” We rarely visit health facility. We do not have information on services provided in health facility nearby. Young people like us visiting health posts especially for sexual and reproductive health problem is stigmatized in our society. Even if we have any problem for example sever stomach pain during menstruation or itching vaginal areas we do not share with anyone.” A group of young girls from Dhangadhi
As we all know that there are more than 1.7 billion young people aged 10-24 in the world, the largest population of young people in history. With growing population young people are facing changes with environments and circumstances that affect their sexual
and reproductive health. Considering Nepal adolescents (10-19 years) make up to 23.8% of total population as per Nepal Demographic and Health Survey 2011. 30% of girls (15-19 years) are already married whereas 17% are already a mother or pregnant with their first child. According to NDHS 2006 only 14.4% of married adolescent girls use contraception, the remaining majority faces a risk to unwanted pregnancies. Girls are reaching their puberty earlier now than in previous decades. Unmarried girls who become pregnant often resort to unsafe abortions. Although the HIV prevalence in Nepal is low at 0.3%, young people are as anywhere else in the world at risk of contracting sexually transmitted infections (STIs) including HIV. Especially young Nepalese men migrating to India are at risk of contracting HIV, and are subsequently passing it onto their young spouses or girlfriends.
The National ASRH Program:
In 2008, the Family Health Division (FHD), Department of Health Services, Ministry of health and Population (MoHP) in Nepal jointly with the GIZ started to discuss options for possible government interventions to improve adolescents’ ability to protect their sexual and reproductive health. Up until then, adolescent-specific health services and information had been mainly provided by non-governmental and private health care providers. The FHD decided to conduct a pilot for the introduction of adolescent friendly services (AFS) into the existing network of public health facilities in line with a rights based approach to health.
In Nepal yet youth sexuality, pregnancy and motherhood outside of marriage continue to stigmatized, young people’s sexuality and reproductive rights are frequently not recognized or upheld by governments and communities. The National ASRH Program was designed with a view to Nepal’s commitment to achieving the Millennium Development Goal (MDG) 5 B: Universal Access to Reproductive Health. This MDG is measured through a reduction in the adolescent fertility rate (AFR) and an increase in the contraceptive prevalence rate (CPR) among women of reproductive age.
Here you can get the detail about National ASRH program of Nepal.
The National ASRH Program was conceptualized in line with the goal and objectives of the National Adolescent Health and Development Strategy (NAHDS) 2000 which are:
- Increase the availability and access to information about adolescent health and development, and provide opportunities to build skills of adolescents, service providers and educators;
- Increase accessibility and utilization of adolescent health and counseling services ,and
- Create safe and supportive environments for adolescents in order to improve their legal, social and economic status.
The current Nepal Health Sector Program Implementation Plan (NHSP IP-2) which lays out the objectives and health sector targets for the period 2010-2015, has included the target of of introducing 1000 AFSs in the public health system by 2015. this represents about 25% of the current total number of government health facilities.
The National health Education Information and Communication Center (NHEICC) which has the role to support major programmatic interventions of the Department of health Services, in line with the new focus on ASRH in the FHD, developed a National ASRH communication strategy for the years 2012-2016. This strategy outlines the objectives, contents and intervention areas for behavior change communication, social mobilization and advocacy. An implementation plan to operationalise the communication strategy is currently in process.
So, scaling up the services is not the only solution to expanding access to youth friendly services. Empower service providers, disseminating appropriate information, and developing an environment where each young person feels safe and knows that services are confidential and steps forward to ensuring to youth friendly services. This is possible only if
- Train health care providers on how to deliver youth-friendly services, including building inter-personal communication skills. 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.
- Make contraception, including emergency contraception, accessible and affordable for all young people.
- Scale-up outreach services, including community-based distribution of contraception 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 a 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 these services.