1.9 Role transitions: marriage and parenthood

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Из курса от партнера The University of Melbourne

Global Adolescent Health

47 оценки

The University of Melbourne

Global Adolescent Health

47 оценки

This course will explore the dynamic factors affecting the health and wellbeing of young people around the world, and how important it is for individuals, communities and nations that we improve the health and life chances of this important population group. With over 25% of the world’s population aged between 10 and 24 years, today’s generation of young people is the largest in human history. As the future leaders and drivers of growth, productivity and innovation, young people are our greatest assets, and investment in their health and wellbeing has social, economic and other benefits that continue across the lifespan and into the next generation. In this course we will adopt a life-course framework to take a holistic view of youth health and wellbeing. We will explore changing patterns of adolescent health and development, including why adolescence is starting earlier and ending later; how puberty and adolescent brain development may shape future health; and how what happens in adolescence can affect the start to life for the next generation. We’ll also look at the major health and social issues affecting young people and ways of addressing these through policy, practice and programming. COURSE FORMAT: This course comprises short video lectures and interviews, required and recommended readings, online discussion, quizzes and written assignments. There is no required text for this course and all readings are provided. DO I HAVE TO PAY FOR THIS COURSE? No- you may access 100% of material in this course for free. You are also welcome to do as much or as little of the course as you like, including all (or none!) of the assessment tasks- it all depends on your learning goals. The option to pay for this course is there for those who wish to receive a Course Certificate as evidence of completion (which does require you to attempt and successfully pass the assessment tasks). WHO IS THIS COURSE FOR? This course will be relevant for anyone with an interest in the health and wellbeing of young people. You do not need to be of any particular personal or professional background to benefit from this course, but having some basic undergraduate study experience will be helpful to your learning (particularly if in a health related field). WHAT IS THE MOST INTERESTING THING I'LL LEARN IF I TAKE THIS COURSE? You’ll learn how so much of what happens during adolescence can impact not only the future health of individuals, but the health of the next generation as well. You’ll develop a greater understanding of the key factors impacting upon youth health and learn how to be a better advocate for the health and wellbeing of young people. View the MOOC promotional video here: http://tinyurl.com/z5l4mod

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Week 1 - Introduction to adolescent health: developmental and ecological perspectives (Part I)

Welcome! Before getting started on this week’s content, be sure to review the materials under the ‘Introduction’ section below to help you get the most out of this course, whatever your learning goals may be. This week we set the scene for adolescent health as a critical area of human health and development. We introduce the conceptual framework used throughout the course, which will assist greatly in building your learning across each week of material. We discuss different definitions of adolescence and young adulthood, and explore how the biological and social transitions associated with this period of life- and our understanding of them- have changed over time.

Week 1-2 Briefing with Susan Sawyer5:41

1.1 Introduction: why adolescent health?7:02

1.2 A conceptual framework for adolescent health14:42

1.3 Definitions of adolescence9:37

1.4 The changing shape of adolescence8:17

1.5 Puberty and adolescent growth6:27

1.6 Growth including brain development in adolescence7:21

1.7 Puberty and health: part I3:40

1.8 Puberty and health: part II7:26

1.9 Role transitions: marriage and parenthood7:21

1.10 Role transitions: contraceptives and condom use5:45

1.11 Role transitions: education and employment7:37

Interview with Dr Judith Diers (USA) 16:10

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Professor Susan Sawyer
Chair of Adolescent Health
Department of Paediatrics
Professor George Patton
Professorial Fellow
Adolescent Health Research

I want to return to the conceptual framework for

adolescent health that Susan introduced in an earlier lecture.

We've previously introduced the idea of adolescence as

a phase of life that begins with the biological event at puberty, and ends with

a series of social role transitions that mark entry into adulthood.

These role transitions have become more complex.

Once upon a time, it was about marriage and parenthood.

Now, it's about completing education,

finding employment that gives financial independence from one's family of origin.

And even achieving the cognitive and emotional capacity to be independent.

In the following lectures, I shall be shifting attention to some of the role

transitions that have set the upper age boundary of adolescence.

I want to begin by addressing the transition that through human history has

most defined the transition to adulthood, that is, marriage and parenthood.

That is about forming a family of one's own.

In this slide from an earlier lecture, we illustrated the changing shape of

adolescence over the past 200 years in many of today's high income countries.

Of note is the changing gap between the onset of sexual activity

and settling into marriage or life partnerships.

In many high income countries this is now well over a decade.

Even greater is the gap between the events that mark reproductive capability and

having a first child.

For girls with early puberty the gap between menarche, and

having a first child is commonly over two decades.

Tied to the good provision of health care, including good access to contraception,

this has transformed risks for reproductive and

maternal health in the adolescent years.

In low income countries, similar trends have occurred.

The potential for gains in adolescent sexual and

reproductive health are huge, but cannot be taken for granted.

So, let's try to understand first what are the recent trends.

The following graph derives from the United Nations Population Division.

It illustrates changes over the last 15 years in

the percentage of young women, aged 15 to 19, who are married.

The data come from high, middle, and low income countries.

The diagonal line allows us to see which countries

have managed to reduce levels of teenage marriage since 1990.

Countries below the line are trending toward lower rates

of teenage marriage 15 years later.

The majority of countries where the high

or low income have followed a similar trend.

High income countries, those with the blue circles,

have much lower rates of teenage marriage at both points in time.

Asian countries, have tended to have higher rates, but

have had very strong trends to lower rates over the last 15 years.

And it should be fairly clear that Sub-Saharan African countries

continue to have the highest rates of teenage marriage.

Mostly in excess of 20%, and in some, in excess of 50%.

However, even within these countries,

most are moving toward lower rates of teenage marriage.

It's not just early marriage where there are very different pictures in

different places.

This global map of birth rates for

girls aged 15 to 19 illustrates some of the huge geographic variations.

In most of western Europe and in a range of other high middle income countries

including China, birth rates to teenage girls are low.

The highest rates are in Sub-Saharan Africa.

And in a few countries of Latin America and

South Asia, teenage birth rates also remain very high.

But, just as rates of adolescent marriage have declined, so

too have rates of adolescent births have also declined over

the last 15 years in the great majority of countries,

whether it be in low adolescent fertility countries of Europe and North America,

intermediate adolescent fertility countries of Latin American and Asia.

Or the high adolescent fertility countries of Sub-Saharan Africa,

the trend toward lower adolescent fertility is clear

with the great majority of countries falling below the diagonal line.

I mentioned earlier that one of the striking changes in high income countries

has been the rise of the sexually active, unmarried adolescents in young adulthood.

So I want to ask the question, to what extent has this occurred in low and

middle income countries?

The answer is quite a lot.

In these selected countries that all have high adolescent birth rates, many

young adult women report that their first sexual experience was outside of marriage.

Indeed is Swaziland, Liberia, and the Congo, over 50% women

report their first sexual experience outside of marriage.

Because these data derive from household surveys where

under reporting is likely to be common, the actual rates of sexual activity before

marriage are likely to be much higher again than I'm showing here.

The rise of sexually active unmarried adolescents,

in a context of limited access to contraception, matters.

The association between having a birth outside of marriage and the proportion of

adolescents who are sexually active prior to marriage is clear in this graph.

The clearest trends are in countries with high adolescent birth rates.

But they are also evident in those with intermediate

levels of adolescent fertility.

It is clear that these widespread changes in role transition into marriage and

parenthood have major implications for sexual,

reproductive and maternal health of adolescence in young adults.

In the next lecture, I will address some of the essential actions that

we in health, need to promote in order to ensure that young people and young women

in particular achieves the gains that we have seen in many high income countries.

And avoid the adverse health and social consequences that might otherwise occur.

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