By Senay Gokbayrak
Since the 1970’s, World HealthOrganisation (WHO) has been putting a great emphasis on the promotionof adolescent health, especially reproductive health, with the contributions of United Nations Population Fund (UNFPA). The Adolescent Health Program, lasted between 1990-99, has developed a widespread implementation area for health promotion including all the aspects of adolescent health and development. Undertaken through this program, governments have been performing various activities in co-operation with the non-governmental organisations providing youth-oriented services. Among the several periods in a life span, adolescence has a priority and attracted strong attention due to various reasons. The basic reason of this interest is the fact that more than 50 % of the world’s population is below the age of 25, and that this rate reaches to 80 % in the developing countries. Given the community health services, the recent developments in immunisation, clean water opportunities and sanitation have permitted greater attention to be given to health problems arising from behaviour, rather than from passively acquired infections. Recently, the importance of behaviour patterns has been consented increasingly for health and longevity. And the origin of these patterns is mostly based on childhood and adolescence.
The change in the social conditions that lead to various transformations on the sexual behaviour and relationships among young people can be summarised as follows: accelerating urbanisation, an earlier start to puberty together with a rise in the mean of marriage, the rapid spread of mass media communication across cultural boundaries, and the decline of the nuclear or extended family structures. Changes in the behaviour patterns experienced alongside with these conditions have caused new health problems to occur. Beside the traditional problems like pregnancy and early motherhood, various other problems have come on the scene, particularly about unprotected sexual behaviour related problems. These include illness, injury, deaths among young mothers; miscarriages, abortion, infertility arising from sexually transmitted infections (STI), and infection from the immunodeficiency virus (HIV) and likelihood of subsequent death from AIDS. Additionally, adolescent motherhood generally comes to mean an end to educational facilities and hence, end to training and economic opportunities for development of the female adolescent outside the home. Adolescent mothers are not qualified enough to bear a child and they are usually deprived of the necessary support of the fathers, who are also adolescent. All these bring forth various problems to occur.
The behaviour patterns causing these problems to occur are generally under the voluntary control of an individual, even if there are many factors and pressures effecting these behaviours. In fact, many young people are aware of moral and cultural norms of their societies. In general, they know what adults expect from them. Nevertheless, these young people are also subjected to struggle with various other factors and personal needs. Depending on their age and development, they may not foresee the consequences of their behaviours and not make dependable decisions for themselves. At that point, counselling services contributing to their overall development will assist them to clarify what they feel and think and to make more dependable decisions for their future.
Although counselling services have a great importance in the development of adolescents, the quality of these services is a more important issue to be underlined. Because, in many societies, these counselling services are highly directive. Such a counselling understanding neither facilitates the development process of the adolescents, nor strengthens the capacity of them in handling with the problems that may arise in the future. If an adolescent feels that s/he is rebuked or intimidated like a child, these services may be counterproductive, even harmful. If it is non-directive, a counselling service is pretty encouraging in order to make young people to decide for and by themselves, and it is much more noteworthy for their long-term developments.
For an efficient and effective counselling service to be achieved, these are the major obstacles: adult or young counsellors’ not having sufficient knowledge about sexuality and their having difficulties in discussing these issues. Quite a few services should be arranged in a way that they would meet the specific needs of the adolescents. Young people generally stay away from these services, since they often feel unwelcome and misunderstood. Counsellors, on the other hand, are not aware of the fact that it is more effective and enduring to help these adolescents in making their own decisions, rather than deciding on behalf of them.
In order to overcome these problems experienced during the counselling services which have a great significance in adolescent development, and to bring forth the characteristics of an effective counselling service, WHO has organised a workshop called “Counselling Skills Training in Adolescent Sexuality and Reproductive Health” through the participation of governments, non-governmental organisations, and specialists from different disciplines and cultures such as psychology, health, social welfare, social politics, youth, education, criminal justice, religion and etc. The topics discussed in the workshop can be enumerated as follows:
Sexual and Reproductive Health
- Sexual Maturation
- Sexual Behaviour
- Sexual Difficulties
- Sexual Orientation
- Sexual Variation
- Sexual Maladjustment or Dysfunction
- Sexual Abuse
- Consequences of Unprotected Sexual Relations
- Adolescent Pregnancy
- Induced Abortion
- Sexually Transmitted Infections (STI)
- Prevention of Unwanted Pregnancy
- Prevention of STIs and HIV/AIDS
Psycho-dynamics of Counselling
- The Initial Interview
- Difficult Moments in Counselling
- Service Considerations
- Counsellor Characteristics
- Counsellor Training
- Counselling Adolescents with Family
Micro-Communication Skills for Counselling
- An Overall Model of Interpersonal Communication Skills for Counselling
- Attending Skills
- The Art of Encouragers
- Reflection of Fact
- Reflection of Feeling
- The Art of Asking Question
- The Skill of Summarising
Counselling skills training evaluated under these headings is pretty meaningful and a significant step with respect to the attainability of the services by young people, its putting forth multi-sectorial services meeting the specific needs of young people and such a need’s arising through out the world. These protective studies provided for young people throughout their development appear as humane and cost efficient approaches in regard to their realising research, training, action, evaluation and sensitising facilities for young people. On the other hand, achieving the sustainability of such studies is much more important than this. Because, young people are the most significant assets for the future of societies.
Source: Counselling Skills Training in Adolescent Sexuality and Reproductive Health, Department of Child and Adolescent Health and Development, WHO Geneva, 2001