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Breaking taboos, reaping dividends

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Swapna Majumdar, Citizen News Service - CNS

Consider these statistics: Globally, 370,000 million children are married every day. By 2020, an additional 142 million girls will be married before their 18th birthday. Six million adolescent pregnancies occur in South Asia--90% of them inside marriage. Further, 34% of all unsafe abortions in the Asia-Pacific region happen to women below the age of 25.

Yet, talking about sexual and reproductive health (SRH) still remains a taboo. The perception that it would encourage promiscuity among adolescents continues to be one of the main reasons for stiff opposition to introducing comprehensive sexuality education in schools in this region. Lack of knowledge has been compounded by denial of access to SRH services and information to millions of adolescents and young people, says the 2014 UNFPA state-of-the-world population report released on November 18, 2014.

The report, which was shared with the media at the Asian and Pacific Conference on Gender Equality and Women's Empowerment: Beijing +20, held recently in Bangkok from November 17-20, 2014, underlined the need for gender equality and the empowerment of women and girls to be at the forefront of all goals. Secondary education, comprehensive sexuality education, and access to SRH services, including contraceptives, were ways to empower girls.

"When I was in school in Japan in the seventies, sexuality education was not comprehensive. I had to seek information from libraries, book stores and visit a gynaecologist as well," said Nobuko Horibe, UNFPA, Asia and Pacific regional director, in an interview with Citizen News Service (CNS) in Bangkok.

According to the report, although many countries have comprehensive sexuality education policy and programmes, its implementation has been poor. Consequently, knowledge about HIV and AIDS has been less than comprehensive. A recent analysis found that less than half of schools provide skills-based HIV education. In fact, only 28% of young women between the ages of 15-24 in sub-Saharan Africa had comprehensive knowledge of HIV. These are the women who are twice as likely to be living with HIV as men in the same age group.

This is why it important to invest in adolescents now, said Horibe. "A youth of 10 in 2015 will be an adult in 2035--the target year for achieving the next generation of sustainable development goals. A majority of them are growing up in poor countries where they face challenges of weak education and health systems, and limited access to SRH services. The report reiterates the need for governments to support young people develop their capabilities to realise their potential. If they have to make informed decisions, education, including comprehensive sexuality education, is an important enabler," she said.

With a population of 243 million adolescents, India has the largest number of young people in the world. "Adolescents comprise 21% of India's population. The highest number of early marriages in the Asia Pacific takes place in India. India has a big role to play in the region and the national adolescent policy introduced by India recently is a good step," said Horibe.

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While early marriage remains a big challenge in the region, early pregnancy is also a problem. Even in Thailand, where fertility rates are low, teenage pregnancy is increasing. "Complications during pregnancy and childbirth are the second cause of death for 15- to 19-year-old girls globally. Adolescent pregnancy remains a major contributor to maternal and child mortality, and to the cycle of ill-health and poverty," she said.

Pregnancy changes the life of an adolescent girl drastically. Besides ending opportunities to education, it puts her and her baby's life at risk. In fact, younger the mother, greater is the risk to the baby. Babies born to mothers under 20 years of age face a 50% higher risk of being stillborn or dying in the first few weeks versus those born to mothers aged 20-29 in low- and middle-income countries. Infants born to adolescent mothers are also more likely to have low birth weight, which carries the risk of long-term adverse health effects.

With little or no access to contraception, young girls lack control over their bodies. According to estimates, one in three deaths related to pregnancy and childbirth could be avoided if all women had access to contraceptive services. Studies have shown that as many as 50% of pregnancies are unplanned, and 25% are unintended. Young women account for a far higher percentage of all 3.6 million unsafe abortions that take place each year than of pregnancies overall. In Pakistan, nongovernmental organisations found child brides in the province of Sindh using rat poison to terminate pregnancies, with fatal consequences at times.

Why do these young girls and women need to die? If governments invested in contraception, money spent on unplanned births and abortions could be reduced substantially. According to a UNFPA-Guttmacher Institute study, each dollar spent on contraception would bring down the total expenditure by $1.40 by cutting down on money spent on unplanned births and abortions. Every woman would get quality maternal and newborn care and the unmet need for family planning would also be taken care of by an additional investment of $12 billion a year. While this may seem like a big investment, the long-term gains are huge: unintended pregnancies can be reduced by more than 66%; 70% of maternal deaths can be prevented; 44% of newborn deaths can be averted; and unsafe abortion can be reduced by 73%.

So if countries invested in their youth, their economies could actually get good returns, said Horibe. "Sexual and reproductive health and rights are pivotal to young people's realization of their full potential and their productivity. When young people are healthy and educated, countries can reap a demographic dividend which can help reduce poverty," she said. But unless governments invest now, attaining full potential and productivity may remain a dream for a child of 10 in 2015 who will be an adult of 25 in 2030, the target year for achieving the next generation of sustainable development goals.

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Swapna Majumdar, CNS

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Citizen News Service (CNS) specializes in in-depth and rights-based, health and science journalism. For more information, please contact: www.citizen-news.org or @cns_health or www.facebook.com/cns.page

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