Young people’s access to Sexual and Reproductive Health information and

services - The need!

Agniva Lahiri, Coordinator NAPY

Concept Paper

A. Rationale
The youth represent nearly half of the world’s population and 62% of the world’s youth
live in the Asia Pacific region and they make 20% of the total population in the region.
“Young people” is defined as persons between the age of 10 and 24 years of age 1.
However youth policies of countries have various definitions. For example the youth
policy of India includes people between the age of 13 and 35 and Youth:
Pakistan considers persons between the age of 15 and 29 years of 14-24
age as youth. Young men and women are a vulnerable group, as Adolescents:
social, economic and cultural situations may lead them to early 10-19
sexual activity and high risk. Also because there are advocacy Young people:
efforts being made for early marriage, the age at marriage is being 10-24
delayed as a result. However many young people become sexually WHO definitions
active before marriage. Therefore it is important that sexual and reproductive health
information and services are made available to them to protect themselves from
Sexually Transmitted Diseases, unwanted pregnancies and subsequent risks of
maternal mortality.

Young people need, want and have a right to sexual and reproductive health services.
Ignoring their sexuality will not make their problems go away. It only makes them worse.
Recognising the need for young people’s sexual and reproductive health services, the
International conference on Population and Development (ICPD) in 1994 in its
Programme of Action “………address adolescent sexual and reproductive health
issues, including unwanted pregnancies, unsafe abortion and STDs, including
HIV/AIDS, through the promotion of responsible and healthy reproductive and sexual
behaviour, including voluntary abstinence, and the provision of appropriate services and
counselling…. for that age group.”2

B.Objectives
• To highlight the issues in Asia-Pacific
• To analyse and critique the SRH youth policies in the Asia-Pacific

Key concerns of young people in Asia-Pacific

• Sexually active adolescents are at risk of getting and passing on STDs
including HIV/AIDS

HIV/AIDS has become the disease of young people. Since the main modes of HIV
transmission in Asia-Pacific are through heterosexual sex and injecting drug use, young
people are at the centre of the HIV/AIDS epidemic. Over 50 per cent of all new infections
1
UNPFA state of world population 2003. Making 1 billion count: investing in adolescent’s health
and rights
2
Programme of Action adopted at the International Conference on Population and Development,
Cairo, 5-13 September 1994
occur among young people below 24 years of age. 3 India has had a sharp increase in
the estimated number of HIV infections, from a few thousand in the early 1990s to a
working estimate of between 3.8 million and 4.6 million children and adults living with
HIV/AIDS in 2002.4 With a population of over one billion, the HIV epidemics in India will
have a major impact on the overall spread of HIV in Asia and the Pacific.

Studies conducted by UNESCO show that sexually transmitted diseases are more
among the young people. For example, in Bangladesh two thirds if all reported STDs
occur among people under 25 years of age and the incidence is much higher among
women aged 15-19 than among men of the same age (Uddin, 1999). In China 8.7
percent of the HIV carrier and AIDS patients belong to the age of 16-19(sun, 2000)4

• High rate of maternal mortality among the adolescents

Because adolescents are not physically and mentally matured the health risks
associated with child birth is quite high. Maternal mortality has always been a concern
for the adolescents. Maternal mortality is estimated to be 3-4times higher in adolescent
girls than adults. Studies reviewed by UNESCO suggest that in Bangladesh the high
incidence of teenage pregnancy has contributed to high maternal mortality. In rural
Bangladesh. In India, 13% of deaths of females below 24 years are related to pregnancy
and childbirth. (UNFPA 2000). Maternal morbidity is also another concern.

• High prevalence of unsafe abortion

According to the World Health Organization, unsafe abortion is the termination of a

pregnancy carried out by someone without the skills or training to perform the procedure
safely, or in an environment that does not meet minimal medical standards, or both. Also
the cost of going in for a safe abortion is too high that the young people are many a
times not in a position to afford. Every 10 minutes 10 teenage girls go through unsafe
abortion. Asia accounts for 50% of the unsafe abortions. Adolescents tend to delay
abortions and resort to unskilled persons to perform it and these unskilled persons use
dangerous methods and do not provide care when complications arise. The
complications of unsafe abortion would be haemorrhage, septicaemia, internal organ
damage, tetanus, sterility and even death.

• Early child bearing impedes the educational, economic and social status of
women
According to the United Nations (2001a), 132 million babies are born world wide
each year. Close to 90 percent of these births (119 million) occur in developing world,
and slightly over three fifths (76 million) in Asia. Of the total annual births in the
world, about 14million babies (10.6) are born to adolescent mothers. In Asia, 6
million babies (8 percent) are born to adolescent mothers.

3
1997-2003 United Nations ESCAP
4
Kumar S. (2003) 'HIV cases rising sharply in India', BMJ, August 2; 327(7409):24
4
Adolescent Reproductive Health in Asia. By Bhakta B.Gubhaju. Paper presented at the 2002
IUSSP Regional Population Conference “South-East Asia’s Population in a Changing Asian
Context. http://www.iussp.org/Bangkok2002/S30Gubhaju.pdf
Factors responsible

A. Limited access to information

Access to information is a right of all young persons. It is the duty of the state to
provide sufficient and appropriate information on sexual and reproductive health
services.
Young people in Asia-Pacific do not have access to proper information on Sexual
and reproductive health. Young people get information from their friends or media,
which are least reliable. There are several misperceptions like “HIV virus will spread
by touching the person who is infected by HIV”, “a girl cannot become pregnant the
first time she has sexual intercourse”. As a result, adolescents are susceptible to
sexual violence and exploitation, infection of HIV/AIDS and other sexually
transmitted infections, and unplanned pregnancies. Apart form these, the cultural
and traditional practises remain as barriers for the young people to practise their
sexual and reproductive health rights. Parents are reluctant to give information to
their children because discussing these health issues are either embarrassing to
them or they think these information would encourage them to experiment with sex.
“Adolescent girls need, but too often do not have access to necessary health and
nutrition services as they mature. Counselling and access to sexual and reproductive
information and services for adolescents are still inadequate or lacking completely,
and a young woman’s right to privacy, confidentiality, respect and informed consent is
often not considered. Adolescent girls are both biologically and psychologically more
vulnerable than boys to sexual abuse, violence and prostitution, and to the
consequences of unprotected and premature sexual relations. The trend towards early
sexual experience combines with a lack of information and services, increases the risk
of unwanted and too early pregnancy, HIV infection and other sexually transmitted
diseases, as well as unsafe abortions…Young men are often not educated to respect
women’s self-determination and to share responsibility with women in matters of
sexuality and reproduction” (Beijing Platform For Action, para.93)

Sex education still remains a taboo in Asia-Pacific region. Sexuality remains a very
sensitive issue. Many people think that sexuality education would make the young
people active at a very early age. However, efforts are being made to spread
information on HIV/AIDS. A comprehensive information package for sexual and
reproductive health is still missing in several countries. Advocacies and lobbying are
going on in the region to make sure that the proper sexual and reproductive health
information is given to adolescents. After the ICPD commitment, rights based
approach is being adopted in order to ensure young people, their right proper
information.

B. Limited access to reproductive health services

High prevalence of unsafe abortion, maternal mortality, HIV/AIDS, early pregnancy
poses a serious health concern for young people. This shows the need for greater
access to reproductive health care services.. Young women are more affected than
the young men. They have a special need because young women are have socially
and culturally determined gender roles and have least control over their bodies and
become more vulnerable to high risk activities. The community and the health care
providers do not always provide young people with proper care. Their needs are
discouraged or ignored. Youth-friendly health care approaches are completely
lacking adding on to the problems of the young people. Young people do not
approach the health care providers because young people’s right to privacy,
confidentiality and respect is not considered. They are often made to feel guilty.

Geographical accessibility also plays a major role. The health centres are not always
at a accessible distance. It is very difficult for the young people to travel to the health
centres. This may incur travel expense, time and are answerable to the elders in the
community. This is one of the reasons why young people do not go to the health
centres. Young people may not have enough money to pay fees for their health care
so they may be reluctant to go to the health centres.
Recommendations
• Provide access to sexual and reproductive health information
Access Sexual and reproductive health information is a right of young people. A
comprehensive programme on sexual and reproductive health should be imparted in
schools and provided to the non-school going young people through peer education,
peer counselling , mass media and entertainment. National policies should include
“providing SRH information” as a health policy. There is also a need to inform the
parents and the community in general of the young people’s issues to make them
sensitive to the problems of the young people. If proper information on sexuality and
reproductive health is made available for the young, the issues/problems of the
young people can be easily solved.

• Provide youth-friendly health services

Young people are a distinct group facing distinct problems. Their issues have to be
addressed in a proper way. Youth-friendly health care approach can help the young
people. This means the health care providers should be trained specially to
understand young people’s psychological and physiological state. Respect them,
honour privacy and confidentiality. Youth-friendly health care services will also
include peer counselling and have to be gender sensitive.

The health care centres should be established in convenient places, which will be
accessed by the young people, which will in turn reduce their travel cost and time.
Provide referrals to other services important to young people’s health like mental
health. Services should be made acceptable to the local community so that they do
not hinder the adolescents to access them.

• Ensuring young people’s participation

Young people’s participation can alone ensure a proper health care information and
youth friendly health care programmes. They alone can bring out their issues and
express their needs to plan policies and programmes and also in monitoring. Service
providers can be confident that they are providing services in the right time, right
place and right style.
 Resources
1. Making 1 million count :State of world population 2003, investing in adolescent’s
health and rights
2. Adolescent Friendly Health Services – An Agenda for Change: world Health
Organisation 2003
3. Programming For Adolescent Health And Development: Report of a
WHO/UNPFA/UNICEF Study Group on Programming for Adolescent Health :
World Health Organization 1999
4. Towards adulthood: Exploring the sexual and reproductive health of Adolescents
in South Asia: World Health Organization 2003
5. Saving Women’s Lives – A Call To Rights-Based Action
6. Situation of Sexual and Reproductive Health (RH) of young people in Asia-Pacific
Region. Www.unescobbk.org/ips/arh-web/newsother/roque_presentation.ppt
7. Malaysian NGO Coordinating Committee For Reproductive Health : National
Youth Seminar
8. http://www.engenderhealth.org/res/onc/sexuality/approach.htm
9. http://www.fpaid.org.nz
10. Adolescent Reproductive Health in Asia by Bhaktab.Gubhaju –
www.iussp.org/bangkok2002/s30gubhaju.pdf
11. Www.id21.org/hiv/guidelines.html
12. www.ippf.org
13. www.populationaction.org/resources/factsheets/YouthFactSheet.pdf
14. www.unfpa.ord
15. www.advocatesforyouth.org
16. www.plannedparenthood.org
17. www.guttmacher.org
18. www.iwhc.org
19. www.who.int/reproductive-health/adolescent

Agniva Lahiri is a youth leader and development consultant based in India, currently coordinating
Network of Asia Pacific Youth. Agniva’s primary interest of work is Sexuality and Rights.