Life skills and reproductive health education at school
M S Siddiqui
WHO (World HealthOrganisation) suggested adolescent reproductivehealth (ARH) and life skills education (LSE) for the physical and emotional well-being of adolescents. ARH and LSE enhance their ability to be healthy and remain free from too-early or unwanted pregnancy, unsafe abortion, sexually transmitted diseases (STDs) including HIV/AIDS, and sexual violence and coercion, sexual assault, rape and prostitution, malnutrition, unsafe abortion.
Life skills are behaviours that enable individuals to adapt to and deal effectively with the demands and challenges of life. There are many such skills, but core life skills include the ability to make decisions, solve problems, and think critically and creatively, clarify and analyse values, communicate, including listen, build empathy, be assertive, and negotiate, cope with emotions and stress, feel empathy with others and be self-aware.
A UN report mentioned that one in every five persons on the earth is an adolescent aged between 10-19 years, and 85% of these adolescents live in developing countries. An estimated 1.7 million adolescents die every year mainly from accidents, violence, pregnancy related problems or illnesses that are either preventable or treatable.
As per study, the majority has no idea about the changes associated with puberty (e.g. menstruation or wet dreams) until they experience them. Though the strong family structure plays a major role in the lives of adolescents, it fails to respond to their needs for reproductive healthinformation. The best investment in and education and health sector should go to this segment of population to shape the future of mankind.
Bangladesh statistics mentioned that about 23% of the total population is adolescents. Among them 52% are male, while 48% are female. The approximate number of adolescents was 33 million in the year 2001. Almost 60% of adolescent girls are married off before they reach the age of 18 years, one third of them start child bearing in their teenage years, while about 28% of adolescent girls are already mothers.
These young people have tremendous demographic significance as their individual development and social contribution will shape the future of the world, investment in children's health, nutrition and education is the foundation for national development.
Adolescents in Bangladesh have very limited access to reproductive healthand life skills information due to cultural, social and religious belief and practice. Nationally, it is reported that only 37.6% of girls and 19.9% of adolescent boys discuss pubertal changes with parents, and 37% of girls and 61% of boys discuss the issue with friends and peers. Discussion about their marriage and marriage partners with parents is even lower. It was reported that most adolescent discussions about reproductive health (RH) and marriage issues take place among friends and peers. It has been shown that teen mothers are more likely to suffer from severe complications during delivery and infants born to adolescent mothers have a greater possibility of dying early. Overall, adolescent girls in the age group of 15-19 contribute 20% of the total babies born in a given year in year 2000. Analysis of available data on variables, such as education, nutrition, fertility, marriage, use of health services, and knowledge and use of contraceptives, confirms that adolescents in Bangladesh are exposed to the same RH risks as adolescents in other developing countries.
Male to male sex is not uncommon in Bangladesh, and often adolescent boys are forced to participate in such sexual acts. Due to lack of awareness and information, most of these sex acts are unprotected and result in the spread of sexually transmitted infections.
Healthcare seeking for the girls and the boys seemed to be different. Generally, the girls did not seek any help for such problems. However, if they felt that the symptoms were becoming severe, they only then would consult their family members. If the family members, especially their mothers, perceived the problem as a serious one, only then would she be taken to a doctor or a hospital or traditional healer, such as Kabiraj or Fakir. The boys followed a similar pattern for seeking RH care; however, they might independently also seek treatments directly from the healthcare providersbefore consulting any family member. The boys might directly seek treatments from canvassers, pharmacies, or village doctors. However, if traditional treatments failed, they would go to a doctor or hospital. They did not find free time to visit the health facilities because of school timings. Many female respondents expressed reservations in seeking RH care from the male doctors.
The emergence of HIV/AIDS gave many governments the impetus to strengthen and expand reproductive health education efforts and, currently, more than 100 countries have such programmes. UN organisations such as UNFPA, UNESCO, and UNICEF have traditionally been the leading international supporters of reproductive health education. The World Bank, through its intensified efforts to help countries fight HIV/AIDS, has also become a major fund provider. Many other bilateral donors and private foundations and organisations support and promote reproductive healtheducation worldwide. Reproductive health education (RHE) system was first established on a national scale in Europe in the 1960s while developing countries introduced school-based reproductive health education in the 1980s.
The objectives of the ARH strategy are: to improve the knowledge of adolescents on reproductive health issues, to create a positive change in the behaviour and attitude of the gatekeepers like parents/guardians, teachers, religious leaders of adolescents towards reproductive health, to reduce the incidence of early marriage and pregnancy among adolescents, to reduce the incidence and prevalence of STIs, including HIV/AIDS, among adolescents. To provide easy access of all adolescents to adolescent-friendly health services (ARSH) and other related services, to create a socio-political condition where adolescents are not subjected to violence or abuse, and which discourages substance abuse and other risk taking behaviours among adolescents.
RH and LSE programmes are preventive in nature and are relatively low-cost. A review of YRH programmes in different developing countries of Asia and Africa found that such programmes cost between US$ 0.30 and US$ 71 per year per person, with a median cost of about US$ 9 per person per year. Moreover, recent studies have found that reproductive health education programmes offer a good return on investment. For example, a study in Honduras found that for each $ 1.00 invested in reproductive healtheducation to prevent HIV infection among youth, the programme would generate up to $ 4.59 in benefits from improved health and reduced medical care costs. This estimate only includes the economic benefits of averted HIV infection and does not include the benefits of other potential programmeoutcomes such as increased education, reduced STIs, and reduced teen pregnancies and abortions.
The Bangladesh government has shown exemplary farsightedness in creating an overall supportive policy and legal environment to promote adolescent reproductive health. The Constitution of Bangladesh guarantees equal rights for men and women irrespective of caste, creed, and colour. All citizens are entitled to equal protection under the law. A number of laws are in place which directly or indirectly dissuade adverse practices. These include the Dowry Prohibition Act, 1980 which says that taking and giving of dowry is an offence and punishable by fine and imprisonment; Cruelty to Women (Deterrent Punishment) Act, 1983 which makes punishment by death or life imprisonment for the kidnapping or abduction of women for unlawful purposes, trafficking women or causing death or attempting to cause death or grievous injuries to wives for dowry; the Immoral Traffic Act and the Women and Children Repression (Amendment) Act, 2000 enacted to regulate offences (like sexual harassment, rape, trafficking, kidnapping, dowry) against women; the Child Marriage Restraint Act, 1929 (Amended in 1983) enacted to restrain child marriage and ascertain the legal age of marriage, which is 21 years for boys and 18 years for girls, and the Children Act, 1974 which provides provisions relating to protection and treatment of children and trial and punishment of youth offenders.
The Population Policy of 2005 has provision of information, counselling and services for adolescents as one of its objectives and outlines a number of strategies for achieving this goal. The draft revised Population Policy has an exclusive section, with the heading of Adolescent Welfare Services, which shows the importance given by the government to the adolescent population. Bangladesh National Food and Nutrition Policy 1997 highlights importance and state duty of raising the level of nutrition and improvement of public health among the primary duties of the state.
The National Youth Policy 2004 defined youth as a citizen within 18-35 years. Unfortunately this definition leaves out the adolescents of 10 to 18 years - about 25 million young people who need special focus. The different sections of the policy emphasise the importance of information and education on RH, HIV/AIDS etc.
The National HIV/AIDS and STD Policy has given specific guidelines for access to information and services regarding sexual health for adolescents and identified as the most neglected section of the society. It also denotes about the child prostitution, sexual abuse and trafficking and safe sex practice of men and development of appropriate strategies in relation to male sexual and reproductive health.
Bangladesh is working on education for all before 2015 and expected to have more children than ever receiving an education. Schools are an efficient way to reach school-age youth and their families in an organised way. The last 30 years have seen an impressive improvement in enrollment rates and reduction of school dropout.
Bangladesh Adolescent Reproductive Health Strategy, July 2006 has the vision and goal to achieve safe and complete reproductive life through access to appropriate knowledge, skills and services in a socially and legally supportive environment, by 2015. All adolescent girls and boys, including the disadvantaged, will be able to enjoy virtually all comprehensive life skill based reproductive health education programmes, promote abstinence from sexual activity as part of the curriculum, and try to teach young people how to resist pressure for unwanted sex.
The experience of India is encouraging. The Andhra Pradesh AIDS Control Society took the lead in implementing a scaled programme in all schools of the state in 2001. The programme was developed in partnership with Department of Education.
In Malaysia, the Ministry of Education imparts knowledge on adolescent reproductive and sexual health through its programme on Family Health Education. In 1989, the curriculum was introduced to secondary school students and in December 1994, elements of it were also introduced to primary school children through Physical and Health Education. In Sri Lanka, the life competency programme was introduced into the junior secondary curriculum from grade 7-9 under the education reform in 1997 and implemented in all schools by 1999. A Ugandan programme that targeted primary school students produced significant, desirable improvements in reports of sexual initiation. Sexual initiation was reduced from 43% to 11% in the experimental group with no change in the control group.
There are problems of introduction of RHE and LSE due to traditions and beliefs, including the expectation that young people abstain from sexual activity until marriage. Thus, traditional leaders - who view themselves as the repository and transmitters of community values and beliefs - are often in the forefront of opposition to reproductive health education in the schools. These conservative forces often mobilise parents and some teachers as allies. In India, conservative forces have effectively blocked sex education in the schools. In Malaysia, although a nationwide family health education curriculum is in place, it gives students little or no information on reproductive health or sexual practice, in large part because of strong resistance from parents and religious leaders. Political leaders are reluctant to risk a religious backlash by openly supporting sexuality education. This is more interesting that religious groups have strongly opposed school-based sexuality education in the United States, Mexico, and Kenya.
Some teachers and school administrators find reproductive health education personally objectionable or lack sufficient understanding of the subject and thus are reluctant or refuse to go along with such programmes.
Despite the resistance and obstacles, the school-based reproductive health and life skill development programmes are successful in developed and developing countries and all government policy documents support the programme. This is the time to include the Reproductive Health and Life Style education in national school curricula.