Youth Speak Out: Advocating for Young Peoples Sexual and Reproductive Health in Nepal

A policy brief on adolescent and youth sexual and reproductive health and Rights in Nepal

Youth Speak Out: Advocating for Young Peoples Sexual and Reproductive Health in Nepal

A policy brief on adolescent and youth sexual and reproductive health and rights in Nepal

Compilation and Analysis

Ajay Kumar Uprety Medha Sharma

Research Support
Yashoda Aryal

Design and Layout

Santosh Bohara

YUWA, 2012 Youth Speak Out: Advocating for Young Peoples Sexual and Reproductive Health in Nepal

YUWA 60 Nirajan Bikram Marga, Kharibot, Minbhawan, Kathmandu, Nepal +977 01 4487743 Email: info@yuwa.org.np www.yuwa.org.np https://www.facebook.com/yuwanepal http://twitter.com/Yuwanepal
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www.yuwa.org.np/yalc https://www.facebook.com/yalcnepal http://twitter.com/YALCnepal

This paper has been developed by YUWA and YALC. YUWA is a youth run and youth led non-profit organization established in the year 2009, working to promote youth participation through empowerment and advocacy. Since its establishment, YUWA has concentrated upon the holistic youth issues and is especially working in 5 thematic issues namely active citizenship, HIV and AIDS and SRHR, environment and sustainable development, economic initiation and innovation and Global information access. Youth Activist Leadership Council (YALC) is a group of 10 youth activist, aged 18 to 24, who advocate at the national and international level for improved sexual and reproductive health policies. YALC is a part of International Youth Speak Out (iYSO) Project that YUWA is implementing in Nepal in partnership with Advocates for Youth, an organization based in Washington, DC that is implementing iYSO in different countries including Ethiopia, Nigeria, Jamaica and Nepal.

Background
In Nepal, 36 percent of people are aged 10-24 years1. The sex ratio for young people aged 15-24 is 84 male per 100 female1. Despite this large population of young people, their needs receive limited programmatic and policy attention. Meanwhile, young people are facing significant challenges when it comes to their sexual and reproductive health and rights.

Age at marriage
Nepalese youth marry early. The median age at first marriage for male is 19 years against 17 years for female1. 10 percent of the women in Nepal are married by the age of 15 and 51 percent by 18 years2. Moreover, 35% of women in Nepal drop-out of school because of marriage1

Proportionate marital status of youth

Age at birth
Nepalese women bear child early too. Fertility among women ages 15 to 19 years is 81 per 1000 and 187 per 1000 for women ages 20 to 24 years3. The median age at first birth is 191. 20.42% women give birth to first child at age less than 20.3

Age wise fertility per 1000

Sexual Behaviors
Talking about sexuality of young people, mean age at first sexual intercourse for the age group 15-19 years is 16.24 and for 20-24 is 18.141. Moreover, on average, young male ages 15 to 24 had 2.6 numbers of sexual partners in lifetime.3

There is poor communication among youth when it comes to discussion about sexual health. 51.80% young girls(10-24) were reported having discussed about the issues related to marriage, pregnancy, menstruation, love, family planning, sexual intercourse, wet dreams and puberty which is more than 48.2% young boys.1

Mean age at first sexual intercourse

Contraceptive Use
Contraceptive use among married women ages 15-19 is 17.6% and 29.5% among married women ages 20 to 24 years. 3
1.

Reference:

Use
NAYS, Nepal Adolescent and Health Survey, 2011

Violence experience
13.6% of women ages 15 to 19 years and 25.3% of women ages 20 to 24 have encountered physical violence.3

2.

UNICEF country Factsheet http://www.unicef.org/infobycountry/nepal_n epal_statistics.html)

3.

NDHS, Nepal Demographic and Health Survey, 2011

4.

NCASC, National Center for AIDS and STD control, Factsheet produced on December

2011

Status of HIV
12% of people living with HIV are young between ages 15 to 24 years in Nepal.4Proportion of women and girls 15-24 living with HIV is 5%.4 97% of young men ages 15 to 19 have heard about HIV in contrast to only 88.7% of young women of the same age group.344% young men against only 28% young women have comprehensive knowledge about HIV.2Only 78.9% young women ages 15 to 24 know that HIV can be prevented by using condoms.396.5% of adolescent girls ages 10 to 14 know that condoms are an effective contraceptive method1 The major sources of information for HIV for young people aged 10-24 are reported as
Sex wise comprehensive knowledge on HIV among youth (15-24

the following: Radio 24.1%, teachers 21.1%, TV 18.1%, and friends 4.5%.1

Factors that negatively impact sexual and reproductive health and stall overall development are deeply entrenched in social and cultural norms. Societal inequalities between men and women, child marriage, traditional methods of delivery and contraception, and trafficking of girls for commercial sex are common in Nepal and are powerful forces that impede efforts to educate young women and men about reproductive health and provide them with needed services. Additionally, continued conflict in Nepal has exacerbated poverty and created increasingly difficult living conditions for many Nepalese, including youth. When they leave home to look for work to help their families or to escape forced involvement in the conflict, young people are vulnerable to sexual abuse from adults, employers and traffickers. While there are policies addressing sexual and reproductive health broadly in Nepal, they are not being implemented effectively. Furthermore, few policies specifically target youth and those addressing sexual and reproductive health issues have been formulated without young peoples involvement.

Agreements, Policies, Strategies, Plans and Programs Supportive of Youth Sexual and Reproductive Health
Nepals Safe Motherhood Program (1997) has Nepal has signed various international declarations that commit to young peoples sexual and reproductive health, including the International Conference on Population and Development (1994), Fourth World Conference on Women in Beijing (1995) and the Millennium Development Goals (2000). the objective of reducing mortality and morbidity among women and newborns during pregnancy, childbirth and the postnatal period, through the adoption of a combination of health and non-health measures. For the effective implementation of the program, the National Safe Motherhood Plan (2002-2017) was developed and includes language that supports the sustained increase in utilization of quality maternal health services.

The Safe Motherhood and Neonatal Health Long Term Plan (2006-2017) gives priority to the reduction of maternal mortality and neonatal mortality by increasing the number of skilled birth attendants, increasing health services and public private partnerships, improving access to information and services relating to safe motherhood, and strengthening community-based awareness on birth preparedness through the Family Community Health Workers Program.

The 11th Amendment Bill on Abortion (2002) allows abortion in the following circumstances: up to 12 weeks

The National Reproductive Health Strategy (1998) brings forth integrated reproductive health packages at all levels by calling for advocating for reproductive health; reviewing and updating Information, Education and Communication (IEC) materials & training; strengthening management systems (especially for reproductive health) at all levels; conducting reproductive health research; constructing and upgrading appropriate service delivery and training facilities; developing reproductive health programs for adolescents; supporting national experts and consultants; and promoting inter-sectoral and multi-sectoral co-ordination.

gestation for any woman; up to 18 weeks gestation if the pregnancy results from rape or incest; and, any time during pregnancy, with the The National Adolescent Health and Development Strategy (2000) directly targets adolescent health and has the objective of increasing the availability of and access to information development. The National Health Policy (1991) addresses maternal health and family planning as preventive health services. The National Health Policy seeks to ensure provision of maternal health and family planning services through all the service delivery points of the government health system
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recommendation of an authorized medical practitioner, if the life of the mother is at risk, if her physical or mental health is at risk, or if the fetus is deformed. However, abortion will be punishable by law if it is practiced for sex selection or if it is performed without consent. the pregnant womans

on

adolescent

health

and

The strategy also calls for

providing opportunities to build skills among adolescents, service providers, and educators; to increase accessibility and utilization of health and counseling services by adolescents; and to create safe and supportive environments for adolescents to improve their legal, social and economic status.

The National Youth Policy (2010) states that youth shall be encouraged to have safe and positive sexual activities, while providing them with education on sexual health safety and freeing them from all kinds of sexual violence. A strategy shall be adopted to keep the Nepalese youths in general from HIV/AIDS, making them aware about possible risks of HIV/AIDS through public awareness programs. In addition, environment shall be created for the youths who are infected from HIV/AIDS to live a dignified and easy life in the society, by running special counseling service centers, regularly providing anti-retroviral medicines to such youths in an easily accessible manner, and providing the infected youths with skills-oriented education, while freeing such youths from all kinds of social discrimination being made against them.

The Second Long Term Health Plan (1997-2017) guides health sector development by outlining approaches to address the disparities in health care, taking into account gender sensitivity and equitable community access to quality health care services. The Plan specifically addresses ways to increase use of modern contraception, antenatal care, and deliveries conducted by trained personnel.

The National Free Health Care Program (2006) provides free maternity services, maternity incentives, free family planning services, and antenatal checkups at all the government health service delivery points

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Gaps and Recommendations

Information, Education, and Skills
Young people lack access to sexual and reproductive health information and related services. They are poorly equipped to face

Recommendations:
Mandate and implement age-appropriate comprehensive sex education from primary schools onward. Improve the current sex education curriculum to be more comprehensive, right-based, and gender-sensitive. Train school teachers to effectively teach age-appropriate, scientifically accurate information that they can delivery in a youth-friendly. Develop and implement comprehensive sex education programs targeted to young people and adolescents who are not part of formal educational institutions. Develop and disseminate youth sexual and reproductive health messages via local mass media in local languages in order to reach marginalized and indigenous people young people. Adopt modern ways of channeling information to reach young people who have access to Internet. Scale-up peer-based education and parent-child communication programs as part of a nation-wide program addressing young peoples sexual and reproductive health needs.

challenges and are in need of skills, education, and information to enable them to make informed choices about their sexual and reproductive health and rights. Use of modern information dissemination channels in the present context of a new media generation is lacking, making it even more difficult to reach young people with critical information and services.

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Access to Services
Sexual and reproductive health services that are youth-friendly are lacking despite the existence of national guidelines that call for youth-friendly services. It is particularly difficult for unmarried young people to access sexual and reproductive health services because in the closed society like Nepal, confidentiality has always been an issue, especially for unmarried. Further, service providers often fail to respect young clients rights. The behavior of health service providers in most of the settings does not facilitate the rights-based access to services. In addition, access to services is particularly limited for marginalized young people, including migrant populations.

Recommendations
Services do not become friendly just by scaling up service centers but also by training service providers, disseminating appropriate information and Train health care providers in how to delivery youth-friendly services. For example, ensure that providers have the capacity to respect young people as clients, respect their rights, and ensure that service-delivery points are conductive to honest and open communication about sexuality and reproductive health issues. Scale-up youth friendly services, including community-based distribution of contraception programs in order to reach large numbers of young people in both urban and rural areas. Maximize accessibility of youth-friendly services by providing care in variety of settings. Provide comprehensive coverage of safe abortion services and ensure that parental/adult consent is not a barrier for young women to access abortion services. Make contraceptives accessible and affordable for all young people.

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Youth Participation
Young peoples meaningful participation in policy-making that provides leadership

Recommendations:
Involve young people meaningfully, particularly marginalized youth, at all levels of program and policy design, implementation, and monitoring and evaluation. Apply strategies to ensure youth-adult partnerships that facilitate meaningful participation of young people on decision-making bodies. Develop and apply mechanisms to ensure the participation of young women and other marginalized groups who are otherwise more difficult to integrate into program and policy decision-making bodies.

opportunity and ownership is limited despite an increasingly conducive environment for youth engagement. Participation of marginalized young people is particularly lacking in spaces to inform policies.

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Effective Implementation, Monitoring and Evaluation

Recommendations:
Ensure adequate resources to successfully implement sexual and reproductive health policy recommendations and national plans, strategies and programs. Institute accountability and quality measures to ensure that sexual and reproductive health policy recommendations, plans, strategies and programs are being adequately implemented. Build young peoples capacity to contribute to monitoring and evaluating implementation of sexual and reproductive health policy recommendations, national plans, strategies, and programs

Implementation, monitoring and evaluation of sexual and reproductive health-related policies are lacking. Resources to adequately implement policies are lacking as well as accountability mechanisms to ensure that they are being properly executed.

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