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Exploring the Sexual and Reproductive Health of Adolescents in South Asia Towards adulthood: exploring the sexual and reproductive health of adolescents in South Asia Edited by Sarah Bott Shireen Jejeebhoy Iqbal Shah Chander Puri World Health Organization Department of Reproductive Health and Research i WHO Library Cataloguing-in-Publication Data Towards adulthood : exploring the sexual and reproductive health of adolescents in South Asia / edited by Sarah Bott … [et al.] 1.Adolescent behavior 2.Sex behavior 3.Risk-taking 4.Knowledge, attitudes, practice 5.Reproductive health services 6.Adolescent health services 7.Asia I.International Conference on Reproductive Health (2000 : Mumbai, India) II.Bott, Sarah. ISBN 92 4 156250 1 (NLM classification: WS 462) Credits Cover design: Máire Ní Mhearáin Cover photo: POPULATION COUNCIL/BONNIE HAZURIA Back cover photo: CENTER FOR COMMUNICATION PROGRAMS, JOHNS HOPKINS UNIVERSITY © World Health Organization 2003 All rights reserved. Publications of the World Health Organization can be obtained from Marketing and Dissemination, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 791 2476; fax: +41 22 791 4857; email: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to Publications, at the above address (fax: +41 22 791 4806; email: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. The named authors alone are responsible for the views expressed in each chapter of this publication. Printed in II I Introduction SARAH BOTT AND SHIREEN J. JEJEEBHOY 2 Adolescent sexual and reproductive health in South Asia: an overview Adolescent sexual and reproductive health in South Asia: an overview of findings from the 2000 Mumbai conference Sarah Bott and Shireen J. Jejeebhoy Conference background in school, experiencing puberty at younger ages, marrying and having children later than in the past. The World Health Organization (WHO) defines Neglect of this population has major implications adolescents as the age group 10–19, a definition for the future, since reproductive and sexual used throughout this volume. The meaning of behaviours during adolescence have far-reaching adolescence as a cultural construct has been consequences for people’s lives as they develop understood in many different ways throughout the into adulthood. world, however. In general terms, it is considered a time of transition from childhood to adulthood, In South Asia, by the end of the 1990s, both during which young people experience changes researchers and governments had begun to shed following puberty, but do not immediately assume their traditional ambivalence towards young the roles, privileges and responsibilities of people’s sexual and reproductive health, and a adulthood. The nature of adolescence varies growing body of empirical evidence and government tremendously by age, sex, marital status, class, interest provided an opportunity to take stock of region and cultural context. As a group, however, the sexual and reproductive health situation of adolescents have sexual and reproductive health youth in the region. In response, HRP1 , ISRRF2 needs that differ from those of adults in important and IRR3 jointly organized an international ways and which remain poorly understood or served conference in November 2000 entitled: “Adolescent in much of the world. Reproductive Health: Evidence and Programme Implications for South Asia”, held in Mumbai, India. Moreover, social, economic and political forces are Although international organizations subdivide Asia rapidly changing the ways that young people must in different ways, this conference focused on five prepare for adult life. These changes have South Asian countries, namely, Bangladesh, India, enormous implications for adolescents’ education, Nepal, Pakistan and Sri Lanka. Insights from other employment, marriage, childbearing and health. Asian settings were also presented, notably from Adolescents are increasingly spending more time China and Thailand. 1 HRP stands for the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction. 2 ISRRF stands for the Indian Society for Research on Reproduction and Fertility. 3 IRR stands for the Institute for Research in Reproduction. 3 SARAH BOTT AND SHIREEN J. JEJEEBHOY The conference aimed to review the evidence on region such as Chile, Colombia, several European adolescents’ sexual and reproductive health countries and the United States of America. The situation, needs and perspectives in South Asia, agenda included 42 full presentations, 12 brief to learn from programme successes and failures abstract presentations, comments from nine in the region, and to identify acceptable yet effective discussants and 72 poster presentations, ways to respond to adolescents’ unique needs. supplemented by panel discussions among young The conference addressed a number of central people themselves and policy-makers. questions, including: What are adolescents’ needs in regards to sexual and reproductive health? How In an attempt to record the evidence and insights can we increase their ability to make informed that emerged from the conference, organizers reproductive choices? How do we enhance their asked the conference participants to write access to reproductive health services that are summaries of their presentations. As a result, this acceptable, unthreatening, and affordable? What volume contains summaries of 40 of the 42 major kind of information do they need in order to presentations and two of the three panel sessions. exercise these choices and access services? How This overview chapter provides a brief social and can we tailor programmes to deliver information demographic profile of adolescents in South Asia, and services? And, how can programmes improve together, where possible, with information on other communication between adolescents and adults? Asian countries—China, Indonesia, the Philippines, Thailand and Viet Nam—to enable This conference brought together researchers from readers to place South Asia within the larger Asian different disciplines, as well as service providers, context. This is followed by a review of the entire programme managers, government representa- collection of papers contained in this volume. tives, policy-makers, representatives from international and donor agencies and, most importantly, young people themselves. Participants Profile of adolescents in South Asia came from more than 13 countries, including South Asia, other Asian countries such as China, Of the estimated 1.2 billion adolescents in the world Indonesia, and Thailand, and countries beyond the today, nearly half live in Asia, and nearly one in Table 1. Demographic profile of adolescents in South Asia and other selected Asian countries Country Estimated Estimated Adolescents Adolescents population aged population aged aged 15–19 aged 10–19 15–19 circa 2000 10–19 circa 2000 (% of total (% of total (thousands) (thousands) population) population) South Asia 135 163 281 840 10 21 Bangladesh 15 089 31 816 11 23 India 100 963 209 148 10 21 Nepal 2 373 5 116 10 22 Pakistan 14 841 32 117 11 23 Sri Lanka 1 897 3 643 10 19 Other Asian Countries China* 100 760 218 497 8 17 Indonesia 21 564 43 355 10 20 Philippines 8 145 17 087 11 23 Thailand 5 807 11 345 9 18 Viet Nam 8 275 1 784 11 22 *Note: Not including data for Hong Kong Special Administrative Region of China. Source: United Nations (2001) World Population Prospects: The 2000 Revision. Volume II. The sex and age distribution of the world population. New York, United Nations. 4 Adolescent sexual and reproductive health in South Asia: an overview four (282 million) live in South Asia. Adolescents not in school, except in Sri Lanka (Table 2). Some aged 10–19 comprise over one-fifth of South Asia’s are unemployed, while others work for pay, or work population (Table 1). Within the region, Bangladesh without remuneration in households, family farms and Pakistan have the greatest proportion of and businesses. Surveys suggest that labour force adolescents, while India has the greatest absolute participation rates are relatively high—both among number. older adolescents aged 15–19 and among younger adolescents aged 10–14 (Table 3). In Bangladesh, Though the situation of adolescents varies widely for example, a 1995–1996 survey found that over within the region and within individual countries, one-quarter and one-third of younger adolescent literacy and school enrolment rates among females and males were economically active, as adolescents have risen in all
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