Dominant Biological and Psychological Factors Affect Adolescent

Awareness about Reproductive Health

Nurul Aini

Department of Nursing, Faculty of Health Science, University of Muhammadiyah Malang, Jalan Bendungan Sutami

No. 188A, Malang, East Java, Indonesia

Keywords:

Reproductive awareness, adolescents.

Abstract:

Knowledge about reproductive health should already be possessed by adolescents, through information

media it is very easy to get it. But with the vast amount of knowledge possessed by teenagers, it has not

been able to foster a sense of belonging to their reproductive health status. This research was conducted

through a cross sectional study approach. This study obtained 221 respondents using purposive sampling

technique. The value of the results of multiple logistic regression tests conducted simultaneously on the

three variables obtained significant results are as follows, X1 (0,000), X2 (0.122) and X3 (0.009). The

results showed insignificant because of the sig value. X2> 0.005. The odds ratio (OR) values of X1 and

X3, are 0.069 and 0.218 which means the greatest odds ratio is on biological and psychological factors.

Various factors that become variables on adolescent awareness about reproductive health are social,

economic and demographic factors, cultural and environmental factors as well as biological and

psychological factors affecting the level of adolescent awareness of their health in terms of reproduction.

Of the three components of the factors mentioned above, biological and psychological factors have the

greatest influence.

1 INTRODUCTION

There are almost one billion young people aged

between 10 and 24 years who live in Asia. These

young people live in diverse socio-cultural and

economic contexts, but there are important

challenges and opportunities related to their sexual

and reproductive health. In all countries, increasing

access to media, and urbanization globalization

contributes to changes in sexual values, norms and

behavior of young people (UNFPA, UNESCO &

WHO, 2015). There is broad international agreement

that young men and women have the right to sexual

and reproductive health (Khatiwada, et al., 2013).

Knowledge about reproductive health should

already be possessed by adolescents, through

information media it is very easy to get it. But with

the vast amount of knowledge possessed by

teenagers, it has not been able to foster a sense of

belonging to their reproductive health status. This

situation cannot be allowed to flow and continue to

flow without any real solution. The future of the

nation's children must be saved. The most feared

danger due to low awareness of reproductive health

is unsafe sex that can result in unwanted pregnancy,

abortion, early marriage, and most recently

HIV/AIDS is ready to threaten (Okigbo & Speizer,

2015). Data in 2011 showed an increase in cases of

premarital intercouse, an increase in unwanted

pregnancies, and an increase in sexually transmitted

diseases experienced by adolescents aged 12 to 21

years in Indonesia, especially in East Java.

Reproductive health is a state of perfect health

both physically, mentally, and socially and not

merely free from disease or disability in all aspects

related to the reproductive system, its functions and

processes (WHO, 2008). Referring to this definition,

it can be said that adolescents who have a low

awareness of attitudes towards reproductive health

are actually being sick. Because of being sick, it is

necessary to be given help, not be judged or

punished when experiencing abusive reproductive

health behaviors. The low awareness of these

attitudes can be influenced by internal and external

factors. This is important to be a concern of health

workers regarding reproductive health for

adolescents. The use of reproductive health services

is an important component in preventing adolescents

from different sexual and reproductive health

problems (Negash et al., 2016). Based on the above

Aini, N.

Dominant Biological and Psychological Factors Affect Adolescent Awareness about Reproductive Health.

DOI: 10.5220/0009119700100014

In Proceedings of the 2nd Health Science International Conference (HSIC 2019), pages 10-14

ISBN: 978-989-758-462-6

background, the purpose of this study is to analyze

the factors that cause low awareness of adolescents

about reproductive health.

2 METHODS

This research was conducted with an observational

research design through a cross sectional study

approach. The population in this study were

secondary students in East Java - Indonesia. The

sampling technique used was purposive sampling

technique. Obtained a sample of 221 respondents.

The instrument used in this study was a

questionnaire consisting of questionnaires about

hormonal factors, knowledge factors, parent factors,

friend factors, advertising factors, demographic

factors, psychological factors, social class factors.

Statistical calculations were performed with the

chi square test to determine the effect of each

variable. Then a multiple logistic regression test is

performed to test the significance of the relationship

of the dependent variables simultaneously with the

dependent variable and find out which factors are

most influential.

3 RESULTS AND DISCUSSION

The result of the study describe in the table 1 and

table 2

Table 1: Frequency of demographic dominance

respondents.

Category

Dominance (%)

Socioeconomic

demography:

Low

High

88 (40)

133(60)

Culture and environment:

Low

High

91 (41)

130(59)

Biology and Psychology:

Low

High

57 (26)

164(74)

Based on the results of bivariate data analysis

using chi square with a significance level of 5% was

carried out to determine the effect of each variable.

While multi-variate data analysis using multiple

logistic regression tests with a significance level of

5% was carried out to test the significance of the

relationship between the dependent variables with

the dependent variable and find out the factors that

most influence between X1 (socioeconomic and

demographic factors), X2 (factors culture and

environment), and X3 (biological and psychological

factors). The data analysis test table results in

multiple logistic regression as below:

Table 2: Logistic regression analysis.

Factor

Konstanta

Sign

Socioeconomic

demography

-2.676

0,000

0,069

Culture and

environment

-.592

0,122

0,553

Biology and

Phsychology

-1.525

0,009

0,218

The value of the results of multiple logistic

regression tests conducted simultaneously on the

three variables obtained significant results are as

follows, X1 (0,000), X2 (0.122) and X3 (0.009).

From these results it can be said that when tested

simultaneously (simultaneously) X2 is said to be

insignificant because of the sig value. X2> 0.005. So

to determine which factors are most influential, just

compare the odds ratio (OR) values of X1 and X3,

which are 0.069 and 0.218. Where from the value of

the two variables that have the greatest odds ratio is

on biological and psychological factors.

This study found that the majority of respondents

were at a high social, economic and demographic

level, this is according to the Indonesian

demographic and health survey (SDKI) in 2012,

which stated that variations in provincial and district

locations significantly influenced the chances of

having premarital sexual relations with or without

considering reproductive health. A study in Ethiopia

was conducted on high school female students in

northwestern Ethiopia, where 3.9% have been

reported to be sexually active. This may be due to

cultural barriers both for having premarital sex and

for reporting having sex. However, this figure is far

lower than a study conducted at Zeway secondary

school (south central Ethiopia) where 31.5%

reported experiencing sexual experiences (Melaku et

al., 2014).

Education and employment become one of the

important determinations in adolescent awareness

about reproductive health. Economic imbalances can

cause differences in terms of education and

employment, members of the community with lower

economies have lower levels of awareness about

reproductive health, this is because adolescents with

lower economies get less knowledge about

reproductive health. Sexual maturation also often

Dominant Biological and Psychological Factors Affect Adolescent Awareness about Reproductive Health

occurs earlier than average than cognitive maturity,

girls tend to mature more quickly than boys. When

combined with the disparities in the socioeconomic

status of young adolescents, the dwellings and rural-

urban living conditions mentioned earlier, these

individual and group variations create significant

challenges to the effective implementation of sexual

and reproductive health (WHO, 2010).

Research has found that there is a relationship

between cultural and environmental factors with

adolescent reproductive health awareness. Family

environment, family structure and communication in

the family have values and norms that are different

from other families, this can affect adolescent sexual

behavior patterns. This is due to several factors such

as some families being more protective of

association from other family members and the

disruption of communication between teenagers and

parents, due to the taboo to discuss matters of

systems, functions and reproductive organs. WHO

collects information about 13–15 years old

perceptions of protective factors (or lack thereof) in

schools, networks of friends and families (such as

whether their parents or guardians know where they

are and what they do when they are not in school), in

alongside student self-reports on their healthy or

risky behavior (WHO, 2010).

Adolescent ignorance about reproductive health

will have serious consequences, such as adolescents

will experience an unwanted pregnancy (unwanted

pregnancy), which in the system and values in

Indonesia, means prolonged disaster. In addition to

the family environment, the environment between

peers can also affect adolescent sexual behavior

patterns because during adolescence, the interaction

and presence of adolescents with their parents tends

to decrease because of the great need to be with their

peers. This results in reduced parental control and

increased peer influence and not infrequently the

perception of parents is considered old-fashioned by

teenagers. Teenagers tend to follow the opinions of

their groups and behave according to agreement. So

that often adolescents behave where the behavior

carries a great risk, one of which is sexual behavior

that can lead to unwanted pregnancy. The

community environment is also one of the factors

that can influence sexual behavior and awareness

about adolescent reproductive health.

In the rural environment sex tends to be

considered taboo while in big cities the promiscuity

between genders among adolescents continues to

increase. The marginalization of rural areas creates

further challenges for adolescents who want to

access and utilize preventive reproductive health

services. Efforts to provide reproductive health

services to adolescents have focused mainly in urban

areas leaving rural areas (Kamau, 2006). Every

society has cultural differences, from these cultural

differences there are still cultures that apply norms

and values that can affect the reproductive health

and sexual behavior of members of the community,

such as there are still strong restrictions on sexual

behavior outside, the prohibition is made to prevent

the occurrence STD or HIV infection and teenage

pregnancy at an early age. Dating behavior or having

a romantic relationship with a partner in this era of

globalization tends to adopt western culture, so the

behavior that is manifested is more permissive.

Having a partner or in other words having a

boyfriend can be things that affect awareness about

reproductive health, this is caused by lust, lust that

arises when you're with a partner. Couples who are

dating, are more likely to make physical contact in

the form of touch to their partners. Sensations that

arise can be excessive and if not controlled can lead

to acts of premarital sexual behavior (Sarwono,

2011).

This study also found that there was a

relationship between biological and psychological

factors and adolescent reproductive health

awareness. Adolescence is characterized by an

increase in emotional, biological and psychological

changes. that change makes adolescents more

vulnerable to unsafe sex, premature marriages,

extramarital pregnancy and unsafe abortion. This is

as said by Odo, et al. (2018) that adolescents

represent 25% of the world's population and are

characterized by a series of physiological,

psychological and social changes that expose them

to unhealthy sexual behavior such as early sex

experiments, unsafe sex and many sexual partners.

So that in adolescence knowledge and awareness

about reproductive health must be increased.

Having a partner (girlfriend) is often considered

as a process to pour out the contents of the hearts of

couples of the opposite sex who love each other,

love and love each other. Dating orientation in

adolescents today has led to behavior beyond the

limits such as sexual behavior to fill leisure time and

do not rule out the possibility of engaging in sexual

behavior that they should not. Puberty and

maturation of reproductive health can cause sexual

urges in adolescents who begin experimenting with

sexuality through courtship. This relationship was

found among teenagers who were interested in

expressing feelings through behavior. These patterns

can illustrate a limited level of reproductive health

awareness regarding gender and social norms during

HSIC 2019 - The Health Science International Conference

puberty. This shows that the age of marriage must be

increased to prevent premarital sexual activity

among adolescents in Indonesia (Sugama, 2016).

Adolescence can be called as a period where a

person's curiosity begins to increase in various ways

including the field of sex. By the time the adolescent

reproductive organs have begun to experience

development, hormones begin to function, changes

in physical form and increased sex drive in

adolescents. Psychological development of

adolescents is shown by the emergence of interest in

the opposite sex and the drive for desire to get

sexual satisfaction. one of the problems that often

arises among adolescents during the early maturity

of the reproductive organs is unsafe sex. Unsafe sex

is a great risk for pregnancy outside of marriage,

whereas in adolescents the reproductive organs such

as the uterus are not quite ready to maintain the

results of conception and fetal development and

mentally at adolescence are not mature enough and

mature (Tucker et al., 2012). Lack of knowledge and

awareness of adolescents about reproductive health

is one of the causes of adolescents having sexual

relations.

The results showed that the most dominant factor

in relation to reproductive health awareness was

biological and psychological factors. A WHO report

in Algeria, Bangladesh, Ethiopia, Indonesia, and

Nigeria shows that the risk of death from

complications related to pregnancy or childbirth is

twice as high for those aged 15-19 years than for

women in their mid-twenties (Odo et al., 2018).

Teenagers are a transitional stage from childhood to

adulthood. In this period, adolescents underwent

several changes in themselves including biological,

psychological, social, moral and spiritual changes.

Biological changes include physiological changes,

hormonal changes and sexual behavior as well as

emotional changes. Psychological changes include

the formation of new identities, changes in the

function of self-identity, the beginning of the

individuation process, understanding new

experiences in life and efforts to adjust.

Teenagers often lack basic reproductive health

knowledge and access to affordable and confidential

health services. In addition, most teenagers do not

feel comfortable discussing reproductive health

issues with their parents (Helano, 2017). Teenagers

at this stage have not yet reached mental and social

maturity so in this period adolescents face many

conflicting emotional and social pressures. In this

period, adolescents will experience rapid physical

changes when adolescents enter puberty. One of the

physical changes is the ability to carry out the

process of reproduction. Problems that often occur

among adolescents regarding reproductive health

include those related to unprotected sexuality, the

spread of venereal disease (sexual transmitted

disease), pregnancy outside marriage or unwanted

pregnancy (adolescent unwanted pregnancy) among

adolescents.

These latter problems can lead to other problems

including unsafe abortion and early marriage. All of

these problems are referred to by WHO as

adolescent reproductive health problems.

adolescence is a phase of life in which young

children are very vulnerable to health risks,

especially those related to sexuality and

reproduction. The most common adolescent

problems related to sexuality and reproductive

health include: HIV / AIDS, unwanted pregnancy,

unsafe abortion, early marriage and teen pregnancy,

sexually transmitted infections and malnutrition

(10). These problems can arise due to the fact that

most teenagers do not yet know and understand

reproductive health, which is about fertility and how

pregnancy occurs and adolescents have not yet

reached mental and social maturity.

4 CONCLUSIONS

Various factors that become variables on adolescent

awareness about reproductive health are social,

economic and demographic factors, cultural and

environmental factors as well as biological and

psychological factors affecting the level of

adolescent awareness of their health in terms of

reproduction. Of the three components of the factors

mentioned above, biological and psychological

factors have the greatest influence.

REFERENCES

Helamo D. 2017. Utilization and Factors Affecting

Adolescents and Youth Friendly Reproductive Health

Services among Secondary School Students in Hadiya

Zone, Southern Nations, Nationalities and Peoples

Region, Ethiopia. Int J Public Heal Saf [Internet].,

2(6):1–7. Available from:

https://www.omicsonline.org/open-access/utilization-

and-factors-affecting-adolescents-and-youth-

friendlyreproductive-health-services-among-

secondary-school-students-inhad.pdf

Kamau AW. 2006. Factors Influencing Access and

Utilisation of Preventive Reproductive Health Services

by Adolescents in Kenya. a Case Study of Murang’a

District;(January).

Dominant Biological and Psychological Factors Affect Adolescent Awareness about Reproductive Health

Khatiwada N, Silwal PR, Bhadra DR, Tamang TM. 2013.

Sexual and Reproductive Health of Adolescents and

Youth in Nepal: Trends and Determinants.

Melaku YA, Berhane Y, Kinsman J, Reda HL. 2014.

Sexual and reproductive health communication and

awareness of contraceptive methods among secondary

school female students, northern Ethiopia: A cross-

sectional study. BMC Public Health

[Internet].;14(1):1–11. Available from: BMC Public

Health

Negash W, Dessalegn M, Yitayew B, Demsie M, Wagnew

M, Nyagero J. 2016. Reproductive health service

utilization and associated factors: the case of north

Shewa zone youth, Amhara region, Ethiopia. Pan Afr

Med J, 25(Supp 2):3.

Odo AN, Samuel ES, Nwagu EN, Nnamani PO, Atama

CS. 2018. Sexual and reproductive health services

(SRHS) for adolescents in Enugu state, Nigeria: A

mixed methods approach. BMC Health Serv

Res.,18(1):1–12.

Okigbo, C. C., & Speizer, I. S. (2015). Determinants of

Sexual Activity and Pregnancy among Unmarried

Young Women in Urban Kenya: A Cross-Sectional

Study. PloS one, 10(6), e0129286.

doi:10.1371/journal.pone.0129286

Sarwono SW. 2011. Psikologi Remaja. Jakarta: Raja

Grafindo Persada;.

Sugama J STRIWESRSKRTATN. 2016. Prevalence of

factors related to active reproductive health behavior:

a cross-sectional study Indonesian adolescent.

Epidemiol Health.;38:e2016041.

Tucker, J. S., Ryan, G. W., Golinelli, D., Ewing, B.,

Wenzel, S. L., Kennedy, D. P., … Zhou, A. (2012).

Substance use and other risk factors for unprotected

sex: results from an event-based study of homeless

youth. AIDS and behavior, 16(6), 1699–1707.

doi:10.1007/s10461-011-0017-9

UNFPA, UNESCO, WHO. 2015. Sexual and reproductive

Health of Young People in Asia and the Pasific.

WHO. 2010. The sexual and reproductive health of young

adolescents in developing countries: Reviewing the

evidence, identifying research gaps, and moving the

agenda. Rep a WHO Tech Consult [Internet].;1–17.

Available from: www.who.int/reproductivehealth

HSIC 2019 - The Health Science International Conference