ONLY years ago the issue of adolescent reproductive health came to the forefront. The big thrust came after the 1994 International Conference on Population and Development that shifted the focus of health and family planning to a unified reproductive health approach. South-South Centre, Bangladesh

brings out a publication on Adolescent

Reproductive Health based on a dialogue it had organized to identify the challenges of adolescent reproductive health in a resource poor country like Bangladesh. The publication develops around a keynote paper delivered at the dialogue and draws from the subsequent discussions and debates on it.

Adolescents are defined differently by different organizations. According to World Health Organization, adolescents are the population between ages 10 and 19 years with the 'characteristics of biological development from the beginning of puberty to sexual and reproductive maturity, psychological development from cognitive and emotional straits of childhood to that of adulthood, and emergence from childhood state of dependence to socioeconomic independence'.

There is no shortcut route to reach adulthood escaping adolescence. Adolescent population in Bangladesh constitutes around 23 per cent of total population numbering nearly 30 million. Currently 48 per cent of the adolescent population are female and 52 per cent male. With 20 per cent of total population bellow 10 years age group plus 23 per cent adolescents totaling 43 per cent of total population will now determine the health and population structure of the country in the years to come.

Adolescent population growth rate is much higher at 4.3 per cent compared to 1.7 per cent for total population. Marriage rate is almost double for the people of this age group while contraceptive prevalence rate for the adolescent is 20 per cent lesser than the national average. This huge size of population will certainly exert high population momentum effect on the increment of total population. The challenge lies not only in containing population growth but also in ensuring health of this mammoth size of population in a world that faces the worst pandemic of AIDS.

75 per cent of the rural girls in Bangladesh are married before reaching observing their sixteenth birthday. Mothers in 15-19 age group have a share of 20 per cent of the total births. The mortality risks for children born to teenage mothers are substantially higher than that of adult mothers. Having survived infancy and early childhood diseases, they have the lowest mortality rates of any age group. An adolescent faces the highest health risks during the pregnancy. The apparent security and immunity of adolescent boys and girls often leave them in a state of no-need-to-take-care as they can well do it for themselves. AIDS has overwhelmed the conti-

nent of Africa and Asia is quickly getting nearer to the African situation. The AIDS pandemic has disproved the myth of immunity of young people. Half of the adolescent population in Africa is HIV positive and the rate is higher for Botswana. Unless there is miracle savior the adolescent population will continue to pay for the complacency of their parents. The risk of death may be two to four times higher depending on the expecting adolescent's health and socioeconomic status.

In Bangladesh 20 per cent births to adolescent women are mistimed and a considerable number of conceptions are unwanted. Mortality rate for adolescent mothers is higher than the national average. Children born to young mothers are

Adolescent Reproductive Health in Bangladesh : A Challenge

Published by South-South Centre, Bangladesh Sponsored by UNICEF Bangladesh

December 2000

more likely to die early as both mothers and children are highly risk prone. Because of early-age childbearing 19 per cent of births are exposed to higher risk of death. Antenatal, neonatal and postnatal cares for adolescent mothers are very low. Adolescents have appallingly inadequate sexual education. One study suggests that the vast majority of them (83 per cent) have never heard of Sexually Transmitted

Diseases (STDs) and AIDS. Another report suggests that about 95 per cent of the young people do not know how to play sex safe.

The publication contains a touchy statement of an adolescent girl named Shamima: 'I can remember the horrifying experience and the trauma that I faced on seeing the first menstrual blood. I screamed, I cried, and I groaned. I had no idea of what it was. I had access to no one who could give me a brief on the sudden flow of this reddened discharge. Am I going to die then? Only an illiterate maidservant came to my rescue. She assured that the same thing had happened to her when she was of my age. That was not a one-shot problem, but a regular monthly feature. I was lucky that I got at least one maid to tell me a few secrets in her own way and according to her own perception. She gave me an incomplete and misleading picture of the process of menstruation. But I know after passing a few years as an adolescent girl, most of the girls of my age faced the same trauma, many of them become worse off with the beginning of menstruation and the same fear continues for years'.

She embarrassed the policy makers and development practitioners by asking whether they had ever given their daughters in puberty any prior idea on menstruation and whether they had ever created a friendly environment that allowed the daughters to ask questions on sex and sexual behavior. The problem remains, as the silence is not broken and talks on sex and reproduction remain a taboo.

Professor Abul Barkat, who wrote the keynote paper, maintains that adolescent reproductive health is one of the least explored, widely talked about and most sensitive global issues. But its knowledge base is at the embryonic stage in Bangladesh. It reveals from his essay that the challenges are multifaceted and inter-woven. The first challenge demands identification of the best ways and means to ensure adolescent friendly services in the socio-cultural setting of Bangladesh. The second one is that of identifying what needs to be done to increase the coverage efficiently. The third one poses a question as to what is needed to be done to overcome the barriers and thereby ensure creation of a conductive environment which will accelerate the process of maximizing RH services utilization by the adolescents. It is encouraging to see that government policy document recognizes the need for treating adolescent as distinct and priority group requiring immediate intervention, both clinical and non-clinical.

The publication emphasizes on the introduction of priority reproductive health services for adolescents. This is an important documentation in the area of reproductive health. The publication is supported by UNICEF. No price is tagged with it probably with the intention that professionals in adolescent reproductive health areas will receive it free of cost from the publisher.