This post is the second in a series of eight stories by young Bangladeshis that illustrates the barriers to young people’s sexual and reproductive health and rights in the youth-led CSO report for Bangladesh’s Universal Periodic Review. These stories were collected by ARROW and Dance4Life. Photo is used for representation only. Read the first part here.
Paiching, a 16 years old tribal girl from the rural area of Rangamati district was in trouble when she noticed that her menstruation had become irregular and stayed out for a few days. She was worried but couldn’t share it with anyone close as she wasn’t free to talk about these concerns with her family members or friends. When she decided to go to the local upazila (sub-district) health centre to consult with a doctor, she returned without a consultation as there were many other people waiting, and she was afraid that the adults would pass judgement on her, given that the consultation would take place in a narrow space used by the local doctor to give medical service right in full view of other patients.
After returning from the health centre, Paiching set off in search for the unqualified village female doctor to get advice and to keep her menstruation problem confidential. However, one week after her consultation with the village doctor, Paiching became seriously anxious, as there were still no signs of her menstruation. One of Paiching’s classmates, Rita, noticed that Paiching had lost a lot of weight, her skin was getting dryer day by day, and that she had become inattentive to her studies. After some probing, Paiching finally shared her story with Rita.
Rita, who was a youth volunteer for the Unite for Body Rights (UBR) project – a youth sexual and reproductive health and rights (SRHR) programme in Bangladesh – suggested to Paiching that she should seek the consultation of UBR’s female counsellor. Rita assured Paiching that the UBR Youth Friendly Service clinic is the best for her and that full confidentiality is maintained there. With Rita’s reassurance, Paiching went to the UBR Youth Friendly Service clinic and received counselling service about her irregular menstruation. The female counsellor made Paiching feel comfortable talking about her concerns and shared with her some of the ways through which an irregular menstruation can happen, which gave Paiching a sense of relief.
However, just two days later Paiching came back to the UBR Youth Friendly Service clinic again to talk to the female counsellor to divulge her secret; a couple of weeks earlier Paiching had sex with her boyfriend. Because Paiching was under the impression that she cannot get pregnant when she has sex for the first time, she did it unprotected.
After finally hearing Paiching’s complete story, the counsellor assured Paiching that the centre offered Menstrual Regulation (MR) services which could reduce Paiching’s worries, with one condition: someone else must take responsibility for the service. Bravely, her friend Rita took the responsibility of Paiching’s condition!
A recent analysis in Bangladesh of the effectiveness and gaps of existing adolescent SRH interventions and programs revealed SRH clinical service delivery remains primarily designed for married women and girls. Limited targeted clinical services are available to unmarried adolescents, which makes them vulnerable to health risks and discriminatory treatment, which is in line with Paiching’s experience and her apprehension at the upazila health centre due to the lack of privacy, and fear of stigmatisation and judgement.
In this sense, Paiching was lucky, as it is not always possible for young unmarried women to receive Menstrual Regulation. Many women are unaware of the existence of MR services, and those who do often shy away from service providers because a third party authorisation by a guardian or spouse is required in practice as a function of social and cultural norms, even though it is not a policy requirement.
Fear of stigmatisation and judgement also contributes to the low (42%) contraceptive use among 15-19 year old adolescents; Paiching is one of many women and girls who are not equipped with proper knowledge of contraception, reproductive rights, family planning and maternal and child health services.
Recommendations for Bangladesh’s 3rd UPR
The Government should ensure that menstrual regulation (MR) policies are revised to explicitly mention that third party authorisation, including of a guardian or spouse, is not required for receiving MR services, and the Government should implement programmes to increase awareness about MR among the community, and services provides and increases the facilities with adequate equipment.
Given that the burden of using contraceptives is always higher on women/girls, the National Adolescent Health Strategy needs to be revised and effectively implemented to ensure a range of SRH services, including contraceptives, which are of good quality and are affordable and accessible for both unmarried young men and women. The Government should also promote the use of contraceptives by men, and ensure that knowledge, information and counselling on contraceptive methods is universally accessible to young married and unmarried men and women, and that policies regarding contraceptive methods are being effectively implemented and monitored.
When Paiching reflects back on her experience, she realises how close she was to despair, depression and suicide. Paiching is now relieved from her worries, after conducting the Menstrual Regulation Management and she has started school again and comes to the UBR Youth Friendly Service clinic from time to time for further advice. Paiching now understands a lot more about her sexuality and menstruation, and she is feeling like she finally owns her body. Paiching now echoes the call brought forward by many youth advocates on the importance of Youth Friendly Services, which should be available in every upazila of every district in Bangladesh!
ARROW collaborated with the Right Here Right Now Bangladesh Platform (RHRN-BD) and the Sexual Rights Initiative (SRI) to submit a youth-led CSO report in October 2017 for Bangladesh’s 3rd UPR. The report focused on the barriers to young people’s sexual and reproductive health and rights (SRHR) in Bangladesh. For the first time in the country’s UPR process, a CSO report has been developed through engagement of young Bangladeshis through a collective process. Read the report here!