〃 聖路加看護大学紀要 No . 3 62 01 0 . 3 . 短 報 Reduct i onofMa t e r na lMor t a l i t yRa t ei nTa n2 : a ni a De ve l opme ntofRe pr oduct i veHea l t hAwa r e nes sMa t eda l st o Pr e ve ntUnwa nt edPr egnanc yt oAdol es ce nt Fr i daE・MADENI l ) ,CM ,BSN Shi geko HORI UCHI 2 ) ,NM ,Ph D M血 aJITSUZAKI 2 ) ,NM , MN 〔 Abs t r act 〕 Pur pos e: Thepur pos eoft hi ss t udywa st o: i de nd y ff a c t or sc ont ibu血gt r oa dol e s c e ntpr e g na nc y , wh i c hi sar is kf a c t or t oma t e r nalmor t a it l y ;c ompa r er e pr oduc dvehe a l hi t s s ue sbe t we e nTa n2 : a ni aa ndJ a pa na ndt he nt ode ve l opa r e pr oduc d vehe lt a h pr og r a mf orTa nz a n i aa dol e s c e nt s I Met hod Twe l vee l e c t r oni cda t a ba s e swe r es e a r c he di nc l ud i ngPubMe da ndCoc hr a neL ibr a r y ;Theke ywor dsus e d we r eTa nz a ni a ,a dol e s c e nt ,pr e g na nc y ,ma t e r na l mor t a ht y ,r e pr oduc dvehe lt a h・On lyr e s e a r c hs t ud i e son nt ■ sbe t we e na ge s1 3 1 1 8y e a r swe r eus e d・We bs i t e sofr e l e va ntor g a ni z a donsa ndr e ie v wsofJ a pa n■ s pa r dc i pa a ndTa nz a ni a ' sc hI i c li a nf or ma dononr e pr oduc dvehe lt a hs e r v i c ewe r ei nc l ude d.Exdude dwe r enonEnghs h l n gua a gepubl i c a donsa ndt hos epubhs he dbe f or e1 99 9・Ni nes t udi e sme tt hei nc l us i onc it r e ia r ・ Fi ndi n gs TheTa n2 : a n i apopu la doni sy oung:65 %i su n de r24y e a r sa nd20% a r ebe t we e n1 5 2 4y e a r s( Na dona l Bu r e a uofSt a ds dc sMa c r o,20 05 ) IYe t ,t he s ey out h whohol dt hek e yt oou rf ut ur ea sana donha vei de ndf i e d m: l a c kofa de qua t ek no wl e d g e , C lt u ur ea ndt r a di dona lpr obl e msa ndpoora c c e s s i bi l i t yt opr ope r i s s ue sofc onc e i nf or ma donf ora dol e s c e nt s ・n ef i ndi ngss how t ha th短hr a t e sofu npr ot e c t e ds e xa ndl a c kofi nf or ma don it h wou ldbet hel e a di ngc a us eofu m Wa nt e dpr e g na nc y・Pr e g na ntt e e mge r Sf a c er e l a t i ona lpr obl e msw 血m山e s , pa r t ne r sa ndc ommuni t y .m e r ei st he r e f or eane e dt os e ns i dz et hec ommunl t ya nds c hoolpe r s onne la bout a dol e s c e ntr e pr oduc dvehe lt a hi s s ue s ・ Concl us i on A pi c t ur edr a mac a na ddr e s st hene e df ors e xe duc a don t oe mpo we ra dol e s c e ntr e pr oduc dvehe lh a t i nc ont ibut r et or e duc ionofun t i nt e nde dpr e gna nc ya sar e s ltofma u t e ma l mor t a ht y k no wl e dget ha tw 〔 Keywords〕 Ta nz a ni a ,a d o l e s c e nt s ,p r eg na nc y ,m a t e r n a lmo rt a h t y , r e p r o d u c dv ehe a l t h I nt f Oduc t i on MDG)f or1 99 0201 5i nc l ude da75 %r e duc ionofma t t e ma l TheUn i t e dNa donsm山e i um de m ve l opme ntgoa ls( ・( ⅦTI O2 007 ) ・De s pi t ena dona le f f or t s ,Ta n2 : a ni aha soneoft heh i g he s tma t e r na l mor t a ht y( MDG 5 )a sana donalt a r ge t mor t li a t yr a iosi t ns ubSa ha r a nAf dc a . n eS ubSa ha r n Af a dc ar e g i onr e pOr t St ha tawome n' Sr is kofdy i ngf rom t r e a t a bl eorpr e ve nt a bl ec omp上c a donsof 1 )Gr adu a t es t u d e n t S t Lu k e ' sCo 皿 e g eo fNu r s i n g ,Ma t e ma lI n f ntNu a r s i ng 2 )S tL u k e r sCo l l e g eo fNu 乃i ng , Ma t e r n a ll n f a n tNurslngandMi d if w er y a n dMi d wi f e r y l 2 0 0 9 年1 1 月1 0日 受理 MADENIe ta l . :Re d u c d o no fMa t e ma lMor t a ht yR a t ei nTa n z a n i a7 5 Fi gur el .Tan z ani a.Sour c eCI A2 0 0 2 r ho t ve rt hec ou r s eofhe rl i f ed mei sli n2 2,c ompa r e dt o li n 7, 30 0i n de ve l ope dr e g i ons pr e g na nc ya ndc hl dbi ( 岨1 1 e nni u m De ve l opme ntGoa l Re por t ,20 08 ) ・Gr e a t e ra t t e i ont m oi mpr ov ings e xua la ndr e pr oduc ivehe t lt a hc a r ea nd ni u ve r s la a c c e s st oa ni t sa s pe c t sa r er e qui r e dt opr e ve ntu mi nt e nde dpr e g na nc l e Sa ndu ns a f ea bor donsa ndt opr e ve nt mor bi di t ya ndmor t li a t y . Adol e s c e nc ea sde 血l e dbyt heWor l dHe lt a h Or g a nl Z a don,i st hepe iodof上f r ebe t we e na ge s1 01 9・UNI CEFr e por t s r ht t omor et ha n1 5m山i onba bi e say e a r ,a c c ount ngf i ormor et ha nl O % ofa nbi r t hswor l dw ide ・ ha t tg ir l sa ge s1 5 1 9g ivebi at hf org ir l sa ge s1 5 1 9( Mor ne a ta l・ ,1 9 99 ) ・ Wor l d ide w ,pr e g na nc yr e l a t e dc ompl i c a t i onsf ora r et hel e a di ngc a us eofde lt A hou g hs omeoft her i s kc a nbea t t ibut r e dt of a c t or sot h er t h n y a ou nga gef ore xa mpl e ,l a c kofa c c e s st oc a r eor us ,s t i n ,t hee f f e c tofy oungma t e r na la geonpr e g na nc yi sar is kt omot he r s ・ Tooe a r l yc hl dbe a r nga i l s o s oc i oe c onom i cs t a t ne ga dve l yi mpa c t st hes u r v i va l oft he i rne wboms ・ or di ngt oa va na bl edat a ,t hey ounge s ta gea twhi c hg ir l sbe c omes e x ua l l y Te e na gepr e gr -c yi sc or r -oni n Ta nz a n i a ・ Ac c a c dvei nt hec ountr yi s11y e a r s( Mpa ng il e , es L ha ba i & K払we r l e , 1 99 3 ) ・ n ot A he rs t udyc onduc t e di nTa nz a ni ai ndi c a t e dt ha t Ka Z a ur ae ta l. ,20 09 ) ・About26 % ofwome ni nt he mor et ha n 40% Ofa dol e s c e nt swe r er e por t e dt obes e x ua n ya c dve ( c ount r ybe in c g hi l dbe a ingdur r ingt he i rt e e ny e a r sbe t we e n1 5a nd 1 9y e a r sofa g e( Bur e a uofSt a ds dc s& Ma c r o 7 ) ・Te e na gepr e 卵 n C yi smor ec or r -ona m ongg ir l sw it h noe duc a ion( t 4 0%) ,a swe na sr ur a lr e s i de nt s I nt e r na dona l,1 99 ( 27 %) ,t ha na monge duc a t e doru r ba nr e s i de nt s( Bur e a uofSt a is t ic t s良 Ma c r oI nt e ma dona l ,1 9 97 ) ・Ac c or di ngt oas t udy t la a dol e s c e nt swe r ea mongt hehi hr g is kma t e ma la geg r oup( Ka 2 : a ur ae ta l・ , 2006 ) . c onduc t e da tTa n2 : a ni aMuhl m bi l iHos pi I nTa nz a n i a , pr e g na nc yi nt e r updoni r sa l l o we don lyi ft hepr e g na nc yi sat hI e a tt Ot hewoma n' suf eOus t e s e ne ta l・ ,1 9 9 2 ) ・ Mos tt e e nA gePr e gna nc i e sa r eu m Wa nt e d;a dol e s c e nt s血 dt he ms e l ve si ng r e a t e Idi f Bc lde u si n ge t t ngr e s our c e sa nda c c e s s n es t udyofMpa la ng i1 ewhi c he x pl ine a dt hea bor d onc as e sa dm it t e di n Da re sSa la a m,h tec a pi t l a t of a c i u de sf ora bor don・ ofTa n2 : a n i a ,s ho we dt ha ta bout35 % oft her e s ponde nt si nt e r v i e we da dm it t e dt oi nt e ndona n yt e f m血a 血gt he i rpr e g na nc i e s ( Mpa ng i1 e ,e ta l. ,1 99 3 ) ・ The s ee s ima t t e sofa bor donc ou ldb eont hel o ws i deduet ounr e por t e dda t a ;ma nya bor donsa r e c onduc t e ds e c r e t l ya ndne ve rr e por t e d・ Pur pos e a ' sa dol e s c e ntpr e g na nc i e si n ag loba lc ont e x tbyc ompa ml gr e Pr Oduc dve n epur pos eoft hi ss t ud ywa st opl a c eTanzani he lt a hi s s ue sbe t we e nTa nz a ni aa ndJ a pa n t he nde ve l opi ngar e pr oduc dvehe lt a he duc a donpr og r a mf orTn aZ a n i a ' s a dol e s c e nt st oi nc r e a s ea wa r e ne s soft heda nge r sofu m Wa nt e dpr e gna nc yr e l a t e dc omp上c a donst ha tc ou ldhke l ye ndupm 7 6 聖路加看護大学紀要 No. 3 62 01 0 . 3 . Tabl e1 .Compar i s onofTan z ani aandJ apan2 0 0 8Vi t alSt at i s t i cs Tanz ani a J apan 3 9, 4 5 9, 0 0 0 1 2 7, 9 5 3, 0 0 0 9 8 0 3 2, 8 4 0 5 0 / 51 7 9 / 81 1 1 8 4 51 8 / 4 9 3 8 9 / 4 4 Tot alex pendi t ur eonheal t h percapi t a( l n t ' l .$2 0 0 6 ) 4 5 2, 51 4 As% ofGDP( 2 0 0 6 ) 5. 5 7. 9 Tot alpopul at i on Gr os snat i onali n c ome percapi t a( PPPi n t er nat i onal S) Li f eexpec t an c ya tbi l l h. mal e / f emal e( y ear s ) Pr obabi l i t yofdyi n ⊆ =」 nderf i v e ( per1 0 0 0l i v ebi r 【 hs ) Pr obabi l i t yofdyi n gbet ween 1 5an d6 0y ear smal e/ f emal e ( per1 0 0 0popul at i on) at i s t i cs2 0 0 8 Sour c e:WHO St ma t e r na l mor t a li t y・ Met hod Twe l vee l e c t r oni cda t a ba s eswe r es e a r c he di ndudi ngPubMe da nd Coc hr a neL ibr a r y ;Theke ywor dsus e dwe r e a ,a dol e s c e nt ,pr e 卵 nC y,ma t e r na l mor t a it l y ,r e pr Oduc dvehe lt a h.I nc l us i on c dt e r i awe r e :r e s e a r c hs t udi e son Ta nz a ni pa r dc i pa nt sbe t we e na ge st hi r t e e nt oe i ght e e ny e a r s ;we bs i t e sofr e l e va ntor ga ni z a ionsa t ndr e ie v wsofJ a pa n' sa nd Ta nZ a la n sc l i ni c li a nf or ma dononr e pr oduc dvehe lt a hs e r v i c e .Exc l ude dwe r enonEng li s hhngt ngepubhc a donsa ndt hos e pub止S he dbe f or e1 999・Ni nes t udi e s ,h短hhg ht e di nt her e f e r e nc es e c ion,me t tt hei ndus i onc dt e da ・ n Aa lys i s l ・Demogr a phccha r act er i s t i cs n i a , whi c hi sc ommon lyr e f e r r e da s , TheUni t e dRe publ icofTa nZa ni ai st hel a r ge s tcou n t r yi n Ea s tAf hc a ,c ove r ng Ta n2 : a 940, 000 s qua r ek i l ome t e r s ,60, 0000fwhi c ha r ei la n ndwa t e r ・Thei la n nd wa t e r si nc l udet hef a mousl a keVi c t ona , Ta nga n再ka ,Ny a s a ,Ma ny a r a ,Na t r on,Rukwaa ndva iouss r wa m ps ・ I ta ls oi nc l ude sgrea tr ive r sl ikeRuv u ma ,Ru丘j i ,Pa ng a m, Ruv u ,Wa i a m ndma nyot he rs ma uone s ・Ta nZ a ni al ie sbe t we e nl ong it ude29oa nd41 0e a s ta ndl a it t udel oa nd1 2os out h qu a t or ・I ts ha r e sbor de r sw it he i h tc g ount ie r s :Ke nyaa ndUga ndat ot henor h;Rwa t nda ,Bur und i ,De moc r a dc oft hee Re publ i cofCongo,a ndZa mbi ato t hewe s ta ndMa la ia w ndMoza mbi queto t hes out h・ n epopu la doni sa bout39mi uon ha n 1 30e t hn i cgr oups e a c hw it hi t so-1hngua ge・ WhLe ( 2008e s 血na t e s )c ompos e dof26r e ions g ITa n2 : a ni aha smor et is K wa h山i st hena dona l1 ngua a ge ,Eng li s hi st hep血 a r yl ngua a geofc omme r c e ,a dm i ni s t r a dona ndh短he re duc a don・ 2.Vi t ls a t at i s t i cs Wor l dHe lt a h Or ga ni z a ion( t 20022005 )e s d ma t e dt ha ta bout51 % oft heUni t e dRe publ i cofTa nz a iapopu n la doni s l i ingbe v l ow t hepove r t yl ne i ,a ndonl es st ha noneUSdoua rada y;30% oft he ma r ec ons i de r e dt obei na bs ol ut epove r t y. r I nr ur la a r e a si nc ome sa r el owe rs ot ha tt hehe lt a hs i t ua donha snotl m pr ove da ndpove r t yl SmOr ew ide s pr e a da ndde e pe ha t ni n ur ba nc e nt r e ' S ・ if L ee xpe c t a nc yl Sl owi nTa nz a nia・ Thenumbe rofc hi l dr e nwhodi eunde ra geBvei shi h ・Pove g r t y i sTa nZani a ' sma j orhu ma n de ve l opme ntpr obl e ma ndc ons e que nt l y,t hemai n l m pe dl me ntt ot hel m pr ove me ntofthe pe opl e she lt a hs t a t us ITa nz a ni apopu la donl ooksa tmuc hgr e a t e rhe lt a ha ndl if edi f ac lt u i e sc ompa r e dt oJa pa n・( Tabl e1 ) 3・Re pr oduct i vehea lt h( Tabl e2) ypl a r - gc ont r a c e pt l Oni n Ta n2 : a ni aa r ef e ma lehor mone si n pi ua ndi ni e c t a bl ef o- ,bot h n ema J orc hoi c e sf or血 血I us e donl ybyf e ma l es IAf t e rpi nsa ndi ni e c t a bl e s ,c ondomsf ol l owsa st hef a vor e dme hodofc t ont r a c e pt i oni nTa nz a ni a . MADENIe ta l・:R e d u c d o no fMa t e ma lMo r t li a t yR a t ei nTa n2 : i m Tabl e2.Repr odu c t i v eHeal t h- 7 7 Compar i s onofRepr odu c t i v eHeal t hSt a t i s t i c sbet weenTanz ani aan dJ apan Tanz ani a Faml l ypl anmn gmet h odf av or edchoi c e. Pi l l san d叫ec t i on J apan Condom Legalage;av er a geagef ormar r i age( f emal e) 1 5;av g.age1 8 2 0 1 6;av g.age2 8 3 0 Youngmot h er s Heal t hi nsur an c e Man y Noheal t hi nsur an c e Ver yf ew Heal t hi n sur an ce er t i l i t yr a t e Tot alf 5. 1 1 ★ 1 . 4 ★ ★ l n f an tmor t al i t yr at edea t h / 1 0 0 0日 v ebi nh 6 8 ★ 2. 5 ★ ★ 7 8 ★ Mat emalmor t al i t yr a t edea t h / 1 0 0. 0 0 0日 vebi r t h 5 7 7. 5 / 6 2. 2 Li t er a c yr at e% mal e/ f emal e 4. 8 ★ ★ 9 9 / 9 9 Lan guage Swahi l i / En gl i sh Rel i ⊆ い 0∩ Mai nl an dChr i s t i an3 0 %,Musl i m3 5 %. Shi n t o/ Bu ddhi sm 8 4 %,ot h er1 6 % Zanz i barmor et han9 9 % Musl i m. Chr i s t i an0. 7 % Japan es e ' Tan z ani ac oun t r yheal t hpr of i l e2 0 0 7,' ' St at i s t i calabs t r ac t sonHeal t han dWel f ar ei nJ apan2 0 0 0 8 d ypl a nni ngi nTa nz a ia n h e W r e a s ,c ondomsa r et he血s tc hoi c ei nJ a pa n( Ma t s umot o, Sl2005 ) .Thema j ors our c e sf orf a r et hegove r r -e nthos pi t lSa a ndhe lt a hc e nt e r swhi c hc ur r e ndypr ov idec ont r a c e pt i ve st O68% pe r c e ntofc ur r e ntus e r s l Ot he rpdva t es our c e ss uc ha ss hops ,hot e l sa ndgues thous e ss uppl yt hema j or it yofma lec ondom us e r s( Na dona lBur e a u ofSt a ds dc s ,2005) . inr e a s onwhi c hl e dt ot hi sbi gdi f f e r e nc e Thenumbe rofa dol e s c e ntmot he r si shi he g ri n Ta nz a ni at ha nJa pa n・Thema ei nf or ma dona boutma t e r na l he lt a hs i t ua donf ora dol e s c e nt s( Mus hie ta l・ ,2007 )a ndt he i sduet odi fe r e nc e si na de quat l i it m e dnumbe rofc h止dr e npe rhmu ybyt het ot a lf e r d l i t yr a t e .Unde r l y i ngf a c t or sa r e :ha -f ult r a di dona lpr a c ic t e swhi c h nat ls a e r v ic e si n Ta n2 : a ni aa ndal a r gega pbe t we e nma lea ndf e ma lel it e r a c yr a t e , a fe c ty ou n gwome n. she a l h;f t r e ea nt e whi c hc ont ibut r e st oa ni ne qua l i t yofge ne r lk a n Owl e dgee s pe c i a l l yr e pr oduc dvehe lt a h・ Ma t e ma l mof t a ht y Tabl e2di s physTa nz a la n ' Sughma t e ma l mor t a ht yr a t e ・Ac c or di ngt oTa nz a ni aDe mogr a phi ca ndHe lt a h Sur ve y ,t hec ur r e ntTa nz a ni n ma a t e ma l mor t a l i t yr a doi sa t578pe r1 00, 000hve 2004/05( Na dona l Bur e a uofSt a ds dc s ,2005 ) ha t9, 000wome ndi ea nnua nyduet opr e gr -c yr nt A e dc a us e s , whi l eaf ur t he r250, 000be c omedi s a bl e d bi r hS t ・ Thi sme n St a rom t f hes a mec a us e s IEa r l ya ndf re que ntpr e gna nc i e sha vea ddi iona t lr is kt oma t e ma lmor t a ht ya ndmor bi di t y.n e lt a h Sur ve ya ls os howst ha t29% ofa dol e s c e ntg ir l sha vet he i rf i r s tbi r t hbyt hea ge18ye a r s , Ta nZ a laDe n mogr a ph i cHe whi c hma yha vec ont ibut r e dt ot hehi ghma t e ma l mor t a ht yr a t e( Muka ma ,2007 ) ・Poorma t e ma l he a l hs t ugge s t sagr e a t e r l h a t swe na sge ne r l he a lt a hi nt e r ve ndonst a r ge t mgwome na ndme ne s pe c i a ny ne e df orl m pr ovmgr e pr oduc dvehe a r e ga r di ngyout hs e xua la ndE d yhe lt a h・ I nf ntmor a t li a t y he g rl e ve l sof I nf ntmor a t a l it ye s 血a t e ss how ade c 血 ef rom 1 00dur ing 19951 999t o 68dudng20002004・Hi e duc a dona la t t inme a nta r ege ne r a u ya s s oc i a t e dw it h l owe rmor t a l i t yr a t e s ,be c a us ee duc a t i on e x pos e smot he r st o if n or ma dona boutbe t t e rnut idon,us r eofc ont r a c e pt i ve st OS pa c ebi r hs t ,a ndk n owl e dgea boutc hl dhoodi u ne s sa nd t r e a t me nt . 4・Fact or sJ ・ el at edt ounwant edpr egnanc yi n Tan2 : a ia m 1 )Lackofadequat ek n ow i edge j ut houghTa nz a ni aHe lt a h Se r ic v eDe pa r t me nt ss t ug r le g st opr omot ema t e r na lhe lt a he duc a dona ndc ont r a c e pt i on,t he r e a r ef e w you n gpe opl ewhor e c e i vea de quat epr e pa r a donf ort he i rs e xua ll i ve s .m sl e a ve st he m pot e n血l l yvuhe r a bl et o uni nt e nde dpr e gna nc ya nds e xua l l yt r a ns it m t e di nf e c ions( t STI s )i nc l udi ngHⅣ .A s ur ve yc onduc t e di n1 997f oundt ha t gg ir l sw it h ve r yl it dee duc a dona swe na sr ur lr a e s i de nt s , ha t na monge duc a t e d t e e na gepr e gna nc ywa smor ec ommona m on orur ba nr e s i de nt s( Bur e a uofSt a is t ic t s良 Ma c r oI nt e r na dona l,1 99 7 ) ・A n ot he rs t udyc onduc t e di n aTa nz a ni apr ima r y 7 8 聖路加看護大学紀要 No. 3 62 01 0. 3. s c hoo ls ugge s t e dt ha tt he r ewe r eahkhnu m be rofa do l e s c e ntg ir l swho ha de a r l yt e H血 I a do nf r om s c hoolduet o pr e g na nc yC r o d deta l・ ,200 4 ) . Tol e a dhe lt a hy,s af e a nde mpowe r e dl i ve s ,y oungpe opl ene e da ppr opr iat ee duc a i tona nd ntf orl m pr o vn igs e xe duc a donpr og r m si a sne e de d (Mard ni uke tal l ,200 3 )i nc l udi ng t oa c c ompl i s ht ha t ,as t r ongage nf i or ma iona t nds e r ic v e sf oc us ngonr i e pr oduc t i vehe a l h be t f or ei nvol ve me nti ns e x ua la c d it v y 1 2 )Cu lt ur e/s oc i la a ndt r adi t i ona l pr obl e ms n Ta n2 : a ni adoe snotha veas mg l ec lt u ur eduet ot hee t mo l l og iC lc a ompos i donwhi c hc ompns e sBa tu a nd1 3 0 Ot he re hni t c gr oups .A lt houg h t he r ea r ec lt u ur l va a ia r ionsa t mongt heg r oupswhi c hmus tbec ons i de r e dwhe npr opos i nghe lt a h e duc a don,c or r -ont oa nt he s ec lt u ur e si st ha th tedi s c us s i onofs e x ua li s s ue si sge ne r a n yc ons i de r e das e ns i dves ubj e c t . r t y , whom ig htbea na unt ,a nu ndeorag r a ndpa r e nt ・Thos ea dol e s c e nt s Se x ua it l yc a non lybedi s c us s e dt hr oug hat hi r dpa a thomeora t t e ndi ng s c hooldo notr e c e i vea de q ua t ea ndr e a is l dci nf or ma don a bouts e xbe c a us ei ti sv ie we da s e mba r r a s s ng・ i Asar e s ltc u hi l dr e ng e tt ool i t deornome a ni n g uli f nf or ma iona t bouts e x ua ht ya ndt e ndt oe x pe ime r ntba s e d ont he止t t l ei nf or ma dont he ye nc ou nt e rf rom h te i rpe e r s ,i nt e me ta ndt e l e is v i on.n ei r r -e di a t er e s ltoft u h i si se i he t r g e ,l e a vl ngy oungWOme nt Of e ndf ort he ms e l ve sw it hf e ws k i l l s I Mos toft he ma r el e f t a dol e s c e ntpr e g na nc yore a r l yma r na it w h ve r yf e w opdonswhi c hl e a dt oe nga ingi g nr is k ybe ha ior( v 叩pa la ng i1 ee ta l・ ,1 99 3 ) ・ Eve nmor ec ont r o ve r s i a l ,i st ha ts omee hn t i cgr oupsi nTa nz a iaf n ol l ow t heol dt r a di t i ona l mar r i a gepr a c t i c eb i ndi ng a di c t st he1 971Ta nz ani aLa wofMa r ia r geAc ts pe c i yi f ng1 5y e a r sa st he muc hy ou n ge rpe opl e ・ Thi spr a c dc es t r ong lyc ontr r y( Na iona t l La ws ,Ta nza iaLe n is g l a donofI nt e r polMe mbe rSt a t e sonSe xua l Of f e nc e s in m imum a gef orag ir lt oma r ・ Thehi h pr g opor donofma r ie r da dol e s c e ntg ir l sr e 且e c t st h et r a di dona lpr a c dc e sa tme na r c he ;ag ir l a ga ns i tCt 山dr e n,2006 ) i sc on丘ne dt oar oom whe r es hema yr e ma inf oral ongd meun le s se a r l i e rhe rha ndi ss oughti n ma r na ge .Dui rngt hi s pe dodofc on血l e me nt ,t heg ir li st a ug h tI . hef t a c t sof止f e1 ■a ndr e c e i ve st hei ns t r uc dona ndgu i da nc ei n pr e pa r a ionf t or a ,1 9 99 ) ma ia m g e ・Us ua ll ye a r l yma r ia r gei sf ouowe dbypr e g na nc y( Kopok n ot A he re xa m pl ei st ha ts omee t mi l cg r oupske pta dol e s c e nt si nt hebus hf oronemont ht opr e pa r ey oungpe opl ef or l et hi si sawe l l e nt e nnga du lt hood・Boy sa ndg ir l sa r et a ughta boutma de dl i f ea ndr e s pons i bi l i t i e sf orpa r e nt hood.Whi y ,s ot ha t nt i e ndone dpr a c dc e ,a dol e s c e nt sr e c e i vei ns uf f i c i e nti nf or ma dona boutr e pr oduc dvehe lt a ha nds k i nsf ors e xua it l a f t e rt he i rs t udyt he ywa ntt opr a c ic t ew it houtk no ingt w heda nge r sofunpr ot e c ts e x.A s ar e s lt u ,g ir l sbe c omepr e g na nt Mushie ta l・ ,2007 ) ・ l e a di ngt ot hehi ghi nc i de nc eoft e e -gec h Ldbe a dng( Ther e l a ions t hi psbe t we e na dol e s c e nt sa ndt hege nde ri mba la nc e sof t e ni nc r e a s et her is ksf a c e dbyy oungf e ma le s I Young it ls a e x ua le x pe de nc e sa ndava ne t yofpa r t ne r s ;f e ma l e sa r enots ope r c e i ve d. ma le sa r ew ide l ype r c e i ve dt one e dpr e mar Thene e dt oc onf o汀nt Ot he s edoubl es t a nda r dsma yc a us ey oungf e ma le st of e a rdi s c l os ngt i he i rs e x ua la c dv it y ,a ndma y r e s lti u nr e l uc t a nc ea m ongt he mt or e por ts e x ul ae x pe ie r nc e s ・ Thsf e a rma ya ls oi nh i bi ts e x ua ll ya c dvef e ma lea dol e s c e nt s rom s f e e k ngc i ont r a c e pt ives e r v i c e s( Ade k a lee n ta l・ ,2 008 ) . I nt h i sr e s pe c tt hee duc a donofg ir l si st hemos ti mpor t ntf a a c t or ,be c a us ei te mpowe r st he mt ode c i dea bouth te i rown l i ve s ;i te na bl e st he mt ode ve l oppl nni a ngbe ha i vor ,f ori ns t nc a et o丘ndwa y sa ndme hodsofc t ont r a c e pdon( Ma c Pha ile t l. a ,2 007 ) ・I nt hel ongr ni u tma ys d mu la t epl a nni ngbe ha ior v ,c ont r a c e pdona ndpr e ve ndonofu n Wa nt e dpr e g na nc i e s ・One s a d va nt a g e sofa dol e s c e ntc hu dbe a ingi r st ha ti tof t e ni nt e m pt se ducadon,be c a us epr e g na ntg ir l sa r e oft hei mpor t n tdi a . You n gme nus ua n yde nyt he i rr e s pons i bi it l yf orapr e g r nnc ya n daba n do nt heg ir lf oranm u be rof s e nta wa yf rom school r e a s onsi nc l u di ng:t hei na bni t yt ot a kec a r eoft hee x pe c t ntmot a he ra ndt heu nborn chud;f e a rt obet a ke nt oc our t gr li ss 山1i n s c hool )a nd h teboy s ■doubt sa bouthi sa c t ua l fat he r hood ( At uy m bee a ta l・ ,2005 ) . ( e s pe c i a n yi ft he i Une mpl o y e da nd t h eg e ne r le a c onom i cs i t ua ionma t ke sy ot ngme nf e e li na de qua t e l ypr e paredt ome e tt hede ma ndsa nd mg h e rpr e g r nnc y・ c os t sofs uppor t 3 )Poora cc es s i bi it l yofpr ope ri nf om at i on la iona t ndDe ve l opme nti nCa ir oi n1 9 9 4,t heprov is i onofs e x ua l i t ye duc a don Att hel nt e r na iona t l Conf e r e nc eonPopu ndc a ont r a c e pt l VeS e r v i c e st oa dol e s c e nt s ,a ndi nduc e da bor dons ,we r ea mongt hemos tc ont r ove r s i la a ndmos tdi s c us s e d l. ,20 00 ) IS nc i et he n,t hea uh tor it ie si nTa nz ni a aha vei nc r e a s ng i l ybe c omea wa r eoft hepr obl e m of i s s ue s( S pe i 2 : e re ta it h f d yphnni ng unwa nt e dpr e 卵 nC i e sa ndi nduc e da bor donsm a onga dol e s c e ntg ir l s ・I nor de rt or e a c ha dol e s c e nt sw i nf or ma iona t nds e r ic v e s ,UMATI ,t heFa r n i l yPl nn a i ngA ss oda donofTa nz a ni a ,ha sa t t e mpt e dt os e tupy out hf de ndl y MADENIe ta l・:R e d u c d o no f Ma t e ma lMo r t li a t yR a t ei nTa n2 : i m 7 9 c e nt e r sO' out h Fr ie nd l y ) ・ n e血血l ypl a nni ngpol ic ya nds e r v i c e ss t a nda r dsGui de l ne i s( 1 9 9 2 )i nr e c og ni donofa dol e s c e nt be i ng s e x ua u ya c d veha sma depr o is v i onsf ors e r ic v ede l i ve r yt oa dol e s c e nt( 1 S te di ion1 t 99 2 ) ・Se c don1( pp3 7 )The g e ,i nc l udi nga do l e s c e nt si r r e s pe c dveoft he i rpa nt ya nd gu i de l ne i sno ws t a t et ha t. a nma le sa ndf e ma le sofr e pr oduc dvea ma it r a ls t a t us ,s ha hha vet her ightofa c c e s st o触 l ypl a nni n gi nf or ma ion,e t duc a t i ona nds e r ic v e s -( M血s t r yofHe lt a h, 1 99 4 ) ・ Wor l dHe lt a h Or ga nl Z a iondi t s c us s i onpa pe r sona dol e s c e ntc ont r a c e pt i veS e vi r c ede l i ve r yf oundt ha tmos tg ir l sa r enot a wa r eoft he i rr ig h tt oa c c e s sc ont r a c e pt i veS e r ic v e s ;t he yr e ga r dt he血∬山ypl a r - gpo止c ya ndc ont r a c e pt i ona SOn ly a va il a bl ef orma r ie r dwome na ndwome nwhoha vebe e npr e gna ntonc e ・' ' Fa i1 m y pl a nr u ngs e r ic v e sc a npl a ya ni mpor t a nt I( 甲HO,20 04,p・63 ) . r ol ei n he l pi ngg ir l st opr ot e c tt he ms e l ve sf r om a l1t hene ga dvec ons e que nc e sofpr e gna nc y . Fur he t r mor et he r ea r eot he rs e iousf r a c t or si mpe di ngt he i fa c c e s st Of a 血l ypl nnl a ng. ・m is c onc e pt l OnSa boutt he i ro wn ypュ a r - gs e r ic v e sa ndt he ya ra f i dt o pr e g na nc yr is k;t he ya r ea ra f idofbe ngc i ons i de r e dpr om is c uousi ft he ya t t e nd血 n山 bes e e nbya n a du lt ,f a 血l yme mbe rorne i h bor g s ,a st he yma yf e a rt ha ti ft he yc ons ltadoc u t ort he i rpa r e nt sma ybe if n or me d. rt ha tg iv ingc ont r a c e pdve st oa dol e s c e nt sw il le nc ou r a g es e x ua la c iv t it yC WHO,20 04 ) ・Pa r e nt s Pa f e nt Sa ndt e a c he r sf e a ndt a e a c he r sne e dt ou n de r s t ndt a ha ts e xua le duc a donf ors c hool c hl dr e nork nO wl e dgea boutc ont r a c e pt i veus edoe snot r a r y ,i the l pst he mt oma kei nf o- e dde c i s i ona boutt he i rs e xua l i t y・I nTa nz a ni a , i nc r e a s et he i rs e xua la c d ide v s ;t ot hec ont a m os l ta nhe lt a hC 血c sa ndhos pi t lsha a vef d ypl a nni ngs e r v i c e sbuta c c or d i ngt oa va i l a bl eda t af r om a20 04s ur ve y ( VHO,2 008 )onl y1 6 % ofr ur l ma a r ie r dwome nus ec ont r a c e pd veme hodsc t ompa r e dw it h3 4% f rom u r ba na r e a s ・Thi s us a gepa t t e r nwou lda ls oa f f e c tr ur la a dol e s c e nt sc ont r a c e pt i veuS e H s ,t e a c he r s , gove r nme nt , r e l i iousg g r oups , e t c . ) Cor r u nuni c a donga pse x i s tbe t we e nt heva iouspl r a y e r s( a dol e s c e nt s , pa r e nt h e nds a hou ldbef me dbyde ve l opi nga na t mos phe r eofmut u lu a m de r s t nd a nga i ndwi u i ng ne s st opr o idege v nui nehe l pt ot a dol e s c e r l tPOpu la don.Re l i iousi g ns dt ut iona la nds c hool ss hou lda ls opa r ic t i pa t ea ndt a ket he i rr e s pons i bi l i t yt oe duc a t e s y oungpe opl e ・ Pr opos mga ndpl a nnl ngPE Ogr a m l ・Conc e ptf ort hee duca ion t TheJ a pa ne s eOr g a ni 2 : a ionf t orl nt e r na iona t l Coope r a ioni t n Fa i1 m yPl a nni ngSe pt e mbe r20 09Ado l e s c e ntSe x ua la nd r ,of f e r e daus e ulmode f lf ora do l e s c e nts e xu a la ndr e pr oduc dvehe lt a h ・The yc r e a t e dthe Re pr oduc dveHe lt a h Se L ni na c ompr e he ns i vetre emode la ndde f i ne dc ompr e he ns i ves e x ua ht ye duc a don" a sahf e l ongpr oc e s sofa c q ur l ngi nf o- a don y ,r e l a dons h i psa ndi n血 a c y. ‖ 00I CFP)bookl e t ,Compr e he ns i ve a ndf or mhga t dt ude ,be 止e f sa ndva lue sa bouti de ndt Se x ua it l yEduc a t ionpp3 )Thet e r mc ompr e he ns i vei ndi c a t e st ha tt hi sf or m ofs e x ua ht ye duc a done nc ompa s s e st hehu r a ngeofi nf o- a don,S k i nsa ndva l ue st oe na bl ey oungpe opl et oe xe r c i s et he i rs e x ua la ndr e pr oduc dver ig ht sa ndt oma k e de c i s i onsr e ga r d i nghe lt a ha nds e xua li t y・Adol e s c e nt sne e dpr ope ri nf or ma dona boutr e pr oduc d vehe lt a h・ Compr e he ns i vet r e e l j _ 一軍一 一 'L i -・ _ I -,_ t r a y ss e x ua it l ya sana t ur lPhe a nome non;i ti sanom a la ndhe l at hypa r t n ec ompr e he ns i ves e x ua li t ye duc a dont r e eport ofhuma nl i f ei fi tc a nbee x pe ie r nc e da nde x pr e s s e di n apr ope rwa y ・ m se mpha s i 2e St ha ta bs t ini a ngl SOneOft heme hod t 80 聖路加看護大学紀要 No. 3 62 01 0. 3. ha t tc a npr ot e c taf e ma lef rom pr e g na nc ya nds e xu lt a r a ns it m t e di nf e c dons ,ag loba l pr obl e mf ora dol e s c e nt s ・ Thea s s umpt i oni s , ha t ti fpr ot e c t e d,s e xa nds uf f i c i e ntk n owl e d gec onc e r r u ngr e pr oduc dvehe lt a h wou ldbet a ug htc l e a r l y it hs uf f i c i e nta c c e s s ,t h i sc ha ne ngema yber e duc e d・m sme a nst ha tc ompl e me nt a r ya c donsa r ene e de dt opr omot e ndw a he a l hyde t ve l opme nti nTa nz a r u ay oungge ne r a don・ The s ea c ionsi t nc l ude : nc i r e a s l nge duc a dona lopportunide sf org ir l sa nd r a g mgg ir l st os t a ym s c hooll onge r ,e duc a t mgy out ha bouts e x ua la ndr e pr oduc dvehe lt a ha ndc ha n g mgs oc i lnor a ms e nc ou r e l a t e dt oa g ea tma r na gea ndf l f S tPr e g na nc y. h,i n Or de rt o ne r ei sane e df ory out hf de ndl y血dI y pュ a r - gs e r ic v e sa ndpr ope re duc a dononr e pr oduc dvehe lt a r e duc eu nwa nt e dpr e g na nc i e sa nda bor iont r e l a t e dc omphc a ionsa t ndde a hsa t monga dol e s c e ntg ir l s畔a s c he tl aり2 00 0 ) . Thee duc a dona lt ool ,t hec ompr e he ns i vet r e e , wubea ne f f e c dvemode lf orc r e a t mga wa r e ne s sa monga dol e s c e nt sf orw is e hi l dr e n,be f or et he yr e a c ht hea gea twhi c h c hoi c e sf ort he i rbod ya ndt ounde r s t a ndt heout c omeofunpr ot e c t e ds e x・A山c he t ybe c omes e x ua n ya c dve ,ne e dt obet a ug h tt her is ksofu n pr ot e c t e ds e xa ndhe l pe dt ode ve l opt hes ki nsne e de dt o pr ot e c tt he ms e l ve sf r om s e x ua lc oe r c i on. He lt a ha wa r e ne s sma t e ia r lt opr omot ea dol e s c e nthe a l h t h At r e e ,whi c hi sas m bolofbot y i l f eanddeath,wu beusedtoexplai nt heda nge ra dol e s c e nc e sma yf a c ei nc a s et he y ma keabl i ndde c i s i on・I ti sas m bolofl y i f ei fi sus e dpr ope r l ya ndas m bolofde y a hi t fi ti sm is us e d. eme t hodi st ha tc hi l dr e na ndy ou n gpe opl ewubee qul pPe dw it h n epmI l a r ygOa lofs e x -l i l ye duc a donbyus i ngt hetre hek t n owl e dg e ,s k i nsa ndva lue st oma ker e s pons i bl ec hoi c e sa boutt he i rs e ua x la nds oc i lr a e l a dons hi psi nawo血da f f e c t e d DSa ndot he rs e xu a n ytra ns i t m t e ddi s e a s e s ・Se x ua ht ye duc a donpr og r a m e r sus ua n yha ves e ve r l mut a ua n y byHⅣ /AI r e i nf or c i ngobi e c d ve ss uc ha s :t oi nc r e a s ek n owl e d gea ndunde r s t a ndi n g,t oe x pl ina a ndc l a if r yf e e l ngs i , Va lue sa nda t it t ude s , t ode ve l opors t r e ng he t ns k i nsa ndt opr omot ea nds us t a nr i is kr e duc ngbe i ha iora v monga do l e s c e nt s ・ Boy sa ndg ir l sunde r g oi ngpube r t yma yl ookphys i c a n yma t ur e ;ho we ve r ,t he yha venoty e tma t ur e d仙l ye modona l1 y ,s o t y ,ag ir l ' s he t i ra bi ht yt oma kew is ede c i s i onsa bouts e xul a ma t t e r si ss i l lde ve l opmg・Dudngt hei ni da ls t a ge sofpube r r e pr oduc iveor t ga nsha venoty e t仙l yma t ur e d;he rbodyi snots t r onge noughbe c a us eoft hei m a t ur it yoft hepe l ic v ・Thsme a nst ha te ve ni fag ir lbe c ome spr e g na nt ,S hema ye x pe ie r nc es e ve r ed i f f i c lde u swhe ng l V l ngbi r ha t ndt hus , bone s s hema ydi edur ingc hi l dbi r h orc t on血uet oe x pe ie r nc ehe lt a h pr obl e msf ort her e s tofhe r止f e ・ emode la sapl C t ur edr a maw山 a s s i s tt hea dol e s c e ntt ode c i dea boutt he i rdi s c us s i onof Us i ngt hec ompr e he ns i vetre pos i iveorne t ga dvebe ha ior v ・n epi c t ur edr a maa ls ohe l psa do l e s c e nt sr e me mbe rt ha tapr e g na ntg if lha st odr opoutof he i r血m山e sa ndc om uni de s ・I ti snota lwa y spos s i bl e s c hoo l ・Th i sha sl ongt e mlhpl ic a donsf ort he ma si nd i idua v lS,t f ort e e na ge rmot he rt ogoba c kt os c hool .m sme a nsa ne ndt oa l lhe rf ut ur epl a nsf orac a r e e r 1 2・Ta r ge t mgpopda t i on i t ybe t we e n n emos tpr om is ngg i r oupst of oc usuponf ora ne duc a iona t lpr ogr a ma r ea llboy sa ndg ir l si nt hec ommun ・ n ej un i orh i hs g c hools t ude nt hea t ge sof1 0t o1 7y e a r sbe c a us et h i st a r ge t e dgr oups pe ndsa m os l ta nt he i r血 ea ts c hool gr oup,i st hemos ti mport a ntonef orc or r e c t i ngWr ongi nf o- a donc onc e ml ngr e pr oduc ivehe t lt a he s pe c i l1 a ys i nc et he y r a ne i dt ot e a c hot he r sa boutr e pr oduc dve ha vea lr e a dye xc ha nge de r r one ousi de a st oe a c hot he r ・Somea dol e s c e nt swi nbet he lt a h,be c a us epe e rt ope e re duc a donwu bemor ec omf or t a bl ea nde fe c t i vef ory out ha ndi sa vaua bl ea l lt h e血 ee ve n a thomewhe r et he yc a nt e a c h ot he r a dol e s c e nt s 3・Ma t e ia r lSa n dTool( Fi g21 1 -3 ) wo・ Two Thes t or yofTa t ua ndMbn ii sba s e donK is wa hn ic ount i ngnumbe r s ,t woa ndt hI e e ・ Ta t ui st hr e ea ndMbuiist ndt a he ea r ec l os enu m be r sa nde a c honephy sas 垣I i 丘c a ntr ol ei nt hepr oc e s sofc ou mt ngf or wa r d. I ti sbe止eve dt ha tt hi s inc w r e a t eagr e a ti mpa c tw it ht hea dol e s c e nt s ,e s pe c i ll a yi ft he yk n ow t ha ti ti st hebe inn g i ngwh i c hma r ks t h ee nd・ MADENIe ta l・:R e d u c d o no f Ma t e ma lMo r t li a t yR a t ei nTa n2 : i m 勉 吉 事 一. 由ぎ 竺 = t 声 宇「ii . 監 造賢 . 1T .t L _ 奉 養 L r 一= #. . r i , 一 -一 「 L ー 81 Tb ca d o k∫ E mta tt h et o po ft b c 加C ,d na mi " ga b o 〟 t"e c k' " gb c r I" i - go a d ,I " C b a sg o i n ga "l oh z k b c re d " c a do "a " db e i 7 2 ga b l et og e t 〟 t,∫ k ei Ja haf b i " ki " ga b o 〟 tb e i n gl o y c d . ago o djo b ,b Two加即ml t ba d o k∫ c e " t sa tt h et o l , TT Y eO nL b el e f tJ b o 2 y Ja "a d o l e J t mtg' 1 1J i t d n ga wd J_ 画mt h eb r w 〝 c b e t " gc u t ,a " do "t h e gr u " " dt b e T "' Jab l kh o b ,J h em1 f〝 o t f d l ld 0 b " 顔" go H m' L bt b cc u tb r w 〝 c b .TT Y C0 7 7t b e痩カ ts h o wsa "a d o ks c mZ g i dc t h eb r d " C bo fL b e如co "wh' c hJ h ei sJ i i h ' " aJ h em1 f f d ui "l ol b eb な h o b. L 7 2 J Z ' d et h eb o bL h c r "I : Pr e g n d H g CO呼 I 3 ' c a do7 2 S ,HI V/Ai d f ,∫ C XWd l i sc a∫ e J ,〟〝 J a f ea b o r i i o "a 〝 dJ u i a ' d c ・ i r w 7 7 J mi He dd Ta t がJf d j Wl ' bi f砂i 7 7 g lod d w' s et b c i rd o " g b t e ra b o 〟 td a 7 7 g e T UO f d d o k∫ c e " t pT e g " a " g. "n g l e c t Jt b e i l ・ d d w' c e〟 〝 d e rh e ra ∬〟 月 中do 〝t h a tJ h cA" o M / Sa i lt b o ∫ e Ta t b ga r el e l il M gh e r . t b i n g Jt Fi g2 1 .Th es t or yo fTa t uan dMbi l i Te a c hi ngma t e i rl as n et e a c h i ngma t e r i lsa a r ede s i g ne dt oa ddr e s st hev u he r a bi ht yofy ou n gpe opl ei n de c i s i on一 ma k i nga bouts e xu a l be ha ior v ・Twot r e e sw it ha dol e s c e nt sa tt het ope x pl int a h e t wodi f f e r e ntde c i s i onsf ora dol e s c e ntwhoe nga gei ns e xua l t l V l t l e S . a c FddaMa de l n,a ut hor ,a ndMi kaTohe i ,a r ds t ,c r e a t e dapI C t u r edr a mat ha tf oc us e sona dol e s c e nt swhoe nga ge di ns e x ua l a c dv ide sl e a di ngt ou m wa nt e dpr e g na nc y・ I ta ls oe xpl a nSt i ha ta dol e s c e nt st obei ng oodhe a l hi t st he i rr ig h ta ndt he ys hou ld be c omef re ef rom c ha 皿e nge st ha tc ns a hor t e nt he i rl i f e ,s poi lt he i rphnsa ndf ut ur e .n epi c t ur edr a mai nc l u de s1 5pi e c e s ofdr a mama t e il r a me a s ur ng3 0c m by42c m・Thef r ontpa r toft hema t e ia r lc ont a nSt i hear twor kwhl et heba c kha st he wdt t e ns t or y ・ Thea ut horus e sat re et ode mons t r a t et hea dol e s c e nts i t ua donbe c a us et heTa nz a ni ae nvi r onme nti sc ove r e d bytre e s ,s ot ha tt hea dol e s c e ntw山bef r e que ndyr e mhde doft hes t or y ・Fi gu r e2e x phi nSt hes t or y ・ m sdr a mawa si nt r oduc e da tt he2 009Se pt e mbe rc onf e r e nc eofStLuke r sCone geofNur s i ngToky o,J a pa n .The n de u r g r a dua t es t ude nt sa ndd i f f e r e ntme mbe r si nc l ud nga i dol e s c e nt sa nda du lt sa t t e nde dt hec onf e r e nc ea ndi tr e c e i ve d pos i t i ver e s pons e sa ndc omme nt st ha tt hedr a mas hou ldbeus e uli f n Ta nz a n i a ・ 4.Eva ha don Weha vet wot y pe sofe va lua don: A.S hor tt e nne va lua ion; t 1 )m swi ni nc l udepr ima r ys c hools t ude nt s IWew山 ma keapr e t e s ta ndpos tt e s tf ora dol e s c e ntde c i s i onmaki ng・A que s donna ire wu beus e dt ot e s tt he i rk no wl e dg e ,a t dt udea nds k i ns ・ 2 )Foc usg r oupi nt e r ie v w-Howa ppr opr ia t ea r et hec l a s sgoa lsf ort hes ubj e c t ,e duc a ionpl t a c e ,t ime ,e f f e c d ve ne s sa nd n de u r s t an di ngf ort hema t e r i lS a ・ BILongt e r me va lua ion; t 8 2 聖路加看護大学紀要 No. 3 62 01 0 . 3 . Fi g2 2 .Th es t or yo fTa t uan dMbi l i 1 )Af t e rs i xmont hsa dol e s c e nt sw山 t hi nka boutt he i rde c i s i onma k ngl i 2 )Af t e rf i vey e a r sho w ma nys u bj e c t sbe c a mepr e g na nta ndwha twe r et hebe ha iorc v ha nge sf ort hos ewhodi dnot be c omepr e g na nt ? Fut ur ePhns e is v ea ndc on血uet ode ve l ope duc a donma t e ia r l s ,t a r ge ts ubj e c t s ,goa ls ,pr omot et hee duc a dona nde va lua don Wew山r a ndt he nwei wl la t t e mptt opr o idet v hi sk ndofe i duc a iont t oc ont ibut r et ot hede c r e a s eofunwa nt e dpr e gna nc i e sr e l a t e d t oma t e r nalmor t a it l yr a t e ・ MADENIe ta l・:Re duc donofMa t e ma lMor t li a y t Rat ei nTa n2 : i m Af e wMO " L bht e r ,Ta 勿d e u e l o l , ∫mo mi " gJ 滋k " C S J ,Ta t "' J f d L b e rb e a r s ∫ o "e o 7 1 ey O "i h7 7 ga " dr a i J C Sh' sy o i c ct oq 〟 c J do nTa h y .Ta t uh ' e ∫t ob i " Jmgt h a tS h ei sb m∫ b i " gb c rt e e t b ・ r ys d fo- Mb i h ' d b o H tb e r pr e g " d 7 g グb " iMb l Gr e je c I J Td t ud c a l d e st ogoloi72 h e r . " No !Ic d "' tt d Ae6 - 0 fJO WPn g n a " gb e c d " S eIa ma ko∫ 勿d c " ち d 2 d . Id o 〝' twa n tl o∫ C C JO ud g W7 7 ' ' Mb i l z I J A〝 dJ a d bb cd b a 7 u i o "h e r ・Ta t "加' e st ob z ' d eb c rpr 2 g n a " gb 〟 tb c r 打i ta 7 2 dd z ' J C 1 0 n dn u eb c r∫ 勿d i e s . ∫ do o lt e a t : h e rd z ' J E 1 0 y e l e g " a " 9 / ・∫b c Ta t Hg O e ∫b a 戊h o mca " dt oz e i lt b cl y u t ba b o 〟 th e rl) i " f o -∫b e r f d L b e ra " d-t i e rb " it b gy e b 〟 kc dh e rJ a Ji " a〝 Gob a c klo _ y e 〟 rb o l fi c 7 C d ,h cm' l Il a kec a nO fJO 〟a n dJO Wb d 勿 ・" 〟wec a "' tl a keL h i JS b a -" ,Td 勿' s f d L b c rJ b o 〟 t e d ・ Td t W2 ' si " 加〝 b l ・Cut " a Ta i wkd y C Jb e r f d m' b ・∫k ei J 坤e l l e dfv " yunm a " io fb e rh o me ・ ∫ do o l ・∫k ei sL b R〟 ゐe d ,a r eh e rc b d 7 7 c c JO fd C b z ' e dn g"a " IO fb e r g o d k f o rt b e f u 7 -I " C b 吻 ago o de d " C d do 〝a " db e i n ga b l et oge tago o djo b ・Al li b c a Jge JC yi 7 3 g ,∫k el o o kT∫ 0∫ d d ・ / c o mm〝 〝 7 l gMe mb e l Tl o o kd tTd hLWh i l e∫ k ei r ・∫k e Sh ed o e s 〝' tk作 o wwh e nJ h cc a ng O ・Tb c ni J7 7 0O n el oPka J ebe M e g ・ l o o kT∫ 0∫ d da " dl o Th' Ji Jag O O d如ewb i c bi 7 di c a t e st h ec mc l " J i o " f o rd d o l e s c e " t JZ b d t : 物 ∫ b o " aA" o wt h a t2 ' tか〝 o tn e c e J S d C y f o rab ya " dg i dwh oa T Y 7 gJ b o " i dk 作 o wL b a tt b cb e s tm/ d γl od y O i d fi e 〝 dfl ob d y e∫ e X・Tb , V e g " a n y,∫ c x" a l加 〝 J m' J j 7 1 0 〝d i s c a J C S ,HI V/ Ai d si sl o" o tl ob a y e 1 b e J e1,r o b kmJ Z fL b ga nu ∫ c d s e xd td l iCo 〝 d o j W∫C a 7 7PT -〝 ta l lt 砂e y eグ d mり/ 0 〟b a r eJ e X・ c o m` 〝o fJ a Ji " g" at oJ c xI B〟 tt h yJ b o " l dn"e "b c rt ob d y et h ec kd ri " t e " k o "J a J /〝 0 ,b o t bJO " rv o i c ea n d)l o wb o d z ys b o " ab eJ a γ i " gi b c Wb e 〝JO h' M g. J a j mt Fi g2 3.Th es t or yofTat uan dMbi l i 8 3 8 4 聖路加看護大学紀要 No . 3 62 0 1 0 . 3 . Ac n owl k edgement Iwou ldl iket ot ha nkt heBi s hopWi l l i a msMe mor ia lFu n dBoa r dMe mbe r s ; Ri ky oUni ve r s i t yToky o, whode c i de dt ot a ke me ,f rom a mongt hema nya ppl i c nt a s ,a st her e c e i ve roft hes c hol a r s hi pgr n twhi a c he na bl e dmeto a t t e r l dt he s es t udi e s I e nde da ls ot ot hef a c lt u ya tSt ・Luke l sCol l e geofNur s mgpardcuhr l yt heMi dw if e r yFa c lt u yf or Mya ppr e c i a donsa r ee xt he t i ra c a de i cl m nPut ・Ia m mos tgr a t e ult f oPr of e s s orShi ge koHor iuc hif orhe rgui da nc e ,a s s i s t a nt s ,unde r s t a ndi nga nd pr of e s s i ona ls uppor ta c a de ic m a u y・Wou ldl i ket ot ha nkDrSa r a hE・Por t e rf orhe re di t ori la a s s i s t a nc e .Ia ls oa c knowl e dge hec t ont dbudongl Ve nbyMi k aTohe i ・He rar ti sr e ma r k a bl e . F・ A hdol wa ,myhus ba nd,Ms a ga dKa 血 dia ndPr i s na Ka uye ,myc h i l dr e n, Iwou ld止ket ot ha nkRe v・Ca n・Ma i mboI W・ f ort he i rmor ls a uppor ta nde nc our a ge me nt . Ref e r e nces Ade 血1 1 e ,D・ ,Ade y e i, m A・& Od u,0.( 2 0 08 ) . Te e na g ea ndnont e e na g epr e g na ntwome ni ns o ut hwe s t e m N垣e ia r ・Ca h ' mt Mc ゐ/ Jo " ma / , 6( 3 ) ,e 5 . , L・ , Mi r e mbe , F. , J oha ns s o n, A. , K止u m血,K & Fa x e l i d,E・( 2 0 0 5 ) . Ex pe ie r nc e sofpr e g na nta do l e s c e nt sIVO i c e sf romWa k i s o At uy a mbe d i s t dc tUg a nd a . Af n ' c a 〝He a bb∫de " c o s ,5( 4 ) ,3 0 4-3 0 9 ・ Bonga a r l s , J ・ &Cohen,B・( 1 9 98 ) ・I nt r odu c dona ndo v e r ie v w・∫h y i k ' e JZ ' "Fa ml gPh" " i " A2 9 ,9 9 1 1 05 1 Bu r e a uofS t a is t dc sa ndM旺f OI nt e f n a dona l・( 1 9 9 7 ) ・Ta n2 , a n i ade mo g r a ph i ca ndhe a l t hs u r ve y ・B-d uO f∫t d 肋 a d Md C nI " l c md L i o " O L l Ci t e d2S e pt e mbe r2 0 0 9 ]Avahb l ef rom URL= ht t p: // ⅥW ・ n1 u 0 r g/ e s a / popu la ion/ t pu b山 c a ions t / pr os pe c t s de c J i ne / mt ur i pdf ・ vra ne 2 : Ou h ,I ・& Mc G血1 ,E・( 2 0 0 8 ) ・Un i nt e nde dpr e g na nc yi ns u bS a h 2 L f a nAf hc a ・M喝r l i t udeoft hepr ob l e ma nd Huba c he f ,D. ,Ma pot e nda lr o l eofc ont r a c e pdvei mpl a nt st oa n e ia v t ei t ・Fa m砂 He L l hhI " l e ma h ' o " a / ,78 ( 1 ) ,7 3 1 8 1 J a pa ne s eOr g a nl Z a io t nf o rl nt e ma dona lCoo pe r a doni n Fa mn yPl a nni n gOOI CFP ) ,Compr e he ns i veS e x ua li t yEd uc a don ( p p3 1 5 ) , Se ina m rhe l di nSe pt e mb e r2 0 0 9a tT c h j 伊y a , Tok y oJa pa n・ ( u npubl i s he d ) J u s t e s e n, AりKa pl g a , S・ H・& A st e n, AI H・ ( 1 9 9 2 ) I Abo r doni nHos pi t a ls e t 血g:Hl d de nr e li a de si nDa re sSa la a m, Ta n z a n i a . ∫ l k / yf o rFa m' g Ph" J W ' " a2 3( 5 ) ,3 25 3 2 9 ・ Ka 2 = a u r a ,R M. ,Ki d A nt O, L H. & Ma s a we , NI S.( 2 0 0 6 ) . Ma t e r na lmor t li a t ya tMu h i mb i l i Na dona lHos pi t a l , Muh i mb i l iNa ion t a lHos pi t l, a Ta n2 a n i a ・EL NIAfi l aJo " ma / ,( 3 ) 2 ,2 3 1 2 5 ・ Ka 2 a u r a ,R・M・良 Ma s a t u,CIM・( 2 0 0 9 )S e x皿lpr a c dc e sa mo ngu r -a r ie r da do l e s c e nt si n Ta n2 = a n i a ・Bi oMe dCc"加 /PH b h ' cHc a hb ,9 , 3 7 3 1 l Ci t e d1 0S e pt e mbe r ] Ava n a bl ef ro m URLht t p= // www・ bi o me dc e nt r l・ a c o m/ c ont e nt / pdf /1 4 71 2 45 8 9 3 7 3・ pdf a , A.( 1 9 9 8 ) IFZ l " d JT q) O r ta d o kJ C mf 呼nd " ciiu eh c d hb∫ L w d z yc o 〝 d " dc di "U" 如′ : 一 秒o fDa re r∫d ha mTd " 甲〝 i dl Ci t e d1 0S e pt e mbe r2 0 0 9 ] Kop ok Ava n a b l e丘o m URLht t p: / / wwwI Buc ・ of g/ i a u p/ s a p/ Mpa ng il e ,S I C. ,L es ha b a r i , T・ M・ 良 K血we l e , D・ J ・( 1 9 9 3 ) ・Fa c t o r sa s s oc i a t e dw it hi nd uc e da bo f d o ni n pub 山 chos pi t a l si nDa fe SS a l a a m, Ta n2 : i .R申ndhdi m y cHe d hbMa Hc ", 2 ,21 311 Ma c Ph叫,C・ ,Pe t df o r , A・ ,Pa s c oe ,S・良Re s s , H・( 2 0 0 7 ) ・Cont r a c e pt ionus ea ndpr e g na nc ya mon g1 5 2 4y e a ro l dS o ut h Af hc a nwome n, Bi oNe dCe 〝 加/Me d i a ' n c ,( 5 ) 31 .lCi t e d4S e pt e mbe r ,2 0 0 9 ]Ava i ] a bl ef rom URLht t p: // www. bi ome dc e nt r a ] . c om/ c ont e nt / pdf /1 7 41 7 01 5 5 31 ・ pdf ・ Ma r in t i u k, AI L,S t e e l ,K 0.& Wi l l , D・K ( 2 0 0 3 ) . Ac l l ユ S t e rr a ndomi 2 : e dt r i lofas a e xe d uc a donpr o g r a r r -ei n Be l i z e ,Ce nt r lA a m e ic r a . I " i -a do " a l Jo " ma Jo fEpi d c mi o hw,3 2( 1 ) ,1 31 1 3 6 ・ Ma t s m ot u o,S・( 2 0 0 5 ) I J a pa ne s eOr g a ni z a donf orht e r -don A ICoope r a do ni n Fa il m yPl a n ni ngPopuladona ndRe pr odu c dveHe lt a h, Wodda ndJ a pa n. ABi r ds e y eVi e wo nPo pu la do na ndr e pr odu c d veHe lt a hbpl O l 3 5 ) OJ npu b止s he d) Me s c e ,D・良 Si ne s ,E・( 2 0 0 6 ) ・Po p〟 hd o "RB j e T n〝 c cB〟 nd " ,U" ∫ d j cAb T o h' o " ・Fa ds& Fl k -I .l Ci t e d1 3August200 9 ]Ava n a b l ef r o m URL ht t p: / / www・ p r bA o r g/ pdf O 6 / Uns a kAbo r do n2 0 0 6 1 iu m m De ve l opme ntGoa l sRe po r t .( 2 0 08 ) ・I 呼ny emd L e ma /h c a h b ,Un i t e dNa do ns ,Ne wYo r k .l Ci t ed 31Aug us t2 0 0 9 l ・Ava hb l e Mi u e f romURLht f t p: // ⅦW ・ un1 0 f g / m山e r iu m mg oa l s / pdf / The %2 0 Mi l l e iu m m%2 0 De ve l opme nt %2 0 Goa lS %20Report %2 0 2 0 0 8 ・ pdf ・ Mh is t r yofHe a l h Ta t n2 1 a n i aa ndPr o gr a mf orht e ma dona lTr a i n i n gi nHe a l h・( t 1 9 9 4 ) ・ Na h ' o " L I LPo b gGN i d c h' "e ∫a"a∫ l o " L h′ 血f o rFa mg 1 ) h〝 〝 i " g∫mD ' E C ・De h ' y c t ya 〝 dTr m' " i " g .Mi n i s t r yofHe a l h,Da t re sS a l a a m. Mo r a n,E・ ,Ge r l us ,R・& S e g u,M.( 1 9 9 9 ) ・ Ma t e r na lmor t li a t yi n ah* r is kpo pu la ion. t Ma t e ma /Mo ′ 血砂 i "Ad o ks l e 〝t ,2 9 ( 2 ) ,21 0 1 2 3 2 ・ Mpa n il g e , SI G. ,e Ls ha ba i, r T・M・良Ki hwe l e , D・ J ・( 1 9 9 3 ) ・Fa c t o r sa s s oc i a t e dw it hl nd uc e da bo r doni npu bh chos pltalsin Da re ss la a a m. Ta n 2 a n i a .R申r u d w' y eHc a h bMa He r l ,2 ,21 31 ・ Mu k a ma , W.( 2 0 0 7 ) ・Ge 7 1 e 柑/J i t uh ' o "o dL n〝 血 Mi n i s t r yofHe a l ha t ndS oc i a lWe l f a r e ,Un i t e dRe pub 山 cofTa n2 a n i a ,岨 l i s t r yofHe lt a h a ndSoc i lWe a l f a r eCou nt r yHe lt a h Pr oB l eDa re ss a 血 m Ta nz a n i aド 1 5 4 )Unpu b hs he d. Mu s h i , LD. ,Mpe mbe n i ,M・ a &J a hn,A・( 2 0 0 7 ) ・Kno wl e d g ea bou ts a f emot he r ho oda ndHI V/ l DSa A mo ngs c hoo lp up 止Si n ar u r l a a r e ai nTa n 2 , i ・Bi m oMo dCe " L r 4 1Pn g m〝 グd 〝 dCb i mb i T i b ,7( 5 ) Il Ci t e d4S e pt e mbe r2 0 0 9 ]Ava ihbl ef rom ht t p: / / Ⅵ W ・ b i o me dc e nt r a l ・ c o m/ c o nt e nt /p df /1 4 71 2 3 9 3 7 5 1 P df ・ Na d o na l Bu r e a uofSt a ds dc s( NBS )Ta n2 : i a m ndORCMa c r o.( 2 0 0 5 )Ta " 甲〝 i aDe mo g n 申h i Ca n dHe d h b∫-J y2 0 0 40 5・l Ci t e d3Se pt e mbe r 2 0 0 9 lAv a l i a b l ef r o m URL恥t t p: / / www・ me a s u f e d hs ・ c o m/ pubs / pdf / DM3 / t a n2 = a n i a _y o ut h _book l e t ・ pdf Na d o na lLa ws ,Ta nz a nbl e is g l a donofht e r p olme mbe rs t a t e sons e x ua lof f e nc e sa g a ns i tc hl d r e n・( 2 0 06 ) ・[ Ci t e d5S e pt e m be r2 0 0 9 ] MADENIe ta l・:Re d u c d onofMa t e ma lMo r t li a t yRa t ei nTa n2 : i m 8 5 Ava na bl ef rom URLht t p: // W y . i nt e r pol . nt i / Publ i c /Ch i l dr e n/Se xua l Abus e / Na dona lLa ws /Cs a Ta nza ni a . pdf Or ng i a nj e ,C・ ,Me r e mi 血 ,M. ,Ek o, H. ,Es u,EIMe r e m ik- ,A.&Eh i r i J .( 2009 ) ・I nt e r ve ndonsf orpr e ve n血 gun j nt e nde dpr e gna nde s a monga dol e s c e nt s ICo c b r u 〝 eDG t db a s eo fS L y ∫ 1 c ma h ' cRhi c w.I s s ue41l Ci t e d 20 09 ]Ava il a bl ef rom ht t p: // www. c oc hr a ne . or g/ r e ie v ws /e n/a bOO5 21 5. ht ml Ra s c h,V. ,S i l be r s c hm i dt ,M・ ,Mc humv u,Y・& M皿a r y ,V.( 200 0 ) I Adol e s c e ntg ir l sw it hi l l e g a nyi nduc e da bor doni n Da re sSa la a m・n e d i s c r e pa nc ybe t we e ns e xu a lbe hv iora ndhc kofa c c e s st oc ont r a c e pdon.R 4m? d u du eHc a hbMa Hc ",8( 1 5 ) ,5 26 2・ Sp ei z e r , S・I . , Hot c hk i s s , R・ D. , Ma g na n i J・ R, Hubba r d, B・ &Ne l s on,K( 20 00 )Dos e r ic v ePr o ide v r si nTa n2 = i Ur m me c e s s a r n yRe s t r i c tdi e nt s Ac c e s st oc on t r a c e pd veme t hods ? ・I " t c md h l o 〝 d / / d m' gph" " i " gp〝申c c h l u e J ,26( 1 ) 1 3 20&4 21 Todd, J・ ,Cha nga l uc ha , J ・ ,Ros s ,D. ,Mos ha ,F・ ,Oba s i ,I ・ ,Pl ur r -e r ,M・ ,Ba ha ,R・ ,e ta l ・( 200 4 ) ・ Thes e x ua lhe a l h ofpup止Si t ny e a r s 4t o60fpr i ma r ys c hool si nr ur lTa a nz a n i a ・ Jo " ma Jo fBl ) 3 ' d c mi o l o ga 〝 dCo mm〟 〝 砂 Hc a hb ,57 ,8 09 81 51 WHO・( 2 007 ) ・ Ma k i ngPr e gna nc ySa f e r ;[ Ci t e d3Se pt e mbe r 2 0 09 ]Ava u a bl ef r om URL: ht t p: // ⅦW . who. i nt /ma ki ng_pr e g na nc y _s a f e r / t opi c s /ma t e ma l_mor t a ht y/ e n/ nde i x. k nl WHO ( 20 08 ) .Ta nz a ni aCount r yPr o丘1 e ・Wor l dHe lt a h Or ga n i z a donDi r e c t or Ge ne r lRoundt a a bl ew it h wome nl e a de r sonMi l l e ni u m De ve l opme ntGoa ls . l Ci t e d2 ndse pt e mbe r20 09 ]Ava na b l ef r om URL ht t p: // www. whol i nt / ma k i ng_pr e gna nc y _s a f e r / e ve nt s / 2008/ md g5/c ou nt ie r s /f i na l_c p_t a n2 : a ni a _1 9 _09 _08. pdf , Wor l ds i t t ndona r ou nda dol e s c e nt sa ndt hene e df orc ompr e he ns i vee duc a don( Oc t200 9 ) . Pr oc e e di ngsf r om ∫c mi " a ro "Ad o ks c e " L T He n / a J a pa ne s eOr ga n i 2 : a donf orl nt e m a don A ICoope r a doni n Fa ∬山yPl 乱n n i ng:Toky oJ a pa n. WHO・ ( 200 22005 ) Cou nt r yc oope r a don s t r a t e g y Un i t e dr e pu bhc ofTa n2 a ni a ;l Ci t e d 2 Se pt e mbe r2009 ] Ava u a bl ef r om UR⊥: ht t p: // ⅥW ・ who・ nt i /c ount r y f oc us /c oope r a don_strat e g y /c c s _t 2 = a _e n. pdf WHO.( 2007 ) ・Wo ′ 〟 Hcdhb ∫t d df dt JGe ne va :Wor l d He a l t h Or ga n i 2 : a don; l Ci t e d 5 Se pt e mbe r2009 ]Ava na bl ef rom URL: ht t p: // ⅥW ・ who・ n亡 i / whos i s / whos t a t 2 007/e n/ nde i x・ hbn l. WHO・( 20 0 4 ) ・ Ad o / c s -iPngno"g・D申d dmc " io fCh' Ha " dAd o ks C e " iHe L l hha " aDc y C / 0 1 ) me " Z ・Wor l dHe a l h Or t g-i z a don,Ge ne va ・l Ci t e d8 Se pt e mbe r2 009 ] ,Ava n a bl ef rom URL: ht t p: // whq l i bdoc . who. l nt / pubhc a t l OnS /200 4/9 2 41 5 91 45 5 _e ng. pdf Yout h Fr i e ndl y , n eSt or yofUMATIa ndt heDa re sSa la a mYout h Ce nt r e , UMATI : Fa m砂Ph" " i " gA∬o c i a h ' o "o fTa " 甲〝 i d ,Da rc J∫a ha m・ l Ci t e d3Se pt e mbe r20 09 ]Ava il a bl ef r om URL: ht t p: // ⅦW . n q) u a . or g/ moni t or ing/c ount r y _e va l s /t a nza n i a / t a n2 a ni a _c ou nt r ye va 1 5 6. pdf .
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