None to look after adolescent health in Bangladesh

By Dr Mahmuda Akhter

Tahmina Khatun, a girl of only 17 years, is a mother of three children. A victim of child marriage, she is now an emaciated woman, who finds life a difficult job to lead. She is suffering from anaemia and other diseases that spring from malnutrition.

But at the age of 13, she was quite healthy, tending cattle of her family and helping her mother do household chores happily and smilingly.

It was not to be four years later.

Thousands of boys and girls in Bangladesh today face the grim ordeal as Tahmina does, thus posing a threat to the survival of the most resourceful segment of the society. Experts say, they are falling victim to sheer negligence towards development of adolescent health.

Adolescence is the most vulnerable period of life. According to World Health Organization, boys and girls falling under 10-19 year age groups are called adolescents. And as different stages of a woman’s life evolve gradually, the health condition of one phase not only affects subsequent phases of her own life, but also have an impact on future generation.

Today’s girls are tomorrow’s women. She bears the responsibility for a new generation. If a mother is physically weak, she will not to be able to do her normal chores properly. Besides, an emaciated mother gives birth to a low weight baby. It is against this backdrop that Bangladesh needs to take steps to look after adolescent reproductive health.

Neonatal mortality rate (NNR) is 66 per 1000 live births but in teenage group, this neonatal mortality rate is as high as 106 per 1000 live births. It is recognised by all medical experts that adolescent women’s health has to be taken care of adequately for emergence of a healthy nation.

An adolescent woman has a great role to p0lay in Bangladesh society. She does all the household chores. She gives birth to children and looks after them. She takes her meal after all the members of a family finish eating.

Bangladesh is an over-populated country in which adolescent group constitute 23 per cent of the total population. Among them, 52 per cent are boys and 48 per cent girls. This potential adolescent group forms 16.2 per cent of total fertile couples in Bangladesh.

Research findings say, among pregnant mothers, 33 per cent belong to adolescent group.

In Bangladesh, Contraceptive Acceptance Rate (CAR) among the fertile couple is 54 per cent, but among teenagers, the rate of CAR is 38 per cent. Fifty per cent of teenagers are suffering from malnutrition.

Sadly, adolescents are the most neglected under the existing health service. Services for adolescents are still not adequate. Significant social changes and increasing incidence of sexually transmitted diseases among the adolescents are some of powerful reasons for which they merit specialized care covering their biological, psycho-social, physical and mental health including reproductive health. Most of the adolescents got their RSH (Reproductive Health Sexuality) information from their friends. But then, this source is not always accurate.

Research found that nearly 80 percent adolescents feel uncomfortable in discussing sexuality with their parents. Ninety percent never talk about pregnancy prevention with their family members. Most of the teenagers can not maintain calendar method for prevention of pregnancy due to poor knowledge. Birth rate is higher among the teenagers than in the group belonging to 20-35 year age group.

It has been found that some adolescents marry early and start family life with poor knowledge about sexual and reproductive health. In most cases, with first baby born within the first year of their married life, they have little time to prepare for mental and physical health. They become burdened with parenthood. Sexuality transmitted disease is higher in adolescent group because adolescents in Bangladesh are increasingly exposed to foreign cultures and ideas. This group drifts away from traditional social and cultural norms . Sexual activity and child bearing early in life carry significant risks for young people. Teenage mothers face twice the risk of dying from child bearing than do women in their 20s and their children are more vulnerable to health risk as well.

Every year, almost half of all new HIV infections and one third of all new sexually-transmitted infections occur to people younger than 25 years.

Health curriculum in Bangladesh’s text-books does not provide detailed information being madly sought by young people. Most teachers are not even comfortable to talk Reproductive Health topics. Discussing adolescent heath matters with parents is taboo. Adolescents believe that they should be involved in the choice of a spouse. Common criteria in choosing a spouse include a good job for the husband and a pretty look of wife. This attitude should be changed through education and Behaviour Change Communication.

Only 25 per cent are males and 13 per cent females attend secondary schools. Dropout rate is higher. Several social barriers hinder the introduction of reproductive health in school curriculum. Some people think sex education may encourage promiscuity. Sufficient knowledge of reproductive health will correct irresponsible sexual behaviour and help adolescents manage their life. Premarital sex and pregnancy outside marriage, menstrual regulation or illegal abortion are more common in adolescent groups in Bangladesh. Considerable marriages are unregistered, thus causing marital sufferings particularly among the adolescent groups. There is considerable stigma associated with regular clinic visits by unmarried adolescents. They only seek accurate information about reproductive health as a last resort. In illegal pregnancy, they want to solve it by traditional methods that are unsafe. It even causes septic abortion, shock and even death. In this crucial moment, they are emotionally disturbed. Sometimes they commit suicide. Adolescents form one-fifth of Bangladesh’s total population. They are the future leaders of the nation. During adolescent period, normal physiological change occurs in the body. It is time that all-out care is given to the long-neglected area so far ignored in Bangladesh, researchers and medical experts suggest

Source: The Dhaka Courier, April 5, 2002

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