Main Issues in Youth Reproductive Health in Nepalese Context

Adolescence is a period of transition, growth, exploration and opportunities, but also a time of risk taking, experimentation, and vulnerability. It is generally a healthy period of life but then they are less informed, less experienced, less comfortable, and have fewer resources to access reproductive health services than adults. This is a period which needs special attention, guidance and supports to address their concerns, problems and needs and assist them in developing healthy life style and develop responsible behavior. Young adolescents (children aged 10-19) are undergoing tremendous physical, emotional, social, and intellectual changes. During this period, many young people begin their transition out of childhood and enter puberty. For most children, early adolescence is marked by good health and stable family circumstances, but this time often brings greater responsibility and rapid transitions to new roles and responsibilities, in particular society, societal pressures to enter marriage, sexual relations, and childbearing resulting roles as caretakers, workers, spouses, and parents within the home. The majority of sexually active girls aged 1519 in developing countries are married. Similar is the case in Nepal, study conducted among women aged 20-49 shows that 60 percent were married by age 18, and 78 percent were married by age 20, whereas 24 percent men were married by age 18 and 45 percent by age 20. Overall, men marry more than three years later than women. Child marriage remains a fact of life in largely rural regions compared to urban. Married girls lies often in neglected category and have low educational attainment; no schooling and employment options; limited control over resources, highly restricted mobility, and little or no power in their new households. Adolescent pregnancy and motherhood is a major social and health issue in Nepal. An early start to childbearing can cause severe health problems and is associated with higher levels of fertility. According to DHS Nepal 2006 half of the women have given birth by the age 20 and almost 90 percent have given birth by age 25. We can find strong correlations between limited schooling and other education based indicators such as literacy and early marriage. Early child bearing is inversely related to educational level; teenagers with no education are three times as likely to have begun childbearing as those with some secondary education. 24 percent of teens with no education have started childbearing whereas only 1.9 percent of teens with SLC or higher level of education that have started childbearing. Hence we can find the remarkable difference in childbearing between educated and uneducated adolescent. Similarly, the age at first birth, overall fertility, and level of unmet need for contraception also vary significantly in most settings by the level of education of the female. Education is a critical component of a healthy transition to adulthood. Education Protects Health and Delays Sex. Lack of information can put them at risk of unplanned pregnancy or sexually transmitted diseases (STDs). Basic information on reproductive health is important for guiding adolescent from risky behaviors. Young women in the developing world face great challenges during pregnancy and childbearing. Young especially first-time mothers, those who are poor and uneducated, are at increased risk of neonatal and infant death along with the threats to their own health. This risk becomes particularly acute when the mother is very young as her body may not be completely ready for childbearing. Access to appropriate maternal health services is critical for positive maternal and infant outcomes. In order to provide proper care and reduce delivery complications GoN has endorsed policy on Skilled Birth Attendants in 2006. 1

Though this policy has been endorsed the national data shows only 14.3 percentage of expected delivery are conducted by SBA at health facility. (Annual report 2007/08). The ongoing Safe Delivery Incentive Program (SDIP) is contributing in poverty reduction efforts by reducing delivery cost for household and impacts of maternal deaths and disabilities on household economy. SDIP shows remarkable increase in institutional deliveries, ANC and PNC checkups. These services can also play an important role in identifying and, if possible, treating STIs and HIV. To ensure that girls have a healthy transition into motherhood, and this requires the provision of accessible, appropriate, and targeted reproductive health care services that have components tailored to young, first-time mothers. In Nepal, percentage of pregnancies among adolescent is 21.97 percent (NDHS 2006). This percent is almost double from worlds scenario. Even when pregnancy among young women is planned, the health risks can be serious. The risk of maternal mortality is two to four times higher for pregnant adolescents than for pregnant women over 20. Infant mortality also is greater among adolescent mothers typically 30 percent higher for infants born to women ages 15 to 19 than for those born to women 20 or older. The use of contraceptive method is another issue, which needs considerations for the use of each method by adolescents. Data from DHS 2006 shows that among currently married women, married adolescent use 16 percent of any contraceptive method, and among all women 10.1 percent adolescent aged 1519 use any contraceptive method. Iron deficiency anemia is one of the common nutritional problems in Nepal, 39 percent of adolescent girls are anemic. Another concern is three in four pregnant women in Nepal were found anemic. In order to address this issue Iron Supplementation Program was introduced in all 75 districts as a part of MOHP nutritional program. Worldwide, young women and men suffer a disproportionate share of unplanned pregnancies, sexually transmitted diseases, including HIV, and other serious reproductive health problems. About one half of all HIV infections worldwide occur among people age 25 and under (World Health Organization). In industrialized countries, two of every three STD infections occur among people under 24 years of age, and the proportion of infected youth in developing countries is believed to be even higher. The national data shows 4.45% of total HIV infected are adult aged between 10-19 yrs. (NCASC HIV data 2066 Mansir). This data is comparatively very low, might be because of under reporting. Most of youth men from mid and Far Western Region is migrant worker traveling to India cities for work, so HIV is major concern in these areas. 42% adults are estimated of HIV infection who is Seasonal Labor Migrant. (DoHs, Annual Report 2007/08) Changing risky behavior requires an individual's commitment it is more important than education. A young adult must then acquire the skills necessary to make the change. Several family planning programs have incorporated elements of behavior change into sex education programs for young people. Young people need to understand and accept the physical changes, to talk about relationships with adults, to learn decision-making and self-esteem and to develop a general vision of their own sexuality. There are several issues that influence youth reproductive health for this vulnerable age group:

Gender perspectives, which are largely defined by social and cultural conditions, shape the adolescents in gaining access to information and services.

Education regarding human development, which includes reproductive anatomy and physiology, sexual behavior (including abstinence as well as sexuality) sexual health (including contraception, STD and HIV prevention, abortion and sexual abuse) is incorporated in school curriculum under SRH topic for school going adults. The implementation level of these courses is though questionable. The systematic way of reaching out-of-school youth, is yet to be developed. The availability and accessibility of contraceptive. Youth targeted programs focused on developing personal skills, values, decisionmaking, communication, negotiation Psychological and social pressures that youth often faces Availability of friendly, affordable, accessible, confidential and non- judgmental Adolescent RH Care Services Adolescent targeted BCC activities

As adolescent period is delicate and vulnerable, their issues needs to be focused and the national program should prioritize these groups in order to get healthy and responsible citizen for its society.