Reproductive health care for adolescents in Bangladesh

by Amal Chakraborty

In both developed and developing countries, generally health is one of the most important sectors that generate tremendous interest of the development planners, health professionals, policy makers and other ideological powers. The basic human rights of the citizens in a country do vary according to their social, political, economic, and religious systems. A Third World country usually prioritize food security, health, and shelter in their development plans rather than the ‘entertainment plaza’. However, majority of the governments in poor countries assign much higher weight on industrial and agricultural growth, rather than health care and ‘right to health services for all’ remained neglected. It can be noted here that lack of funding and supply of inappropriate types of medical care effectively reduce the access of the poor to the health care facilities available in the Third World countries like Bangladesh.

A World Bank report entitled, "In search of healthy Bangladesh: Expectations in the Twenty-First Century", says Bangladesh is at the top of the list with regards to malnutrition, maternal and child mortality. Reasons for these as identified are poverty, illiteracy and largely inadequate health care. A newspaper report says that in Bangladesh 70% mothers and children suffer from malnutrition. Every day 600 children die due to malnutrition and every year a little more than 27,000 mothers die due to pregnancy related diseases and complication. It may be mentioned here that the mortality rate for both child and mother in Bangladesh is higher compared to some other developing countries due to unavailability of easy access to the health care services. Less than 40% of the population in the country has access to basic health care, only 27% pregnant women receive prenatal care, while less than 95% of all deliveries take place at home attended by untrained birth attendants. A recent study report has revealed that a meager 12% of the total health care is used by rural people provided by the government health care facilities.

Adolescent groups in Bangladesh are considered in Bangladesh as the most important segment for health care issues. Adolescent period is remarkably a sensitive period for boys and girls. This is the time when most of them commit mistakes due to curiosity and ignorance. Changes in their body structure and hormonal activity surprise them unless proper knowledge on physiology is imparted to them. The adolescent population in Bangladesh constitutes around 23% of total population numbering nearly 30 million. Currently 48% of the adolescent population are female and 52% male. 20% of total population below 10 years of age plus 23% adolescents totaling 43% of total population is to determine the health and population structure of the country in the years to come.

A recent study in Bangladesh population sector reveals that adolescent population growth rate is much higher at 4.3% compared to 1.7% for total population. It is most likely that this large number of population segment will influence in greater extent the development planning of the authorities concerned in health issues. The challenge in this segment is not only the population growth but also to ensure health of this mammoth size of population in a world that faces the epidemic of AIDS / STD. It is likely that a significant number of population in Bangladesh in general and adolescent group of people in the rural areas of Bangladesh in particular will continue to experience epidemiological transition unless adequate intervention will be undertaken to address the issue, says a national broad sheet report.

Rural girls in Bangladesh, about 75%, are married before reaching their sixteenth birthday and some even before they can reach their puberty. Conservative tradition in our rural society does tremendously affect the health of the rural adolescents, especially the girls. They are oppressed and being maltreated if they deny to be married off quite early. Mothers in 15 - 19 age group have a share of 20% of the total births. The mortality risks for children borne to teenage mothers are substantially higher than that of adult mothers. This mortality risk of course is nonetheless ironic to accept. It has been shown in the health studies that an adolescent faces the highest health risks during pregnancy.

Rural adolescent girls are not well equipped with the reproductive health education, which is in fact a crucial issue to impart to.

International and national GOs and NGOs have been implementing the health programs in Bangladesh over the years. Improvement in the health status of the rural people in general has been noticed. However, complete reduction of health hazards could not be overcome in the rural areas, unless awareness is intensified, health services are made more accessible to the people, and demand driven programs are designed to provide health services at the grassroots level. There should be more investment in the health sector to address the adolescents health issues.

In Bangladesh 20% births to adolescent women are inappropriate and a considerable number of conceptions are unwanted. Unlike the growth rate, mortality rate for adolescent mothers is higher than the national average. Children borne to young mothers are more likely to die early as both mothers and children are highly-risk prone.

Researches in the population sector of Bangladesh have revealed that about 19% of births from adolescent mothers are exposed to higher risk of death. Antenatal, neonatal and postnatal cares for adolescent mothers are very low. Adolescents have empathetically inadequate sexual education. One study suggests that the vast majority rural adolescent have never heard of Sexually Transmitted Diseases (STDs) and AIDS.

Adolescent reproductive health is one of the most sensitive health issues that the world has been facing. It is very important to face the challenges that exist in our society.

We should identify the best ways and means to ensure adolescent-friendly services in the socio-cultural setting of Bangladesh.

In addition, identification of what needs to be done to overcome the barriers and thereby ensure creation of a conducive environment will accelerate the process of maximizing reproductive health services utilization by the adolescents.

It is indeed a moral obligation for the Government of Bangladesh, donor agencies, development practitioners and other non-government organizations (NGOs) to prioritise

immediate intervention, both clinical and non-clinical, to curb and prevent adolescent health related problemss in Bangladesh

Source: The Daily Independent, Dhaka, December 31, 2001