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DO THEY MATCH? Young People’S Realities and Needs Relating to Sexuality and Youth Friendly Service Provision in Bangladesh

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DO THEY MATCH? Young People’S Realities and Needs Relating to Sexuality and Youth Friendly Service Provision in Bangladesh DO THEY MATCH? Young people’s realities and needs relating to sexuality and youth friendly service provision in Bangladesh A participatory research on the quality of and acces to youth friendly sexual & reproductive health services for young people This research and report were made possible through support from IPPF and Rutgers WPF (formerly Rutgers Nisso Groep and WPF), with funding from the Dutch Government (SALIN+ and MFSII). DO THEY MATCH? YOUNG PEOPLE’S REALITIES AND NEEDS RELATING TO SEXUALITY AND YOUTH FRIENDLY SERVICE PROVISION IN BANGLADESH A PARTICIPATORY RESEARCH ON THE QUALITY OF AND ACCESS TO YOUTH FRIENDLY SEXUAL & REPRODUCTIVE HEALTH SERVICES FOR YOUNG PEOPLE A research commissioned by IPPF Carried out by Rutgers WPF in consultation with Dr. Papreen Nahar and the youth research team: Akhter Moshammat Sabina Islam Mainul Hasan Islam Mohammad Jahidul Khatun Parijat Pervas Kamal Rahman Mahfuza Ray Mithon Kumar Sume Afroza Khanam Tanzir Azmarina in cooperation with FPAB Bangladesh and IPPF August 2010 Report by Papreen Nahar Project nr: 1303 OV Dr. Miranda van Reeuwijk and Henri van den Idsert MA (Eds) FOREWORD - IPPF Young people are at the heart of the International Planned Parenthood Federation’s work. IPPF is one of the leading service providers, working to ensure universal access to sexual and reproductive health for young people around the world. We have a successful record of working with young people; 1 in every 3 clients who visits our clinics is young. We still feel that we need to increase demand amongst under-served young people – a group that continues to bear a disproportionate burden of sexual and reproductive ill- health across the world. We must constantly strive to improve the quality of our services and to think critically about why some young people do not want to come to our services. One of the best ways to gain a better understanding of how to increase demand is to partner with young people themselves. IPPF has a long history of working in equal partnership with young people at all levels, from peer education to governance. In this publication we highlight how young people in our Federation are making major contributions to the improvement of our services through research. Having over twenty years of experience working with young people, the Family Planning Association of Bangladesh (FPAB) was invited to embark on the Do They Match research project alongside researchers from Rutgers WPF and supported by IPPF Central Office and South Asia Regional Office. The Do They Match research illustrates the true value of involving young people as co- researchers. Given the youth research team’s unique insight into the ‘real lives’ of their peers, the findings provide reliable evidence that can inform the development of FPAB’s youth programmes and services for years to come. Furthermore, FPAB now has a superbly trained group of youth researchers who are able and willing to conduct more research and assist in the monitoring and evaluation of other youth programmes. We want to thank the young researchers and staff of FPAB for their commitment to excellence in the provision of sexual and reproductive health services and information for young people. Also, many thanks to the Rutgers WPF team for their dedication, hard work and vision. Lastly, we must thank the 237 respondents for their honesty and courage in speaking out about the realities of their everyday lives. Doortje Braeken IPPF - Senior Advisor, Adolescents + Young People January 2011 LIST OF ABBREVIATIONS CHW: Community Health Worker CO: Central Office CRC: Convention on the Rights of the Child ECP: Emergency Contraceptive Pill FGD: Focus Group Discussion FPAB: Family Planning Association of Bangladesh HIV / AIDS: Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome IEC: Information Education & Communication IPPF: International Planned Parenthood Federation KI: Key Informant M.A: Member Association MDG: Millennium Development Goal M&E: Monitoring & Evaluation MR: Menstrual Regulation NGO: Non Governmental Organisation NHQ: National Head Quarters PE: Peer Educator PMC: Programme management Committee RHP: Reproductive Health Promoter SALIN: Strategic Alliance with International NGOs SARO: South Asia Regional Office SDP: Service Delivery Point SIS: Service improvement System SRH: Sexual Reproductive Health SRHR: Sexual Reproductive Health & Rights STI: Sexually Transmitted Infection STD: Sexually Transmitted Disease UTI: Urinary Tract Infections YR: Youth Researcher YFS: Youth Friendly Service YIF: Youth Incentive Fund Do they match? August, 2010 Table of contents 1 Introduction 1.1 Why this research? 1.2 Research framework and questions 1.3 Research objectives 1.4 Research setting: Tarar Mela (FPAB YFS) in Jessore 1.5 Research location: Jessore 1.6 Structure of this report 2 Research methodology 2.1 Youth participation and ‘emic’ approach 2.2 Data collection phases 2.3 Methods used for data collection 2.4 Limitations 3 Significant sexuality issues for adolescents 3.1 Curiosity 3.2 Desires and pleasure 3.3 Misconceptions and concerns 3.4 Sources of information about sexuality 4 Sexual behaviour of adolescents 4.1 Romantic love and dating 4.2 Sexual activities 4.3 Pornography 4.4 Stigma and fear 4.5 Eve-teasing and harassments 4.6 Suppressing sexual arousal and curiosity 5 Quality and access of youth friendly services 5.1 Enabling factors to access Tarar Mela from young people’s perspective 5.2 Limiting factors to access Tarar Mela from young peoples’ perspective 5.3 Limiting factors to providing youth friendly services from a provider's perspective 6 Stakeholder workshops 7 Research process 8 Ethics 9 Analysis of key findings 9.1 Introduction 9.2 Analysis of main findings relating to young people’s sexuality in Bangladesh 9.2 Need and demand: Are the services that the MA is offering relevant for adolescents? 9.3 Awareness, access, and quality: Analysis of key factors that limit and enable adolescents to use the YFS August, 2010 Do they match? 10 Discussion and key recommendations 10.1 Introduction 10.2 Need and demand: Increasing relevance of services by matching adolescents' primary sexuality concerns 10.3 Awareness of and motivation to use YFS 10.4 Access: De-stigmatize YFS and find alternative acceptable ways to offer information and services to adolescents 10.5 Quality: Increase 'safety' at YFS and invest in skills of staff 10.6 Organisational and management factors influencing the delivery of YFS References Annex- 1 Hypothetical cases (boys and girls) Annex- 2 Question-box questions Annex- 3 Standards for good quality and accessible YFS Do they match? August, 2010 1 Introduction 1.1. Why this research? Access to services is a central concern in the promotion of sexual and reproductive health and rights (SRHR) of young people1. In developing countries, approximately 45% of new HIV infections occur among 15-24 year olds (and in Africa 75% of them are girls)2; worldwide the largest proportion of STIs is believed to occur in people younger than 25 years3; adolescents account for an estimated 2.5 million of the approximately 19 million unsafe abortions that occur annually in the developing world; almost 70% of the adolescents in Sub-Sahara Africa and south central and southeast Asia have an unmet need for contraceptives; and Malawi and Bangladesh have among the highest teenage pregnancies in the world (more than 120 per 1000)4. Provision of services for adolescents and young people, like the provision of information, contraception, STI and HIV testing and counselling, are believed to play a key role in the prevention of unwanted pregnancies and STI’s including HIV. For the International Planned Parenthood Federation (IPPF) and its Member Associations the role of SRH services is not only important in terms of public health and the prevention and treatment of diseases. Access to information and services are seen as basic human rights necessary to guarantee healthy sexual development and sexual wellbeing of individuals. This entails a more holistic (so-called ‘positive’) approach towards sexual health compared to the more narrowly defined biomedical approach and includes mental and social aspects of sexuality that influence self esteem, fulfilment, enjoyment and safety in sex and sexuality. Concretely, this means that IPPF expects its Member Associations (MA’s) to commit to the Sexual Rights Declaration5 (IPPF 2008a) and to offer services that include addressing issues like sexual and gender-based violence, sexual diversity, discrimination, relationship issues and fears and concerns about sex and sexuality. MA’s are also expected to commit to the declaration in the way they work: to offer service “… that young people trust and feel is there for them and their needs, and is supportive of young people’s sexuality so that they have a happy, healthy and safe sexual life regardless of gender, sexual orientation, disability, income level or marital status” (Springboard, IPPF 2008b). Such services are referred to by the term Youth Friendly Services (YFS). Despite the efforts of MA’s to provide services in a youth-friendly manner and executing strategies to increase access and quality of their services for young people, uptake of services by young people, and in particular adolescents (12-18 yrs), is considered to be low. IPPF has commissioned Rutgers WPF, the Dutch Member Association of IPPF, to conduct research in cooperation with young people and the MA’s in Bangladesh and Malawi, to investigate why this uptake is low and to formulate recommendations that can help to increase the uptake. Much research that investigates access and quality of YFS focuses on youth in general, often including primarily older youth in the age range between 18 and 24 years. These young people are more frequently married and it is 1 For this research the term ‘young people’ refers to those aged between 10-24 years; the term ‘adolescent’ specifically refers to young people between the ages 12-18.
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