The article is originally posted in http://www.yuwa.org.np/wp-content/uploads/2012/06/YUWA_SRHR_Policy_brief.pdf.
Youth have become focal points of discussions and debates regarding sexuality and reproductive health matters. However, little research has been done particularly in Nepal to examine their knowledge concerning sexual and reproductive health & rights, abortion as well as contraception. Research indicates that a substantial proportion of adolescent pregnancies are unintended or unwanted. Sexual and Reproductive health issues are very sensitive. Thus having accurate and comprehensive knowledge about SRHR is pivotal, in the case of unintended or unwanted pregnancy or when engaging in unprotected sex or experiencing contraceptive failure that could lead to pregnancy.
While, there are policies addressing sexual and reproductive health broadly in Nepal, they are not being implemented effectively. Furthermore, few policies specially target youth and those addressing sexual and reproductive health issues have been formulated without young people’s involvement.
Agreements, Policies, Strategies, Plans and Programs supportive of Youth sexual and reproductive health
Nepal Has signed various international declarations that commit to young people’s sexual and reproductive heath, including the International Conference on Population and Development (1994), Fourth World Conference on Women in Beijing (1995) and the Millennium Development Goals (2000).
Nepal’s safe Motherhood Program (1997) has 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 (2002-2007) was developed and includes language that supports the sustained increase in utilization of quality material health services.
The Safe Motherhood and Neonatal Health Long Tern Plan (2006-2007)gives priority to the reduction of maternal mortality and neonatal mortality by increasing the number if 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 Female Community Health workers’ Program.
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.
The 11th Amendment Bill on Abortion (2002) allows abortion in the following circumstances: up to 12 weeks gestation for any woman; up to 18 weeks gestation if the pregnancy results from rape or incest; and, any time during pregnancy, with the 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 the pregnant woman’s consent.
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.
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 on adolescent health and development. 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.
Although Nepal has plenty of policies, strategies, plans and programs supporting youth sexual and reproductive health, young people lack access to sexual and reproductive health information and related services. They are poorly equipped to face 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. Despite existence of national guidelines that call for youth-friendly services, sexual and reproductive health services that are youth -friendly are lacking. Young people’s meaningful participation in policy making that provides leadership 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.