The Impact of Sexual and Reproductive Health Experiences on Adolecent Mental Health in the Upper East Region of Ghana

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Poor mental health may lead to increased risk behaviour (i.e., unprotected sex), which may, in turn, result in adolescent pregnancy and/or postnatal HIV infection. Likewise, adolescent pregnancy and/or living with HIV may contribute to mental health challenges. Despite this significant relationship, less attention has been shown toward adolescents' sexual and reproductive need. Aims and objectives: The main aim of the study was to examine the intersection between adolescent sexual and reproductive health and mental health among adolescents in the Upper East Region of Ghana. Methodology : This study is quantitative cross-sectional survey. Data was collected using a structured questionnaire. Data entry was done using EpiData Entry Client v4.2.0.49 and exported to STATA v16.1 for analysis. Microsoft Excel was used to generate graphs and tables for clearer explanations of results. Chi square test was performed to find the association between independent and dependent variables. Results: A total of 385 adolescent boys and girls aged 10-19 years were surveyed. Among them, 141 (36.6%) participants reported unwanted pregnancies, and 129(33.5%) had attempted abortions. The prevalence of early marriage among the participants was 16(4.16%) and the reported prevalence of early marriage among participants' colleagues who weren’t part of the study stood at 67 (17.4%). Majority of the respondents (60%) doubt the confidentiality of the health workers which also serves as a barrier and challenge to reproductive health. More than half (64.2%) of the participants stated that they want SRH-related programs to be implemented in their communities. Conclusion and recommendation: Based on the findings of the study, it can be concluded that the prevalence of early marriage among the participants was lower than the reported prevalence of early marriage among participant’s colleagues. The prevalence of unwanted pregnancy and abortion was high in this study. Also, the prevalence of mental depression, irritable and hopelessness among the participants was high as well. Health care providers negative attitude towards adolescents serves as a barrier and challenge to reproductive healthcare among adolescents. Again, lack of trust and confidentiality also serve as a barrier and challenge to reproductive healthcare. Finally, majority of the adolescent want mental health to be integrated into reproductive healthcare. Adolescent reproductive healthcare and mental healthcare facilities should be provided in the various schools and communities to help young adolescents to have access to reproductive and mental healthcare. Adolescent reproductive and mental health education should be incorporated in the syllabus to give young people first-hand information on their mental and reproductive health. Healthcare providers should exhibit good and positive attitude towards adolescents seeking for reproductive and mental healthcare service. Sexual & Reproductive Medicine Impact Sexual Reproductive Health Mental Health Adolescents Figures Figure 1 Figure 2 1.0 INTRODUCTION Adolescence is a critical developmental phase marked by rapid physical, emotional, and psychosocial transitions that significantly shape an individual’s lifelong health trajectory. Within this period, sexual and reproductive health (SRH) and mental health emerge as pivotal and interconnected determinants of well-being (Patel et al., 2018 ; WHO, 2019). Mental health, defined as a state of well-being in which individuals realize their abilities, cope with normal life stresses, and contribute productively to society, is often influenced by SRH experiences during adolescence (Patel et al., 2018 ). Conversely, SRH, encompassing safe sexual experiences, bodily autonomy, and access to reproductive services can be severely impacted by poor mental health outcomes such as depression, anxiety, and trauma (Haegeman & Palfreyman, 2019 ). Emerging evidence highlights a bidirectional relationship between these domains. For example, adolescents experiencing depression may engage in high-risk sexual behaviors, leading to unintended pregnancies or sexually transmitted infections (STIs), including HIV (Maina et al., 2020 ; WHO, 2019). In turn, these SRH challenges can exacerbate mental health issues such as suicidal ideation, post-traumatic stress disorder (PTSD), and social withdrawal (Gage, 2013 ; Vreeman et al., 2017 ). Despite this intersection, SRH and mental health are frequently addressed in isolation within health systems, particularly in low- and middle-income countries (LMICs) like Ghana, where health services for adolescents remain fragmented, stigmatized, and underfunded (Gelaye et al., 2016 ; Chandra-Mouli et al., 2019). In Ghana, early marriage, gender-based violence, and limited access to youth-friendly reproductive services persist as significant challenges to adolescent SRH (Esantsi et al., 2015 ; Alhassan, 2013 ). Simultaneously, 10–20% of adolescents globally are affected by mental health disorders, yet coverage of mental health services remains disproportionately low (Kieling et al., 2011 ; Erskine et al., 2017 ). Given the growing adolescent population in sub-Saharan Africa, projected to reach 435 million by 2050 (Desa, 2017 ), integrating mental health and SRH services is not only urgent but necessary for sustainable development. According to the Ghana Health Services, from January to May 2025, a total of 2,436 teenage pregnancies (girls aged approximately 10–19) were recorded in the Upper East Region. Among these cases, 25 pregnancies involved girls aged 10–14 during the same five‑month period10-year-olds expecting babies. This study investigates the intersection between adolescent SRH and mental health in the Upper East Region of Ghana, addressing a critical gap in research and informing strategies to improve adolescent well-being through integrated, context-sensitive interventions. 2.0 MATERIALS AND METHON 2.1 Study Design and Participants This was a quantitative, cross-sectional survey targeting adolescents aged 10–19 years residing in the Upper East Region of Ghana. A total of 385 adolescents participated in the study. This study employed quantitative cross-sectional survey design; it has been widely used in similar previous studies. This design is also appropriate because the research wasn’t intended to be carried out over a long period of time for respondents to be followed up due to the limited time for the study. 2.2 Sampling Procedure and Sample Size Determination A multistage sampling technique was used to select respondents for this study in three stages. In the first stage, three (3) sub districts within the municipality were randomly selected for the study. The three sub districts were given proportional quotas based on the population of adolescents in the sub districts. In the second stage, each sub district was divided into clusters and in each cluster, a complete list of all households was compiled. In the third stage, a systematic random sampling technique was used in selecting the respondents for the study. All the households in each cluster were serially numbered and the sampling frame computed by dividing the total number of households in a cluster over the sample size. The first household was selected using simple random sampling and subsequent selection of households to visit was made by adding the sampling interval to the selected number. For households that was selected but did not have a target respondent, the next household was considered. Sample size was calculated using the formula: n = Z² × P(1-P)/d² With 95% confidence level, P = 0.5, d = 0.05, and a 10% non-response rate, the final sample size was 422, though 385 responses were completed and analyzed. 2.3 Data Collection Tools and Techniques A questionnaire was designed which was structured with closed ended (pre-coded) questions and was administered to participants by the Researcher. The questionnaire was divided into four parts. The first part was the socio-demographics of participants and the second part the prevalence of adolescent sexual and reproductive health challenges affecting mental health status of adolescents. The third part of the questionnaire contained questions assessing the barriers to sexual and reproductive mental health among adolescents. The final part was also to explore ways in which mental and sexual reproductive health of can be integrated. The questionnaires were administered in a language that participants understand and are comfortable to respond. 2.3 Data Analysis After collections of data, the data was exported to STATA v16.0 for analysis. Microsoft Excel was used to generate charts for better understanding. Categorical variables were calculated in percentage and cross tabulation while continuous variables were measured in mean and standard deviation. A Chi-Square test was used to test the demographic characteristics of women associated with sexual reproductive health challenges. Descriptive statistics such as, frequencies, proportions and percentages were performed on categorical variables. Means and standard deviations were used on quantitative variables. The findings, and the results were presented in tables. Chi-square test and logistic regression was used to establish association between categorical dependent variables and categorical independent variables at a p-value < 0.05 considered as statistically significant at 95% level. 2.4 Ethical Considerations Participation in the study conformed to the required ethical guidelines regarding the use of human subjects. Ethical approval for the study was obtained from the University for Development Studies Research Ethical Committee. Permission was obtained from the Municipal Director of Health Services before the commencement of the study. Copies of clearance letters and permission to proceed were shown to all who needed to see. The risks and benefits of the study was clearly stated and the respondents had the right to refuse to participate or withdraw from the study at any time. Those who voluntarily agreed to participate were then consent to by appending their signatures/thumb prints on the informed consent form before questionnaires were administered to them. The informed consent form for this study was written in English language. This means that, at instances where respondent could not read and understand, the investigator read and explain to him or her. 3.0 RESULTS 3.1 Background information of study participants Figure 4.1 shows the sex distribution of the respondents. More than fifty percent (56.28%) of the participants were females and the remaining (43.72%) were males Table 4.1 shows the age distribution of the respondents. The mean (± SD) age of the respondents was 15 ( = ± 1.327) years, ranging from 10 to 19 years. The results showed that the majority (62.60%) of the respondents were within the age group of 10–14 years. Table 4.1 Age distribution of the respondents Age in years Variable Frequency (n = 385) Percent (%) Age in years Mean (± SD 15 ± 1.327 10–14 241 62.60 15–17 119 30.91 18–19 25 6.49 SD: Standard deviation Figure 4.2 shows the marital status of the respondents. From the figure below, 98.17% were single and 1.83% were married. 3.2 Distribution of responses from adolescents on the prevalence of mental health challenges In the survey, adolescents were asked to indicate which of the signs they experienced by indicating, not at all (NAA), some days (SD), more than half the days (MHD), and nearly every day (NED). Based on the response given, 318(82.6%) stated that they don’t feel down, depressed, or irritable whiles 67 (17.4%) said they have that depression and irritable feelings. 350 (90.9%) also said they don’t move or speak so slowly that other people could have noticed or the opposite being so fidgety or restless and (9.1%) of them responded that they do experience such. Again, 298(77.9%) said they don’t experience poor appetite, weight loss, or overeating and 87(22.1%) said they experienced it. Moreover, 43 (11.2%) of the respondents stated that there has been a time in the past months when they had serious thoughts about ending their lives whiles 342 (88.8%) said they have never thought of that. Furthermore, 16(4.2%) also said that there were instances in their lives when they tried to kill themselves or made a suicide attempt whiles 369 (95.8%). Table 4.2 Distribution of the responses from the adolescents on mental health Variables NAA SD MHD NED n (%) n (%) n (%) n (%) Feeling down, depressed, irritable, or hopeless? 318 (82.6%) 41 (10.6%) 17 (4.4%) 9 (2.4%) Little interest or pleasure in doing things? 276 (71.7%) 73 (19.0%) 18 (4.7%) 18 (4.7%) Trouble falling asleep, staying asleep, or sleeping too much? 300 (77.9%) 73 (15.1%) 18 (4.7%) 9 (2.4%) Poor appetite, weight loss, or overeating? 298 (77.4%) 55 (14.3%) 22 (5.7%) 10 (2.6%) Feeling tired, or having little energy? 248 (64.4%) 96 (24.9%) 28 (7.3%) 13 (3.4%) Feeling bad about yourself – or feeling that you are a failure, or that you have let yourself or your family down? 350 (90.9%) 19 (4.9%) 12 (3.1%) 4 (1.1%) Trouble concentrating on things like school work, reading, or watching TV? 334 (86.8%) 35 (9.1%) 11 (2.9%) 5 (1.2%) Moving or speaking so slowly that other people could have noticed? Or the opposite – being so fidgety or restless that you were moving around a lot more than usual? 350 (90.9%) 20 (5.2%) 7 (1.8%) 8 (2.1%) Thoughts that you would be better off dead, or of hurting yourself in some way 350 (90.9%) 25 (6.5%) 6 (1.6%) 4 (1.0%) Question Yes No In the past year have you felt depressed or sad most days, even if you felt okay sometimes? 244 (63.4%) 141(36.6%) Has there been a time in the past month when you have had serious thoughts about ending your life? 43 (11.2%) 342 (88.8%) Have you EVER, in your WHOLE LIFE, tried to kill yourself or made a suicide attempt? 16(4.2%) 342(95.8%) Question Not difficult at all Somewhat difficult Very difficult Extremely difficult If you are experiencing any of the problems on this form, how difficult have these problems made it for you to do your work, take care of things at home or get along with other people? 204 (52.99%) 112 (29.1%) 45 (12.21%) 22 (5.71%) 3.3 Distribution of responses from the adolescents on the prevalence of sexual reproductive health challenges. Table 4.3 shows percentages of adolescents reporting to have ever had a sexual experience, combined with responses about their colleagues who are not part of this study. Overall, 93(24.2%) had sexual experience and the remaining 292(75.8%) haven’t had sexual experience. Furthermore, the study shows that 16 (4.16%) of the study participants had an abortion. However, the respondent stated that they know a large number, 141(36.6%) of their colleagues who had an unwanted pregnancy, and out of this number, 129 (33.5%) attempted an abortion as a way of getting rid of the unborn baby. Moreover, 56 (14.5%) of that number who attempted the abortion developed serious complications such as severe bleeding and pains. In addition, 16(4.16%) of the respondents were forced into early marriage. The participants further stated that they know about 66 (17.1%) of their colleagues who were forced into early marriage. The reason stated for attempting abortion is that they are not ready to give birth to a child at a younger age. Another reason stated is that they are afraid. Table 4.3 distribution of responses from adolescents on sexual reproductive health Variable Frequency (n) Percent (%) Have you ever engaged in sexual intercourse? Yes 93 24.2 No 292 75.8 If YES, how old were you during your first encounter? 10 1 0.30 11 3 0.78 12 5 1.30 13 9 2.38 14 6 1.56 15 8 2.08 16 11 2.86 17 10 2.60 18 19 4.94 19 21 5.45 When was your last sexual encounter? 2—3 months ago 156 40.52 4 or more months ago, 176 45.71 Within the last week 21 5.45 Within this month 32 8.31 Have you been touched inappropriately before? Yes 185 48.05 No 200 51.95 If yes, did you feel the person took undue advantage of you without you consenting? Yes 196 50.91 No 189 49.09 Did you tell anybody? Yes 187 48.57 No 198 51.43 Has this affected the way you relate to opposite sex? Yes 185 48.05 No 200 51.95 Do you know if abortion is legal? Yes 93 24.2 No 292 75.8 Do you know anyone of your age who has had an unwanted pregnancy? Yes 141 36.6 No 244 63.4 Do you know how she got pregnant? Yes 153 39.74 No 232 60.26 If YES, what did they do about it? Abort it 129 33.51 Conceived 256 66.49 Do you know how and where they did it? Yes 157 40.78 No 228 59.22 If yes , Herbal medicine 128 33.25 Hospital 207 53.77 Took OTCs 50 12.99 Were they forced to take this action? Yes 152 39.48 No 233 60.52 If YES, by who? Parents/ Guardian 207 53.77 Father of the child 129 33.51 Religious Authorities 0 0.0 Other (specify…… 49 12.73 Did they suffer any complications from the procedure Severe pain and bleeding 56 14.55 No please 280 72.73 Don’t know 49 12.73 Have you ever had an abortion? Yes 16 4.16 No 201 52.21 Have you ever made a lady to abort a pregnancy before Yes 8 2.08 No 160 41.56 If YES, why did you have one I wasn’t ready 5 1.30 I was afraid 3 0.78 What month was the pregnancy? 1 3 0.78 2 2 0.52 3 2 0.52 4 1 0.26 Have you ever seen a colleague of yours’s forced into early marriage? Yes 66 17.1 No 319 82.9 Have you in anytime forced into early marriage Yes 16 4.16 No 369 92.3 If yes, by who Mother 9 2.34 Father 1 0.26 Uncle 2 0.52 Brother/sister 4 1.04 3.4 Barriers and challenges to adolescent sexual reproductive health Participants were asked questions on the barriers and challenges to adolescent reproductive health. Out of the 385 participants surveyed, only 82(21.3%) of the respondents had ever sought sexual reproductive healthcare. Furthermore, 76(19.7%) stated that their reproductive health history was asked. Also, 85 (22.1%) of the respondents indicated that they were educated or counseled on reproductive health. Likewise, 207 (53.8%) of the respondents were educated or counseled on sexual reproductive health in their schools or communities and less than fifty (40%) responded that health facilities observed confidentiality. However, most of the respondents 301(78.2%) indicated that physicians showed a negative attitude towards them. Table 4.4 Barriers and challenges of adolescent sexual reproductive health Variable Frequency (n) Percent (%) Have you ever sought sexual reproductive healthcare before Yes 82 21.3 No 303 78.7 If yes, what was the last time you received sexual reproductive healthcare 1–3 months 15 3.9 4–6 months 17 4.42 7–9 months 20 5.2 10–12 months 19 4.94 More than a year 11 2.86 Were you asked about your sexual reproductive health history Yes 76 19.7 No 309 80.3 What was the attitude of the physician towards you? Good 84 21.8 Bad 301 78.2 Were you educated or counselled on your sexual reproductive health Yes 85 22.1 No 300 77.9 Have you been educated or counselled on your sexual reproductive health in your school or community before Yes 207 53.8 No 178 46.2 Do you think the health facility observes confidentiality Yes 154 40.0 No 44 11.4 Maybe 73 19.0 Don’t know 114 29.6 3.5 Integrating mental health into adolescent sexual and reproductive health Table 4.4 shows respondents views on the integration of mental health into adolescent sexual and reproductive health. Per the data collected, 247 (64.2%) of the participants stated that they want SRH related programs to be implemented in their communities. Again, majority 232(60.3%) indicated that they haven’t had information regarding SRH issues. Table 4.5 integrating mental health into adolescents sexual and mental health Variable Frequency (n) Percent (%) Is there anyone in the family or friends who you can talk about Yes 176 45.7 No 209 54.3 Do you get information on SRH-related issues if and when you get Yes 153 39.7 No 232 60.3 Do you want SRH-related programs implemented in your community? Yes 247 64.2 No 138 35.8 3.6: Relationship between adolescent reproductive health and mental health The Pearson chi-square and Fisher’s exact test were conducted to determine Relationship between adolescent reproductive health and mental health. Early marriage and abortion had a statistically significant association with mental health respectively (p = 0.007) (p = 0.002) (Table 4.6 ). Table 4.6 Relationship between reproductive health and mental health Variable (reproductive health) X 2 df. (P-value) Have you ever engaged in sexual intercourse? 0.412 8 0.937 Have you been touched inappropriately before? 0.556 8 0.760 If yes, did you feel the person took undue advantage of you without you consenting? 1.732 8 0.421 Have you ever had an abortion? 5.671 0.002 Has this affected the way you relate to opposite sex? 1.760 8 0.184 Do you know anyone of your age who has had an unwanted pregnancy? 2.403 8 0.337 Have you ever seen a colleague of yours’s forced into early marriage? 1.616 8 0.425 Have you in anytime forced into early marriage 12.17 8 0.007 Have you ever made a lady to abort a pregnancy before 0.166 8 0.993 Did they suffer any complications from the procedure 0.917 8 0.719 DISCUSSION The findings of this study affirm the intricate and bi-directional relationship between adolescent sexual and reproductive health (SRH) and mental health, particularly in a resource-constrained setting like the Upper East Region of Ghana. The high prevalence of mental health issues, such as depression, irritability, suicidal ideation, and social withdrawal among adolescents reflects broader global trends where mental health conditions account for a substantial burden of disease among young people (WHO, 2019; Kieling et al., 2011). The association between mental distress and SRH challenges found in this study is consistent with previous research, which shows that adolescents experiencing poor mental health are more likely to engage in high-risk sexual behaviors, including unprotected sex, which may lead to unwanted pregnancies, unsafe abortions, or exposure to STIs such as HIV (Maina et al., 2020; Vreeman et al., 2017). One of the most notable findings of this study is the significant association between abortion and early marriage with indicators of poor mental health. Adolescents who had undergone or were aware of peers who had undergone abortion reported higher levels of emotional distress. This aligns with research that identifies abortion, particularly when clandestine or forced, as a major stressor among adolescent girls, often resulting in feelings of shame, trauma, and depression (Gage, 2013; Le Strat et al., 2011). Early marriage, although reported at a relatively lower rate among participants (4.16%), was significantly associated with psychological distress and echoes previous literature which demonstrates how early marriage can lead to social isolation, loss of autonomy, and increased vulnerability to intimate partner violence, all of which are well-established risk factors for poor mental health (Haegeman & Palfreyman, 2019; John et al., 2019). Moreover, the study revealed a notable gap in access to SRH services, with over 78% of respondents never having sought such care. Among those who had, the majority reported negative experiences with healthcare providers, including judgmental attitudes and lack of confidentiality. These barriers discourage help-seeking behavior and reinforce stigma surrounding adolescent sexuality, a concern widely documented in sub-Saharan African contexts (Mchome et al., 2015; Chandra-Mouli et al., 2019). In fact, the perception that healthcare workers breach confidentiality was identified as a primary deterrent to accessing services. This concern is critical, as trust in healthcare systems is a prerequisite for effective utilization of SRH and mental health services. Despite these barriers, there was clear enthusiasm among adolescents for the integration of mental health into SRH programs. Approximately 64% of respondents expressed the need for SRH-related programs in their communities. This reinforces recommendations by the WHO and other scholars advocating for task-shifting approaches, where primary care and community health workers are trained to deliver integrated mental health and SRH interventions, particularly in LMICs with limited specialist availability (Gelaye et al., 2016; WHO, 2008). The support for integration also reflects adolescents’ recognition that these issues do not occur in isolation; rather, they compound one another and must be addressed simultaneously for effective health outcomes. In sum, this study corroborates international findings that adolescents' mental health is deeply influenced by their SRH experiences and the social contexts in which they live. Adolescents in Cape Coast face a complex landscape marked by stigma, inadequate services, and harmful gender norms. However, their expressed willingness to engage in programs that address these dual health domains offers a hopeful path forward. The integration of mental health into SRH frameworks is not only feasible but necessary, as it holds potential to reduce stigma, improve service uptake, and ultimately enhance adolescent well-being across multiple dimensions. CONCLUSION AND RECOMMENDATION This study explored the intersection between adolescent sexual and reproductive health (SRH) and mental health among adolescents in the Upper East Region. The findings revealed a substantial prevalence of both SRH challenges and mental health concerns within the adolescent population. Key SRH-related issues identified included unwanted pregnancy (36.6%), abortion attempts (33.5%), and early marriage (4.16%), while mental health indicators such as depression, irritability, suicidal ideation (11.2%). Adolescent reproductive healthcare and mental healthcare facilities should be provided in the various schools and communities to help young adolescents to have access to reproductive and mental healthcare. Furthermore, adolescent reproductive and mental health education should be incorporated in the syllabus to give young people first-hand information on their mental and reproductive health. Also, healthcare providers should exhibit good and positive attitude towards adolescents seeking for reproductive and mental healthcare service. Declarations The parents or legal guardians of all participants provided informed consent for their children by signing an informed consent form before taking part in the study. The study protocol and consent procedures were reviewed and approved by the University for Development Studies ethics committee. Consent for publication Not applicable Availability of data and materials All data is presented within the paper. The datasets generated and analyzed for this study are available from the corresponding author upon request. Competing interest The authors declare that they have no competing interests. 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Journal of the International AIDS Society, 20(3), 100–109. https://doi.org/10.7448/IAS.20.4.21497 World Health Organization (WHO). (2019). Adolescent mental health. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health World Health Organization (WHO). (2008). Integrating mental health into primary care: A global perspective. Geneva: WHO & World Organization of Family Doctors (Wonca). Desa, U. N. (2017). World population prospects: The 2017 revision, key findings and advance tables. Additional Declarations The authors declare no competing interests. Supplementary Files SHADRACH2.sav RAW DATA Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7282821","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":494877705,"identity":"4ea0f841-ad70-404d-afb0-f3d19ed3ae4c","order_by":0,"name":"SHADRACH ABULIKO A-OBILIYA","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7ElEQVRIie3PMYvCMBTA8QcP0uV5twaqfoYehSL0QPwmSkGXFPwAIgcHGZ3d/Ao33VwoV5dC1+4BBych4CgmJ65txoPLnwQeIT9IAHy+P1hUAKBdDNGMwIe9ZFLgg7wEcm4J9ZL3JxlTHdkDB3JsSr3epAvJhT63mwlBUP58dZGkzli4r1aG5N+pqMzDaLlsO0mRMSRW/pJYMEM4JZ0kbhRqulkiTrG4OZC3NoNwIA2hGlUunYhKwsFuFctAJpjvOLG+v0TNQmm6pqPDJyotrtvxa1BWneTZ7AOAcTsxl+u2qdl4cb3t8/l8/6s7xSVIfwVw56UAAAAASUVORK5CYII=","orcid":"https://orcid.org/0009-0005-0651-4947","institution":"UNIVERSITY FOR DEVELOPMENT STUDIES","correspondingAuthor":true,"prefix":"","firstName":"SHADRACH","middleName":"ABULIKO","lastName":"A-OBILIYA","suffix":""}],"badges":[],"createdAt":"2025-08-03 10:42:10","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-7282821/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7282821/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88411511,"identity":"6fbd7509-eca0-46f0-b310-2153f6698185","added_by":"auto","created_at":"2025-08-06 08:26:32","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":18792,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eFigure 4.1: Sex distribution of the respondents\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7282821/v1/fc32435290920eb964ff4472.png"},{"id":88411509,"identity":"55127be4-ed92-4a49-ac50-bdc29b53d8ee","added_by":"auto","created_at":"2025-08-06 08:26:32","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":22140,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eFigure 4.2: Marital status of the respondents\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7282821/v1/ac7117bf728ad8a817e60269.png"},{"id":88413810,"identity":"e86ccc82-716f-4eac-b805-2bc17abc9eae","added_by":"auto","created_at":"2025-08-06 08:42:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1951969,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7282821/v1/50612dc6-eb69-4a8a-b8ed-3adf4fa23446.pdf"},{"id":88411515,"identity":"1ed89d43-c26b-48b5-af81-023d157972ba","added_by":"auto","created_at":"2025-08-06 08:26:32","extension":"sav","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":329096,"visible":true,"origin":"","legend":"\u003cp\u003eRAW DATA\u003c/p\u003e","description":"","filename":"SHADRACH2.sav","url":"https://assets-eu.researchsquare.com/files/rs-7282821/v1/f3856c68a467acfea2c6eaae.sav"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eThe Impact of Sexual and Reproductive Health Experiences on Adolecent Mental Health in the Upper East Region of Ghana\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"1.0 INTRODUCTION","content":"\u003cp\u003eAdolescence is a critical developmental phase marked by rapid physical, emotional, and psychosocial transitions that significantly shape an individual\u0026rsquo;s lifelong health trajectory. Within this period, sexual and reproductive health (SRH) and mental health emerge as pivotal and interconnected determinants of well-being (Patel et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; WHO, 2019). Mental health, defined as a state of well-being in which individuals realize their abilities, cope with normal life stresses, and contribute productively to society, is often influenced by SRH experiences during adolescence (Patel et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Conversely, SRH, encompassing safe sexual experiences, bodily autonomy, and access to reproductive services can be severely impacted by poor mental health outcomes such as depression, anxiety, and trauma (Haegeman \u0026amp; Palfreyman, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eEmerging evidence highlights a bidirectional relationship between these domains. For example, adolescents experiencing depression may engage in high-risk sexual behaviors, leading to unintended pregnancies or sexually transmitted infections (STIs), including HIV (Maina et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; WHO, 2019). In turn, these SRH challenges can exacerbate mental health issues such as suicidal ideation, post-traumatic stress disorder (PTSD), and social withdrawal (Gage, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Vreeman et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Despite this intersection, SRH and mental health are frequently addressed in isolation within health systems, particularly in low- and middle-income countries (LMICs) like Ghana, where health services for adolescents remain fragmented, stigmatized, and underfunded (Gelaye et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Chandra-Mouli et al., 2019).\u003c/p\u003e\u003cp\u003eIn Ghana, early marriage, gender-based violence, and limited access to youth-friendly reproductive services persist as significant challenges to adolescent SRH (Esantsi et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Alhassan, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Simultaneously, 10\u0026ndash;20% of adolescents globally are affected by mental health disorders, yet coverage of mental health services remains disproportionately low (Kieling et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Erskine et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Given the growing adolescent population in sub-Saharan Africa, projected to reach 435\u0026nbsp;million by 2050 (Desa, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), integrating mental health and SRH services is not only urgent but necessary for sustainable development.\u003c/p\u003e\u003cp\u003eAccording to the Ghana Health Services, from January to May 2025, a total of 2,436 teenage pregnancies (girls aged approximately 10\u0026ndash;19) were recorded in the Upper East Region. Among these cases, 25 pregnancies involved girls aged 10\u0026ndash;14 during the same five‑month period10-year-olds expecting babies.\u003c/p\u003e\u003cp\u003eThis study investigates the intersection between adolescent SRH and mental health in the Upper East Region of Ghana, addressing a critical gap in research and informing strategies to improve adolescent well-being through integrated, context-sensitive interventions.\u003c/p\u003e"},{"header":"2.0 MATERIALS AND METHON","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Study Design and Participants\u003c/h2\u003e\u003cp\u003eThis was a quantitative, cross-sectional survey targeting adolescents aged 10\u0026ndash;19 years residing in the Upper East Region of Ghana. A total of 385 adolescents participated in the study. This study employed quantitative cross-sectional survey design; it has been widely used in similar previous studies. This design is also appropriate because the research wasn\u0026rsquo;t intended to be carried out over a long period of time for respondents to be followed up due to the limited time for the study.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Sampling Procedure and Sample Size Determination\u003c/h2\u003e\u003cp\u003eA multistage sampling technique was used to select respondents for this study in three stages.\u003c/p\u003e\u003cp\u003eIn the first stage, three (3) sub districts within the municipality were randomly selected for the study. The three sub districts were given proportional quotas based on the population of adolescents in the sub districts. In the second stage, each sub district was divided into clusters and in each cluster, a complete list of all households was compiled. In the third stage, a systematic random sampling technique was used in selecting the respondents for the study. All the households in each cluster were serially numbered and the sampling frame computed by dividing the total number of households in a cluster over the sample size. The first household was selected using simple random sampling and subsequent selection of households to visit was made by adding the sampling interval to the selected number. For households that was selected but did not have a target respondent, the next household was considered.\u003c/p\u003e\u003cp\u003eSample size was calculated using the formula:\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;Z\u0026sup2; \u0026times; P(1-P)/d\u0026sup2;\u003c/p\u003e\u003cp\u003eWith 95% confidence level, P\u0026thinsp;=\u0026thinsp;0.5, d\u0026thinsp;=\u0026thinsp;0.05, and a 10% non-response rate, the final sample size was 422, though 385 responses were completed and analyzed.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Data Collection Tools and Techniques\u003c/h2\u003e\u003cp\u003eA questionnaire was designed which was structured with closed ended (pre-coded) questions and was administered to participants by the Researcher. The questionnaire was divided into four parts. The first part was the socio-demographics of participants and the second part the prevalence of adolescent sexual and reproductive health challenges affecting mental health status of adolescents. The third part of the questionnaire contained questions assessing the barriers to sexual and reproductive mental health among adolescents. The final part was also to explore ways in which mental and sexual reproductive health of can be integrated. The questionnaires were administered in a language that participants understand and are comfortable to respond.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Data Analysis\u003c/h2\u003e\u003cp\u003eAfter collections of data, the data was exported to STATA v16.0 for analysis. Microsoft Excel was used to generate charts for better understanding. Categorical variables were calculated in percentage and cross tabulation while continuous variables were measured in mean and standard deviation. A Chi-Square test was used to test the demographic characteristics of women associated with sexual reproductive health challenges.\u003c/p\u003e\u003cp\u003eDescriptive statistics such as, frequencies, proportions and percentages were performed on categorical variables. Means and standard deviations were used on quantitative variables. The findings, and the results were presented in tables.\u003c/p\u003e\u003cp\u003eChi-square test and logistic regression was used to establish association between categorical dependent variables and categorical independent variables at a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 considered as statistically significant at 95% level.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Ethical Considerations\u003c/h2\u003e\u003cp\u003e Participation in the study conformed to the required ethical guidelines regarding the use of human subjects. Ethical approval for the study was obtained from the University for Development Studies Research Ethical Committee. Permission was obtained from the Municipal Director of Health Services before the commencement of the study. Copies of clearance letters and permission to proceed were shown to all who needed to see. The risks and benefits of the study was clearly stated and the respondents had the right to refuse to participate or withdraw from the study at any time. Those who voluntarily agreed to participate were then consent to by appending their signatures/thumb prints on the informed consent form before questionnaires were administered to them. The informed consent form for this study was written in English language. This means that, at instances where respondent could not read and understand, the investigator read and explain to him or her.\u003c/p\u003e\u003c/div\u003e"},{"header":"3.0 RESULTS","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Background information of study participants\u003c/h2\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e4.1\u003c/span\u003e shows the sex distribution of the respondents. More than fifty percent (56.28%) of the participants were females and the remaining (43.72%) were males\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e4.1\u003c/span\u003e shows the age distribution of the respondents. The mean (\u0026plusmn;\u0026thinsp;SD) age of the respondents was 15 (\u0026thinsp;=\u0026thinsp;\u0026plusmn;\u0026thinsp;1.327) years, ranging from 10 to 19 years. The results showed that the majority (62.60%) of the respondents were within the age group of 10\u0026ndash;14 years.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4.1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAge distribution of the respondents\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge in years\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency (n\u0026thinsp;=\u0026thinsp;385)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercent (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge in years\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean (\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15\u0026thinsp;\u0026plusmn;\u0026thinsp;1.327\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u0026ndash;14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e241\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e62.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15\u0026ndash;17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e119\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e30.91\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u0026ndash;19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.49\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eSD: Standard deviation\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e4.2\u003c/span\u003e shows the marital status of the respondents. From the figure below, 98.17% were single and 1.83% were married.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Distribution of responses from adolescents on the prevalence of mental health challenges\u003c/h2\u003e\u003cp\u003eIn the survey, adolescents were asked to indicate which of the signs they experienced by indicating, not at all (NAA), some days (SD), more than half the days (MHD), and nearly every day (NED). Based on the response given, 318(82.6%) stated that they don\u0026rsquo;t feel down, depressed, or irritable whiles 67 (17.4%) said they have that depression and irritable feelings. 350 (90.9%) also said they don\u0026rsquo;t move or speak so slowly that other people could have noticed or the opposite being so fidgety or restless and (9.1%) of them responded that they do experience such. Again, 298(77.9%) said they don\u0026rsquo;t experience poor appetite, weight loss, or overeating and 87(22.1%) said they experienced it. Moreover, 43 (11.2%) of the respondents stated that there has been a time in the past months when they had serious thoughts about ending their lives whiles 342 (88.8%) said they have never thought of that. Furthermore, 16(4.2%) also said that there were instances in their lives when they tried to kill themselves or made a suicide attempt whiles 369 (95.8%).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4.2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution of the responses from the adolescents on mental health\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNAA\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMHD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNED\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFeeling down, depressed, irritable, or hopeless?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e318\u003c/p\u003e\u003cp\u003e(82.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41\u003c/p\u003e\u003cp\u003e(10.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17\u003c/p\u003e\u003cp\u003e(4.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9\u003c/p\u003e\u003cp\u003e(2.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLittle interest or pleasure in doing things?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e276\u003c/p\u003e\u003cp\u003e(71.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73\u003c/p\u003e\u003cp\u003e(19.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18\u003c/p\u003e\u003cp\u003e(4.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e18\u003c/p\u003e\u003cp\u003e(4.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTrouble falling asleep, staying asleep, or sleeping too much?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e300\u003c/p\u003e\u003cp\u003e(77.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73\u003c/p\u003e\u003cp\u003e(15.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18\u003c/p\u003e\u003cp\u003e(4.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9\u003c/p\u003e\u003cp\u003e(2.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePoor appetite, weight loss, or overeating?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e298\u003c/p\u003e\u003cp\u003e(77.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55\u003c/p\u003e\u003cp\u003e(14.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22\u003c/p\u003e\u003cp\u003e(5.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10\u003c/p\u003e\u003cp\u003e(2.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFeeling tired, or having little energy?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e248\u003c/p\u003e\u003cp\u003e(64.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e96\u003c/p\u003e\u003cp\u003e(24.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28\u003c/p\u003e\u003cp\u003e(7.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13\u003c/p\u003e\u003cp\u003e(3.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFeeling bad about yourself \u0026ndash; or feeling that\u003c/p\u003e\u003cp\u003eyou are a failure, or that you have let yourself\u003c/p\u003e\u003cp\u003eor your family down?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e350\u003c/p\u003e\u003cp\u003e(90.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003cp\u003e(4.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12\u003c/p\u003e\u003cp\u003e(3.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(1.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTrouble concentrating on things like school\u003c/p\u003e\u003cp\u003ework, reading, or watching TV?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e334\u003c/p\u003e\u003cp\u003e(86.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35\u003c/p\u003e\u003cp\u003e(9.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11\u003c/p\u003e\u003cp\u003e(2.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e(1.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMoving or speaking so slowly that other\u003c/p\u003e\u003cp\u003epeople could have noticed?\u003c/p\u003e\u003cp\u003eOr the opposite \u0026ndash; being so fidgety or restless\u003c/p\u003e\u003cp\u003ethat you were moving around a lot more than\u003c/p\u003e\u003cp\u003eusual?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e350\u003c/p\u003e\u003cp\u003e(90.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003cp\u003e(5.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7\u003c/p\u003e\u003cp\u003e(1.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8\u003c/p\u003e\u003cp\u003e(2.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThoughts that you would be better off dead,\u003c/p\u003e\u003cp\u003eor of hurting yourself in some way\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e350\u003c/p\u003e\u003cp\u003e(90.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003cp\u003e(6.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003cp\u003e(1.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(1.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eQuestion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIn the past year have you felt depressed or sad most days, even if you felt okay\u003c/p\u003e\u003cp\u003esometimes?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e244 (63.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e141(36.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHas there been a time in the past month when you have had serious thoughts about\u003c/p\u003e\u003cp\u003eending your life?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e43 (11.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e342 (88.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHave you EVER, in your WHOLE LIFE, tried to kill yourself or made a suicide\u003c/p\u003e\u003cp\u003eattempt?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e16(4.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e342(95.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eQuestion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot difficult at all\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSomewhat difficult\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eVery difficult\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eExtremely\u003c/p\u003e\u003cp\u003edifficult\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIf you are experiencing any of the problems on this form, how difficult have these\u003c/p\u003e\u003cp\u003eproblems made it for you to do your work, take care of things at home or get along\u003c/p\u003e\u003cp\u003ewith other people?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e204\u003c/p\u003e\u003cp\u003e(52.99%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e112\u003c/p\u003e\u003cp\u003e(29.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e45\u003c/p\u003e\u003cp\u003e(12.21%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e22\u003c/p\u003e\u003cp\u003e(5.71%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Distribution of responses from the adolescents on the prevalence of sexual reproductive health challenges.\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e4.3\u003c/span\u003e shows percentages of adolescents reporting to have ever had a sexual experience, combined with responses about their colleagues who are not part of this study. Overall, 93(24.2%) had sexual experience and the remaining 292(75.8%) haven\u0026rsquo;t had sexual experience. Furthermore, the study shows that 16 (4.16%) of the study participants had an abortion. However, the respondent stated that they know a large number, 141(36.6%) of their colleagues who had an unwanted pregnancy, and out of this number, 129 (33.5%) attempted an abortion as a way of getting rid of the unborn baby. Moreover, 56 (14.5%) of that number who attempted the abortion developed serious complications such as severe bleeding and pains. In addition, 16(4.16%) of the respondents were forced into early marriage. The participants further stated that they know about 66 (17.1%) of their colleagues who were forced into early marriage. The reason stated for attempting abortion is that they are not ready to give birth to a child at a younger age. Another reason stated is that they are afraid.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4.3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003edistribution of responses from adolescents on sexual reproductive health\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency (n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercent (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHave you ever engaged in sexual intercourse?\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e24.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e292\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e75.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIf YES, how old were you during your first encounter?\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.78\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.38\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.56\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.08\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.86\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.94\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.45\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWhen was your last sexual encounter?\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u0026mdash;3 months ago\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e156\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40.52\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4 or more months ago,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e176\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e45.71\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin the last week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.45\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWithin this month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8.31\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHave you been touched inappropriately before?\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e185\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e51.95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIf yes, did you feel the person took undue advantage of you without you consenting?\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e196\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e50.91\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e189\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e49.09\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDid you tell anybody?\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e187\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48.57\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e198\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e51.43\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHas this affected the way you relate to opposite sex?\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e185\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e51.95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDo you know if abortion is legal?\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e24.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e292\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e75.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDo you know anyone of your age who has had an unwanted pregnancy?\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e141\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e244\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e63.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDo you know how she got pregnant?\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e153\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e39.74\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e232\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e60.26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIf YES, what did they do about it?\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbort it\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e129\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33.51\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConceived\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e256\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e66.49\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDo you know how and where they did it?\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e157\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40.78\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e228\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e59.22\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIf yes\u003c/b\u003e,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHerbal medicine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e128\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33.25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e207\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e53.77\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTook OTCs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12.99\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWere they forced to take this action?\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e152\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e39.48\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e233\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e60.52\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIf YES, by who?\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParents/ Guardian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e207\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e53.77\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFather of the child\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e129\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33.51\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReligious Authorities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther (specify\u0026hellip;\u0026hellip;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12.73\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDid they suffer any complications from the procedure\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSevere pain and bleeding\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14.55\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo please\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e280\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e72.73\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDon\u0026rsquo;t know\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12.73\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHave you ever had an abortion?\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e201\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e52.21\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHave you ever made a lady to abort a pregnancy before\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.08\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e160\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e41.56\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIf YES, why did you have one\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI wasn\u0026rsquo;t ready\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI was afraid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.78\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWhat month was the pregnancy?\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.78\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.52\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.52\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHave you ever seen a colleague of yours\u0026rsquo;s forced into early marriage?\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e319\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e82.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHave you in anytime forced into early marriage\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e369\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e92.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIf yes, by who\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMother\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.34\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFather\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUncle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.52\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBrother/sister\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.04\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e3.4 Barriers and challenges to adolescent sexual reproductive health\u003c/h2\u003e\u003cp\u003eParticipants were asked questions on the barriers and challenges to adolescent reproductive health. Out of the 385 participants surveyed, only 82(21.3%) of the respondents had ever sought sexual reproductive healthcare. Furthermore, 76(19.7%) stated that their reproductive health history was asked. Also, 85 (22.1%) of the respondents indicated that they were educated or counseled on reproductive health. Likewise, 207 (53.8%) of the respondents were educated or counseled on sexual reproductive health in their schools or communities and less than fifty (40%) responded that health facilities observed confidentiality. However, most of the respondents 301(78.2%) indicated that physicians showed a negative attitude towards them.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4.4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBarriers and challenges of adolescent sexual reproductive health\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency (n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercent (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHave you ever sought sexual reproductive healthcare before\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e303\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e78.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIf yes, what was the last time you received sexual reproductive healthcare\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u0026ndash;3 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u0026ndash;6 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.42\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u0026ndash;9 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u0026ndash;12 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.94\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMore than a year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.86\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWere you asked about your sexual reproductive health history\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e309\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e80.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWhat was the attitude of the physician towards you?\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBad\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e301\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e78.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWere you educated or counselled on your sexual reproductive health\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e22.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e300\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e77.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHave you been educated or counselled on your sexual reproductive health in your school or community before\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e207\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e53.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e178\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e46.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDo you think the health facility observes confidentiality\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e154\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaybe\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDon\u0026rsquo;t know\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e114\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e3.5 Integrating mental health into adolescent sexual and reproductive health\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4.4\u003c/span\u003e shows respondents views on the integration of mental health into adolescent sexual and reproductive health. Per the data collected, 247 (64.2%) of the participants stated that they want SRH related programs to be implemented in their communities. Again, majority 232(60.3%) indicated that they haven\u0026rsquo;t had information regarding SRH issues.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4.5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eintegrating mental health into adolescents sexual and mental health\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency (n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercent (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIs there anyone in the family or friends who you can talk about\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e176\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e45.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e209\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e54.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDo you get information on SRH-related issues if and when you get\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e153\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e39.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e232\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e60.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDo you want SRH-related programs implemented in your community?\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e247\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e64.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e138\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e3.6: Relationship between adolescent reproductive health and mental health\u003c/h2\u003e\u003cp\u003eThe Pearson chi-square and Fisher\u0026rsquo;s exact test were conducted to determine Relationship between adolescent reproductive health and mental health. Early marriage and abortion had a statistically significant association with mental health respectively (p\u0026thinsp;=\u0026thinsp;0.007) (p\u0026thinsp;=\u0026thinsp;0.002) (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e4.6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4.6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRelationship between reproductive health and mental health\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable (reproductive health)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003edf.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(P-value)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHave you ever engaged in sexual intercourse?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.412\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.937\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHave you been touched inappropriately before?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.556\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.760\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIf yes, did you feel the person took undue advantage of you without you consenting?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.732\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.421\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHave you ever had an abortion?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5.671\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHas this affected the way you relate to opposite sex?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.760\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.184\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDo you know anyone of your age who has had an unwanted pregnancy?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.403\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.337\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHave you ever seen a colleague of yours\u0026rsquo;s forced into early marriage?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.616\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.425\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHave you in anytime forced into early marriage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.007\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHave you ever made a lady to abort a pregnancy before\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.166\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.993\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDid they suffer any complications from the procedure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.917\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.719\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe findings of this study affirm the intricate and bi-directional relationship between adolescent sexual and reproductive health (SRH) and mental health, particularly in a resource-constrained setting like the Upper East Region of \u0026nbsp;Ghana. The high prevalence of mental health issues, such as depression, irritability, suicidal ideation, and social withdrawal among adolescents reflects broader global trends where mental health conditions account for a substantial burden of disease among young people (WHO, 2019; Kieling et al., 2011). The association between mental distress and SRH challenges found in this study is consistent with previous research, which shows that adolescents experiencing poor mental health are more likely to engage in high-risk sexual behaviors, including unprotected sex, which may lead to unwanted pregnancies, unsafe abortions, or exposure to STIs such as HIV (Maina et al., 2020; Vreeman et al., 2017).\u003c/p\u003e\n\u003cp\u003eOne of the most notable findings of this study is the significant association between abortion and early marriage with indicators of poor mental health. Adolescents who had undergone or were aware of peers who had undergone abortion reported higher levels of emotional distress. This aligns with research that identifies abortion, particularly when clandestine or forced, as a major stressor among adolescent girls, often resulting in feelings of shame, trauma, and depression (Gage, 2013; Le Strat et al., 2011). Early marriage, although reported at a relatively lower rate among participants (4.16%), was significantly associated with psychological distress and echoes previous literature which demonstrates how early marriage can lead to social isolation, loss of autonomy, and increased vulnerability to intimate partner violence, all of which are well-established risk factors for poor mental health (Haegeman \u0026amp; Palfreyman, 2019; John et al., 2019).\u003c/p\u003e\n\u003cp\u003eMoreover, the study revealed a notable gap in access to SRH services, with over 78% of respondents never having sought such care. Among those who had, the majority reported negative experiences with healthcare providers, including judgmental attitudes and lack of confidentiality. These barriers discourage help-seeking behavior and reinforce stigma surrounding adolescent sexuality, a concern widely documented in sub-Saharan African contexts (Mchome et al., 2015; Chandra-Mouli et al., 2019). In fact, the perception that healthcare workers breach confidentiality was identified as a primary deterrent to accessing services. This concern is critical, as trust in healthcare systems is a prerequisite for effective utilization of SRH and mental health services.\u003c/p\u003e\n\u003cp\u003eDespite these barriers, there was clear enthusiasm among adolescents for the integration of mental health into SRH programs. Approximately 64% of respondents expressed the need for SRH-related programs in their communities. This reinforces recommendations by the WHO and other scholars advocating for task-shifting approaches, where primary care and community health workers are trained to deliver integrated mental health and SRH interventions, particularly in LMICs with limited specialist availability (Gelaye et al., 2016; WHO, 2008). The support for integration also reflects adolescents’ recognition that these issues do not occur in isolation; rather, they compound one another and must be addressed simultaneously for effective health outcomes.\u003c/p\u003e\n\u003cp\u003eIn sum, this study corroborates international findings that adolescents' mental health is deeply influenced by their SRH experiences and the social contexts in which they live. Adolescents in Cape Coast face a complex landscape marked by stigma, inadequate services, and harmful gender norms. However, their expressed willingness to engage in programs that address these dual health domains offers a hopeful path forward. The integration of mental health into SRH frameworks is not only feasible but necessary, as it holds potential to reduce stigma, improve service uptake, and ultimately enhance adolescent well-being across multiple dimensions.\u003c/p\u003e"},{"header":"CONCLUSION AND RECOMMENDATION","content":"\u003cp\u003eThis study explored the intersection between adolescent sexual and reproductive health (SRH) and mental health among adolescents in the Upper East Region. The findings revealed a substantial prevalence of both SRH challenges and mental health concerns within the adolescent population. Key SRH-related issues identified included unwanted pregnancy (36.6%), abortion attempts (33.5%), and early marriage (4.16%), while mental health indicators such as depression, irritability, suicidal ideation (11.2%).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Adolescent reproductive healthcare and mental healthcare facilities should be provided in the various schools and communities to help young adolescents to have access to reproductive and mental healthcare. Furthermore, adolescent reproductive and mental health education should be incorporated in the syllabus to give young people first-hand information on their mental and reproductive health. Also, healthcare providers should exhibit good and positive attitude towards adolescents seeking for reproductive and mental healthcare service. \u0026nbsp;\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThe parents or legal guardians of all participants provided informed consent for their children by signing an informed consent form before taking part in the study. The study protocol and consent procedures were reviewed and approved by the University for Development Studies ethics committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data is presented within the paper. The datasets generated and analyzed for this study are available from the corresponding author upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was not funded by any source or funding agency.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAlhassan, E. (2013). Early marriage of young females: A panacea to poverty in the Northern region of Ghana? Research on Humanities and Social Sciences, 3(12), 18\u0026ndash;31.\u003c/li\u003e\n \u003cli\u003eChandra-Mouli, V., Lane, C., \u0026amp; Wong, S. (2015). What does not work in adolescent sexual and reproductive health: A review of evidence on interventions commonly accepted as best practices. Global Health: Science and Practice, 3(3), 333\u0026ndash;340.\u003c/li\u003e\n \u003cli\u003eErskine, H. E., et al. (2017). The global coverage of prevalence data for mental disorders in children and adolescents. Epidemiology and Psychiatric Sciences, 26(4), 395\u0026ndash;402. https://doi.org/10.1017/S2045796015001158\u003c/li\u003e\n \u003cli\u003eEsantsi, S., Onyango, F., Asare, G., Kuffour, E., Tapsoba, P., Birungi, H., \u0026amp; Askew, I. (2015). Understanding the reproductive health needs of adolescents in selected slums in Ghana: A public health assessment. Reproductive Health.\u003c/li\u003e\n \u003cli\u003eGage, A. J. (2013). Association of child marriage with suicidal thoughts and attempts among adolescent girls in Ethiopia. Journal of Adolescent Health, 52(5), 654\u0026ndash;656.\u003c/li\u003e\n \u003cli\u003eGelaye, B., Rondon, M. B., Araya, R., \u0026amp; Williams, M. A. (2016). Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries. The Lancet Psychiatry, 3(10), 973\u0026ndash;982.\u003c/li\u003e\n \u003cli\u003eHaegeman, E., \u0026amp; Palfreyman, A. (2019). Mental health, maternal health and sexual and reproductive health and rights. Disability Inclusion Helpdesk Research Report No. 11, 1\u0026ndash;18.\u003c/li\u003e\n \u003cli\u003eJohn, F. A., Abu, M., \u0026amp; Utazi, C. E. (2019). Geospatial correlates of early marriage and union formation in Ghana. PLoS ONE, 14(10), 1\u0026ndash;17. https://doi.org/10.1371/journal.pone.0223296\u003c/li\u003e\n \u003cli\u003eKieling, C., et al. (2011). Child and adolescent mental health worldwide: Evidence for action. The Lancet, 378(9801), 1515\u0026ndash;1525. https://doi.org/10.1016/S0140-6736(11)60827-1\u003c/li\u003e\n \u003cli\u003eLe Strat, Y., et al. (2011). Prevalence and correlates of lifetime abortion: The National Comorbidity Survey. Journal of Clinical Psychiatry, 72(11), 1455\u0026ndash;1462.\u003c/li\u003e\n \u003cli\u003eMaina, B. W., Ushie, B. A., Kabiru, C. W., \u0026amp; Izugbara, C. O. (2020). Adolescent mental health and risky sexual behavior in sub-Saharan Africa: A review of existing evidence. Global Health Action, 13(1), 1748257.\u003c/li\u003e\n \u003cli\u003eMchome, Z., Richards, E., Nnko, S., Dusabe, J., \u0026amp; Mapella, E. (2015). A \u0026lsquo;Mystery Client\u0026rsquo; Evaluation of Adolescent Sexual and Reproductive Health Services in Health Facilities from Two Regions. PLoS ONE. https://doi.org/10.1371/journal.pone.0120822\u003c/li\u003e\n \u003cli\u003ePatel, V., Saxena, S., Lund, C., Thornicroft, G., Baingana, F., Bolton, P., ... \u0026amp; Un\u0026Uuml;tzer, J. (2018). The Lancet Commission on global mental health and sustainable development. The Lancet, 392(10157), 1553\u0026ndash;1598.\u003c/li\u003e\n \u003cli\u003eVreeman, R. C., McCoy, B. M., \u0026amp; Lee, S. (2017). Mental health challenges among adolescents living with HIV. Journal of the International AIDS Society, 20(3), 100\u0026ndash;109. https://doi.org/10.7448/IAS.20.4.21497\u003c/li\u003e\n \u003cli\u003eWorld Health Organization (WHO). (2019). Adolescent mental health. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health\u003c/li\u003e\n \u003cli\u003eWorld Health Organization (WHO). (2008). Integrating mental health into primary care: A global perspective. Geneva: WHO \u0026amp; World Organization of Family Doctors (Wonca).\u003c/li\u003e\n \u003cli\u003eDesa, U. N. (2017). World population prospects: The 2017 revision, key findings and advance tables.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Self funded","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Impact, Sexual Reproductive Health, Mental Health, Adolescents ","lastPublishedDoi":"10.21203/rs.3.rs-7282821/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7282821/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Mental health has a directional relationship with the experience of adolescent sexual and reproductive health. Poor mental health may lead to increased risk behaviour (i.e., unprotected sex), which may, in turn, result in adolescent pregnancy and/or postnatal HIV infection. Likewise, adolescent pregnancy and/or living with HIV may contribute to mental health challenges. Despite this significant relationship, less attention has been shown toward adolescents' sexual and reproductive need.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAims and objectives:\u003c/strong\u003e The main aim of the study was to examine the intersection between adolescent sexual and reproductive health and mental health among adolescents in the Upper East Region of Ghana.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology\u003c/strong\u003e: This study is quantitative cross-sectional survey. Data was collected using a structured questionnaire. Data entry was done using EpiData Entry Client v4.2.0.49 and exported to STATA v16.1 for analysis. Microsoft Excel was used to generate graphs and tables for clearer explanations of results. Chi square test was performed to find the association between independent and dependent variables.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e A total of 385 adolescent boys and girls aged 10-19 years were surveyed. Among them, 141 (36.6%) participants reported unwanted pregnancies, and 129(33.5%) had attempted abortions. The prevalence of early marriage among the participants was 16(4.16%) and the reported prevalence of early marriage among participants' colleagues who weren’t part of the study stood at 67 (17.4%). Majority of the respondents (60%) doubt the confidentiality of the health workers which also serves as a barrier and challenge to reproductive health. More than half (64.2%) of the participants stated that they want SRH-related programs to be implemented in their communities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion and recommendation:\u003c/strong\u003e Based on the findings of the study, it can be concluded that the prevalence of early marriage among the participants was lower than the reported prevalence of early marriage among participant’s colleagues. The prevalence of unwanted pregnancy and abortion was high in this study. Also, the prevalence of mental depression, irritable and hopelessness among the participants was high as well. Health care providers negative attitude towards adolescents serves as a barrier and challenge to reproductive healthcare among adolescents. Again, lack of trust and confidentiality also serve as a barrier and challenge to reproductive healthcare. Finally, majority of the adolescent want mental health to be integrated into reproductive healthcare. Adolescent reproductive healthcare and mental healthcare facilities should be provided in the various schools and communities to help young adolescents to have access to reproductive and mental healthcare. Adolescent reproductive and mental health education should be incorporated in the syllabus to give young people first-hand information on their mental and reproductive health. Healthcare providers should exhibit good and positive attitude towards adolescents seeking for reproductive and mental healthcare service.\u003c/p\u003e","manuscriptTitle":"The Impact of Sexual and Reproductive Health Experiences on Adolecent Mental Health in the Upper East Region of Ghana","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-06 08:26:28","doi":"10.21203/rs.3.rs-7282821/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"347ffba9-030e-486c-b0d8-850550026ca2","owner":[],"postedDate":"August 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":52716799,"name":"Sexual \u0026 Reproductive Medicine"}],"tags":[],"updatedAt":"2025-08-06T08:26:28+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-06 08:26:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7282821","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7282821","identity":"rs-7282821","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}