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Siddhartha Yadav: Sexual and reproductive health of adolescents in South Asia

20 Apr, 10 | by Siddhartha Yadav

Last week I participated in the “Adolescent Sexual and Reproductive Health Workshop” organised by the International Federation of Gynecology and Obstetrics (FIGO) in Bangalore, India. We had gathered there to formulate a set of guidelines and protocols for adolescent reproductive health services specific to Asia. 

As a youth representative from Nepal, my task was to provide a youth perspective and give inputs on the guidelines being formulated. However, in addition to my contribution, it turned out to be a huge learning opportunity for me. I became aware of many complex issues surrounding the sexual health of adolescents.

For instance, take the example of a doctor who is visited by a typical South Asian unmarried adolescent girl due to an unwanted pregnancy. If the doctor asks her in an overpowering, impatient tone in the presence of other patients to quickly tell him/her why she is there, will the adolescent girl still say that she is there because of the pregnancy? Probably not.

Given the crowded condition of our government hospitals, this approach is not unlikely. In the obstetrics and gynaecology out patient department of the university hospital in Nepal where I did my training, we used to have five to seven doctors seated in a single room, sharing two desks and two examination tables between them and each seeing a different patient. There was no privacy. Everyone could hear what anybody in the room said. How many cases like the one mentioned above could we have missed because of this?

Having separate clinics for adolescents within the framework of a primary care centre or a hospital would be desirable for improving access to adolescents. Even if this is not possible, the approach of medical professionals in dealing with adolescents can make a huge difference. Medical professionals need to be non-judgmental and friendly when dealing with the sexual and reproductive health issues of adolescents. Although this may seem like a very simple and well-understood requirement, it is surprising to note how often medical professionals pronounce moral judgments in our part of the world.

Outside of the health system, the school education system in any country can serve as an excellent medium to inform adolescents about sexual and reproductive health issues. However, ‘sex education’ in schools has met some stiff resistance from parents, teachers and religious groups in different parts of South Asia. It has wrongly been taken akin to encouraging adolescents to have sex. For this reason, ‘sex education’ is now being passed under the name of ‘life-skill education’ in many parts of South Asia to avoid getting unwanted attention.

Another aspect that has a huge say in the sexual and reproductive rights of adolescents is the existing laws and policies regarding adolescents in any country. Even medical practitioners need to be made aware of such laws and policies in their respective countries. For instance, can a doctor give condoms to a fourteen year old? Can a sixteen year old provide consent to an abortion? Answers to questions like these differ from country to country in South Asia but nevertheless, they play a huge role in determining the access to services.

Many more issues were discussed and debated during the workshop. And although India seemed to dominate most of the issues, most of these discussions were relevant to other countries in South Asia as well. It was interesting to note the different perspectives of different people. This is the advantage of having representatives from different backgrounds and countries. There were doctors, social workers and representatives from NGOs and INGOs as participants. Young people were in a short supply though. Sarah (from Sri Lanka) and I were the only youth representatives. The young people from Bangladesh and Pakistan had to miss out because of visa issues.

The biggest challenge for the workshop is yet to come. The challenge lies not in formulating the policies and guidelines but implementing them. We were successful in coming up with guidelines and policies through the workshop but it remains to be seen to what extent they get implemented in practice. At this point, we can only hope and wish that the guidelines will help improve the sexual and reproductive health and rights of adolescents in this region.

Competing interest: My expenses for the workshop, including air fare and stay, was covered by FIGO.

Siddhartha Yadav is a former BMJ Clegg Scholar.

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  • Dr. Punita

    Hi..Sid…went through the article and totally agree with u. The issue of adolescent sexual and reproductive life is very sensitive and need to be addressed properly . Though polices have been formulated but not implemented well. I have worked in the Various INGos and had conducted reproductive health camps for adolescent in different places of Nepal, what i felt that girls rarely seeks advice for such problems. Being a CAC (comprehensive abortion care) provider i have witnessed many service seeker coming to private clinic for help even though it is illegal. And i think all is due to lack of privacy so..i complete go with your saying that adolescent needs a separate clinic with friendly medical personnel.

  • http://daktre.com Prashanth

    Very nice post. However in the interest of integration of services I wouldn’t agree with your suggestion for separate adolescent clinic. Making doctors more aware of the sensitivity ofadolescent care is definitely a priority.

    Cheers
    Prashanth

  • Dilip Kumar Yadav

    Very well written article Siddhartha!! You have very well described the situation of the consultation room in so far deemed one of the best service centre in Nepal.Besides ,you have raised very important issues like the difficulties faced to include ‘sex education’ in curriculum of modern education but having to do it by changing its name all together to avoid getting unwanted attention.All other aspects of the article are excellent.Keep writing.Great job!!

    Cheers once again,
    Dilip

  • Siddhartha Yadav

    Thank you Dr. Punita, Prasanth and Dilip for your interesting perspectives on this issue.

    Dr Punita: I agree with you that lack of privacy is forcing adolescents (and for that matter even many adults) to expensive illegal private clinics for abortions.

    Prasanth: Could you please elaborate a bit more on why you do not agree with the idea of a separate clinic for adolescents within the framework of a primary care centre or a hospital? I would love to hear your views which, hopefully, will expand my understanding of this issue. Thanks.

    Dilip: Thanks for the encouragement. Indeed, there are a lot of issues that need to be addressed in the health system as well as the education system to ensure the sexual and reproductive rights of adolescents in this region.

  • http://BMJblogs Nancy Kerr

    Hi Siddartha. I am confused, since my understanding was that abortion was made legal in Nepal in about 2002, and became available clinically a couple years later. Is it only legal in public hospitals and not legal in private offices or clinics? If so, why? Is there much use of medical abortion. About half of abortions in US are now done using medical ab, much more private for patients who prefer that.

  • Siddhartha Yadav

    Hi Nancy,

    Thank you for your comment and query. Indeed, abortion is legal in Nepal. Since 2002, Nepal’s abortion law has allowed termination until the 12th week of uterine gestation for any reason, or up to 18 weeks if pregnancy results from rape or incest.

    Abortion is legal through only government approved Comprehensive Abortion Care (CAC) Centres and by medical personnel who are trained in Comprehensive Abortion Care. Such CAC centres can be both, government owned or private(the private ones are usually run by NGOs).

    However, many women still seek abortion from private clinics which are not approved by the government as CAC centre and where the medical personnel are not trained in CAC. Such centres are expensive and illegal (in terms of providing abortion care), yet women go there for privacy.

    I hope I have been able to answer your query.

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