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Old battles, new challenges
By Meera Murugesan
August 17, 2004
Every minute around the world, one woman dies from complications of pregnancy and childbirth, 10 teenage girls undergo an unsafe abortion, and 57 people catch a sexually-transmitted disease.
These figures clearly indicate that there is still a long way to go in addressing sexual and reproductive health issues around the world, and presenters at last month’s Asian Regional Roundtable on Population, Sexual and Reproductive Health and Poverty reaffirmed the dire situation.
A rise in conservatism, slow action on the part of policy makers, cultural norms and practices and lack of funding, all serve to hamper efforts toward fully achieving the goals set at the International Conference on Population and Development in Cairo in 1994.
“The truth is that we still have a lot of work ahead of us,” says Jill Sheffield, president of Family Care International, who spoke on safe motherhood.
“Some progress has been made in some countries, but at a global level, we have not succeeded in dramatically reducing the maternal mortality rate in the past decade.”
At least 530,000 deaths occur yearly around the world as a result of complications due to pregnancy and childbirth, and the largest numbers occur in Asia.
In India, a woman’s lifetime risk of dying from a pregnancy-related cause is estimated to be one in 55; in Sri Lanka, it’s one in 610; in Cambodia, it’s 437 for every 100,000 births.
Lack of access to proper care and skilled attendants are major causes of these deaths, explains Sheffield, but gender inequality, unequal access to education for girls, poverty, and lack of political will and commitment also add to the problem.
“HIV and AIDS are also making our work to improve women’s health both more urgent and more challenging,” she adds.
Contraception can meanwhile do much to improve the health of women, says Sheffield. A third of maternal deaths can be avoided simply by improving women’s access to family-planning information. Yet, more than 120 million women worldwide do not have access to contraception.
The results are often improperly-spaced pregnancies that present risks to both mother and child, and unwanted pregnancies that lead to unsafe abortions.
In some countries like Malaysia, reducing maternal mortality and improving access to contraception are battles already won, but there are new challenges that include the delicate task of tackling adolescent sex and its consequences.
About 10,000 adolescent Malaysian girls get pregnant and deliver every year so there is a need to equip young people with adequate knowledge about preventing pregnancies, says Dr. Ravindran Jegasothy, of the Malaysian Medical Council’s ethics committee, one of the Malaysian speakers at the conference.
“We need to get away from the moralistic attitude that sex doesn’t happen,” he says.
“Instead, we should equip young people with knowledge that can save their lives and protect their health. Religious education is important in sending the message that sex is not to be freely indulged in, but we cannot just put our heads in the sand and say it doesn’t occur either.”
“We must learn how to talk about sex, as it’s not a taboo subject anymore,” says Mary M. Luke, the executive vice-president of Ipas, an organisation that helps women globally to exercise their sexual and reproductive rights. She spoke on adolescent sexual and reproductive health rights.
Pre-marital sex is a reality, especially in Southeast Asia, says Luke, and many reports indicate an increase in such activity among young people.
Despite these changes in behaviour among young people, traditional attitudes towards pre-marital sex remain and the double standards continue unchanged.
While boys’ sexual activities are condoned, says Luke, a girl’s reputation remains of paramount concern to her and her family.
Therefore, unmarried adolescent girls are afraid to seek services or contraceptive supplies because they fear discovery and embarrassment.
“Such double standards put unmarried adolescent girls in Asia at high risk for unprotected sexual relationships, unsafe abortions, early child-bearing and sexually-transmitted diseases,” says Luke.
In many Asian countries, even raising the issue of teen sex is difficult because sex itself is not a subject that is deemed suitable for public discussion, and parents feel that educating youth about safe sex will only encourage their children to experiment.
But many countries are starting to see the importance of sex education. In Taiwan, for example, schoolchildren are now receiving information that’s not just related to reproductive physiology but also on maintaining relationships with family and friends of the opposite sex, sexual behaviour and the social and cultural aspects of sex, says Tom Te-Hsiung Sun, president of the country’s Planned Parenthood Association.
Taiwan’s Ministry of Health has also established 55 health clinics for adolescents in 22 cities. Even parents are being educated and taught how to communicate with their children on sex issues.
In Taiwan, like many countries around the world, the sexual attitudes of adolescents is influenced by television, pornographic VCDs and the Internet, says Sun. The open sexual attitudes of young people is also leading to more active sexual behaviour.
About 40,000 induced abortions are carried out annually on women aged between 15 and 19 in Taiwan, says Sun, and this is a serious social and health problem.
Unsafe abortions are one of the major reproductive health problems facing adolescents, stresses Luke, and many young people die needlessly or painfully from these procedures.
Due to shame, stigma and lack of money, unmarried adolescents are more likely to delay seeking treatment, and many seek help from unsafe providers who charge significantly more for services to unmarried women, she says.
In the long run, the best way to prevent abortion-related deaths is to make contraception, including emergency contraception, widely available, and to make safe abortions available as well where it is legal for those women who need it, says Sheffield.
And post-abortion care should also be provided when necessary.
Half of the world’s illegal abortions take place in Asia, and many of these are unsafe, resulting in 70,000 deaths each year.
“These deaths are tragic and these deaths can be easily prevented,” says Sheffield.
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