Adolescent reproductive health status in Bangladesh
Reported, December 21, 2011
Bangladeshs adolescent population (ages 1524) was estimated at about 28 million in 2000. Due to the effect of population momentumthrough which populations can continue to grow even as the rate of growth is declining (since ever more people are added to the base population each year)and other effects, this age group will contribute significantly to the incremental population size of Bangladesh during the next 20 years, increasing by 21 percent to reach 35 million by 2020.With a total population of about 130 million, adolescents comprise 22 percent of the total population. Educational attainment is increasing for both boys and girls, and there has been a significant increase in the percent of boys and girls obtaining a secondary or higher education. This increased from 10.5 percent to 54.9 percent for boys, and 5.5 percent to 47.1 percent for girls between 1994 and 2000 (Figure 2). Births to adolescents will increase from 2.2 million in 2000 to 2.9 million 2020.Unmet need for contraceptives has improved slightly over the past six years. It is now about 20 percent for girls ages 1519, and slightly lower at 18.1 percent for girls ages 2024.
The main causes of mortality in young mothers are toxemia, abortion, and obstructed labor (caused by immaturity of the birth canal). In addition to its associated health consequences, early childbearing has an adverse effect on a young mothers socioeconomic status. It cuts short her education, limits her ability to earn income for the family, and can lead to marital difficulties.
Adolescents appear to be poorly informed with regard to their own sexuality, physical well-being, health,and bodies. Whatever knowledge they have, moreover, is incomplete and confused. Low rates of educational attainment, limited sex education activities, and inhibited attitudes toward sex contribute to this ignorance.
The reproductive health needs of young women are quite different from those of young men, principally because of their young age at marriage. According to WHO, worldwide, girls younger than 18 are up to five times more likely to die in childbirth than are women in their twenties.The government of Bangladesh has thus identified adolescent health and education both as a priority and a challenge and to face the challenge, has incorporated this issue in the current Health and Population Sector Program.
The nutritional status of adolescents in Bangladesh is deplorable. A large number of adolescent girls suffer from malnutrition. The prevalence of malnutrition is found to be markedly higher among female children compared with male children. Short maternal height has been found to account for a sizeable number of low birthweight babies (2.5 kilograms) who are subsequently more susceptible to infections and death in infancy. Those who survive grow up as undernourished adults, giving rise to an intergenerational cycle of undernourishment. Additionally, small pelvis size may cause obstructed labor due to cephalo-pelvic disproportion. The consequences for women range from ill health (from chronic morbidity due to infections of the reproductive system and conditions such as vesico-vaginal fistulae) to death during and after child birth.
Over one-half of adolescent girls are stunted and more than one-third of adolescent girls in rural areas are wasted. Adolescent girls suffer from iron, iodine, and vitamin A deficiencies. Forty-three percent of adolescent girls suffer from iron-deficiency anemia.
Knowledge of nutrition among adolescents is poor and they are generally unaware of the need to consume healthy quantities of foods such as fish, meat, eggs, milk, vegetables, and fruits during pregnancy and lactation. One study in Bangladesh sought to evaluate adolescents understanding about food required for pregnant and lactating mothers: 40 percent mentioned fish, 27.5 percent mentioned meat, 38 percent mentioned eggs, and 34.7 percent mentioned milk. Similar proportions of adolescents mentioned food
requirements like meat, fish, eggs, and milk for themselves.
The study described above also asked the female guardians (mothers of adolescents) their opinions on whether adolescent girls or boys need to increase their food intake. Of these guardians, 43.1 percent indicated that boys require more food than girls, 19.4 percent indicated that female adolescents need more food, and 37 percent mentioned that the requirement was the same for male and female adolescents.
Perceived reasons for boys needing more food included boys doing more physical activity/manual labor (52.5 percent); boys becoming earning members of the family (32.1 percent); the need for good health/strength for boys (6.2 percent); and the need for boys to develop good brains/studies (3.4 percent).
Management of menstruation
The maintenance of hygiene during menstruation is a vital aspect of ARH. Although almost 70 percent of the adolescent girls in the FPAB study were aware of the need for maintaining some cleanliness during the menstrual period, these girls noted that they came to understand only after two to three years of the onset of menstruation that a clean pad or cloth is important.
Most girls (80 percent) in the Bangladesh Rural Advancement Committee (BRAC) study used pieces of old rags (nekra) as pads during
menstruation, while others did not use anything. Sixty percent of the adolescent girls used rags that were wet or had not been dried in a hygienic fashion. Ninety-nine percent of the girls in the urban slum study associated menstruation with being unclean or impure.
The consequences of not maintaining hygiene during menstruation (e.g., becoming sick, itching, or ulceration of genitals) were least known among the female adolescents, especially those who were unmarried. Mothers, sister-in-laws, and friends are the sources of information about menstruation for most of them.
Credits :
Abul Barkat, PhD
Professor, Department of Economics, University of Dhaka
and Chief Advisor (Hon)
Murtaza Majid, MD
Advisor, Public Health Research, Human Development Research Center
Dhaka, Banglades
More Information at:
http://www.policyproject.com/pubs/countryreports/ARH_Bangladesh.pdf