Scientific Justification of Measures for the Prevention of Reproductive Health Disorders in Adolescent Girls of the Krasnodar Region

The dissertation by Kibel' O.A. is devoted to the scientific justification of measures for the prevention of reproductive health disorders of adolescent girls of the Krasnodar Region. The research encompasses a wide range of issues: medical-social characteristics of modern adolescents, the epidemiological situation regarding gynecological diseases and sexually transmitted infections, the practice of termination of unwanted pregnancies, as well as an analysis of reproductive attitudes, level of awareness, and psychodiagnostic state of the examined girls. Based on a comprehensive analysis, key risk factors have been identified and a system of preventive measures has been developed, including educational programs and trainings, including the use of summer health camps for girls from medically and socially risk groups.

At the present stage of societal development, against the backdrop of a low population reproduction rate and a persistently increasing morbidity among children and adolescents, the problem of national health constitutes a priority task of state policy (A.G. Vishnevsky, 1997; A.A. Baranov, 1998). Particular concern is aroused by the state of reproductive health of adolescents, which is determined by contemporary trends of increasing the number of sexually active adolescents (both young men and young women), a decline in the age of menarche onset, and an increase in the age of marriage, along with associated problems of adolescent pregnancies, abortions, the birth of out-of-wedlock children, as well as a high level of infection with sexually transmitted diseases (Baklayenko N.G., Gavrilova L.V., 2000). Such problems as adolescent pregnancy, sexual violence, and the rise of sexually transmitted infections have in recent years become leading issues in virtually all countries of the world (Khamadyanov U.R., 2000; Stevens S., 1995, et al.). In Russia, the incidence of gynecological diseases among adolescent girls has increased threefold over the last five years (Dolzhenko I.S., 2001). According to E.V. Uvarova (2003), pathological damage to the reproductive system of girls has reached 112%. Psychoemotional factors play a leading role in the emergence of disorders of the reproductive system of adolescent girls, reaching a level of 87.6% (Shevchik N.V. et al., 2002). Changing socio-economic conditions of society and the intensification of the educational process contribute to the disruption of the formation of the reproductive function in adolescent girls (Zatula N.V., Parashchuk Yu.S., 2001), while the destruction of family foundations and low culture of behavior characteristic of our youth and the parents and adults surrounding them do not contribute to the formation of skills of a healthy lifestyle, psychological resilience, and sex education for future wives and mothers (I.S. Savelieva, 2001). In connection with this, the preservation and restoration of reproductive health has become an important medical and state task, the successful resolution of which determines the possibility of species reproduction and the preservation of the gene pool (Kulakov V.I., 2002). The growing threat of disorders of reproductive and sexual health of modern youth, especially young women, dictates the necessity of conducting research aimed at identifying the main trends of recent years in the sphere of reproductive health, sexual and contraceptive behavior of adolescent girls in order to develop preventive programs for strengthening the reproductive potential of society. The goal of the research is to scientifically substantiate and develop proposals for the prevention of reproductive health disorders of adolescent girls of the Krasnodar Region. The research tasks are: 1. To determine the specifics of reproductive health of adolescent girls of the Krasnodar Region at the present stage. 2. To identify the specifics of their life attitudes, behavior, and psychological state depending on place of residence. 3. To establish the degree of preparedness of adolescent girls on issues of healthy lifestyle, sex education, and reproductive health and their needs for training. 4. To develop measures for enhancing awareness and necessary rehabilitation of adolescent girls on issues of healthy lifestyle, sex education, and reproductive health. Scientific novelty: This research was conducted among girls — the most receptive contingent of adolescents to the impact of the external environment and the most vulnerable in terms of psychological state and reproductive health and consequences for the reproduction of future generations. The specifics of somatic, mental, and reproductive health, as well as the character of sexual attitudes and behavior, psychological status, and level of knowledge on issues of sex education of modern adolescent girls of the southern region of Russia have been determined, taking into account their place of residence, the state of family relations, and their needs for training; on this basis, a scientifically grounded system of prevention of reproductive health disorders of girls has been developed — conceptual approaches and specific measures aimed at solving this task. Practical significance: It consists in the development of a system of testing and education of adolescent girls on issues of interpersonal relations, ethics of family relations, choice and use of contraceptives, prevention of STIs and HIV/AIDS. One of the solutions to this problem is the use of summer health camps for adolescent girls from medically and socially risk groups (with a certain experience of psychological maladjustment) for corresponding training of adolescent girls, which allows not only conducting their education and psychological training but also forming leaders who will be able to actively disseminate the acquired knowledge in their environment. Implementation in practice: The provisions of the dissertation have been used in the preparation of the substantiation of the Federal Target Program "Children of Russia"; an analytical reference for the State Duma "Demographic Situation in the Russian Federation", as well as in the creation of the author's training program for adolescent girls based on humanitarian principles and in the writing of three methodological manuals, which included the author's proposals for the prevention of diseases of the reproductive system for medically and socially risk groups. Dissertation research results were reported at: • International Conference "Healthy City — Healthy Children" (Stavropol, 2002); • Russian Scientific and Practical Conferences "Strategy of Reforming Regional Healthcare" (Moscow, 2003, 2004); • Republican Meeting "Children of Russia" (Moscow, 2005, 2006); • International Seminar "Protection of Women's and Children's Health" (Moscow, 2006). Publications: Four works have been published on the dissertation topic. Propositions to be defended: 1. Adolescent girls in modern society surpass adolescent boys in sexual activity, as well as in psychoemotional disorders accompanied by more pronounced syndromal disorders, including arterial hypertension and mental disorders, suicidal attempts. 2. Along with early initiation of smoking and consumption of alcoholic beverages, sexual contacts, the preparedness of adolescent girls for sexual life, their knowledge regarding contraceptive behavior, routes of infection, and measures for the prevention of STI and HIV infection are extremely low. 3. One of the promising methods of instilling in adolescent girls knowledge about reproductive and sexual health, the culture of sexual relations, and measures for the prevention of unplanned pregnancy and infection is their training according to a specially developed program in summer health camps specialized for adolescent girls from the medically and socially risk group.