Sivananthi Thanenthiran, Executive Director, ARROW (@SivananthiT)
Globally, adolescents aged 10-19 comprise 18% of the population; more than half of the world’s 1.2 billion adolescents live in one region of the world, Asia and the Pacific. Just four countries in the region – India, China, Indonesia and Pakistan – have a combined adolescent population of 500 million adolescents. So while a lot of effort has been focused on Africa, I would like to remind that Asia continues to host 60% of the world’s population, and it is a continent which though has experienced rapid economic development, this rapid development has also created great inequalities between countries, and within countries. We also come from political systems which today, many countries are hearkening back to cultural, traditional and religious values over human rights values. So I would like to posit a picture amidst such inequality and conservatism you can see the burden falls unequally on marginalized and vulnerable populations such as adolescents especially girls in our countries.
A case which illustrates this was a report that emerged at the end of last year from UNAIDS and Unicef on how adolescents are most-at-risk for HIV, with 220,000 adolescents were estimated to be living with HIV in Asia and the Pacific. This is a result of the inability of countries to make the paradigm shift to provide comprehensive sexuality education for those in-school and out-of-school, provide access to services for safe sex and pregnancy prevention.
We need to move away from our traditional framing of young people and perhaps three approaches will help us.
One, we need to view adolescents especially girls with the lens of non-discrimination and autonomy. Adolescent girls are one group which will face their entire sexual and reproductive health life-cycle ahead of them, and the lens of non-discrimination and autonomy will help us take it one step further. We have talked about youth-friendly services for a long time, but still but there needs to be a transformation of attitudes. Evidence shows that young people face greater discrimination in accessing contraceptive services. Studies in Kenya, Zambia, Lao PDR and China show that health providers believe that distributing information on contraceptives to young people encourages promiscuity. Young women are more affected by double standards on sexual behaviour. Young or nulliparous women are denied contraception because of provider beliefs that contraception is not for women without children. In this context of fulfilling rights, we should also be able to advocate for and argue for privacy and confidentiality from an agency perspective and to do away with parental and spousal consents for accessing SRH services. Hence viewing girls and young women as autonomous beings with the right to make decisions about their lives and choices about their lives and ensuring there is non-discrimination will enable us to transform access to services, but also transform traditional attitudes and societal perceptions of girls and young women.
The second approach is for us to look at inter-sectional approaches when dealing with adolescents and girls. When we talk about goals and targets, we very often forget that human beings live and circumstances cannot be fitted into these silos of goals and targets. And it is not impossible to link some of these targets and indicators to tell a story of development, rights and SRHR of girls. Many young women and girls are living in countries beset either by conflict or climate change. For girls especially – in many of the countries in my region lesser household resources are set aside for girls, girls eat last, eat less, and eat less nutritious food. Girls often have to help out with carrying water for their families, or fetching firewood – often long and arduous tasks.
The poverty of women and girls is something we don’t talk about but is essential if we want to make a real difference. For example, a female child may be born with low birth weight because their mothers were malnourished. She may grow up deprived of adequate nutrition to become an undernourished and stunted woman, and living in low quality shelters that exposes her to multiple infections. She would have limited opportunities for adequate educational attainment and may be employed in backbreaking and hazardous occupations. She may be exposed to risk of sexual debut and sexual violence before her teenage years, marry or cohabit early, and give birth as a teenager facing associated risks of death and disability. She will have limited ability to control her sexual and reproductive life and little or no access to quality healthcare services.
This is the story of Chanh who is 23 years old and already has 6 children so her child-bearing began in her adolescent years. This is not uncommon for women in rural Lao as there is little access to SRHR services, information and access to contraception. Her already vulnerable situation and heavy responsibility of looking after six children was worsened by a destructive draught that damaged agriculture and livestock a few years ago. She was forced to walk nearly 20 km every day to a water source and forest where there was food to forage so she could keep her family alive.
So if we want to make a real difference in the lives of girls and young women like Chanh we need to connect the targets, across different goals and be able to write a possible trajectory, which will make a difference for the girls in our part of the world.
The third and last approach I would advocate for is utilizing the values we derive from human rights. When we talk of human rights values we must realize all of us who are called to work with adolescents and young people have a duty and obligation (because indeed we are all duty-bearers to young people) to recognize, promote, protect and fulfill their rights. In this context of fulfilling the human rights of young people would also entail obligations to end early marriage, end FGM, end violence against adolescents and young people especially sexual violence. One such story comes from Bangladesh, where we work – Sumitra’s village was affected by cyclone Sidr in 2007 and flood Aila in 2009. Her community is heavily dependent on fishing as both a source of food and income, which were affected drastically. This led to further impoverishment of the communities, and families started marrying girls off early – a practice parents encourage during difficult times as they hope it will safeguard their daughters’ futures. Sumitra met this fate. She got pregnant soon after her marriage but was unable to access proper food or medical care because her village was cut off during one of many the climate disasters. She suffered malnutrition and a number of reproductive health problems and consequently miscarried.
This is not going to be an easy task, and we have to ask whether we are prepared to take up this challenge? This would require us to address socio-cultural, religious norms in our society, change laws or rather enforce laws – which may be difficult especially in countries where there is a strong conservative force in our legislature. But indeed this is something we would need to do. Because a human rights approach is not only about providing youth-friendly service to avoid pregnancy and HIV, but also to enable choices on who to marry, when to marry, if at all in our societies.
It is about enabling a life free from all forms of violence – including traditional and cultural practices. It is about ensuring that adolescent girls are able to enjoy better opportunities than their mothers. When we can do the best for the most marginalized and vulnerable amongst us then we can truly say we are a developed society.
This is really the harder battle, but one that we must not and cannot shy away from because we owe it to the next generation.