Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 14 nº 1 - Jan/Mar - 2017

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Páginas 74 a 87


Sexual and reproductive rights in adolescence: an integrative review

Derechos sexuales y reproductivos en la adolescencia: una revisión integral

Direitos sexuais e reprodutivos na adolescência: uma revisão integrativa

Autores: Maria Beatriz de Assis Veiga1; Adriana Lemos Pereira2

1. Doctoral student, Graduate Studies Program in Nursing and Biosciences (PPENFBIO), Rio de Janeiro State Federal University (UNIRIO). Master's Degree in Nursing, Rio de Janeiro State Federal University (UNIRIO). Rio de Janeiro, Rio de Janeiro State, Brazil
2. PhD in Collective Health, Institute of Social Medicine (IMS), Rio de Janeiro State University (UERJ). Lecturer, Graduate Studies Program in Nursing, Rio de Janeiro State Federal University (UNIRIO). Rio de Janeiro, Rio de Janeiro State, Brazil

Maria Beatriz de Assis Veiga
Universidade Federal do Estado do Rio de Janeiro
Avenida Pasteur, 266, Urca
Rio de Janeiro, RJ, Brasil. CEP: 22290-240
maribi.v@uol.com.br

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Keywords: Adolescent, pregnancy in adolescence, human rights.
Palabra Clave: Adolescente, embarazo en la adolescencia, derechos humanos.
Descritores: Adolescente, gravidez na adolescência, direitos humanos.

Abstract:
OBJECTIVE: Identify Brazilian scientific productions over the last ten years about teenagers' sexual and reproductive rights.
METHODOLOGY: Integrative review using the Health Virtual Library network to research studies dealing with this subject during 2002 to 2012.
RESULTS AND DISCUSSION: From 10 articles, 90% had qualitative approach; the larger number of publications took place between 2011 and 2012, on the psychology field, and were carried out on Southeast region of Brazil. It was evident that beyond teenagers' right violation, there is an association between reproduction and socioeconomic conditions.
CONCLUSION: Half of the analyzed production was centered on Psychology field with a predominance on qualitative approach researches, disclosed on 2011 and 2012. The central themes were focused on gender discussion, sexual and reproductive rights and sexuality and reproduction. An important gap about this subject has been identified on Nursing field, which points to the need of expansion of this kind of the researches.

Resumen:
OBJETIVO: Identificar las producciones científicas brasileñas en los diez últimos años sobre derechos sexuales y reproductivos del adolescente.
METODOLOGÍA: Estudio de revisión integral utilizando la red de la Biblioteca Virtual de Salud para estudio de estudios abordando la temática durante los años 2002 a 2012.
RESULTADOS Y DISCUSIONES: Del total de 10 artículos, 90% tenían abordaje cualitativo; el mayor número de publicaciones fue entre los años de 2011 Y 2012, en el área de psicología, realizados en la región Sureste de Brasil. Se evidenció que además de la violación de los derechos de los adolescentes, hay asociación entre reproducción y condiciones socioeconómicas.
CONCLUSIÓN: La mitad de la producción analizada se concentró en el área de la psicología, con predominio de pesquisas cualitativas divulgadas en los años 2011 y 2012. Los núcleos temáticos se concentraron en la discusión de género, en los derechos sexuales y reproductivos y en la sexualidad y reproducción. Se identifica una laguna importante en el área de Enfermería acerca de la temática, apuntando a la necesidad de ampliar pesquisas a ese respecto.

Resumo:
OBJETIVO: Identificar as produções científicas brasileiras nos dez últimos anos sobre direitos sexuais e reprodutivos do adolescente.
METODOLOGIA: Estudo de revisão integrativa utilizando a rede da Biblioteca Virtual de Saúde para levantamento de estudos abordando a temática durante os anos de 2002 a 2012.
RESULTADOS E DISCUSSÕES: Do total de 10 artigos, 90% tinham abordagem qualitativa; o maior o número de publicações foi entre os anos de 2011 e 2012 na área da psicologia, realizados na região Sudeste do Brasil. Evidenciou-se que além da violação dos direitos dos adolescentes, há associação entre reprodução e condições socioeconômicas.
CONCLUSÃO: A metade da produção analisada concentrou-se na área da psicologia com predomínio de pesquisas qualitativas, divulgadas nos anos de 2011 e 2012. Os núcleos temáticos concentraram-se na discussão de gênero, nos direitos sexuais e reprodutivos e na sexualidade e reprodução. Identifica-se uma lacuna importante na área de Enfermagem acerca da temática, apontando para a necessidade de ampliar as pesquisas a esse respeito.

INTRODUCTION

Adolescence is a phase in the human life cycle that runs from 10 to 19 years of age, and currently encompasses 18% of the Brazilian population1. Acknowledged as a time of preparation for adulthood, it is permeated by sweeping biological, psychological and social changes that affect not only youngsters experiencing them, but also their families and the societies that surround them. Subject to brusque alterations, youngsters rediscover their sexuality, when the first genital contact usually occurs2, with puberty that allows reproduction.

The belief that children and adolescents need specific protection was firmed up in 1924 with the Declaration of Geneva3. But it was only in 1990 that the Children's and Adolescents' Statute (ECA)4 was enacted in Brazil which, although ensuring all human rights for this segment of the population makes no specific mention of the rights to sexuality and reproduction, which were addressed during the International Conference on Population and Development and the World Conference on Women, held in 1994 and 1995 respectively. Both these events stressed the need for adolescents to have access to sexual health and reproduction services, with information helping them reach the maturity levels needed to take responsible decisions.

With regard to sexuality and reproduction during the teen years, some aspects have steered actions in this field, including the Nursing and Medical Codes of Ethics that ensure privacy and confidential treatment for young people. The Family Planning Act (1996) that regulates the right of access to care, conception and contraception; the Adolescent Health Program (PROSAD, 1996); the National Guidelines for Comprehensive Care for Children and Adolescents (2010); and the School Health Program (PSE) that is conducted within the context of the Family Health Strategy (ESF), focusing some of its actions on promoting sexual and reproductive health among schoolchildren.

Vital at all phases of life, sexuality is influenced by social contexts and relationships, involving practices, knowledge, satisfaction, pleasure and health, among other aspects. Adolescence allows discoveries and experiments, while building up abilities required for taking decisions, taking choices and bearing responsibilities. However, there is a clear denial of some rights that guide the exercise of sexuality, prompted by heavy pressures on sexual preferences, unequal gender relationships and sexual exploitation, as well as stigmas and stereotypes related to sexuality and reproduction during the teen years5.

Teen pregnancy is a matter of concern for healthcare practitioners, education professionals and society in general. The view of pregnancy during this stage of life as "unwanted", "unplanned" or "too early" blurs broader-ranging aspects of the right to comprehensive sexual and reproductive healthcare as a duty of the State and Society, and as a right of young people6.

Bearing in mind the regulatory and legal frameworks addressing teen sexuality and reproduction as a right and attempting to understand the context within which they are deployed, this study explores the following key question: "How have the sexual and reproductive rights of adolescents been portrayed in Brazilian scientific publications during the past ten years?". The subject of the study was defined as scientific output on this topic between 2002 and 2012, striving to identify pertinent scientific output from Brazil.


METHODOLOGY

The method used by this study was the integrative review, which synthesizes research projects currently available on this topic, helping ensure that practical activities are focused more tightly on this clientele, rendering better care8.

The stages in this research project consisted of: preparation of the key question; the objectives of the integrative review; inclusion and exclusion criteria for identified studies; definition of information to be selected from the chosen texts; and analysis and discussion of the findings.

The papers were selected between April 27 and May 1, 2013 from the Virtual Health Library (BVS), which was chosen as it offers online access to technical and scientific information that is important for the development of healthcare-related activities, proposed and set up by the Latin-American and Caribbean Health Sciences Information Center (Bireme).

Initially, the key words: "sexual rights" and "reproductive rights" were keyed in separately, with 1,488 and 893 results, respectively. Next, the "adolescent" descriptor was added to these terms, this time resulting in 467 and 131 titles respectively. Taking into consideration only studies including one of these two combinations - "sexual rights" and "adolescent", or "reproductive rights" and "adolescent" - a total of 535 research projects was obtained, as shown in Table 1.




Subsequently, the following inclusion criteria were established for this project: full texts (for a better understanding of the subject of the studies); written in Portuguese (for familiarity with the issue at the national level, due to regulatory and legal frameworks in place); published between 2002 and 2012 (thus portraying the latest scientific output); and published as papers (in order to focus specifically on scientific output addressing the selected topic).

The exclusion criteria were: texts not available in full during the specific period; written in some other language; studies other than papers; research projects not specifically addressing the topic of sexual and reproductive rights during adolescence, or portraying only sexuality and reproduction from the standpoint of violence; and when duplicate papers were found, only one was taken into consideration.

After applying the selected criteria, forty papers remained, of which thirty were excluded after reading their abstracts: one as it did not specifically address sexuality and reproductive rights; two because they were duplicated; eleven as they did not specifically portray the adolescent population; and sixteen because they explored violations of rights focused only on violence and the sexual exploitation of children and adolescents. This resulted in a sample universe of ten papers, as shown in Table 2.




After collecting the materials, an analysis grid was drawn up with the following items: Provenance / year of publication; Paper title; Authors; Journal and remarks. After reading the papers, the main aspects of each of them were presented in this grid (Table 3).




The results obtained during the previous stage were analyzed, interpreted and discussed in order to reach the goal and answer the key question, outlining the profile and characterizing the topic identified in the analyzed publications.


RESULTS AND DISCUSSION

Among the papers analyzed, five were in the field of psychology (50%), three addressed collective health (30%), one focused on nursing (10%) and one on medicine (10%); with nine adopting a qualitative approach (90%) and only one being quantitative (10%). Most of the qualitative studies were justified by the characteristics of the issue in question, related to values, taboos and subjective aspects of human life that are hard to measure.

The largest number of papers were published in 2011 and 2012 - three in each year - that together account for 60% of the studies (Table 4).




Out of the total sample, three were bibliographical surveys, one analyzed a data system, one organized teen groups in order to foster interpersonal skills, and five obtained data through interviews. Among them, one included rights counsellors as respondents in the study, one focused on adolescents and their families, one addressed healthcare practitioners and youngsters, and two focused only on adolescents. Among the studies analyzed, 70% (7) contained original data, with 57.14% conducted in Southeast Brazil, 14.28% in the Northeast, 14.28% in the Center-West and 14.28% in the South, which may be justified by the fact that Southeast Brazil was home to the largest number of youngsters between 10 and 19 years old during the period under study1.

Evidence-based research focuses on a hierarchical classification system, depending on the methodological approach adopted8. Consequently, among the seven levels of evidence proposed in the consulted literature9, those found in this study varied from 4 to 6, with 60% at the latter level, including descriptive and qualitative studies.

With regard to the topic proposed for this review - Sexual and Reproductive Rights of Adolescents - the data were clustered by similarity, with common aspects allowing a better analysis. Consequently, three core themes were identified: gender-related issues; sexual and reproductive rights ranging from negligence to breach; and autonomy and responsibility for the exercise of sexuality and reproduction during the teen years.

Gender-related Issues

The social contexts surrounding male and female respondents were a striking aspect of this survey, as 70% of the studies included remarks on social and cultural aspects reflecting gender inequality, consequently finding that: "differences between males and females" are "limited not only to the body, but also to the social and cultural spheres" (page 177)10, resulting in boys and girls experiencing them differently, including within the context of sexuality and reproduction.

One of the studies felt that the International Convention on the Rights of the Child and the Children's and Adolescents' Statute (ECA) were limited, as they did not specifically address differences between boys and girls11. On this aspect, according to the scientific literature, gender is related to:

Cultural aspects associated with each of the sexes, contrasting with the anatomical and physiological dimensions of human beings. Male and female absorb characteristics from multiple cultures, which are understood as cultural constructs rather than allusions to biological activism. Thus, status of being a man and being a woman occurs only as established in the culture that is produced /reproduced/shaped in each society12 (page 65).


Some of the studies listed here10,13, as well as another conducted previously15, described the naturalization of the condition of the home (private) as the place intended for women, with the street (public) for men.

Knowledge about the influence of religion and the macho culture on the classroom among adolescents, identified macho behaviors in terms of STD/HIV/AIDS, as shown in a study held in 20127. On the other hand, teen inhibitions about discussing issues such as sexuality and STD/AIDS prevention was noted10, as well as gender inequality that places women in a position of submission with little autonomy in affective-sexual decisions. However, it was noted that fertility control13 and blame for STD/AIDS infections are also assigned to women10,15, aligned with data that also indicate the continuation of the old standard assigning reproductive responsibility to women16, 17.

Trust between partners is viewed as a way of preventing STD16, with difficulties in negotiating the use of preventive and contraceptive methods also widely mentioned10,15.

Factors such as poor education, gender-unequal relationships, the absence of preventive strategies specifically targeting the youth public, and the lack of links with healthcare practitioners and facilities, identified as places only for women, were also identified as contributing factors leaving them more vulnerable to STD/AIDS10.

Epidemiological data18 reflect in figures the phenomenon of the "feminization of AIDS" among adolescents. During the 1990s, the number of young males between 10 and 19 years of age with confirmed diagnoses was some three times greater than the figures for girls. However, from 1998, onwards, this situation was reversed, with more of cases registered among girls.

Negative moral judgements are noted for unmarried girls getting pregnant, upholding the belief that female sexual activities are intended to fulfill the social functions of matrimony and motherhood19.

In counterpart, one study6 found that more than 90% of pregnant adolescents were unmarried, with a similar situation found in a study of young parents, with most of them live separately from their partners16.

The mainstream social model associates an active sexual life with maleness, indicating one of its fundamental requirements: virility13,15, with this factor already described as a vulnerable point for teen fatherhood14. Along these lines, the studies analyzed here indicate that sexual and reproductive constraints are limited to the female universe, with teen fatherhood still largely invisible in epidemiological and bibliographic terms, reflecting a lack of interest in exploring this reality and hampering the inclusion of these youngsters in public policy programs15.

This criticism has already been expressed in other studies14,16 addressing the need to include teen fathers in healthcare services13,15, steered by the recommendations issued by the International Conference on Population and Development (1994), the National Comprehensive Healthcare for Women´s Program, the Adolescents' and Young People´s Healthcare Program, the Comprehensive Men's Healthcare Program and some guidelines issued by the Ministry of Health, such as Sexual and Reproductive Rights: A Government Priority20, which encourage male involvement during pregnancy.

Traditional family structures still assign tasks, duties and responsibilities on gender-related bases, which is reproduced in terms of teen fathers, as they are also viewed as providers, with a significant resignification of work for playing this role16, as already shown previously14,16.

White, heterosexual, middle-class Judeo-Christian masculinity has already been described as the accepted and legitimized identity, viewed as the norm21. However, different aspects are also vital for the affirmation of the core identity, thus indicating what is permitted or not22. On the other hand, sexist and heterosexist cultural practices make women and homosexuals the first victims of breaches of sexual and reproductive rights23. Along these lines, it is stressed that there is repressive control over the bodies of young people: with girls, this focuses on pregnancy viewed as occurring too early; among boys, social doubts target homosexuality24.

It has already been mentioned that the teen years are a time of discovery and experimentation, when sexual expressions may occur among people of the same sex, as mentioned in a previous study 2. Fear of rejection caused by discrimination against homosexuality may expose youngsters to risks through attempting to disguise their status. This study found a link between homosexual experiences and higher family violence levels, drinking alcohol, taking drugs and prostitution, while also underscoring the importance of ensuring places in healthcare facilities where teens can speak openly and receive guidance that helps lower the risks inherent to their sexual practices.

It is noted that the social and cultural values assigned to each gender are also present in the views of these youngsters, such as: acceptance of hetero-normal families, submission of women and sovereignty of men23.

These descriptions show that sexuality and reproduction are experienced in ways that are pre-set by society for both boys and girls: if on the one hand girls are placed in a position that is submissive and inferior to boys, at the same time, the harmful consequences of the exercise of sexuality are also blamed on them, such as unplanned pregnancies and STD/AIDS infections. On the other hand, men suffer from invisible fatherhood15 and demands in terms of their sexual preferences. These socially in-built standards are reproduced by youngsters23, helping buttress breaches of their rights of sexuality and reproduction.

Sexual and Reproductive Rights: from negligence to breach

Sexuality is present throughout the entire human lifecycle and "during adolescence, sexuality has a special dimension, which is the appearance of reproductive capacities in human beings, concomitant with the restructuring of the psyche"20 (page 20).

In one study, the relatives and carers of youngsters living with HIV mentioned fears of positive-negative transmission; however, it was apparent that they did not feel qualified to address topics linked to sexuality with these youngsters25. However, these adolescents mentioned the need for support in the use of condoms and more detailed guidance. These teens acknowledge the need for help in safe sexual practices, and, despite passive concern over transmission during sexual intercourse among their carers, they will not avoid it. The positive-negative transmission discourse is strange, as who can ensure that these adolescents will not have intercourse with someone who also carries the HIV virus or some other sexually transmitted disease? The study in question made no mention of concerns over infection through viral exchanges or some other virus or bacteria, also sexually transmitted. These data may also be related to all the repercussions and stigma hovering around this disease, and it must also be borne in mind that the sample for this study was selected at HIV/AIDS reference facilities. Who knows whether guidance is lacking at the healthcare facilities where these youngsters are treated? This query derives from the fact that the practitioners monitoring these youngsters must not limit their care to only the disease, with concerns focused on controlling viral loads and medication use, as they are also living through adolescence, with all its physical and emotional repercussions, including the exercise of sexuality.

In general, a low level of information about STD/AIDS, ways of infection and types of prevention, in parallel to the absence of actions implemented through programs reaching out to the youth public, and links between healthcare facilities and adolescents10.

In today´s world, youngsters must cope with ambiguities related to the exercise of their sexuality, as on the one hand they are exposed to sex and nudity, while on the other they are subject to the moralistic influences of their social cultures, with stumbling-blocks hampering a thematic approach to these issues at healthcare facilities, as well as in their schools and their homes, resulting in neglected sex education19. Furthermore, limited dialogues with families and a lack of preparation among healthcare practitioners, patchy distribution of contraceptives and financial difficulties faced by youngsters attempting to buy them or hampers contraceptive management among adolescents and consequently the prevention of sexually transmitted infections 17.

When mentioned in the analyzed papers, Brazilian legislation - such as the Family Planning Act (1996) and the Resolution on Emergency Contraception (2006) - underscore the fact that they do not directly mention the word "adolescent", and that this group is included in the descriptions covered by other phrases such as "citizens" and "rights of all"; however, the rights of sexuality and reproduction of this segment of the population are not guaranteed26. The International Conference on Population and Development (1994) and the World Conference on Women (1995) that established sexual and reproductive rights as human rights are viewed as a step forward, as it was from then on that sexuality appeared as a right, without necessarily being linked to violence, marriage and reproduction13,24.

Adult discourse is descriptive and standardizing, viewing teens as irresponsible, unstable, immature and rebellious 13. The comments from the Children´s and Adolescent´s Rights Protection Council Members highlight reflections on the ambiguity of current discourse focused on ensuring comprehensive protection for adolescents, as this indicates that they are viewed as unworthy of trust, with the mention of care possibly being used to control their actions in order to ensure such protection, as mentioned in the scientific literature consulted24. Consequently, formal acknowledgement of adolescent rights does not reflect full acceptance and understanding of them, particularly those related to sexuality and reproduction11.

Some legal disputes contribute to this situation, such as the Brazilian Civil Law Code which ensures full exercise of rights from 18 years of age onwards; the fact that the Criminal Law Code forbids sexual intercourse with minors under 14 years old; Labor Laws allow work only after reaching 16 years of age; and the "optional" right to vote is also valid from 16 years of age onwards11. Associated with this is the fact that the Children's and Adolescents' Statute (ECA) and the Convention on the Rights of the Child are relapse, when portraying sexuality and reproduction only from the standpoint of its abuse and exploitation6,11,26.

These remarks prompt unfavorable repercussions among healthcare practitioners and education professionals in terms of guidance on sexual and reproductive health, due to fears of lawsuits and accusations that might undermine the quality of care for this public11. The studies portray the difficulties faced by the healthcare and education sectors when addressing the topic of teen sexuality and reproduction10,26. Difficulties encountered by these practitioners when dealing with this topic do not seem to be prompted only by a lack of technical skills, but also ethics linked to prejudice, prompting them to maintain a stance grounded on repressive control, with no effective guarantee of rights for this clientele24. It has already been mentioned that adolescents need access to information and practitioners trained to assist them, not limited to just technical skills, but also demanding the sensitivity needed to respect and encourage autonomy15.

Teen pregnancy is viewed as a social problem. This pathologization always views teen pregnancy as occurring too early, unwanted and unplanned6,13,15. However, such pregnancies may be wanted within this context, and even planned13, as shown in earlier studies 17,27,28,29.

The social representations of pregnancy among girls living at low social and economic levels is reproduced through the social discourse of its unsuitability during their teens. They nevertheless see pregnancy as a gateway to social acknowledgement and appreciation, as the lack of options open to them turns motherhood into a goal in their life stories19, as already mentioned27, with a strong link detected between underprivileged social and economic conditions and teen pregnancy. Furthermore, teen fatherhood has also been linked to underprivileged social and economic conditions, in addition to the lack of professional progress15, with this information already corroborated by other studies16,17.

Harsher social and economic factors with poorer care are associated with repeat pregnancies during the teen years6, as described above17, in parallel to fewer pre-natal care appointments, less access to education and difficulties in entering the job markets. This precarious access to social resources undermines the abilities of these adolescents to take autonomous choices when deciding on the number of children they want to have and when6.

Social inequalities have already been described as a factor hampering the exercise of sexuality among the underprivileged masses as dialogues on sexuality are limited, professional prospects are few, and pregnancy - even when unexpected - ensures easier exercise of sexuality with less embarrassment during this phase. Among youngsters in more privileged economic conditions, sexuality is more easily accepted, if properly managed in parallel to classroom progress and future ambitions17.

Some challenges must be surmounted when attempting to affirm the sexual rights of adolescents: discourse focused on the irresponsibility of youngsters which would justify a protective parental stance, and failure to assign high priority to problems involving the exercise of sexuality24.

Adolescents are interested in matters linked to sexuality and reproduction, but are overwhelmed by a lack of preparation for dealing with this need for information, where adults (relatives, teachers and healthcare practitioners, among others) produce a single type of standard reply about sexuality and reproduction during this phase of life, instead of easing up on their prejudices and value judgements. This situation is linked to socially unequal conditions surrounding Brazilian youngsters where there are links between underprivileged social and economic conditions and teen pregnancy in the reproductive field, which pave the way for some reflections: would it be fair to seek conception merely because it is biologically possible? Or because there are no other possibilities of achieving personal or professional fulfilment? Regardless of social, economic and cultural status, the wish to have children or not, constitutional rights do not ensure sexual and reproductive activities that are not violations. Fear of lawsuits and weak skills for addressing this topic and plain prejudice hamper approaches between adolescents and adults, with the discourse of protecting immature youngsters turning into control over their lives with little consideration for their real wishes, thus undermining the quality of the information to which these youngsters have access on the exercise of sexuality and reproduction in autonomous and responsible manner.

Autonomy and Responsibility in the Exercise of Sexuality and Reproduction during the Teen Years

The health-education-family triad is rated as crucial for ensuring the safe and healthy exercise of sexual and reproductive rights26. There is also a clear lack of places where adolescents can discuss and reflect on the exercise of their sexuality15,23. Schools address topics linked to sexuality and reproduction mainly from the biological standpoint23, while the healthcare sector focuses on preventing pregnancy and avoiding STDs, thus perpetuating normative and disciplinary practices that do not encourage self-care10,24. Mention is also made of the importance of providing conditions that favor the full exercise of sexuality with support, following the guidelines established by the International Conference on Population and Development and the World Conference on Women15.

With regard to the sexuality of youngsters living with HIV, approaches may not be limited to precautions ensuring that HIV-positive youngsters do not infect their HIV-negative partners; interventions are needed that help them conduct their lives in autonomous, aware and pleasurable ways6.

Confidentiality and privacy during medical appointments with adolescents is assured by the Nursing and Medical Codes of Ethics6, but this may not exclude contacts with families, which should be encouraged to participate in the lives of their younger members6,26. However, the right to privacy and confidentiality may foster more effective care in terms of guidance and encouragement to achieve responsibility and autonomy11.

During the teen years, individuals acquire their own sexual, family and job identities, with this phase recognized as a time of transition, which tends to blur the needs specific to this period, with a lack of respect for their rights. In order to reshape this situation, their potential must be properly appreciated, listening to their thoughts, criticisms and ideas30. Along these lines, the following is stressed in the scientific literature:

Adolescence needs adults across the board. Support offered to these youngsters is vital during this time of life, and ushering them through a wide variety of social, cognitive and psychic conflicts means listening, considering, negotiating and offering conditions that help ensure their initial choices and decisions are responsible and healthy, allowing them to be experienced with autonomy26 (page 51).


The authors7 believe that introducing preventive actions and activities promoting health must reach out to the teen world in order to build up knowledge about their behaviors and attitudes. More specifically, nursing practitioners must: "realize that they are not there to teach, but rather to offer conditions for building up knowledge jointly with their subjects"7 (page 574).

The social, cultural and economic diversity of these youngsters must also be taken into consideration 19, in parallel to investments fostering gender equality, working closely with the healthcare sector, schools, community and religious groups, parents and these youngsters themselves, in order for them to find places of dialogue and support that allow them to become the main players in the exercise if their rights10.

Swept by psychological and physical changes to which they must adapt, adolescents must also learn to live in this new social area surrounding them during the transition from childhood to adulthood. Their own immaturity and lack of experience, together with the eagerness to experiment, leaves them vulnerable to harm. It is well known that people with more experience can help in this process of discoveries, matches and mismatches, underscoring the importance of initiatives undertaken by social players with whom these youngsters come into contact, allowing them to access information and venues for discussions that prompt reflection on the ways in which they wish to lead their lives.

This is why relatives, education professionals and healthcare practitioners, among others in the many different social spaces where adolescents enter, must strive to collaborate with the experiencing and maturing processes of these youngsters, but without taking decisions for them, not confusing protection with control, as these teens have their own rights and potential, although still maturing. Consideration must also be given to the fact that each of them lives within a specific, social, cultural and economic context as individuals, with their own beliefs and desires, backed by guaranteed constitutional rights, including that of pursuing their own destiny.


CLOSING REMARKS

As a time of discovery and adaptation, adolescence requires backing and support to live through it more easily, which is why public policies and government programs assure the rights of this segment of the population, including autonomy in the exercise of sexuality and reproduction. However, families, schools and healthcare practitioners are not sufficiently prepared to promote the sexual and reproductive health of these youngsters, with qualified technical skills that are prejudice-free.

Consequently, identifying contemporary Brazilian scientific output on the sexual and reproductive rights of adolescents offers an overview of the real-life situations of these youngsters in terms of the exercise of their sexuality and reproduction. Acknowledging the paths followed by these studies on this topic may help steer actions and healthcare activities for adolescents and young people. This review revealed an incipient output on this topic, particularly in the Nursing, field, which indicates a pressing need for more research projects that could provide input for reflections and practices caring for the health and rights of this segment of the population.

Surveys such as these, which help identify the real needs and specific characteristics of adolescence and its many processes, in addition to the social, cultural and individual contexts of these youngsters will allow healthcare practitioners not only to convey information focused on preventing Sexually Transmitted Diseases (STDs) and lowering teen pregnancy rates, but would also steer investments in healthcare practices grounded on adolescent rights, including the exercise of sexuality and reproduction, thus perceiving individuals as autonomous beings in this field and above all as protagonists in their own lives.


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