Sexually Healthy and Personally Empowered Adolescents

Puberty signals the beginning of adolescence. It refers to the physiological or bodily changes that
result in development of sexual and reproductive capacity. It is a time of rapid physical growth that
brings about confusion, insecurities, and even fear among many adolescents.
>>All the bodily changes you have indicated on your body maps are part of puberty. At puberty, your
bodies are changing. Understanding your changing body will help you become comfortable with the
changes.
• The growth of your body from childhood to adulthood is known as puberty.
• Puberty is the biological changes of adolescence. It is the time in a boy’s and a girl’s life when their
body physically changes to become adults. The body grows bigger and taller.
• Puberty happens to everybody. But it doesn’t happen to everyone at the same time. At puberty,
boys and girls experience two most important physical changes. One is “growth spurt” and the other
is “sexual maturation.”
• “Growth spurt” means the body suddenly grows at a rapid rate. Boys and girls increase in height
and weight.
• At puberty, the body achieves “sexual maturation.” This means that boys and girls have become
capable of reproduction. It also includes enlargement of primary sex organs.
• Ito ang panahon ng inyong pagdadalaga at pagbibinata.

>>How does puberty start?

• About two years before you noticed the bodily changes, your brain started the work that will
eventually change you from children to adolescents.
• Two parts of the brain – the hypothalamus and the pituitary gland - start making more growth
hormones and sex hormones. The pituitary gland is located at the base of our skull at the back of our
head. [Help participants find the location of the pituitary gland by asking them to touch the base of
their skull at the back of their head.]
• The hormones act on other parts of the body to make the changes happen.
• The hormones that tell the body to sexually mature are testosterone, estrogen, and progesterone.
Every human has all these three hormones. Generally, females have more estrogen and progesterone
while males have more testosterone. But we all have some of each.

>>Puberty happens early for some people and later for others.
• When does puberty start?
○ Girls generally start puberty earlier than boys. Girls “growth spurt” usually starts when they are
around ten (10) years old or sometimes, as early as eight (8).
○ For boys, the first manifestation of changes often happen a little later than they do for girls,
somewhere between 10 and 12 years.
○ Boys continue to grow three (3) to four (4) years after most girls have finished growing until age
twenty (20) or twenty-one (21).
o The start of puberty is influenced by genes inherited from biological parents. Genes are like
instructions or codes in the body’s cells that define, for example, a person’s eye color, height, skin
color, and even the shape of ears.
○ Start of puberty is also influenced by nutrition (type and amount of food intake) and a host of other
factors such as physical activities and presence or absence of serious illnesses.
○ Because of genes, people are different from each other and go through puberty at different times
and at different rates. Some people seem to go through all the changes easily and others may have
a few problems.
○ Each one of us is unique. Let us respect and accept each one’s uniqueness.
One’s body image can affect self-esteem, decision-making, and behavior. You must learn to love
and take care of your bodies and should not conform to society’s standards about bodily
appearance that can affect your self-esteem. Love yourself!
4. At puberty, sexual and reproductive organs begin to mature. It’s a big deal when your looks
change but the biggest change of all during puberty are things you cannot see. These are the things
happening inside the body.
5. Most girls start to have menstruation or monthly period.
a. Beginning menstruation or “having a period” is one of the most significant events of puberty for
young women. Most girls begin menstruation between the ages of nine (9) and sixteen (16). The
average age is twelve (12) or thirteen (13).

b. It is advisable for girls who have not menstruated by 16 years old to consult with a medical
practitioner.
c. It is normal for young women to have an irregular pattern of menstrual cycles when they first start
having their period. It can take up to two or more years for young women to establish their regular,
more predictable cycles.
6. Boys begin to have erections and wet dreams or nocturnal ejaculation.
a. Ejaculation is the expulsion of semen through the penis. The sticky liquid is semen, not urine. It
contains millions of invisible sperms. Usually, about a teaspoon of semen is released at a time. Sperms
are the male reproductive cells.
b. The body continuously produces semen. Thus, if a boy does not masturbate or have sexual
intercourse, his semen may be ejaculated during sleep
7. Physical maturity is different from emotional maturity. While your reproductive system is already able
for pregnancy, parenthood is a totally different concern that requires emotional, financial, and social
maturity which you do not still have.
8. What can be done to have an enjoyable and healthy puberty?
a. Know and be aware of the various changes that are happening in your body.
b. Puberty is a time of rapid physical growth, so taking care of the body is especially important. Take
care of yourself by eating healthy foods, exercising, and getting plenty of rest so that your body has
the energy to cope with all the growing it still has to do.
c. Do not compare yourself with others. Each one goes through puberty at his/her own pace. Do not
be pressured by societal standards about bodily appearance because you are unique.
d. Consult experts when experiencing unusual changes in your body
9. Synthesis of the key messages:
a. At puberty, your bodies are changing. Understanding your changing body will help you become
comfortable with the changes.
b. Adolescents undergo puberty at different paces or speed. You have different body shapes, sizes,
and appearances. There is no “perfect” or “normal” body type.
c. Because of genes, the kind of food you eat, the kind of physical activities you engage in, and
whether or not you have an illness, your body will reach maturity at your own pace.
d. Physical maturity is different from emotional maturity. While your bodies may be ready for
parenthood, emotionally, you may not be prepared for the responsibilities of parenthood.
e. Make puberty an exciting time for all of you

FERTILITY
1. At puberty, you become fertile and ready for reproduction.
2. For girls, fertility is the ability to conceive or become pregnant and bear children.
3. Male fertility is the ability of males to provide healthy sperm capable of starting a healthy
pregnancy. A male is fertile if he has the ability to provide healthy sperm capable of starting a healthy
pregnancy in a female.
4. You need to be aware of your fertility to make you more responsible in expressing your sexuality.
Knowing one’s body and fertility empowers the person to make a healthy, informed and responsible
decision on his/her family life aspirations.
5. A female is fertile only on certain days of each menstrual cycle and these are only the days when
she can become pregnant. Unlike the males who are fertile every day throughout their life, females
are fertile only on certain days of each menstrual cycle and these are only the days when they can
become pregnant. A female’s “fertile days” are those that fall on the few days before and during
ovulation.
6. What is Ovulation?
a. Girls are born with two ovaries which both contain thousands of eggs.
 b. When a girl reaches puberty, the hormone estrogen tells an ovary to release one egg every
month. Then the two ovaries take turns releasing an egg each month. When an ovary releases an
egg, the process is called ovulation.
c. Each month, only one ovary releases an egg. On rare occasions, however, both ovaries
release an egg in a month.
d. Around the time when the ovary is about to release an egg, females get a whitish and
sticky liquid from the vagina. If sexual intercourse happens around this time and sperm is ejaculated
into the female’s vagina, the sticky liquid helps sperm travel through the cervix and uterus to meet
and join the egg in the fallopian tube.
e. A female’s “fertile days” are days she ovulates. Sperm can survive in the fallopian tubes for
as long as five (5) days and the egg, if it is not fertilized, survives for as long as 24 hours. It is difficult to
predict the fertile days because the period from the beginning of menstruation to ovulation may
change.
f. Some females learn how to observe the changes in their secretions and body temperature
to track their fertile period. This is called the “fertility awareness” technique.
g. If the egg is not fertilized, it leaves the body together with some tissues and blood from the
uterus through the vagina. This signals the start of menstruation or beginning of the next menstrual
cycle.
What is Menstruation?
a. Menstruation comes from the Latin word mensis, which means “month.” Most females have
a period each month. This is why menstruation is also called “monthly period.”
b. Menstruation is when females release fluid, including blood, through their vagina. It happens
because the lining of uterus (called endometrium) sheds and leaves the uterus passing through the
vagina.
c. The first time menstruation happens is called “menarche.”
d. Menstruation is part of the female reproductive process just as sperm production is part of
the male reproductive process. Only females have menstruation.
e. The beginning of menstruation is a natural and very important moment in every girl’s life. It
marks the beginning of her transition from being a “girl” to becoming a “woman.” It also signals that
her body has become capable of getting pregnant or having a baby.
f. There is no “right” or “exact” time for menstruation to begin. Periods will start when the body
is ready. Most females, however, start to have menstruation between the ages of 10 and 16. There are
those who start to have it earlier or later.
The Menstrual Cycle
A female’s menstrual cycle starts from the first day of one period and lasts until the
beginning of the next period. Then the cycle starts again.
A period lasts for a few days (three to seven days). This is the time when the body sheds the
ruptured uterus lining. When the period stops, one of the ovaries gets ready to release another egg
and the uterus starts to build a thick lining again.
The egg is then released and travels through the fallopian tube.
For a 28-day cycle and 5–day menstrual flow, the following describes what happens inside
a female’s reproductive system:
Menstrual Phase (Menstruation or period)
o The first day of the cycle is the first day of menstruation. A woman experiences bleeding
from her vagina during menstruation which normally lasts from three to five days.
o The menstrual phase includes all days of menstrual bleeding.
o The bleeding experienced by the woman is actually the shedding of the thickened uterine
lining which is prepared in case there is a pregnancy.
o During menstruation, the ovaries are resting, the cervix is open allowing the uterine lining to
flow to the vagina.
o There is no cervical mucus present.
o The basal body temperature is low, around 360 C to 35.50C when a drop in estrogen and
progesterone occurs. The period where estrogen and progesterone levels are its lowest-- shedding of
endometrial lining took place.
Pre-Ovulatory Phase (preparation of the egg)
 o The pre-ovulatory phase includes all dry days after the menstrual bleeding stops. The length
of the pre-ovulatory phase varies. Some women may not be able to observe dry days after
menstruation, especially women with short cycles.
o During this phase, the following changes are happening inside a woman’s body:
■ bleeding has stop;
■ egg cells begin to develop and mature;
■ lining of the uterus starts to thicken;
■ mucus forms a plug - this mucus prevents entry of sperms;
■ the cervix is firm and closed (A woman experiences dry feeling and no mucus); and
■ the pre-ovulatory phase is the relatively infertile phase which includes all dry days
after the menstrual bleeding stops.

Ovulatory Phase
o This is the highlight of a woman’s fertility. It Occurs 12-14 days before the onset of the next menses.
o One mature egg is released and stays in the fallopian tube. It can be fertilized by the male sperm for
only up to one day or 24 hours.
o The uterine lining continues to thicken, ready to receive the fertilized egg.
o The cervical mucus is wet, slippery, stretchy, and clear. This mucus helps sperm live and swim to
reach the egg. It nourishes the sperms.
o The vaginal sensation is wet.
o There is a slight dip in the basal body temperature, about 0.50 Celcius.
o The cervix is soft and open.
o The estrogen drops a bit, but remains high.
o Progesterone begins to rise.

Post-Ovulatory Phase
o No egg is present. If there is no meeting of egg and sperm, the cell deteriorates and is absorbed.
Lining of the uterus has thickened.
o The mucus forms a plug again to prevent entry of sperms.
o Women experience dry feeling with no mucus at all. If mucus is present, it is sticky, cloudy, crumbly,
or pasty.
o Because there is no pregnancy, the woman will experience menstruation and another cycle begins
o The post-ovulatory phase is absolutely infertile phase which covers about 14-16 days.
o It has a constant length which is approximately 14-16 days. After ovulation, the follicle is transformed
into the corpus luteum, which produces an increasing amount of the hormone called progesterone.
h. Tracking your Menstrual Cycle
To keep track of menstrual cycle, when they begin and end – it is helpful to keep a personal
calendar. Each month, circle or shade the days when you are having your menstruation. If you do this
for a year or two, you will see a regular pattern of your menstruation. This will enable you to easily
predict your next period.
Keeping a calendar will also help you to know if your period is late or early. It will inform you
whether you have to consult a doctor.
8. A male is considered fertile if he has the ability to provide healthy sperm capable of starting a
healthy pregnancy in female.
a. Beginning at puberty and for the rest of their life, males are fertile every day for as long as
they are healthy although fertility declines with age.
b. The main purpose of the male reproductive system is to produce the sperm that is needed
to fertilize a female’s egg. Sperm are the male reproductive cells whereas the ova or eggs are the
female’s reproductive cells. These two cells are necessary to reproduce or to create a new life or to
make a baby.

How are sperms produced?

 Sperm is the male sex cell. Under a very powerful lens or a high magnification, they look
like tadpoles. They appear to have a head and a long tail.
To produce healthy sperm, the testicles have to be slightly cooler than normal body
temperature – two to three degrees lower. This is why the penis and scrotum hang outside the body.
Notice that when it is cold, the penis and scrotum shrink. They draw themselves closer to the body to
keep warm. When it is hot, they will hang loose away from the body.
The testicles begin to produce sperm only during puberty. During puberty, the level of the
hormone testosterone in the male body begins to rise and this causes the penis and testicles to get
bigger, and the testicles to begin producing sperm.
During sexual excitement, the testicles and epididymis release sperm that move through
the sperm ducts towards the penis. Along the way, they mix with a fluid so they can move more easily.
The sperm and this fluid are now called semen. It is whitish and quite sticky. The sperm are too tiny to
see – a drop of semen that is the size of the period at the end of this sentence would contain roughly
a million sperm. Semen leaves the penis through the urethra. This is a tube that goes through the
middle of the penis. (Urine also leaves the body through the urethra, but never at the same time as
semen).
From the time boys had their first release of semen, called ejaculation, they have become
fertile and able to father a child for the rest of their life.
d. What are erections? Erections can occur for any number of reasons, but are usually triggered by
sexually arousing thoughts or stimulation. During arousal, hormones, muscles, nerves, and blood vessels
all work with one another to create an erection. Nerve signals, sent from the brain to the penis,
stimulate muscles to relax. This, in turn, allows blood to flow to the tissue in the penis.
Boys may also experience erections during their sleep, which can sometimes result in a “wet
dream,” which occurs if one ejaculates while sleeping.
e. When semen spurts out of the penis, it is called ejaculation. It happens when muscles at the base of
the penis start to expand and contract (tighten). This pushes the semen through the urethra and out
through the tip of the penis. But this will not happen every time you have an erection. It will usually
happen if you are very sexually excited.
For every ejaculation, a male releases millions of sperm.
Before the ejaculation, the Cowper’s glands release a drop or two of fluid through the tip
of the penis. This is called pre-ejaculate, and it cleans the urethra. The pre-ejaculate alone does not
contain a sufficient number of sperms that are strong enough to cause pregnancy (unless sperm from
a recent ejaculation are still present).
Once a male ejaculates (inside a female’s vagina), he can cause a pregnancy.
9. FERTILIZATION AND PREGNANCY. When a male’s sperm unites with a female’s egg or ovum,
fertilization takes place and pregnancy may happen.
a. When a sperm joins with an egg (fertilization), an embryo may be formed. The sex of the
embryo is determined by the male’s sperm, not by the female’s egg.
b. A pregnancy results if the embryo attaches to (is implanted in) the lining of the uterus. It is
this embryo that will develop into a fetus if the pregnancy continues.
10. Most commonly, pregnancy occurs through vaginal intercourse between a male and a female.
a. When the male ejaculates, the semen (containing the sperm) inside the male reproductive
organs is released into the female’s vagina. An ejaculation contains at least four million sperm.
b. The sperm swims up the vagina, then to the uterus, and move towards the fallopian tubes.
c. Hundreds of sperm surround the egg, but only one sperm will be successful to fertilize the
egg.
d. The egg and sperm join together to form one new cell. Few hours later, this new cell splits to
create two cells. These cells continue to split until a ball of cell is formed. This ball of cell is called a
“blastocyst.” The blastocyst continues to form more cells as it moves down the fallopian tube. It takes
about seven days for the blastocyst to reach the uterus. When in the uterus, the blastocyst attaches
itself to the soft lining.
e. The cells inside the blastocyst will grow into a baby. The cells on the outside join the wall of
the uterus and form a protective organ called the “placenta.” The placenta provides the baby with
food and oxygen from the mother.
11. Being aware of your own fertility process helps you to take care and protect yourselves from
unintended pregnancies.
a. While pregnancy can happen due to sexual maturation of adolescents, it is a choice that needs to
be made responsibly based on one’s psychological, physical, emotional and financial preparedness.
12. Synthesis of the Key Messages:
a. At puberty, boys and girls become fertile. A female is fertile if she has the ability to become
pregnant and carry a healthy pregnancy to birth. This means that her ovaries are able to release an
egg each month, which when fertilized by sperm, will develop into a baby and delivered after nine
months.
b. Females have “fertile days” or certain days in their menstrual cycle when they can become
pregnant. These days fall on the day of ovulation – when an ovary releases an egg to the fallopian
tube – and five days before ovulation. This period is difficult to predict. It may vary for certain women
and on certain menstrual cycle. What is fixed is that 14 days after ovulation, menstruation begins and
a new menstrual cycle takes place.
c. A male is fertile if he has the ability to provide healthy sperm capable of starting pregnancy in a
female. This means that his testicles or testes are able to produce healthy sperm – enough in number
and able to swim up to the fallopian tubes – that can fertilize the female’s egg.
d. Unlike females, males are fertile from the time of his first ejaculation and through the rest of his life
for as long as he is healthy.
e. Fertility declines naturally with age for both males and females, although this decline takes place
earlier in females.
f. When a male’s sperm unites with a female’s egg or ovum, fertilization takes place and pregnancy
may happen.
g. Most commonly, pregnancy occurs through sexual intercourse between a male and a female –
during which the male’s penis enters the female’s vagina and the male ejaculates, releasing sperm.
h. While pregnancy can happen due to sexual maturation of adolescents, it is a choice that needs to
be made responsibly based on one’s psychological, physical, emotional and financial preparedness.

FEMALE PARTS
MALE PARTS
1. Early pregnancy among adolescents is caused by complex and interrelated factors. Some of the
factors identified by literature include the following

2. Social norms and peer pressure influence sexual behaviors among adolescents. However, negative
peer pressure including engaging in sexual activities should be challenged through critical thinking
and assertiveness.
a. It is not because “everybody is doing it” that one should be pressured to do the same. Critical
thinking and assertiveness are needed to prevent consequences of negative pressures from peers,
media, or the society as a whole.
b. It is always okay to be different!
3. Too early pregnancy puts the young mother and her baby at risk of health complications and even
death.
a. Motherhood at a very young age entails a risk of maternal death that is much greater than
average, and the children of young mothers have higher levels of morbidity and mortality.
b. Pregnant adolescents are exposed to the following health risks especially when they fail to access
timely and appropriate maternal health care:
Obstructed labor or difficult delivery. Adolescent girls are still growing and their pelvis has
not yet reached its full size. Pregnancy increases the body’s nutritional needs and can slow down
growth size. If an adolescent girl gives birth and her pelvis is not yet at its full, she may suffer from what
is called “obstructed labor” delivery or difficult delivery.
Obstetric fistula. A damaging complication of obstructed labor is obstetric fistula. In this
case, there is a hole between the vagina and the bladder or rectum. A female afflicted with this
condition constantly leaks urine or feces and smells bad.
Unsafe abortion. Overall, complications from unsafe abortion is one of the main causes of
maternal deaths. Since most of teenage pregnancies are unintended or unplanned, and because of
the shame, social stigma, and unpreparedness of the young mother and father to bear the child,
many pregnant girls resort to unsafe abortion. Unsafe abortion can also result in lasting and
devastating consequences including, sepsis, perforation of the uterus or intestines, hemorrhage,
chronic pelvic infection, and infertility.
Pressure to mental health. Carrying a baby and becoming a mom not only creates
physical changes. Women also go through mental changes. Young moms face added stress from
sleepless nights, arranging child care, social stigma, and attempting to finish schooling.
c. The baby of adolescent mothers or teen moms are also exposed to medical complications. Studies
have shown that children among mothers have higher levels of mortality and morbidity (diseases).
Some of the health risks among babies born from young mothers include:
 Babies of adolescent mothers are likely to have low birth weight;
They may also run a higher risk of being premature; and
Have a higher risk of dying before delivery.
4. Too early pregnancy puts you at risk of having DISRUPTED dreams and aspirations (i.e. social cost of
teenage pregnancy):
a. – Dropping-out of school due to difficulty of balancing the physical stress of carrying a child and
completing studies;
b. – Incapacity to assume parental and familial responsibilities further resulting to incapacity of young
couples to raise their child and family responsibly;
c. – Social stigma and discrimination attached to negative and prevailing assumption of social
promiscuity among pregnant adolescents;
d. – Repeat pregnancy especially resulting from continued exposure to sexual activities with the
mother’s partner;
e. – Unemployment or underemployment – primarily due to lack of education or training required for
available or higher paying jobs;
f. – Poverty – Without education and employment, young parents have high vulnerability to poverty;
g. – Taking illegal drugs or substance abuse – as a means to “escape” from or deal with the difficulties
of being a young mother or father;
h. – Emotional instability or crisis due to the pressure and tension from taking care of the pregnancy,
social stigma, and lack of family support, among others; and
i. – Dependence to family and government on basic needs – as young couples are unable to
provide for their needs, they will be highly reliant to their families and to the government.
5. Too early pregnancy also affects the adolescent father:
a. Inability to cope with the demands of fatherhood;
b. Isolation from friends;
c. Inability to relate with equally young and inexperienced wife; and
d. Opposition or inadequate support from their family.
6. To prevent early and unwanted pregnancy, you should abstain from or delay the debut of your
sexual relations.
a. Not engaging in sex or abstinence is the safest and most effective way to prevent pregnancy.
Adolescents need the capacity to refuse, abstain, or at least delay engagement in sexual intercourse.
For this, adolescents need proper information about their sexuality so they can be effectively guided
in making responsible decisions.
b. For sexually active adolescents, correct and consistent use of contraception (or family planning
method) can prevent pregnancy. All adolescents regardless of age and sex are allowed by law to
seek reproductive health or family planning information from any health facility or services provider.
However, the Responsible Parenthood and Reproductive Health law requires parental consent from
adolescents below 18 years old for accessing modern methods of contraception.
7. Mutual consent is a requirement before any sexual activity with a partner. Any unwanted sexual
activity that happens when one partner is pressured, tricked, threatened, or forced in a nonphysical
way by the other partner is sexual coercion.
a. Coercion can also make one think she/he owes sex to someone such as her boyfriend (i.e. for fear
of being abandoned).
b. Sexual coercion and harassment are violations of human rights that need to be reported to
authorities.
8. There are medically and legally safe and acceptable methods of contraception or family planning
(FP) that can prevent adolescents from getting pregnant and STIs. Access of minors (below 18 years
old) to modern methods of family planning requires parental consent.
a. Different methods of contraception have different mechanism of action, effectiveness rate, benefit
or advantages, and side-effects. It is important for any user to receive full information about these
methods so they can decide based on informed choice and voluntarism.
b. The various family planning or contraceptive methods available and certified as non-abortifacient
in the country are as follows:
9. Preventing teenage pregnancy requires the participation of both male and female adolescents.
Boys can prevent teenage pregnancy by:
a. abstaining from sex;
b. communicating with his female partner and respecting his partner’s decision not to have sex;
c. educating himself about the different contraceptive or family planning methods;
d. using condoms correctly and consistently for sexually active adolescents;
e. avoiding risky behaviors such as smoking, drinking, and taking illegal drugs; and
f. supporting his partner to finish her education towards the achievement of their aspirations or
dreams.
10. Synthesize the discussion with the following:
a. Engaging in unsafe sexual intercourse may lead to pregnancy. Too early adolescent or teen
pregnancy puts mother and baby at risk of health complications. In addition, it causes adolescent
mothers, and also adolescent fathers, to stop schooling, and bear its social cost.
b. The surest way to prevent pregnancy is NOT to have sexual intercourse. Everyone has the right to
refuse sex. Everyone should respect that right.
c. People who have become sexually active but do not want a pregnancy can choose to use
contraception.
d. Contraception or family planning is any method used to prevent pregnancy. Different methods are
used in different ways and at different times.
e. Consulting a health care provider can help in choosing a suitable contraceptive or family planning
method. Those below 18 years old, however, need parental consent to access contraceptive or
family planning services.

PREVENTING SEXUALLY TRANSMITTED INFECTIONS

1. Sexually transmitted infections (STIs) are infections spread through sexual activity. They are
preventable.
a. There are many kinds of sexually transmitted infections (STIs). Among the STIs that can have serious
consequences are: HIV (the virus that causes AIDS), syphilis, gonorrhea, chlamydia, trichomonas, and
herpes.
b. In the early years of the HIV/AIDS epidemic (1984-1990), 62% (133 of 216 cases) of those diagnosed
were female. From 1991 to present, males comprised 94% (52,539) of the 56,048 diagnosed cases in
the Philippines. However, the number of diagnosed HIV infections among females has also been
increasing in recent year.
The number of females diagnosed from January to June 2018 (304) was almost three times the
number of diagnosed cases compared to the same period of 2013 (110), five years prior. 93% (3,373)
of all female cases were in the reproductive age group (15-49 years old) at the time of diagnosis.
The predominant age group among those diagnosed has shifted from 35-49 years old between
2001 to 2005, to 25-34 years old starting from 2006 to present.
The proportion of HIV positive cases in the 15-24 age group increased from 25% in 2006-2010 to
29% in 2011- 2018.
c. Some STIs cause symptoms or discomfort. Others do not always have symptoms (especially among
females). Even when an infection does not produce symptoms, it can have serious health
consequences including endangering fertility or even life.
d. For some STIs, girls are physiologically more vulnerable to infection than boys.
e. AIDS (acquired immunodeficiency syndrome) is a syndrome caused by a virus called HIV (human
immunodeficiency virus). The disease alters the immune system, making people much more
vulnerable to infections and diseases. This susceptibility worsens if the syndrome progresses.
HIV is found throughout all the tissues of the body but is transmitted through the body fluids of an
infected person (semen, vaginal fluids, blood, and breast milk).
How is HIV transmitted?
Sexual transmission — it can happen when there is contact with infected sexual fluids (rectal, genital,
or oral mucous membranes). This can happen while having sex without a condom, including vaginal,
oral, and anal sex.
Perinatal transmission — an infected mother can transmit HIV to her child during childbirth,
pregnancy, and also through breastfeeding.
Blood transmission — pertains to the risk of transmitting HIV through blood transfusion. Among people
who inject drugs, sharing and reusing syringes contaminated with HIV-infected blood, is extremely
hazardous.
2. The surest way to avoid getting or transmitting an STI is not to have sex. For sexually active young
people, they need to correctly use condom to protect themselves from these infections. Persons
infected with STIs including HIV should seek timely and appropriate treatment from public or private
health facilities.
a. Every person has the right to protect himself or herself against STIs. Likewise, everyone has the right
to refuse unsafe sex or sex that is unwanted for any reason. This right should be respected at all times.
b. Some but not all STIs are curable. Taking proper preventive measures can prevent re-infection.
Proper treatment can often reduce symptoms and/or dramatically slow the progress of those STIs that
cannot be cured (for example, herpes, HIV infection, and HPV).
c. For the prevention of STI and HIV/AIDS, observe A-B-C-D-E:
– Ayoko Muna! (Abstinence)
– Basta tayong dalawa lang! (Be faithful!)
– Condom ay laging gamitin! (Condom use)
– Check-up ay ugaliin! (Seek check-up, testing and timely treatment)
– Drugs ay iwasan! (Drug prevention)
– Edukasyon ay kailangan (Educate self and others about STI, HIV/AIDS prevention)

d. Any person who is HIV-positive has the right to obtain needed services and treatment.
Care may include, for example, access to medications, special medical attention during
pregnancy or illness, and social services with ongoing counseling support.
3. In real life, many people do not use protection against STIs including HIV.
a. Some people do not use protection because they lack information, skills, or basic access to
services.
b. With some people, engagement in sex is spontaneous, thus, they do not have time to access
condom. Communication between partners for protected sex can help the prevention of STI and HIV
infections.
c. Some people do not use protection because they are in circumstances of unequal social power.
Young people, particularly girls, may feel pressured by their partner to show their love by having sex
without a condom. Moreover, a significant age gap between partners may make it difficult for the
younger person to insist on condom use.
Within marriage, women and girls are often obligated to have sex or to have a child, even if they
feel that it is not safe.
Both men and women who are paid to have sex may be paid extra — or coerced — to have sex
without condoms.
Initiating a discussion about sex or sexual health may be considered inappropriate or taboo for
women and girls.
Some people feel that asking a partner to use condom may provoke suspicion of sexual infidelity
and may trigger conflict, anger, or violence. Such reactions result in serious harm to many women
throughout the world.
Sex that is forced (in addition to being an act of violence) often takes place without condoms;
hence, it is more likely to carry a risk of HIV and other STIs.
4. All people have a right to know their own HIV status and to obtain confidential testing and
counseling services. People also have a right not to be tested.
a. People living with serious and incurable STIs such as HIV infection can live a long time and can
maintain a relatively normal life, including having safe, satisfying, and supportive sexual relationships.
However, doing so requires social and health care support and attention to the rights of people living
with HIV or AIDS.
b. People living with HIV or AIDS need counseling and support to be comfortable speaking with others
about their status.
c. Some people suffer as a result of telling their partners or family members that they are HIV-positive.
Many find that their partners and family members are understanding and helpful.
d. People living with HIV or AIDS have the right to live free of stigma and discrimination. Unfortunately,
this right is often not respected.
5. Synthesis of the Key Messages:
a. STIs are preventable. The safest way to prevent STI is not to engage in sexual activity. People who
are sexually active can take steps to prevent themselves from getting an STI. One of them is using a
condom correctly every time they have sex or prevent from having sex.
b. Don’t leave STIs undiagnosed and untreated to prevent affecting your future fertility.
c. Every person has the right to protect himself or herself against STIs. This is true whether one’s partner
is of the same or the other sex.
d. HIV is one of the most serious infections that people can acquire through sex. People who have
had an unprotected vaginal or anal sex in the past six months should take the HIV test.
e. All people have the right to know their own HIV status and to obtain confidential testing and
counseling services. People also have the right not to be tested.
f. Reach out to local peer educators or HIV counsellors for HIV testing.
g. Abstain; Be faithful; use Condom!; get Check-up and testing; prevent Drug use; and Educate self
and others.

a. After childhood, everyone goes through the adolescence phase. Adolescence is the period in life
when children turn to adults. It is a transition period, meaning a temporary or passing state. It begins
with puberty or all the physical changes that prepare a child to become adult.
b. Puberty begins early for some people and later for others. Age of puberty is influenced by genes,
nutrition, physical activities, absence or presence of illness, and other environmental factors unique to
individuals.
c. At puberty, sexual and reproductive organs begin to mature. Females begin to grow breast buds,
grow underarm and pubic hair, have menstruation, and other physical changes. Males begin to grow
hair on their face, pubic area, and underarm, to have wet dreams, and other physical changes. All
these changes can be both confusing and exciting.
d. At puberty, young males and females become fertile. A male is fertile if he is able to provide
healthy sperm that can make a female pregnant. A female is considered fertile if she is able to
become pregnant and carry a pregnancy to birth. When a male’s sperm unites with a female’s egg
through vaginal intercourse, fertilization takes place and pregnancy occurs.

e. In addition, puberty brings about new feelings, which we will discuss more in the next module. One
of them is curiosity about sex. Adolescents may explore their sexuality by themselves or with a sexual
partner. If they engage in sex without using any form of contraception, it may lead to pregnancy
and/or an STI including HIV.
f. Too early pregnancy puts the health and life of the adolescent mother and baby at risk of problems
including death. Most STIs, if left undiagnosed and untreated, may lead to infertility in adulthood. HIV,
if left undiagnosed and untreated, may lead to the deadly AIDS. Girls who have sex during
adolescence are doubly at risk of getting the human papilloma virus (HPV) that causes cervical
cancer. These are more than enough reasons for adolescents like you to decide against engaging in
sex at this point in your life.
g. The surest way to prevent pregnancy is not to have sex. Everyone has the right to refuse sex
especially if it is unwanted for any reason. If you have become sexually active, you can protect
yourself against unwanted pregnancy by using a contraceptive or family planning method that suits
you. Consult your local service provider.
h. The surest way to prevent STIs including HIV is not to engage in vaginal, anal, or oral sex. Everyone
has the right to refuse unsafe and unwanted sex. If you have become sexually active, you can
protect yourself by using a condom correctly each time you have sex. To learn about proper condom
use, consult your local peer educators or HIV counsellors.
i. Knowing about your changing body can be exciting and empowering. It enables you to own your
body and protect it from possible harm and abuse, including unwanted sex.

Puberty and Boys

For boys, puberty usually begins between the ages of 10 and 13, a couple of years later than it begins
for girls. Boys typically finish puberty in their late teens or early twenties, when skeletal growth is
complete.
What changes do boys experience during puberty? Like girls, boys may find that their feelings and
interests change during puberty. Physical changes also occur. These changes are different for every
person but typically occur in this order:
• The testes and penis grow larger.
• Pubic hair begins to grow; it gradually increases in amount and becomes coarser and curly.
• The voice begins to change and deepen, usually gradually but sometimes suddenly.
• About a year after the testes begin to grow, a boy may begin to experience ejaculation (release of
a white milky fluid called semen from the penis).
• Underarm hair grows and sweat changes scent to adult body odor.
• Facial hair develops.
Boys also experience a growth spurt and muscle growth. Skin becomes oilier, increasing the likelihood
of acne, a skin condition. About half of boys experience slight temporary breast growth, which
disappears in a year or two.
What causes erections? Erections occur throughout life. An erection is caused by blood filing the
spongy tissue in the penis as a result of sexual stimulation; lifting or straining; dreaming; being cold;
wearing tight clothing; feeling fear or excitement; or having a full bladder on waking. An erection
may have no apparent cause, especially during puberty. Boys often get sudden or spontaneous
erections, sometimes many times a day. These are the result of high or changing levels of the
hormone testosterone.
Having an erection without ejaculation, this may cause a temporary feeling of “heaviness” but is not
harmful in any way. If an erect penis is not touched, the erection will subside by itself.

What happens during ejaculation?

Prior to ejaculation, the Cowper’s glands release a drop or two of fluid through the tip of the penis.
This is called pre-ejaculate, and it cleans the urethra. The pre-ejaculate alone does not contain a
sufficient number of sperm that are strong enough to cause pregnancy (unless sperm from a recent
ejaculation are still present). HIV may be present in the pre-ejaculate, however. Full ejaculation
involves the release of semen, which typically contains hundreds of millions.
What are wet dreams? Men regularly have erections during sleep, and about 80 percent of them
occasionally ejaculate. This kind of ejaculation is called a nocturnal emission or “wet dreams.”
Men regularly have “wet dream.” Wet dreams are common during puberty, but adult men may also
have them. A boy or man who masturbate or has regular sex is less likely to have “wet dream.”
Wet dreams (and masturbation) are not harmful in any way. They may release tension and be a
source of pleasure. Nor do wet dreams “waste” sperm. The testes are continuously making new sperm
and wet dreams are one way the body rids itself of stored sperm.
Puberty and Girls
For girls, puberty begins between the ages of eight (8) and 13, about two years earlier than for boys.
Girls typically finish puberty between the ages of 16 and 17 or around the time that their skeletal
growth is complete.
What changes do girls experience during puberty? Changes at puberty differ from person to person.
Although they may vary in timing, sequence, and speed, girls’ bodies typically develop in this order:
• Breast growth begins, often on only one side at first. Full development takes about two years.
• Pubic hair begins to grow, gradually increasing and becoming coarser and curly.
• Inside a girl’s body, the surface of the vagina thickens and the uterus and ovaries increase in size.
• The first menstrual bleeding, menarche, usually occurs two to three years after breast development
begins. Many girls have irregular periods for the first couple of years. Once a girl ovulates, she can
become pregnant.
• Underarm hair grows and body sweat changes, resulting in adult body odor.
• The cervix starts producing mucus that is discharged from the vagina. This mucus is normal and is a
sign of natural changes related to fertility and menstruation.
Girls also experience a growth spurt, their pelvis and hips widen, fat tissue increases, and the skin
becomes oilier, increasing the likelihood of acne. As with boys, girls’ interests and feelings may also
change with puberty. In the days before menstruation, girls commonly experience strong feelings of
different kinds, for example, joy, sadness, sensitivity, and anger.

Managing menstruation
Menstruation is natural and part of being a healthy female. Having one’s first menstrual period
can be an exciting event, especially if the girl knows what to expect. Unfortunately, many girls worry
or are afraid when their first period comes because no one has explained to them what it means and
requires. Some parents may feel embarrassed to talk about it. Or the girl may have absorbed
messages from her culture or religion suggesting that menstruation is somehow unclean.
Menstruation, however, is part of the body’s means of renewing itself and maintaining fertility. During
menstruation a girl can generally engage in all of her regular activities. Bathing during menstruation is
important. The vulva should be washed with water and mild soap to remove any blood that is left.
How women take care of their menstrual flow varies in different settings. Many women use pads to
absorb the blood. In some places, women buy pads that can be thrown away after use. In other
places, they employ reusable pads made from folded cloth; these must be washed thoroughly after
each use with soap and water. Having a private place to change or wash pads (both at home and
at school) is important.
Many women and girls use tampons instead of — or in addition to — pads. A tampon is a small mass,
made of cotton (or other absorbent material), and often shaped like a finger to fit comfortably into
the vaginal canal. Tampons are inserted into the vagina to absorb the menstrual blood. Tampons
must be changed at least twice a day. Leaving a tampon in for more than a day can cause a serious,
even deadly, infection. (Inserting any unclean object into the vagina can also cause a serious
infection.)
The amount of menstrual bleeding — the menstrual flow — varies from day to day and by person.
Bleeding may be heaviest during the first days of the period. Some girls and women also experience
pain — abdominal cramping — during these days. In some cases, these cramps are strong and
include nausea. A mild painkiller such as ibuprofen helps. Taking a bath, or placing a bottle filled with
warm water on the lower belly or lower back, may also help.
A few days before their menstrual period begins, some girls and women may experience one or more
kinds of discomfort. These include sore breasts, constipation, tiredness, pimples, and strong feelings
that are harder than usual to control. Other months they may experience, some, other, or none of
these. Many girls and women find that their premenstrual discomfort and their menstrual cramps tend
to decrease if they exercise regularly throughout the month.
Girls commonly have questions or difficulties with menstruation. They may find that speaking with a
health care worker, female relative, or friend is helpful.
Menstrual Cycle (Ovulatory Cycle)
What is the menstrual or ovulatory cycle? At puberty, girls begin to experience cycles of fertility. Unlike
males, who are fertile continuously from puberty onward, females can become pregnant only during
certain days of the cycle. The length of the cycle varies from person to person but is generally about
one month. During each cycle, the female body goes through many changes. The most obvious part
of the cycle is menstrual bleeding, also called menstruation or the “period.”
We often think of menstruation as the climax of the cycle, but menstruation is just one part of an
amazing array of changes that take place during the cycle. These changes are the body’s way of
preparing for a potential pregnancy. They include producing mucus at the cervix, growing and
releasing an egg, and changes in the lining of the uterus. These changes are controlled by hormones
(natural chemicals produced by glands in the body and carried in the bloodstream).
These hormonal changes affect many parts of the female body, and also how women feel and
function. Knowing about these changes can give a girl or woman a sense of greater comfort and
control regarding her own body. A woman can learn simple techniques for identifying when she is
ovulating and when her menstrual period is due.

What changes does the body go through during the cycle?

Before Ovulation
Menstrual bleeding — menstruation, or menstrual bleeding, signals the beginning of a new cycle.
During menstruation, blood and tissue are shed by the uterus and flow out of the vagina. The first day
of bleeding is designated as “day one” of the cycle. Bleeding usually lasts between four and six days.
Dryness — after menstrual bleeding ends, the vagina may feel dry because hormone levels are
low and the cervix is producing little or no mucus.
Thick mucus discharge/thickening of the uterine lining — after a few days, as her body releases
more hormones, the woman (or girl) may notice a vaginal discharge of mucus. At first, this mucus is
cloudy-white or yellowish and may feel sticky. At the same time, although she cannot detect it, the
lining of her uterus begins to thicken and an egg (also called the ovum) “ripens.”

Ovulation
Clear mucus/ovulation — as the egg ripens, the mucus becomes clearer and slippery, often similar
to raw egg white. Often it can be stretched between the fingers. This clear mucus nourishes sperm
and helps them to move toward the egg. At this time, a woman’s sexual desire may also increase.
The release of the egg from the ovary is called ovulation. The days just before and around the time of
ovulation are the time when a girl or woman can become pregnant. These are sometimes called her
“fertile days.”
The female body goes through other changes around this time as well. For example, some women
experience an increase in sexual desire and in their sense of well-being for a few days.
Some feel a twinge or slight discomfort on one side of their abdomen at about the time the egg
pushes out of the ovary.

After ovulation
Post Ovulation — after ovulation, the egg can live for one day. The mucus again becomes thicker
and creamy or sticky. For the next 14 days (more or less), hormones keep the thickened lining of the
uterus in place. The body temperature also rises slightly.
Menstrual Bleeding — if no pregnancy has occurred at the end of the 14 days, the hormone levels
fall. The lining of the uterus sheds, and the body temperature falls back down. This shedding is
menstruation, and a new cycle begins. (If a pregnancy occurs, the body continues to produce
hormones to keep the thickened lining of the uterus in place for nine months.)
How long is the ovulation-menstrual cycle?
During the first year or two after menarche (the first menstrual period), the length of time from one
period to the next may vary. Several months may pass between periods. Even for adult women, the
length of the cycle may vary from one woman to the next. It may also vary from cycle to cycle for
any one woman. It can be affected by things like travel, stress, depression, malnutrition, and illness.
Most commonly, however, women begin a new cycle every 24–36 days.
The part of the cycle from the beginning of menstrual bleeding until ovulation may vary a great deal.
It can be as short as a couple of days or as long as several months or more. Most commonly, it lasts
between one and three weeks. In contrast, the part of the cycle from ovulation to the next menstrual
period does not vary; it is always close to 14 days. In other words, once ovulation occurs, a girl or
woman knows that — unless she has become pregnant — her menstrual period is due in 14 days.

Which are the fertile days of the cycle? The fertile period includes the day of ovulation and the five
previous days. Sperm can survive in the female genital tract for as long as five or six days, and the egg
(if it is not fertilized) survives for as long as 24 hours. Predicting the fertile days is difficult, however,
because the first phase of the cycle (from menstruation to ovulation) is the part that may vary widely
in duration.
Some women learn how to observe the changes in their mucus (and in their body temperature) so
that they can tell when they are likely to be ovulating. Some women also feel a slight pain when they
ovulate. Many women and girls use such “fertility awareness” techniques to have a better sense of
when their menstrual period is due.
Knowing which days are the fertile ones can be useful for women who are trying to become pregnant
and for those who want to avoid pregnancy. Using fertility awareness techniques correctly, however,
requires thorough instruction, follow-up, and careful ongoing observation.
How long do women have menstrual or ovulatory cycles?
As women enter mid-life, their hormone levels change. Eventually they stop releasing eggs and
menstruation also ceases. This phase, called menopause, also signals the end of fertility. The age of
menopause varies by woman and differs in different settings, but typically it begins in the mid-40s in
developing countries and in the early 50s in developed countries.

Reproduction and Pregnancy

How does pregnancy occur? Before a pregnancy can occur, an egg and a sperm must join. This
event is called fertilization. Fertilization can occur only during the fertile phase of a woman’s menstrual
cycle.
During the woman’s fertile phase, one of her two ovaries releases an egg. This event is called
ovulation. Within minutes, fingerlike projections (called fimbria) at the ends of the fallopian tube begin
moving to surround the egg and draw it into the tube. Also during the fertile phase, the woman’s
cervix moves into a position that eases the sperm’s entry from the vagina. The cervix secretes a large
amount of clear cervical mucus. This mucus provides nourishment to enable sperm to survive for
several days. The mucus also provides an environment that helps sperm swim upward toward the
fallopian tube, to reach the egg.
During sexual intercourse, the sperm are ejaculated near the cervix. They enter the cervix within
seconds. If the woman is fertile, some sperm may reach the egg in the fallopian tube within five
minutes, while other sperm can survive in the clear (“fertile-type”) mucus in the cervix. In this way, for
up to five days after ejaculation, sperm continue to exit the cervix and are available to fertilize an
egg. Hence, a woman who ovulates several days after she has unprotected sex is likely to have sperm
remaining in her cervix, and these sperm may still be able to reach the fallopian tube and fertilize the
egg.
Once ovulation occurs, however, fertilization must occur within 24 hours because the egg can survive
for only that long. Fertilization takes place in the fallopian tube. Once a sperm has fused with the egg,
it creates a barrier to other sperm. The fertilized egg continues down toward the uterus, propelled by
tubal contractions and by the cilia (little hair-like projections within the tube).
What happens after fertilization? In the fallopian tube, the fertilized egg, or zygote, begins to divide
and grow, as it moves toward the uterus. This journey takes about five days. After it has divided once,
it is called an embryo. Within two days of reaching the uterus, the embryo attaches or implants itself in
the lining of the uterus. Implantation is the beginning of pregnancy.
How can a woman tell if she is pregnant? Early signs of pregnancy differ from woman to woman and
between pregnancies. These include:
• a missed period;
• tender or swollen breasts;
• sensitive nipples;
• frequent urination;
• unusual fatigue;
• nausea and vomiting;
• cramps;
• feeling bloated;
• changes in appetite; and
• feeling unusually emotional.

Pregnancy can be confirmed with a pregnancy test, which may be performed by a health care
provider or purchase pregnancy test kit from a pharmacy. Some women who have learned how to
detect when their body is ovulating can predict fairly well which day menstruation is due; therefore,
they may be aware of a pregnancy as soon as their period is late.
What happens during pregnancy? After implantation, the embryo (at this stage called a blastocyst)
also gives rise to an amniotic sac and a placenta. The sac provides a protective fluid environment for
the growing fetus. The placenta provides the fetus with nutrients and oxygen from the mother, and
carries out waste products. An umbilical cord connects the placenta to the fetus.
Human pregnancy lasts 38 weeks after fertilization (about 40 weeks from the last menstrual period).
Pregnancy is divided into three periods of about three months each, called trimesters.
During the first trimester, until the 12th week, all of the major organs and structures of the body are
formed: the brain, heart, lungs, eyes, ears, arms and legs. After the eighth week, the embryo is called
a fetus. Women commonly feel nauseous during the first trimester; the nausea is sometimes called
“morning sickness.”
During the second trimester, from the 13th to approximately the 27th or 28th week, the fetus grows
rapidly. Usually around the 19th week, the woman can feel fetal movement. Most women begin to
put on weight during the second trimester.
In the third trimester, the fetus continues to gain weight, and its movements become stronger and
more frequent.
What can women do to promote a healthy pregnancy? Is particularly important for a pregnant
woman to avoid taking unnecessary medications, drugs, and alcohol. Taking the recommended
vitamins and mineral supplements (especially iron and folic acid) is very important (including before
pregnancy, if possible). She should also visit an antenatal-care provider, from whom she can get
medical check-ups, and can learn about her pregnancy, potential danger signs, and childbirth.
Women infected with HIV should take anti-HIV medication to prevent the fetus from becoming
infected and to maintain their own health. Treatment with anti-HIV medicines transmitting HIV to the
baby. during labor and delivery is critical for reducing the risk of transmitting HIV to the baby.

Abortion
What is abortion? An abortion is the removal or expulsion of an embryo or fetus from the uterus,
resulting in or caused by its death. This can occur spontaneously as a miscarriage, or be artificially
induced through chemical, surgical or other means. A pregnancy that ends on its own is called a
spontaneous abortion or a miscarriage. An induced abortion is an intentional removal of the fetus
from the uterus.
How common is abortion? Abortion is very common. About one in five pregnancies ends in
spontaneous abortion (often before the woman is aware that she is pregnant). A similar number —
about one in five pregnancies — ends in induced abortion. Most abortions — whether spontaneous or
induced — take place when the pregnancy is eight weeks of gestation or earlier.
Is abortion legal? Article II of the 1987 Philippine Constitution says, in part, "Section 12. The State
recognizes the sanctity of family life and shall protect and strengthen the family as a basic
autonomous social institution. It shall equally protect the life of the mother and the life of the unborn
from conception."
The act is criminalized by Philippine law. Articles 256, 258 and 259 of the Revised Penal Code of the
Philippines mandate imprisonment for women who undergo abortion, as well as for any person who
assists in the procedure. Article 258 further imposes a higher prison term on the woman or her parents if
the abortion is undertaken "in order to conceal [the woman's] dishonor".
In many places, however, abortions are performed by people who lack the necessary skills. Often
they are performed in an environment that does not meet minimum medical standards. In these
situations, abortion carries great risk. Globally, nearly half of all abortions are unsafe, and nearly all of
these (95 percent) are performed in developing countries. The risk is often greatest in rural areas. As a
result, nearly 70,000 women and girls die every year from complications of unsafe abortion. These
deaths are preventable.

Childbirth and Breastfeeding

What happens during childbirth?
When a woman is about to give birth, her body enters a stage called “labor.” Labor often begins with
one or more of the following: clear or pink-colored mucus flowing from the vagina; amniotic fluid
flowing from the vagina; and contractions of the uterus that are perceived as a hardening of the
belly. The intensity of the contractions increases during labor. The cervix opens and the uterine
contractions help push the baby through the opened cervix and vagina. Labor generally lasts
between five (5) and 18 hours, but varies among women. It usually becomes quite painful (although
the perception of pain varies among women and may depend on the preparation the woman made
during antenatal care), exhausting, and can be anxiety provoking. However, many women
experience labor and childbirth as a wonderful and incredible experience.
What is a cesarean section?
Cesarean section, also known as C-section, is a surgical method of childbirth. During this procedure,
an incision is made through the woman’s abdomen and uterus and the baby is removed. It is usually
performed when a vaginal delivery would put the mother’s or baby’s life or health at risk. Sometimes it
is performed for the benefit of the doctor rather than for that of the woman or baby, for example to
allow the doctor to schedule a convenient time for delivery.
Unnecessary cesarean sections may increase risks to the health of the mother and the baby, including
the risk of death.
What help do women need when giving birth?
Wherever a woman gives birth — whether at home, in a health post, or in a hospital — she needs
assistance from a trained person such as a midwife or doctor. Proper conditions and access to
emergency care are also necessary in case of complications. Conditions and practices related to
childbirth vary around the world. In some countries, all women have access to skilled assistance, but in
other places most women give birth at home without the help of a trained attendant and lacking
proper conditions and emergency backup care. In some places, women in labor also rely on support
from other women. In other places, the woman’s husband or partner is present and can give her
support. Some women give birth alone, without any help
What are the consequences of giving birth without skilled assistance?
Because complications occur in about 15 percent of all births, the lack of trained assistance and
access to emergency care results in preventable illness and death. Every year, more than half a
million women die and eight (8) to 15 million women suffer serious injury or disability, such as obstetric
fistula, from causes related to pregnancy and birth. Nearly all of these deaths occur in developing
countries. Almost all of these deaths could be prevented with skilled attendance at delivery and
timely emergency obstetric care for complications, use of family planning methods to reduce
unintended pregnancies, and access to safe abortion services.
What is an obstetric fistula and how does it affect women?
An obstetric fistula is an opening between the vagina and the bladder or rectum, sometimes in both,
that allows urine and/or feces to leak continuously. When a woman experiences blocked labor and
has no access to a cesarean section procedure, the prolonged pressure of the baby’s head on the
tissue between the bladder and the vagina or rectum can cause an opening, called a fistula.
In most cases, the baby dies because of the prolonged labor. For the woman, the ongoing smell of
leaking urine or feces, or both, is constant and humiliating; many women and girls with this condition
are abandoned by their husbands and avoided or shunned by their family, friends, and communities.
Untreated, fistula can lead to chronic medical problems, including ulcerations, kidney disease, and
nerve damage to the legs.
About 100,000 cases of obstetric fistula occur each year, mostly in sub-Saharan Africa and Asia.
Fistulas occur disproportionately among impoverished girls and women, particularly those who have
small pelvises, because their growth is not yet complete or has been stunted by malnutrition. Fistulas
can usually be surgically repaired at a hospital. However, an estimated two million women are living
with untreated fistula.
Why is breastfeeding important?
Breastmilk is the only perfect food for a baby, especially for a newborn. The first yellowcolored milk,
called colostrum, is rich in nutrients and antibodies that protect the baby from diseases and infections.
Colostrum also helps to clean the baby’s gut. Breastfeeding during the first hour after birth helps the
uterus to stop bleeding and the milk to start flowing. In addition, breastmilk is always clean, ready, and
of the right temperature. It helps the mother and baby to feel close and it costs nothing. (The World
Health Organization recommends breastfeeding without other food for the first six months of a baby’s
life. If possible, extend breastfeeding beyond six months in combination with safe and nutritious
foods.)
What can a pregnant woman who is HIV-positive do to reduce the chance of passing the virus to her
baby?
A pregnant HIV-positive woman can transmit the virus to her baby during pregnancy, labor, and
delivery, and through breastfeeding. If she takes no preventive drugs and breastfeeds, she runs about
a 20 to 45 percent chance of transmitting her infection to her baby.
Today, however, effective drugs can prevent the transmission of HIV from pregnancy, labor, and
delivery, and through breastfeeding. If she takes no preventive drugs and breastfeeds, she runs about
a 20 to 45 percent chance of transmitting her infection to her baby. Today, however, effective drugs
can be used when there is advice from a physician about which drugs to take and when. HIV-positive
mothers prevent the transmission of HIV from a mother to her baby during and after should also speak
with their health care providers about appropriate feeding options for their newborn pregnancy.
An HIV-positive woman who is or wants to become pregnant should can reduce the chance of
transmission through breastmilk. In areas where a mother may not have sought the advice of a
physician about which drugs to take and when. HIV-positive regular access to safe water and infant
formula, it is better to breastfeed exclusively for the first six months. Mothers should also speak with their
health care providers about appropriate and then to wean abruptly.
Combining breastfeeding with commercial formula or starter foods carries the greatest risk of passing
HIV infection from mother to child. By taking preventive medicines and following the appropriate
guidelines, an HIV positive mother can reduce the chance of passing HIV to her baby.
Family Planning Methods
Fertility Awareness-Based (FAB) Methods involve techniques of becoming aware of a woman’s fertile
and infertile days within a menstrual cycle based on two naturally occurring fertility signs - changes in
cervical mucus and changes in basal body temperature. These signs can be used to avoid and also
to achieve a pregnancy.
Types: ○ Billings Ovulation Method (BOM) entails daily observation of cervical secretions whose
amount, color, consistency, slipperiness and viscosity change during fertile and infertile days.
○ Basal Body Temperature (BBT) involves determining a woman’s resting body temperature (body
temperature after three hours of continuous sleep), which is lower before ovulation and rises around
the time of ovulation.
○ Symptothermal Methods (STM) combines BOM and BBT together with other signs such as breast
engorgement and unilateral abdominal pain.
○ Standard Days Method (SDM) is based on calculated fertile and infertile periods for menstrual cycles
that range from 26 to 32 days. This method uses a device, color-coded “cycle beads” to mark the
fertile and infertile days of the menstrual cycle. The fertile days of the menstrual cycle are days eight
(8) to 19, counting from the first day of menstruation. This is the start of a woman’s cycle.
○ Two-Day Method involves observing daily the cervical secretions; if there is secretion yesterday or
today, a woman should consider herself fertile and should avoid sexual intercourse today.
○ Lactational Amenorrhea Method (LAM) is the use of breastfeeding (exclusive) as temporary method
of preventing pregnancy; exclusive breastfeeding temporarily prevents the release of the hormone
that causes ovulation.
Three (3) conditions must be met for this method to be effective:
Full breastfeeding;
Menses have not returned since childbirth; and
Baby is not more than six (6) months old.
Their effectiveness depends on the couple’s ability to identify the fertile and infertile periods, and
motivation to practice sexual abstinence when required.
Advantages:
○ No physical side effects
○ No prescription required
○ Inexpensive; no medication involved
○ Build better understanding of the couple about their sexual physiology and reproductive
functions
○ Promote shared responsibility for family planning
○ Foster better communication between partners
Disadvantages:
○ May inhibit sexual spontaneity
○ Except for SDM, require extensive practice –about two to three menstrual cycles to accurately
identify the fertile and infertile periods
○ Require consistent and accurate recording and close attention to body changes
○ Require periods of abstinence from sexual intercourse, which may be difficult for some couples
○ Offer no protection against STI including HIV

Hormonal Methods
○ Combined Hormonal Contraceptives (pills, injectable) are drugs that contain hormones (estrogen
and progestogen) similar to those found in a woman’s body. These drugs prevent conception by: (a)
suppressing ovulation or release of an egg from the ovary and (b) thickening the cervical mucus and
impairing the entry of sperm to the uterus. They may be administered orally (pills) or through injection
(injectable). They are not recommended for women who are breastfeeding because they can
reduce milk supply.
○ Progestin-Only Contraceptives contain only the hormone progestin, which is like the natural
hormone progesterone in a woman’s body. They work mainly to thick the cervical mucus and impair
the entry of sperm to the uterus. They may be administered orally (pills), through injection (injectable)
or subdermal implant. They are recommended for women who are breastfeeding because they do
not affect quality and quantity of milk.

○ These contraceptives are safe, effective and reversible. These, however, do not provide protection
against STIs including HIV.
Long Acting and Permanent Methods
○ The Intra-Uterine Device (IUD) is a small plastic device inserted into a woman’s uterine cavity to
prevent pregnancy. It prevents pregnancy by:
inhibiting fertilization
inhibiting sperm transport into the upper genital tract
inhibiting ovum transport
IUDs have long lasting effectiveness (up to 12 years). They have no effect on the quality
and quantity of breastmilk (if insertion is made after childbirth). They have to be inserted by a trained
service provider. They provide no protection against STIs including HIV.
○ The Bilateral Tubal Ligation (BTL) is a safe and simple surgical procedure that provides permanent
contraception for women who do not want more children. The procedure, which is also known as
ligation or female sterilization, involves cutting or blocking the two fallopian tubes. ○ It is effective,
permanent, safe, simple and an out-patient procedure. It has no known long term side effects or
health risks. It offers no protection against STIs including HIV.
○ The No-Scalpel Vasectomy (NSV) is a permanent method of contraception for men in which the
vas deferens (the tubes that serve as passageway of sperm) are tied and cut or blocked through a
small opening on the scrotal skin. This procedure is also known as vasectomy.
○ Three months after the procedure, sperm is absent in the seminal fluid as a result of the blocking of
the vas deferens. Hence, no fertilization can occur.
○ It is effective, permanent, safe and simple, which can only be performed by a trained service
provider. It has no long term side effects or health risks. It does not result in loss of sexual ability. It,
however, does not provide protection against STIs including HIV.
Barrier Methods
○ These are devices that mechanically prevent fertilization. It includes the male condom (there is a
female condom that is not yet available in the country), a thin sheath of latex rubber made to fit a
man’s erect penis. It creates a barrier that keeps the semen and other body fluids from entering the
vagina, anus or mouth.
○ It protects against the pregnancy and transmission of STIs including HIV.
○ Its effectiveness depends on the user. Risk of pregnancy or STIs is highest if it is not used correctly and
consistently during sexual intercourse.
Sexually Transmitted Infections (STIs)
Sexually transmitted infections (STIs) are infections passed primarily by sexual contact, including
vaginal, oral, and anal intercourse. A variety of different organisms may cause an STI. Certain
parasites such as pubic lice and scabies also may be transmitted by sexual contact. STIs are part of a
broader group of infections known as reproductive tract infections, or Reproductive Tract Infections
(RTIs).
Some STIs can be transmitted by skin-to-skin contact. Some are transmitted through the exchange of
bodily fluids. Some can be passed to a baby before it is born, during childbirth, or through
breastfeeding.
STIs can have serious health consequences for men and women. Many common STIs are difficult to
detect among women, however, and some have more serious consequences for women than for
men. For example, the spread of chlamydia or gonorrhea to the upper reproductive organs is a
common cause of infertility among women. Infection with certain STIs increases the likelihood of
acquiring or transmitting HIV infection. Some, but not all, STIs are curable. Others, such as HIV, are not.
Early treatment eliminates or reduces the consequences of most STIs.
How can people prevent acquiring or transmitting STIs?
• Find out if you have an STI by being tested by a health care provider.
• If you have an STI, obtain treatment, and notify all of your recent sex partners so that they can also
be tested.
• Find out whether your partner has an STI, and if so, make sure that he or she is tested and treated.
• Talk with your partner about ways to be sexually intimate that do not involve the risk of transmitting
an infection.
• Use male or female condoms and avoid sexual contact that allows transmission of an infection.
Condoms protect against most STIs (including HIV). They do not protect against all STIs.
• Obtain a vaccination for those STIs that can be prevented. At the present time, a vaccine exists for
hepatitis B and human papilloma virus (HPV).
A person is at risk of acquiring an STI and should be tested if he or she has one or more of the
following: • symptoms of an STI;
• a sex partner who has an STI, or who has signs of an STI;
• more than one sexual partner;
• a new partner in the past three months;
• a partner who has or may have other sex partners; and
• a partner who lives elsewhere or travels often.
Early testing is important. A person diagnosed with an STI can obtain treatment and can help their
recent partners to be tested as well. A couple should not resume sexual activity until both partners
have been tested and have completed any necessary treatment. Because some STIs do not show up
in test results right away, a repeat test may be necessary.
Types of STIs
HIV (Human Immunodeficiency Virus) and AIDS (Acquired Immune Deficiency Syndrome)
What is the difference between HIV and AIDS? HIV (human immunodeficiency virus) is a virus that
attacks and breaks down a person’s immune system. When the immune system becomes weak from
HIV, the body can no longer fight off illness and may develop serious, often life-threatening, infections
and cancers. This condition is known as AIDS (acquired immune deficiency syndrome). People with
HIV may also be diagnosed with AIDS if their blood tests show that their cells that fight diseases have
fallen below the normal level.
How is HIV transmitted? HIV is present in the bodily fluids of persons infected with the virus. A person
who is HIV positive can pass the virus to others through their semen (including the pre-ejaculate),
vaginal secretions, breastmilk, or blood. The virus is most commonly transmitted through the exchange
of semen and vaginal secretions during sex. HIV is transmitted not only through vaginal or anal sex
between a man and a woman; it can also be transmitted through anal sex between two men.
Having a sexually transmitted infection can increase the risk of acquiring or passing HIV during sex. HIV
can also be passed to others by transfusion of infected blood or by sharing needles with an infected
individual for drug or steroid use, body piercing, or tattooing. HIV can also be passed from an HIV-
positive mother to her baby during pregnancy, delivery, or breastfeeding. Oral sex also carries some
risk for HIV transmission.
Although using contaminated instruments during manicures, pedicures, or shaving may carry a risk of
infection, HIV transmission through these routes is highly unlikely. HIV cannot be transmitted by
touching, kissing, sneezing, coughing, or by sharing food, drink, or utensils, or through everyday
contact at work, school, or home. It is not transmitted by using swimming pools, public toilets, or
through insect bites. HIV cannot be transmitted by saliva, tears or sweat. Urine and feces do not
transmit HIV if they do not contain blood.
How can HIV be prevented? Currently no vaccine or cure for HIV has been developed, so prevention
is essential. Sexual transmission can be prevented by abstaining from unprotected sexual intercourse
or by using male or female condoms for every instance of intercourse. Another approach to
prevention is to confine oneself to a single sex partner, that is, to be “faithful” or monogamous. This
approach works only if both partners are truly monogamous and if both partners are HIV negative.
Unfortunately, many people are unaware that they — or their partner — are already infected with
HIV; the only way to be certain is to be tested for HIV.
Moreover, no one can guarantee that his or her partner will never have another sex partner. For these
reasons, the “be faithful” approach carries risks for many people. For men, circumcision offers some
protection against HIV, but it does not eliminate the risk of infection. For women there are currently no
known direct benefits of male circumcision. Therefore, circumcised males should still use condoms.
Needle transmission from sharing an infected needle can also be prevented by using only new or
sterile needles for all injections or skin piercing.
Mother-to-child transmission — Pregnant women should always be tested for HIV. HIV positive
pregnant women can take preventive medicines to reduce the chance that their baby will be
infected with HIV during pregnancy and birth. Transmission of the virus from mother to baby can also
occur after delivery through breastfeeding. HIV-positive mothers must seek the advice of a health
care provider in order to prevent transmission of the infection during pregnancy and delivery, and
also to learn appropriate feeding options for their newborn.
Can HIV infection be cured or treated? HIV infection cannot be cured, but it can be treated. The
current treatment for HIV is called antiretroviral therapy (ART). ART is a combination of drugs that
reduces the level of HIV virus in the blood and slows down the destruction of the immune system. ART
has improved the quality and length of life for many individuals with HIV. These drugs also reduce
illness and death due to AIDS, the most advanced stage of HIV. Not all people respond equally to the
drugs. Without treatment, however, a person infected with HIV generally progresses to AIDS within one
to ten years of becoming infected. Without treatment, a person with AIDS may live less than a year.
How can a person know if he or she — or his or her sex partner — has HIV? The only way to know if you
have been infected with HIV is to take an HIV test. The only way to know if your sex partner is HIV-
positive is if he or she takes an HIV test and shares the result with you. Millions of people who are HIV-
positive feel and look completely healthy; they have no symptoms, and have no idea that they are
passing the virus to others.
The HIV test detects special cells (called HIV antibodies) that are present if the person is infected. Tests
can usually detect HIV antibodies within six to eight weeks of exposure. In rare cases, it may take as
long as six months for the antibody level to be detected by a test.
A positive HIV test means that the person has HIV antibodies and is infected with the virus. If the first
test is positive, a second, different test is conducted to confirm the results.
A negative HIV test means that the person is not infected with HIV. Or it may mean that he or she is
infected but has not yet made enough HIV antibodies to test positive. Someone who tests HIV-
negative but suspects that he or she was recently exposed to the virus should take the test again in a
few months.
Why should people be tested for HIV? Being tested for HIV is important for many reasons. Obtaining a
negative test result can bring enormous relief to a person. It can also encourage that person to
practice safer sexual behavior in the future. Those who test HIV-positive can begin to seek care and
treatment. Treatment can improve the quality of life and significantly prolong the life of an HIVpositive
person. Those who are tested can also inform and protect their sex partners. For a woman who is — or
would like to become — pregnant, knowing her HIV status is important so that she can take action, if
necessary, to reduce the risk of transmission to her baby.
What support do people living with HIV and AIDS need? When people find out that they are HIV-
positive, they may feel frightened, confused, and depressed. Being infected with HIV is life-changing,
and it takes time to adjust to the knowledge. People living with HIV need a strong emotional support
system, which may include parents, their spouse or partners, other family members, friends, counselors,
social workers, other people living with HIV and AIDS, or religious or spiritual leaders.
They need to find a doctor who is caring, respectful, and knowledgeable about HIV and AIDS, and to
have access to medical treatment when they need it. They need to learn as much as possible about
HIV and AIDS, and how to protect their own health and that of their sex partners. To stay as healthy as
possible, they need to eat well, exercise regularly, rest adequately, avoid smoking and drinking too
much alcohol, and avoid using recreational drugs. Most important, by always practicing safe sex,
they can protect themselves from other sexually transmitted infections and avoid infecting others with
HIV.