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European Parliamentarians
This video captures the insights of European Parliamentarians in Bangladesh during their tour visiting projects supported by the Reproductive Health Initiative for Youth in Asia.
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| OVERVIEW |
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The Programme
RHIYA Bangladesh partnered with 5 NGOs to improve the sexual and reproductive health of young people aged between 10 and 24. This was done through information and education campaigns, the provision of youth friendly services and the development of advocacy initiatives. The target was 250,000 adolescents and youth across 17 districts. While different NGOs took lead roles in these different components, they all offered a range of interventions for urban, peri-urban and rural youth.
Key objectives were to develop positive changes in SRH attitudes and gender-sensitive behaviour and practices among youth and adolescents and to create an empowering and supportive environment to increase awareness of reproductive health and access to quality services. Peer educators and community health promoters made over 92,000 contacts with young people over the course of the programme. Resource centres and adolescent spaces were set up for young people and clinical services were provided at 73 Youth Friendly Centres (YFC) around the country. Nearly 250,000 consultations on STIs HIV/AIDS, Family planning etc. were provided for young people under the RHIYA.
The Achievements
Results of the RHIYA Baseline and Endline survey show that the programme had very positive effects on young peoples sexual and reproductive health knowledge and behaviour with almost all indicators showing a sharp improvement. Young peoples knowledge of STI prevention increased from 1.5% to 20.6%. These improvements have been especially large for unmarried people and for those under 20, thus showing that RHIYA has met the needs of young people who are usually underserved by traditional services. Contraceptive use also increased from 60% to 78%.
The RHIYA programme was also been successful in mobilizing community gate-keepers and generating huge support of the community to promote ARSH in a country where there have traditionally been religious and cultural barriers to such interventions. Strategies and approaches to bring communities on board are documented in a case study Whatever It Takes: Creating Youth-Friendly Communities in Bangladesh and the Booklet entitled Making Common Cause: Good Practices for Creating and Enabling Environment.
The Way Forward
Despite the obvious success of RHIYA in Bangladesh, many sexual and reproductive health issues remain unresolved. Women remain disadvantaged in terms of access to information and services, and are at greater risk of sexual and reproductive health problems. RHIYA has demonstrated it is possible to provide quality youth programming and to close the gap between male and females, but on the whole the gap remains. RHIYA interventions need to be scaled up, there are a number of steps that need to be taken to support scaling up:
- The policy and strategic direction are established. The new ARH strategy has drawn a roadmap of good coordination and partnership development with various stakeholders: Community participation, advocacy, health facility availability and knowledge transfer are key areas, as well as support of local gate-keepers.
- Standardized, youth friendly and equitable services across the country (confidential, technically competent etc.) with guidelines for the quality of care, such as those established by RHIYA partners are required
- RH and HIV services need to be integrated to include STI/HIV prevention information, Voluntary counselling and testing services, general health care, psychological support, including support for the victims of gender based violence
- Maternal health services which focus on the needs of young women, even though they are married adolescent mothers need focussed support and care
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M&E officer explaining SRH to peers
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| PROFILE |
History / Culture: Bangladesh gained independence after a war with Pakistan in 1971. It is a secular country with different religious groups such as Muslims, Hindus, Christians and Buddhist, although 85% of the population is Muslim and 98% is ethnically Bengali.
Geography: Bangladesh is a big delta formed by two big river systems, Ganges-Padma and Brahmaputra-Jamuna. It is situated on the Tropic of Cancer, 90 degree East longitude with an area of 147 thousands square kilometres and inhabited by 143.4 million people.
Population / Demography: By 2025 the population of Bangladesh is projected to increase up to 178.8 million. Bangladesh is the 9th most populous country, one of the world's most densely populated areas (950 people/sq km). The population is mostly rural although 25% currently live in urban areas. If this trend continues, Dhaka will become the second largest mega-city in the world by 2015 (following Tokyo), with a projected population of over 22 million people. The city is expected to continue growing at over 3% per year during this period.
Economy / Productivity: Bangladesh has huge reserves of natural gases and some coal, mud stone and petroleum. Gases are mainly used for generating electricity, producing fertilisers, industrial use and household purposes. The economy of Bangladesh mainly depends on primary activities. Major agriculture products are rice, jute, sugar cane, tobacco and tea. Agricultural productivity heavily depends on the monsoon climate. About 18% of the GNP comes from industrial/secondary sectors and about 50% from service/tertiary sectors. Major industries are jute, textile, cement, ceramic and garments manufacturing. Presently, the garment industry is the major source of foreign currency earning and has created huge opportunities for women employment. It has increased the female labour force to a level now standing at 25 million [while male labour force is at 35 million (1995).] However, the majority of the population lives below the absolute poverty line, and Bangladesh remains one of the least developed countries.
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| BACKGROUND |
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Characteristics of Youth and Adolescent Population: Young people aged 10-24 represent one third of the total population, and the group aged 0-24 still represents about 50% of the entire population of Bangladesh, despite Bangladesh efforts to reduce the population growth rate. Given Bangladesh's type of structural evolution, the adolescent population continues to be important. However, even though adolescent population is numerous, there has been few focus on them in the past. While Family Planning Programmes used to target primarily women and children, the government, with the assistance of ICPD, now puts an emphasis on adolescents' issues and their health needs, even though challenges are remaining. For example, nutrition deficiency is still a major problem in Bangladesh, especially amongst young females.
Education / Socio-economic development: Although there have been large gains in literacy rates and in girls’ education over recent years, about half of female adolescents are illiterate, since they stay at home to help their family with the housework and take care of children. Early pregnancies seem to be related to the lack of education. According to a Study on urban youth, 1 out of 10 adolescents had never attended school; among in-school adolescents, 18 % of males and 1 out of 10 females declared having worked for earnings; concerning out-of-school adolescents, 63% of males and 19% of females declared to be employed in some form of paid work (1). Poverty is widespread and job opportunities for many young people are very low. The government aims at reducing the Population Growth rate in an effort to promote socio-economic development and struggling against poverty, since about 34 % of the population lives below the poverty line (UNFPA).
Health and Knowledge on sexuality and reproductive health: Unmarried young people are unable to access basic reproductive health information or government services, and sex education is not taught by teachers in schools although some basic reproductive health topics are included in the school curriculum. Any discussion of SRH with families, especially with adolescents is strictly taboo. Several studies show that majority of the adolescents has poor understanding and knowledge of the reproductive health issues and problems. Their knowledge of symptoms, transmission and presentation of RTI/STIs and HIV/AIDS is inadequate. The HIV/AIDS prevalence is at a low level, although there is concern that it is rising in at risk groups such as commercial sex workers and injecting drug users.
Traditional values and Attitudes / Marriage: The society is predominantly conservative Islamic and patriarchal, and gender inequalities and violence against women are prevalent. Laws have had little impact on traditional practice of early marriage: 85% of rural girls are married before reaching the age of 16, and dowry practices are increasing and are a source of violence and discrimination. The family remains the cornerstone of the Bangladeshi society and parents/elders exert a tight control on the lives of adolescents. Contacts between young people of different sexes are controlled and premarital sex is strongly discouraged for both sexes. However, male peer educators stated that boys do use the services of commercial sex workers before marriage. The country’s Total Fertility Rate (TFR) is 3 and Contraceptive Prevalence Rate (CPR) is 58%.
Actions: Despite deepening levels of rural poverty and growing numbers of impoverished city dwellers, the Bangladeshi government, working closely with UNFPA, is committed to reducing poverty by improving health and welfare of its citizens. It has introduced a major five-year reform in the health sector, entitled "Health and Population Sector Programme” (HPSP) in 1998. Particular emphasis was placed on reproductive health and the provision of an essential service package, including RH treatment, communicable diseases, child care and simple curative care, to the most vulnerable populations. Thanks to the Government’s strong commitment towards implementing the goals stated in the ICPD Programme of Action and the HPSP, the country has seen a sharp decline in its fertility rate (from an average of 6.3 births per woman in 1971–75 to 3.3 in 1995–2000) and a notable improvement in primary health care. In addition, Bangladesh is making progress towards lowering both the maternal (380 per 100,000 live births) and infant (56 per 1,000 live births) mortality rates.
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1) http://unesdoc.unesco.org/images/0012/001246/124690e.pdf
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There was work to be done with adults.