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Adolescent and youth reproductive health Issues, Programmes & Operational barriers Authors: Aparnaa Somanathan, Vindya Eriyagama, Ruwanthi Elwalagedara Health Policy research Associates http://www.hpra.lk Key questions What are key RH issues affecting adolescents and youth in Sri Lanka? How have the government and NGO sector responded to the needs of adolescents? What are the barriers to ensuring that adolescents have adequate access to ARH services and information? What are some ways of improving government health policy towards A&YRH services? Who are Adolescents Adolescence? A transitional period from childhood to adulthood Outline Background RH issues affecting adolescents and youth Existing programmes and policies on A&YRH Operational barriers to A&YRH Policy recommendations Outline Background A & YRH issues in Sri Lanka Existing programmes and policies on A&YRH Operational barriers to A&YRH Policy recommendations Background In 2002 19.7% or 3.7 million of Sri Lankan population were adolescents It is estimated that the number will decrease to 3.1 million by 2021 Focus on A & YRH is important in SL context. Knowledge and services will allow adolescents and youth to make informed decisions relating to sexual & RH matters T o t a l a d o l e sc e n t p o p u l a t i o n ( a g e s 15 - 2 4 y e a r s) , 2 0 0 1- 2 0 2 1 4000 2000 0 2001 2011 Female 2021 Male Source: Population projections for Sri Lanka by Prof. I W De Silva Profile of Adolescents in SL Education Employment Marriage Years of Education completed 2003/04 (percent) (Ages 15-24) 70 60 57.5 52.1 50 41.6 40 33.4 30 20 10 7.1 4.8 2 1.4 0 Males No Schooling Primary (grades 1-5) Females Secondary (grades 6-9) Higher (grades 10+) Source: The consumer finance and socio economic survey report 2003/2004. Central Bank of Sri Lanka Employment by sex, 2003 ('000) (Ages 15-24) 800 Employed 700 600 500 400 Employed 300 Unemployed Unemployed 200 100 0 Male Female Se x Employed Unemployed Source: Labor force survey 2003. The Department of Census and Statistics. Sri Lanka Risk Taking Period: Sri Lanka 1901 Age at Menarche 4yrs 14yrs Age at Marriage 18yrs 2000 14yrs 12yrs 26yrs Outline Background A & YRH issues in Sri Lanka Existing programmes and policies on A&YRH Operational barriers to A&YRH Policy recommendations A & YRH Issues Early, High risk pregnancy Unwanted pregnancy unwanted pregnancy among adolescents in SL is exceptionally low by international standards Abortion Illegal, unsafe, on the rise (150,000-175,000 performed annually) HIV/AIDS/STDs On the rise, and primarily a concern because of poor awareness among high risk groups (i.e. workers in free trade zones, in tourist industry, commercial sex workers, displaced persons) Sexual abuse About 10% of early adolescents and 14% of mid and late adolescents admitted to have been sexually abused Outline Background A & YRH issues in Sri Lanka Existing programmes and policies on A&YRH Operational barriers to A&YRH Policy recommendations A&YRH programmes School – based health education Community – based interventions National Youth Campaign Telephone hotlines Peer education NGO programmes Operations research Programs beyond health Outline Background A & YRH issues in Sri Lanka Existing programmes and policies on A&YRH Operational barriers to A&YRH Policy recommendations Operational Barriers to A & YRH • Lack of knowledge and public awareness about ARH issues REASONS: Lack of human resources with necessary skills and experience on RH issues Cultural factors have limited open discussion of issues difficult for “safe” channels of information to develop Inability to obtain services There are very few, if any, reproductive clinics or centres from which adolescents can obtain services. Public provision of contraceptives targets married couples almost exclusively REASONS: Lack of public awareness lack of understanding of the gravity of the issue in the community little impetus for strong policy action General lack of resources in the health sector Lack of research Lack of research on A&YRH and the needs of adolescents and youth, particularly among underserved and minority groups CONSEQUENCES: Scarce data and knowledge severity of A&YRH issues is not known to public weak political commitment for coherent policy initiatives Outline Existing programmes and policies on A&YRH Operational Policy barriers to A&YRH recommendations Policy recommendations A more holistic approach to A&YRH : health and education sectors + legislative action to influence risk taking behaviour Capitalizing on political support in establishing programmes that support A & YRH services. Provision of information to adolescents: Importance of school-based programmes cannot be overstated Improve pre-marital counselling Work through the pharmacy network Conduct research on sexual behaviour and special population groups References De Silva, W.I., Somanathan. A., and Eriyagama. V. 2003. “ Adolescent and youth reproductive health in Sri Lanka. Status, Issues, Policies and Programs” Hardee K, Pine P, Wasson, L T. 2004. ”Adolescent and youth reproductive health in the Asia and Near East Region. Status, Issues, Policies and Programs” Thalagala N.I. , Rajapakse L. 2004 National Survey on emerging issues among adolescents in Sri Lanka. UNICEF Colombo. Department of Census and statistics Sri Lanka. Sri Lanka demographic and health survey. 2000, LFS 2003. Central Bank of Sri Lanka. 2003/2004. The consumer finances and socio economic survey report Family health Bureau, Ministry of Health Sri Lanka. Annual report and other publications.