Adolescents are in a period of transition from childhood to adulthood, facing profound physiological and psychological changes and challenges (1). The period of adolescence can be frustrating; both cognitive and social development can be painful, traumatic, excruciating, and unsatisfactory (2). The onset of adolescent development brings physical and physiological changes, as well as new vulnerabilities, sometimes including human rights abuses, particularly in the areas of sexuality, marriage, and childbearing (3). As a result, adolescents face a range of health and social challenges as they mediate the biological and social transition into adulthood.
The experiences of older adolescents (aged 18-19 years) vary greatly by gender, race, ethnicity, socio-economic status, and other factors that shape the way in which they respond to their physical and emotional development and assumption of the roles of adulthood. People commonly develop a deeper sense of identity during late adolescence, such as a personal sense of gender and sexuality, establish values about sexual behaviour and develop skills for romantic relationships (4). Sexual relationships for adolescents mean early entrance to the world of adulthood and potential parenthood. Lacking adequate knowledge and skills about developing sexual relationships can make adolescents vulnerable to a higher risk of unintended pregnancy, unsafe abortion and sexually transmitted infections (STIs), including HIV/AIDS (5).
The ultimate objective of sexual health not only concludes the attainment of physical, emotional, mental and social well-being in relation to sexuality, but it also focuses on the absence of disease, dysfunction or infirmity (6). A positive and respectful approach to sexuality and sexual relationship as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence are keys to sexual health and well- being (7). Additionally, sexual rights which embrace certain human rights at the international and region level as well as national laws must be respected, protected and fulfilled for all people in order for the highest attainable standard of health (8, 9). These are a necessary condition attaining sexual health. Rights critical to the realization of sexual health include: the right to health, the right to be free from discrimination, the right to privacy, the right not to be subjected to torture or ill-treatment, the right to determine the number and spacing of one’s children, and the right to be free from sexual violence (9, 10). More recently, the World Health Organization (WHO) works to promote and protect everybody, including adolescents to achieve their full potential for sex and reproductive health and well-being in order to meet the needs of diverse populations, particularly the most vulnerable (11).
Adolescent sexual and reproductive health (ASRH) in low and middle income countries is a major public health challenge (5, 11). WHO (5) report that over 1 million adolescents contract a Sexual Transmitted Infection every day worldwide. Globally, almost half of new HIV infections occur in men and women aged 15-24. All sexual infections cause a huge health and economic burden, especially in low- and middle-income countries where they account for 17% of economic losses caused by ill-health. Adolescents are a high-risk group who face barriers to access accurate information about their health and rights and how to protect themselves from pregnancy and sexually transmitted infections (STIs) (12). Comprehensive sexuality education plays a crucial role in empowering young people to know and exercise their rights, including the right to delay marriage and the right to refuse unwanted sexual advances.
There are an estimated 580 million adolescent girls in the world today, and 88% of them live in low-income and middle-income countries (LMICs) (8). Sexual and reproductive health (SRH) continues to elude many, and many are denied the right to make safe and informed decisions that affect their health and wellbeing (13). Clearly, SRH is only one among the many dimensions of adolescent girls’ health, including notably nutrition and mental health, and improvements in SRH depend on progress in other dimensions of health; at the same time, girls’ SRH situation has huge implications both for their later health as well as the health of the next generation (13). As the UN reviews 20 years of implementation of the ICPD Programme of Action (14) and designs a new global agenda for 2015 and beyond, it is important to review the situation of today’s cohort of adolescent girls and assess their need for sustained and expanded national and global attention and investment.
There are various public health concerns worldwide caused by high-risk behaviour among adolescents, such as early sexual initiation, multiple partners, and unprotected sexual intercourse. The United Nations Population Fund reported there has been a 25 per cent increase in the global contraceptive prevalence rate in worldwide (15). As a result of this, it is internationally recognised that the adolescent birth rate has decreased steeply and the maternal mortality ratio has declined. However, the improvement has been slow and varied by country. This is because an estimated 100 million women worldwide are still not using safe and effective family planning methods to prevent unwanted and unintended pregnancy and a new global target (SDG 3.1) on reducing maternal death have been not met (11) One of five critical targets to help countries in reducing preventable maternal deaths is that 65% of women to be able to make informed and empowered decisions regarding sexual relations, contraception use and their reproductive health. Therefore, urgent action is needed to improve the health and survival of women and babies and assist countries greater equality and coverage at the national and subnation level (11).
Thailand, as an upper middle-income economy, is faced with an increasing number of adolescent pregnancies and the rate of new Sexual Transmitted Infections, including HIV/ AIDS (16). These increasing of statistics have been attributed to the consistently falling prevalence of contraceptive use (16). The national survey on the prevalence of consist condom use at the last sex among young people and adult aged 15-24 years found that merely 60% had consistently used condoms (17). According to a study (18) in Thailand uncovered the highest prevalence and determinants of contraceptive use among unmarried adolescents which was 75.8% of secondary school adolescents used contraception during sexual intercourse. Of these, 84% consistently used condoms, followed by emergency pills and the calendar method. Using contraception among unmarried school-going adolescents is very crucial to maintain a stable balance between their sexual and reproductive health. Therefore, adolescents could be promoted to use contraception and mentally prepared to practice safe sex. Typically, young people are fully developed in their sexual identity by this stage (19).They may also live independently from their families and may take on adult responsibilities and roles (20). Late adolescents are able to understand the consequences of current actions and are very concerned about their future, career goals, and often consider desirable potential spouses or life-partner related to the transition to the adult role (19, 21). Consequently, they speedily develop the ability to make independent decisions and to compromise. These trends can also encourage adolescents to take pride in their work and be self-confident.
Adolescents considered to be in older adolescence (ages 18-19 years) are targeted because of the likelihood that they have increased cognitive ability and psychological development that allow clear decision-making regarding participation and discussion of sensitive topics (Peterson et al., 1995). They also face novel challenges, including engagement in romantic and sexual relationships (22). Previous studies have discovered the experiences of pregnant adolescents and revealed that contraceptive decision-making is influenced by sexual health education, especially knowledge about contraception and adolescents’ perception regarding hormonal contraception as well as gender power imbalance (23, 24). Gender role is one of various factors involving adolescent pregnancy (1, 15, 24, 25).
Young women inclined to engage in sexual relationship for showing love or long-term relationship, but young men engaged in sexual relationship for curiosity or the need to satisfy sexual drive (26). Moreover, the adverse consequences of sexual activity among young women were unwanted pregnancy, sexual violence, or partner abandonment. These young women also experienced unequal gender relations influenced on their sexual health (1, 24, 27).
To be effective, adolescent male should be involved in sexual reproductive health experience and addressed men’s behaviours in their various roles as well as their reproductive health and rights as human beings. Young men also lacked really understand and sexual health education as well as inform prevention messages and services. In order to prevent pregnancy and the risks of STIs and HIV/ AIDS, accessing and using contraception enables adolescents and their partners to exercise their rights to decide freely and responsibly the number and spacing their children and to have the information, education and means to do so. Enhancing sexual reproductive health education is therefore a vital issue among older adolescents, as this can assist in preventing adverse outcomes of sexual relationship such as sexual transmitted infections or unintended pregnancy (5). Understanding sexual reproductive health experience and its impacts on practices among older adolescents both genders are crucial for promoting sexual reproductive health and rights in the transition to adulthood as well as opportunities for improving sexual and reproductive health care services and interventions.
Due to the private and sensitive nature of the subject, relatively little is known about SRH among those in older adolescence and their knowledge, attitudes, and practices, particularly in Northern Thailand. To address this gap and provide data for improving understanding SRH experience and inform prevention message and services to female and male university students, this study conducted an interpretive phenomenological study to really understand and describe late adolescent experience of SRH in order to generate evidence relevant to a wide range of SRH programmes for adolescents and practitioners.