. In public sector, the health and population’ sector program (HPSP) incorporated the RH elements. The RH services will be available to all people through the provision of ESP. In the NGO ‘Sector, National integrated population and health program (NIPHP) has been addressing RH issue. The programs are financed by World Bank, UNICEF, UNFPA, UNDP and USAID.^4,5 Although all the above mentioned plan of action is taken by the Government only to make the program successful, Bangladesh still faces formidable obstacles in the path to the goal of health and reproductive well being. So everyone should be conscious and concern about their health needs and health problems. Adolescent RH is a major concern here as adolescent girls will experience the RH in the near future. They should bear a very good, sound, complete and ‘clear knowledge about different RH issues otherwise the load of early marriage, teenage pregnancy and burden of STD’s and AIDS will be unbearable for the country within a very short period.

Justification of the study

 The appearance of the child at birth enable its father and mother to play the roles of parents a demanding but very self-fulfilling set of roles. During the adolescent years, the young person is still depended, both functionally and emotionally, on parents and other adults.⁷

 During this time of adolescence the adolescents naturally become curious about, their changing anatomy, physiology and psychology. But due to the tradition, culture customs and believes of our country their curiosities regarding sexuality and reproductive life is ignored very much. They get too little guideline and knowledge about reproductive health care service. In our country there is no provision of sex education in the schools and colleges. Formal educational lacks very much to address the special needs of the adolescents. Rigid social norms prevent them from talking about their physiological, anatomical and psychological changes and also prevent them to exchange their views about different aspect of sexuality and reproductive with other person.

Most of the teenagers in our country learn about sex and reproductive health from friends, family, surrounding culture and from media. They usually share their feeling and themes with their peer groups and a little extent with mother and sister. In this way they learn about reproduction and sexuality from inauthentic source as a secret, private and forbidden aspect of life. And thus they are thrown in the realm of mystery. So their knowledge regarding reproductive issues remains inadequate and inaccurate and sometimes incorrect and misleading. It may even encourage risky behavior for the adolescents. Usually in our country the adolescents fail to show responsible behavior about reproductive health and sex. Due to anxiety and tension sometimes they become helpless to adjust themselves with their surrounding environment.

Reproductive health of adolescents is of going concern today. As reproductive health issues are intimately adherent with women life, mother of adolescents must have proper knowledge about it.

For adolescent girls, menstruation is the major biological event of puberty. During this time the girls know nothing about the management of menstruation. Therefore they suffer from many infections of genital organ and other gynecological problems.

The general tendency of mothers is to view reproductive health as a female concern only for pregnant women. In the past few years the issue of adolescent pregnancy has been increasingly perceived as a problem. The International Conference on Population and Development (ICPD) identified the adolescents as a distinct target group in need of ad hoc reproductive health programs and services. In many developing countries, government officials working in the social sectors readily identify it as one of the pressing social issues. However, this perception is rarely translated into programs intended for adolescents; or into programs which, although intended for them, effectively reach them. As a group, they have been overlooked due to a lack of awareness of their needs and’ the cultural specificity of these needs.

Adolescence is a difficult time for young people. It is a time of major physical changes including the adolescents growth spurt, in which the size and shape of the body change markedly and the difference between boys and girls are accentuated. These years are also the time when mental and psychological development takes place, putting great stress on young people and those around them, and influencing and affecting their relationships with their peers and adults. Puberty is also a time of behavioral change when the reproductive capacity is established; the sex hormones secreted during this period not only affect the tissues of the body, but are also relate to changes in sexual and emotional behavior.

Among the major problems of adolescent reproductive health are those resulting from the traditionally early marriage of girls that still prevails in many, especially rural, parts of the developing world. Despite legislation designed to eliminate the practice, many girls marry shortly after puberty and are expected to start having children almost immediately.

Young people have special sexual and reproductive health needs because ‘of their relatively high risk of being exposed to inaccurate or incomplete information, acquiring HIV and other sexually transmitted infections (STIs), and experiencing unintended pregnancies and maternal complications.(International Family Planning Perspectives, 2004,30(3):1 10-117.

These times are confusing and children tend to look at different sources for solutions. Sadly, more often than not, they seek help from the wrong sources, Such as their friends who arc needless to say, of the same age groups. This often leads to them becoming confused. But it is hardly the children’s faults. In a country like Bangladesh, it is some sort of a taboo to speak of matters related to puberty arid sex and therefore, the parents themselves discourage children from asking these all important questions. Parents have to get over this shyness and start to communicate as it is the health of their children that is at stake. Since fathers, in a typical Bangladeshi family tend to be a little distant, it is easier for the mothers to initiate this process of clearing up, and also, because mothers are around their children most of the time, has to be understood that the mothers have to be perceptive themselves in order to explain things clearly otherwise the result may turn out to be the opposite of what we desired.

When young people lack guidance and information, and measure to prevent exposure are inadequate, they will be less likely to seek timely professional medical help and more likely to undertake dangerous self-treatment. The consequences of this may be permanent impairment of health, infertility, psychological damage and even death, with long-term effects not only on’ their immediate families but also on society as a whole.

At an age when a boy is about to turn into a man and a girl into a women, nobody can play better role than a mother in helping them to understand about themselves.

What is the level of perception among mother about adolescent’s reproductive health problem?

Objectives

 General objectives

To assess the perception of the mothers about adolescent reproductive health problems.

Specific Objectives

1. To identify the mothers level of perception about reproductive health problems during adolescence.
2. To assess their level of knowledge about healthy reproductive   behavior.
3. 3.  To identify the factors influencing perception of mothers about adolescents reproductive health problems.
4. 4.  To find out socio-demographic character of the respondents.

 List of variables

a.   Socio-demographic variables–

• Age

• Religion

• Educational levels.

• Number of adolescents of the respondents

• Combined family income

• Occupation of the respondents

b.    Knowledge variables related to healthy reproductive behavior and reproductive health problem of adolescents.

• Adolescents period changes

• Sources of information regarding reproductive health

• Management of menstruation

• Reproductive health problems of adolescents

• Problem solving regarding reproductive health by the respondent

• Treatment seeking behavior due to RH problem

• Safe-motherhood

• Male involvement in decision making

• Sexual diseases

• Symptoms, transmission & prevention of RTIISTD

• Legal age of marriage (both in male & female)

• Effects of early marriage

• Effects of early pregnancy

• Effects of unsafe abortion

• Facilities for safe abortion

• Management of reproductive health problems ‘

• High risk behavior of adolescent

• Prevention of high risk behavior

• Obstacles regarding getting proper information on reproductive & sexual life

• Ways of overcoming obstacles

• Necessity of education on RTI/STD in schools

Type of study

Descriptive type of cross sectional study

Place of study

The study will conducted at about 10 to 11 different schools which will purposively selected in Sylhet district. Both private and Govt. schools (Girls and Boys) will include into my study place.

Study period

The study will conduct for a period from January 2012 to June 2012

Study population

Mothers waiting in front of schools having adolescent boys and gins, who will willing to take part in the study irrespective of their age, religion and socioeconomic status. Total number of 95 mothers will interviewed during study period.

Sample size

To minimum sample size, the following standard formula widely used in biomedical and social research.

I want in my study-

Degree of accuracy 5% level-

95% confidence interval level

n=z² pq/d²

Here,

n= The desired sample size

Z= The Standard Normal Deviation usually set at 1.96 which corresponds to the 95% confident level

P= The proportion of the target population

q=1-p

d= Degree of  precision and in this study it will set at 6%

Since there is no ready reference on the mothers perspective about reproductive

health problems of their adolescent, we can assume = 50% to be adequate.

So, p= 0.5, q=1- 0.5=0,5

So sample size

n= (1.96)² x (0.5)(0.5) I (.06)²

= 226.76

Due to allocation of data collection time (2 weeks}, the feasible sample size will be 95.

Sampling Technique

The sample will be taken purposively among the mothers having adolescents (10 to 19 years) who will waiting in front of the schools.

Data collection instrument and its development

A pre-tested interview schedule will prepare and used for data collection,

Data collection procedure

A semi structural questionnaire for client and face-to-face interview will conduct to collect relevant information.

Data analysis

All data will analyze after thorough checking, editing and compiling by the software SPSS. Descriptive statistics will be done.

Limitation of the study:

The study aimed to interview the mothers waiting in front of the schools but mothers having adolescents will be scarcely found in front of school. So I have to go several schools (Private and Govt.). The study will select purposively so the conclusion drawn from the study may not represent all mothers having adolescents all around Bangladesh. I have to depend on the memory of the respondents. So some recall bias in my study.

OPERATIONAL DEFINITION

a. Age– Age was taken in completed years and recorded as told by them.

b. Religion– Religion was taken as told by the respondents.

c.  Educational levels– Educational level was taken in completed classes as  told by them. These are grouped as below:

0= Illiterate                                                ,1

                            1= Class V pass

2= SSC pass

3= HSC pass

4= Honors / degree pass

5= Masters pass

9= Other type of education

d.    Number of adolescents of the respondent — Number as told by the respondent.

         e.    Combined family income– Means monthly income from all the sources of the family (in Taka).

f.    Occupation of the respondent– The main job the respondent

Housewife= Doing household chores, no source of personal income.

Govt. job Earn from govt. office.

Private job= Earn from private office/ NGO.

Business = Earn from business.

Others= Earn from agricultural source, rent, etc.

g.     Adolescent period change– Knowledge of the respondent about + physiological and psychological changes.

h.     Sources of information regarding RH– From where the respondent got the information regarding RH

i.      Management of menstruation– Means what the respondent’s daughter uses during menstruation.

j.    Reproductive health problem– Problems related to reproductive health during adolescence.

k.    Problem solving of reproductive health by the respondent– Means how the respondents solve the RH problems of adolescence.

1.     Treatment seeking behavour due to RH problem– Means where the respondents wanted to go for treatment of RH problem of the adolescenL

m.    Safe motherhood– Means creating the circumstances within which a      woman is enable to choose whether she will become pregnant and if she does ensuring that she receives care for prevention and treatment of pregnancy complication, she has access to trained birth attendant and she receives care after birth.

n.    Male involvement in decision making_— Whether it is necessary for male participation regarding RH decision of adolescents.

o.     Sexual diseases– Means what the respondent thinks about sexual diseases.

p.     RTI/ STD– Indicates knowledge about symptom, transmission and prevention about RTI/ STD.

q.    Legal age of marriage (both in male and female)– Indicates age,  marriage rule of the Govt. prevailing now.

r.   Effects of early marriage – Means effect of marriage if it occurs in  adolescent period.

s.   Effects of early pregnancy– Knowledge about consequence of adolescence pregnancy.

t.      Effects of unsafe abortion– Knowledge of the respondent about the consequences of unsafe abortion.

u.     Facilities for safe abortion– Means knowledge of the respondent to have safe abortion.

v.    High risk behaviour of adolescent– Knowledge of the respondent of the risky behaviour of the adolescent.

w.   Prevention of high risk behaviour– Respondent’s knowledge of prevention of high risk behaviour of the adolescent.

x. Obstacles for getting proper information on reproductive and sexual life– Means respondents opinion about the obstacles for getting proper information on reproductive and sexual life.

y.  Ways of overcoming obstacles– Means respondents suggestions for  overcoming obstacles.

z. Necessity of education on RTI/ STD in schools– Means respondent’s opinion of the necessity of education on RTI/ STD in schools.

LITERATURE REVIEW

This  is not a complete review of literature. However an attempt was taken to review available literature on issues, concepts, problems and various aspects of reproductive health of adolescence girls and boys.

Adolescence

Adolescence has been defined by the world health organization (WHO) as the period of life spanning in the ages between 10 & 19 years. Adolescence ‘is a period of transition from childhood to adulthood. This is the period when maximum amount of physical, psychological, behavioural changes take place.About on fifth of the world population or more than a billion are adolescent and about 85% live in developing countries’. Adolescents include both boys and girls but in Bangladeshi context the cultural differences are vast with regard to their conduct

Adolescents-include both boys and girls but in Bangladesh context the cultural differences are vast with regard to their conduct and are based on traditional adult roles stereotypes. For a girl, the onset of puberty implies more restrictions on her movement, fewer interactions with boys and men, and more active participation in household chores. Boys begin to exercise greater freedom to move about, expected to seek educational and vocational pursuits as a priority and to take adult roles. Besides there are variations arise from factors such as urban, rural and tribal residence, ethnicity and socio economic levels of the family.

History of adolescents

The concept of adolescence changes overtime. G, Stanly Hall is known as the father of the psychology of adolescence. He wrote about the modem scientific concept of adolescent in his famous book ‘Adolescence first published in l904. The concept of adolescence has its roots in the works of the early Greeks. Plato and Aristotle mentioned with special significance about the transitional period between childhood and adulthood.

The current day concept of adolescence has evolved through ancient roots, medieval views, Renaissance to modern views in the eighteenth and nineteenth century. The word adolescence comes from the Latin word adolescence (to grow up) has been used in the English language since fifteenth century.

Reproductive Health

The concept of RH is comprehensive, which includes all health events related to reproduction in the life cycle of a person. Initially during the year 1970, a special program was undertaken by world Health organization (WHO) to address the issues of “Human Reproduction”. At that time its objectives were limited to the research and development of safe, acceptable and effective methods for fertility regulation and development of safe, acceptable and effective methods for fertility regulation and thus population control. Later the scope of the program was gradually broaden to include infertility, sexually transmitted disease, HIV/AIDS and maternal and child health issue still later, it was realized that, human reproduction problems cannot be addressed as a separate entity. In fact, it is inextricably linked to reproductive rights, freedom and development of women’s status and also health needs and problems of adolescents, as because adolescent constitute considerable proportion of the whole population.

In the past few years the issue of adolescent pregnancy has been increasingly perceived as a problem. The International Conference on Population and Development (ICPD) identified the adolescents as a distinct target group in need of ad hoc reproductive health programs and services. In many developing countries, government officials working in the social sectors readily identity it as one of the pressing social issues. However, this perception is rarely translated into programmes intended for adolescents, or into programs which, although intended for them, effectively reach them.

As a group, they have been overlooked due to a lack of awareness of their needs and the cultural specificity of these needs.

Changes during Adolescence

Physiological Changes

The term adolescence means the state of becoming an adult. It is the adolescent years that see the changes in physical appearances and physiological functioning enable each individual to take on the form and functions appropriate to his/her sex. For females this means the enlargement and elevation of the breast, changes in uterine and pelvic areas and the initiation of the menstruation cycle. For males, it means of facial hair, the deepening of the voice and the ability to produce semen. For both sexes adolescents means increase in height and weight, growth of body hair in the pubic and under arm areas, eruption of new teeth and marked changes in the contours of face and body.

Psychological changes                                           

There are marked psychological changes during adolescence. The maid change is the development of an integrated and internalized sense of identity. This means, to some degree, drawing apart from older member of the family, developing more intense relationship with peers and taking major decisions.

Critical role of the family

The child is born to a family a develop from childhood through adolescence to adulthood, normally within the family circle. The adolescent years are a crucial and dynamic period in the lives of young people. It is a time when adolescents growing capabilities most affected by family influences for they are like raw materials of human  development who can be molded and shaped by those around them.

In the homes of alienated youths, the problem is not parental harshness but frustration. The parents of alienated adolescents are often disillusioned people with deep feelings of despair and anomie. Interestingly adolescents from traditional families don’t experience + the identity crisis that so many other young people suffer through .

Management of menstruation

 Maintenance of hygiene during menstruation is a vital aspect of adolescent reproductive  health. The consequences of not maintaining hygiene during menstruation (e.g. becoming sick, itching or ulceration of genitals) were least known among the female adolescents, especially those who are unmarried. Mothers, sister-in-laws and friends are the sources of information about menstruation for most of them.

Reproductive health problem

Dysmenorrhoea is the most common gynaecological disorders among female adolescents with prevalence of 60% to 93%. Primary dysmenorrhoea, painful   menstruation without pelvic abnormalities maybe associated with vomiting, fatty, back pain, headache, dizziness and diarrhoea.

Adolescent RH situation in Bangladesh cannot be denoted as satisfactory. Menstrual problem are common among adolescent  unhygienic practices during menstruation as commonly reported.

Reproductive behaviour

Key component of reproductive behaviour which impact women’s reproductive and sexual health. This include the ages which sexual activity and reproduction begins, levels and trends in fertility over the past decades and adolescence pregnancy and child earing.

The mean age at marriage is rising although early marriage remains a problem in many countries. The onset of menarche comes typically earlier, however sexual relation often, begin in adolescence, either during or before marriage. Although more adults then ever are now using some form of modern contraception. Most adolescents who have sexual do not use contraceptives or condoms to prevent pregnancy or STD/ HIV AIDS.  Adolescent pregnancies early child birth endangers the health and lives of both mother and child. In many cases adolescent girls who become pregnant and give birth forgo any chance of finishing their education or of finding suitable enemployment²⁴. In Bangladesh the proportion of pregnancy has generally declined over time, although not in a steady fashion. Most adolescent are at risk of early and unwanted pregnancy.

Unsafe abortion

 A large proportion of adolescent pregnancies are unwanted and it is estimated, as many as 4.4 million abortion are sought by the adolescents each yea.

Septic abortion is one of the leading causes of death among the adolescent who want to end a pregnancy that is unplanned. These adolescents choose the path of clandestine abortion self infected by or inducted by the untrained individuals and are often result by sepsis of the uterus and birth canal. In Bangladesh 14% total maternal death is due to  abortion.

High risk behavior of the adolescent

Key risk factors for serious adolescent aggressive behaviour originate in the family. Further aggression in the area increases the risk of aggressive behaviour in the schools and other settings.

Adolescents, especially the urbanity are susceptible to the risk of many harmful, substances like tobacco, alcohol, drugs and bad influence of satellite media. A many of the behaviour patterns such as gender relation, sexual conduct, use of tobacco, alcohol and other drugs, eating habit and dealing with conflicts and risks are acquired during adolescence intervening during this period provides opportunities to prevent the onset of health damaging behaviour and their future repercussions.

STD/HIV/ AIDS

Sexually transmitted diseases are a major health concern in the country, the risk of contacting sexually transmitted diseases including H1V/ AIDS is a major public concern for adolescents including the youth. Two-thirds of all reported STDs occur among persons under 25 years of age, and the incidence tend to be higher among woman aged 15-19 years, than men of the same group.

A Baseline Survey on ARH by UNEPA shows that 59% percent of female adolescent respondents reported having at least one kind of symptom of an STII STD not related to menstruation (Barkat A, et al., Baseline Survey, UNFPA, December 2002) this matches another study conducted in the slums of Dhaka (Kamal and Rashid, 1999) and some other studies among females of all ages.

 This cross-sectional study was done among 95 mothers having adolescent children, who were waiting in front of several schools of Dhaka city to determine the level of perception about adolescent reproductive health problems. The study also tried to find out the respondents level of knowledge about healthy reproductive behavior of adolescents and the factors influencing of their perception. The data has been arranged in such a way that the early portion of this chapter dealt with the characteristics of the respondents, and then the later part with the different aspects, of the respondents’ perception and knowledge.

Socio-demographic characteristics

 In this section, the characteristics of the respondents are discussed, relating to age, religion, educational status, occupation, number of adolescent children and monthly family income. ‘ ‘

 Table-1 Age Distribution of the respondent

Mean age= 37.80 SD ± 5.688 year

Regarding distribution of the respondent’s age table-1 shows that the mean age of the respondent was 37.80 years with SD of ± 5.688 years.

 Table-2 Distribution of the respondent by religion.

As the table shows that among the respondents 84.2% were Muslim, 12.6%  were Hindu.

Among the total respondents 67.4% were house wife, 15.8% non-government service holders, 7.4% were in government service, 6.3% in business and 3.2% were day laborer.

      Table-4: Distribution of respondents by monthly family income

Mean monthly income = 16531.58 taka. SD ± 11427.573Monthly family income has shown in table 4. About 28.4% respondents family income were within the range of Tk. 5001-l000O. Less than Tk. 5000 were 18.9% and more than Tk. 30000 were 7.4%.

Table-5 Distribution of the respondent by how many children (10-19) years                                               

The table shows that the total number of daughters have been more (86) than the sons (67)

Table-6 Distribution of the respondent from where information obtained regarding reproductive health                   

While enquiring about the sources of information regarding reproductive health, 25.3% of the respondents, informed that they received the information from their mother or aunty, from TV Radio (6.3%) and 9.5% got information from all the possible answers present in the questionnaire. (Table-6)

Table-6 Distribution of the respondent by those mental and social changes occurred in females adolescent               

Regarding pubertal change in female most of the respondents knew that physical, mental and social changes occur during adolescence. About 11.6% of the respondents could answer about all of the changes mentioned in the questionnaire. (Table-7)

Regarding management of menstruation 55.8% of the adolescent use sanitary pad, 34.9% use old cloth and others 9.3%, although all of the respondents are from the urban area.

Table-8 Distribution of the respondent by the knowledge of the reproductive health problems of females during adolescent  

Regarding the knowledge about RH problem 14.7% had knowledge of all the structured answers.

(Table-8)

Table-9 Distribution of the respondent by how they solved or will solve the problem of their adolescents                 

Regarding how they solved or will solve the problem of adolescent, 10.5% respondents told

that they solved themselves. (Table-9) 

Table-10 Distribution of the respondent by knowledge about safe motherhood                                               

Table 10 show that regarding safe motherhood, 22.1% knew nothing about it.

Table-11 Distribution of the respondent by what do think about sexual diseases                                          

The respondents asked whether it is necessary for male participation regarding RH decision 82.1% thought that it’s necessary. About 4.2% told that it is not necessary and 13.7% told sometimes it is necessary. About sexual diseases 4.2% could not understand anything about it. 52.6% told that they agree with all the answers. (Table 11)

Table-12 Distribution of the respondent by the knowledge of the symptom of RTI & STD mentioned here                    

About symptoms of RTI/STD, 18.9% knew nothing and 15.8% knew all the symptoms mention (Table-12)

 Table-13 Distribution of the respondent by awareness RTI/ STD transmitted                                               

Among the 95 respondent, 38.9% were aware of transmission of RTI/STD and 8.4% were not aware. (Table-13)

Regarding prevention of RTI/STD 29.5% could understand the ways mention in the questionnaire and the others could not. (Table — 14)

About the question how do you want to tell your adolescent about RTI/STD. 44.21 % wanted to tell directly 31.6% with help of guardian, through TV/Radio 4.2%, 21% could not understand how to tell their adolescent.

Table-15 Distribution of the respondent by the obstacles for getting proper information regarding reproductive and sexual life                                                                  

Table-16 Distribution of the respondent about the question how these obstacles can be prevented                           

Regarding the issue that how these obstacles could be prevented among the 95 respondents. 22.1% agreed to all of the given answers. From the remaining respondent 10.5% told that, only media can prevent the obstacles and 5.3% could not give any answer. (Table — 16)

Table-17 Distribution of the respondent about the knowledge of what pubertal change occurs in male adolescents          

Table-18 Distribution of the respondent by the RH problem in male adolescent                                             

For reproductive health treatment of adolescent42.6% among 95 mothers wanted to go private clinic 32.7% preferred general practitioner 26.8% to Govt. hospital and 2.1% respondent told they did not know.

Table-19 Distribution of the respondent by age of marriage for male (by govt. rules)                                       

Table-20 Distribution of the respondent by age of marriage for female

 (by govt. rules)                                                                  

 Majority of the respondent knew the correct answer regarding marriage age rules for females. Only 3.2% failed to say correct answer. (Table — 20)

Table-21 Distribution of the respondent by consequence of unsafe abortion                                           

In case of unsafe abortion, 37.9% of the respondents heard about the consequences (Excessive bleeding, Infection, Perforation of uterus, Death), 4.2% knew nothing.

Table-22 Distribution of the respondent by the knowledge where to have safe abortion facility                               

About 36.8% respondents chose health clinic for safe abortion facility, 10.5% did not know where to go.

 Table-23 Distribution of the respondent about the knowledge of the risky behavior of adolescent                          

About 21.1% of respondent knew about the risky behavior, but 4.2% could not identify the risky behavior of the adolescents. (Table — 23)

 DISCUSSION

 Adolescent reproductive health has, become an important issue for Bangladesh. Since independence, though Bangladesh has achieved remarkable progress in important aspects of health and family welfare, but the overall health status mainly reproductive health status in the country remains unsatisfactory. Bangladesh still.. faces formidable obstacles in the path to the goals of health and reproductive wellbeing due to inadequate knowledge or misconception about reproductive health issues. So proper knowledge is a pertinent part of life. In the present study and attempt was made to assess the knowledge of mothers about particular aspects of reproductive health.

The study was carried among 95 respondents of several schools in Dhaka city. The respondents experienced various types of problems of their adolescent (10-19) yrs.

Majority of the respondents had a correct knowledge about menstruation. They told their female children about it, but less than 50% told that after menstruation. Most of the respondents mentioned about problems during the time of menstruation, and 6.3% of them identified painful menstruation as the main problem whereas 45.3% mentioned about different types of mixed problems like excessive bleeding, whitish discharge, painful menstruation, itching, less than .20% could identify all the problems.More than half (55.8%) of the respondents knew the practical use of sanitary pads during menstruation but 34.9% adolescents of the respondents use old cloth. This discrepancy may be due to their low financial condition i.e. sanitary pads were not affordable to them.            In relation to occupation most of the respondents are housewife (67.4%) and among them 30.5% are educated up to secondary school and the higher secondary school level. The mother of adolescent of Dhaka city had more or less similar characteristics though there is a variation in the income level (less than 1k. 5000 to more than Tk, 30.000)

In the inquire of sources of information regarding reproductive health, 25.3% of the respondent informed from their mother or aunty,/ from TV Radio 6.3%, 9.5% got information from friends, book, ‘newspaper, TV, radio, etc.

Regarding problems of early marriage 42.1% told that they agreed with all the answers (Early pregnancy, Health effect of mother, Sexual diseases, Education postponement) but 51.6% agreed with education hamper and early pregnancy.In case of adolescent pregnancy, lots of problems occur. About 44.2% agreed to all the answers (Education hamper, Maternal mortality Abortion, Low birth weight baby).In this question what are the obstacles for getting proper information regarding reproductive and sexual life, 18,9% agreed to afraid of spoil, shame, wrong information ‘from friends, social impediment, absence of facility for education on RH and sexual life, absence of friendly relationship with parents, etc. 2.1% could not tell anything.  Among 95 respondents 77.9% agree to discussion of health matters regarding puberty, anti addiction activities, media, program make by participation, etc.’ from the remaining 10.5% told that only media can prevent these obstacles, 5.3% could not give any answer.

Regarding pubertal changes in female most of the respondents knew all the physical change. Regarding mental and social changes, 11.6% of the respondent can answer all the changes like sensitive, behavioral change, reluctant to food, reluctant to study, lively, attraction for opposite sex, secrecy, unsocial, etc. Pubertal changes in case of male adolescent arc voice change, physical change, moustaches, bears, flairs in an axilla and genitalia, attraction to opposite, behavior change, friend preference, peer pressure, food habit change, etc. 3 1.5% of the respondents agreed to all of the changes.

The study reveals that 45.3% had knowledge of most common reproductive health problems of female adolescent. Only 14.7% had the knowledge of all the reproductive health problems. The study also reveals that 3 5.8% of the respondents had the knowledge of reproductive health of male adolescents. 15.8% knew nothing about it.   Reproductive health problems in male adolescent are Nocturnal emission, Masturbation, change in the shape of sex organ, ulcer in the genitalia, pain abdomen, Pus or discharge through the urethra, scrota) pain and swelling, etc. 22.1 % have knowledge about nocturnal emission. 15.8% could identify any problem of male adolescent.

More than half (53.7%) respondents desired to solve the reproductive health problem of adolescent with help of their husband, less than twenty percent desired to seek advice only from physician.

About RTI/STD transmission 38.9% were aware of all the ways, 8.4% had no awareness. Regarding RTI/STD prevention, 29.5% had very good knowledge, 30.6% had good knowledge and 1.1% had 1ow knowledge

For RH treatment of adolescent 25.3% among 95 mothers wanted to go to private clinic, 18,9%% preferred general practitioner, 14.7% to Govt. hospital, 1.1 % respondent told that they did not know.  21.1% of respondent agreed to drug addiction, sexual desire, inattentiveness in education, attraction for opposite sex, involvement in social crime, etc, but 4.2% could not identify the risky behaviour of adolescent.

In the question of how risky behaviour can be prevented 18.9% agreed to all the answers (parent’s guidance, re1igious practice, proper knowledge regarding sexual diseases, media), could not give any suggestion 4.2%,When 95 respondents were asked whether education regarding adolescent problems should be included in the school curriculum, majority (94.7%) said they wanted to see very eagerly 5.3% did riot know what to tell. About sexual diseases 4.2% could not understand anything about it. More than fifty percent (52.6%) told that they agreed with all the answers.

The respondents asked whether it is necessary for male participation regarding RH decision 82.1% (majority) thought that it’s necessary. 4.2% told not necessary and 13.7% told it is sometimes necessary.

On the other hand majority of the respondents had average knowledge about different aspects of reproductive health, such as hygiene management, early pregnancy~ safe motherhood, unsafe abortion. This level of knowledge is not up-to the mark probably due to the fact that the women knowledge was not proper. The information about these matters, which they received from their mother/ aunty were in old theory and different media like TV, radio, newspaper, etc was not complete and consistent.

On the basis of the findings of the study, the following recommendations are put forward for consideration of the future researcher and policy makers-

• Sound policies must be developed for effective reproductive health program for adolescents.

• The health services structure in Bangladesh should be tailored to provide reproductive health care, which suits the needs of the male and female adolescent.

• Efforts should be made to strengthen the ability of health care providers to youth family services and improve provider attitude towards sexually active adolescents.

• Adolescents Family Life Education (AFLE) should be implemented and ensured by arranging special hours or special days for the male and female adolescents and also orienting and providing on how to counsel and treat the adolescents.

• The health care approach must be modified friendly adolescent and mother child program.

• Mass media should come forward to focus on adolescent reproductive issues and also notifying the available adolescent friendly service delivery centers.

• Community awareness, participating program can be done to provide to the mothers about adolescence.

• The basic reproductive health should be included in the school curriculum.