Adolescent pregnancy: unmet needs and undone deeds
A review of the literature and programmes
There is widespread acknowledgement that although adolescents share many characteristics with adults, their health-related problems and needs are different in a number of significant respects. There is a growing recognition among clinicians and public health workers alike that the approaches used to prevent and respond to health problems in adults need to be tailored (to a greater or lesser extent) if they are to meet the special needs of adolescents.
Unfortunately, even though WHO advocacy statements often draw attention to the particular vulnerabilities of adolescents (for instance to health problems resulting from unprotected and unwanted sexual activity, or from substance use) its guidelines on clinical management tend to be directed towards meeting the needs of adults or children. This is the justification for the systematic analysis of the recommendations given in these guidelines, with a view to examining whether or not these need to be tailored to meet the special needs of adolescents.
The Department of Child and Adolescent Health and Development (CAH) in collaboration with other WHO departments has initiated a process of reviewing the literature in order to identify existing recommendations on clinical management, and to assess how appropriate these are for adolescents across a wide range of health issues.
In the short term, it is expected that this process will lead to the formulation of new recommendations (on clinical management) where none exist or where existing ones are inappropriate. In the medium to long term, the process is also expected to contribute to the improvement of existing WHO guidelines and algorithms (and possibly to the development of new ones, and other “work aids”) to enable health care providers (especially at the primary care level) to meet the special needs of adolescents effectively and with sensitivity.
The review process has now resulted in the production of a number of Discussion Papers (see below) and these have already provided the evidence used to develop WHO guidelines produced by CAH and other WHO departments. Examples include: CAH job aids for health workers working with adolescents; the Contraception Medical Eligibility Criteria; STI guidelines; the Essential Care Practice Guides (integrated management of pregnancy and childbirth (IMPAC), and a guide to decision-making for contraception); the Practical Approach to Lung Health (PAL); and the Integrated Management of Adolescent and Adult Illness (IMAI).
Discussion papers have been developed in the areas of: contraception; pregnancy care; sexually transmitted diseases; unsafe abortion; nutrition; lung health; and malaria. Others are now being developed on HIV/AIDS care; chronic illness; mental health; and substance abuse. Shortened versions have been or will be published in peer-reviewed journals in addition to the completed papers.