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Adolescent and Youth Reproductive Health in the Asia and Near East Region Status, Issues, Policies, and Programs

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Adolescent and Youth Reproductive Health in the Asia and Near East Region Status, Issues, Policies, and Programs POLICY OCCASIONAL9 P APERS Adolescent and Youth Reproductive Health in the Asia and Near East Region Status, Issues, Policies, and Programs Karen Hardee Pamela Pine Lauren Taggart Wasson January 2004 POLICY POLICY is funded by the U.S. Agency for International Development under Contract No. HRN- C-00-00-00006-00, beginning July 7, 2000. The project is implemented by Futures Group International in collaboration with Research Triangle Institute (RTI) and the Centre for Development and Population Activities (CEDPA). ISBN 0-9605196-9-6 PO LI CY POLICY Occasional Paper #9 Adolescent and Youth Reproductive Health in the Asia and Near East Region Status, Issues, Policies, and Programs Karen Hardee Pamela Pine Lauren Taggart Wasson January 2004 Contents Acknowledgments iii Executive Summary iv Abbreviations viii Introduction 1 Demographic and Social Context of Adolescent and Youth Reproductive Health 3 Demographic Profile, 2000–2020 3 Social Context 3 Education 5 Employment 6 Marriage and Childbearing 7 Adolescent and Youth Sexuality 8 Adolescent and Youth Reproductive Health Issues 9 Lack of Knowledge about Sexuality and Reproductive Health 9 Low Contraceptive Use 11 High Unmet Need for Contraception 11 Abortion 12 STIs and HIV/AIDS 12 Sexual Abuse, Exploitation, and Prostitution 14 Legal and Policy Environment for Adolescent and Youth Reproductive Health 15 Near East 15 South Asia 19 Southeast Asia 21 Adolescent and Youth Reproductive Health Programs 24 Near East 24 South Asia 27 Southeast Asia 31 Summary 34 Operational Barriers to Adolescent and Youth Reproductive Health 37 Recommendations 41 Endnotes 46 References 49 ii Acknowledgments OLICY Occasional Papers are ◗ Ajit Pradhan and Molly Strachan Pintended to promote policy dialogue on (Nepal) family planning, reproductive health, and ◗ Aysha Khan and Pamela Pine (Pakistan) HIV/AIDS issues and to present timely ◗ Christine A. Varga and Imelda Zosa- analysis of issues that will inform policy Feranil (Philippines) decision making. The papers are ◗ W. Indralal De Silva, Aparnaa disseminated to a variety of audiences Somanathan, and Vindya Eriyagama worldwide, including public and private (Sri Lanka) sector decision makers, technical advisors, ◗ Khuat Thu Hong (Vietnam) researchers, and representatives of donor ◗ Arwa Al-Rabee’ (Yemen) organizations. An up-to-date listing of POLICY publications is available on the web Karen Hardee oversaw the project, and Lily at www.policyproject.com. Copies of these Kak and Elizabeth Schoenecker from publications are available at no charge. USAID and Ed Abel and Koki Agarwal from POLICY provided support. Karen This paper provides a synthesis of the Hardee, Pamela Pine, Lauren Taggart findings from a 13-country study of Wasson, and Nancy McGirr reviewed and adolescent and youth reproductive health edited the country reports. Felicity Young, issues, policies, and programs on behalf of Jeff Sine, and Don Levy were helpful in the Asia/Near East Bureau of the U.S. locating consultants to write the profiles. Agency for International Development Katie Abel assisted with compiling and (USAID). The reports were researched analyzing the country data. The STARH and written by: Program (Sustaining Technical ◗ Abul Barkat and Murtaza Majid Achievements in Reproductive Health), (Bangladesh) under the direction of Gary Lewis and ◗ Graham Fordham (Cambodia) Adrian Hayes from the Johns Hopkins ◗ Julia Beamish (Egypt) Center for Communication Programs, ◗ S.D. Gupta (India) supported the preparation of the Indonesia ◗ Iwu Dwisetyani Utomo (Indonesia) country report. ◗ Issa S. Almasarweh (Jordan) ◗ Julia Beamish and Lena Tazi Abderrazik Views expressed in this paper do not (Morocco) necessarily represent those of USAID. iii Executive Summary he POLICY Project conducted adolescent and youth reproductive health Tassessments of adolescent and youth necessitates a multisectoral approach—one reproductive health in 13 countries in the that focuses on decreasing girls’ Asia and Near East (ANE) region that vulnerability, promoting gender equity and represent diverse population sizes and schooling, and expanding life options for geographic, cultural, and socioeconomic both females and males. Each of the 13 settings. The countries include Egypt, countries needs to make more progress in Jordan, Morocco, and Yemen in the Near this regard. East; Bangladesh, India, Nepal, Pakistan, and Sri Lanka in South Asia; and Cambodia, Nonetheless, the ANE region has achieved Indonesia, the Philippines, and Vietnam in social, policy, and programmatic progress, Southeast Asia. In 2000, the 13 countries with some countries demonstrating accounted for a total of 354 million young substantially more progress than others. people ages 15 to 24 years. The purpose of Some countries’ adolescent and youth the assessments was to highlight the populations have greater knowledge of reproductive health status of adolescents and reproductive health, improved access to youth in each country within the context of information and services, and better overall the lives of young males and females. life circumstances as a result of policies and programs designed to address their Most young people in the ANE region begin reproductive health needs. Other their sexual lives within marriage, although, populations of young people, however, have as the age at marriage in the region rises, seen little progress and therefore are at an increasing number of young people are greater risk of early pregnancy, gender-based beginning to engage in sex before marriage. violence, and sexually transmitted infections While programs can and should promote (STIs), including HIV, and have limited delayed sexual initiation, young people— options for education and other life choices. regardless of when sexual activity begins— need to be adequately prepared for their The social and cultural context pertaining to sexual lives and relationships instead of young people differs considerably among the “being kept in the dark” until marriage. 13 countries, but the assessments found Programs can help prepare young people for several universal challenges in the region. sexual relationships by increasing their These challenges include the paucity of understanding of sexuality and the choices research and data on the age group, they can make to protect their reproductive particularly with regard to rural and health. Correspondingly, addressing minority adolescents and youth; insufficient iv attention to enormous gender disparities; that affect them. Youth must be actively lack of information and services available to involved in both discussing the issues facing young people (including married adolescents their generation and developing solutions and youth), often leading to unwanted that meet their needs for good pregnancy and disease; weak or nonexistent reproductive health. policies directly addressing adolescent and youth reproductive health; and small-scale 2. Inform policymakers about the needs of and generally weak programs, even where young people and advocate for policy national and other policies exist. In addition, and program change. the global environment in terms of both information (e.g., from films and television) Adolescent and youth reproductive health and resources (e.g., dependence on foreign remains a politically and socially sensitive aid) has had both positive and negative topic; policymakers are often reluctant or effects on the status of adolescent and youth unable to develop multisectoral policies reproductive health throughout the region. that address adolescent and youth reproductive health. Stakeholders need to The 13 country assessments indicate that advocate to policymakers based on an adolescent and youth reproductive health understanding of existing laws and policies. should be addressed by involving youth in Youth and adolescent reproductive health policy design and implementation; advocates should encourage development of advocating for policy and program relevant laws, policies, and guidelines to development; educating policymakers, ensure adequate protection and promotion teachers, parents, and adolescents and of adolescent and youth reproductive youth; facilitating family communication; health and attention to associated social promoting gender equity; expanding access issues, such as gender equity in education to information and services; and conducting and the economy. The support of an needed research to ensure that programs are individual, high-profile political figure can evidence-based. These challenges are not be crucial to improving a country’s new, although they take on more urgency in adolescent and youth reproductive health an era of rising prevalence of HIV/AIDS in policies and programs. This person’s the region. Nor are the challenges unique to advocacy and action can catalyze high-level the ANE region, even though the region is discussion and even effect change. home to the world’s largest group of adolescents and youth. Nevertheless, it is 3. Educate policymakers, teachers, parents, imperative that the 13 nations address the community leaders, and young people to challenges in order to improve the change public opinion about the reproductive health of today’s and future importance of meeting youth and generations of adolescents and youth. adolescent reproductive health needs. 1. Involve youth in developing policies and It is essential to reach—through the programs to meet their needs. appropriate means—village and community leaders and religious and Young people are often left out of opinion
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