Assessment of laws and policies for strengthening adolescent

Assessment of Laws and Policies for Strengthening Adolescent Sexual and Reproductive Health in Bangladesh Experience of implementing human rights related activities at country level

Anna Häggblom - Child & Adolescent Health Unit - WHO Country Office for Bangladesh

HUMAN RIGHTS IN BANGLADESH “The Republic shall be a democracy in which fundamental human rights and freedom, and respect for the dignity and worth of the human person shall be guaranteed” Constitution of Bangladesh, article 11

 All the international human rights treaties has been ratified (except CMV)  Bangladesh has participated in almost all major international conferences related to human rights  The right to life, food, health, shelter, basic necessities of life, speech, education are enshrined in the Bangladesh Constitution

BANGLADESH CONTEXT  Legal age of marriage: 18 years  Mean age at first marriage: 15.7 years

18

14.9 years

16

14

Age

10-14 15-19 20-24

12

13 years 10

8 BDHS 93

BDHS 96

BDHS 99

BDHS 04

BDHS 07

Source: Bangladesh DHS 1993-2007

BANGLADESH CONTEXT (contd.) •Contraceptives are only provided to married adolescents through public facilities •Abortion is illegal, but menstrual regulation allowed (within 6-10 weeks) • Mean age at first birth: Age

30 25

18.7

18.4

1999-2000

2004

19

19

20 15 10 5 0 2007 Source: Bangladesh DHS 1999-2007

BANGLADESH CONTEXT (contd.)  General fertility rate: 105 births/1000 women  Adolescent specific fertility rate: 126 births/1000 women 200

196

192

180

188

192 173

160

ASFR/1000

140

140

147

144 135

120

126

10-14

100

15-19

80

20-24

60 40 20 0

4.6 BDHS 93

13.0 BDHS 96

9.8

4.8

BDHS 99

BDHS 04

BDHS 07

Source: Bangladesh DHS 1993-2007

 Poor, non-educated, rural adolescents most vulnerable

THE WHO GENERIC TOOL  Developed by WHO HQ and Harvard School of Public Health  Aim: improve awareness and understanding of States’ human rights obligations  Method: systematic examination of the SRH status of vulnerable groups, involving non-health sectors, fostering civil society participation and developing recommendations to address regulatory and policy barriers to SRH with clear assignment of responsibility  Goal: Strengthen the links between human rights and SRH, and contribute to national achievement of the highest attainable standard of health

THE BANGLADESH PROCESS      

Entry point: adolescent pregnancy Advocacy efforts with Government of Bangladesh + other stakeholders Formation of Technical Advisory Group Formation of Core Group (respondents) Conduction of workshop for national adaptation of generic tool Objectives: 1. To examine the status and implications of human rights approach for adolescent health in Bangladesh 2. To study the national laws and policies related to core aspects of adolescents’ SRH 3. Review health data together with laws, policies and regulations related to adolescent SRH, in the context of human rights 4. Review and document government efforts to respect, protect and fulfill adolescents’ right in the context of SRH 5. Identify possible discrepancies in laws and policies that might be barriers to adolescent SRH

THE BANGLADESH PROCESS (contd.)  Data collection  Workshop with policy makers and programme managers Interviews with legal and public health experts Document review  Analysis using SWOT (Strengths, Weaknesses, Opportunities, Threats) framework  Report writing  Decision after feedback from HQ and regional level: further analysis needed

CURRENT SITUATION     

Incomplete data on national laws and regulations Non-systematic analysis of health issues Unclear barriers and recommendations No clear linking with relevant human rights instruments Example of existing barriers:  Inadequate protection of girls/women from early marriage  Discrepancy between the Health Law/ Religious Law and the Criminal Code with regards to family planning information  Inadequate legal provisions for unmarried adolescent women to access reproductive health services  Inadequate provision of privacy, confidentiality and informed consent

 Senior legal expert and public health expert to work for 2 months to fill data gaps, more thoroughly conduct analysis  identify barriers and formulate recommendations/suggestions

CHALLENGES  Culturally sensitive topics related to adolescent SRH  Reluctance in GoB to discuss human rights  Lack of knowledge?  Fear of criticism?

 Difficult to talk about human rights “in isolation”  Formulation of specific recommendations on how to overcome barriers without “pointing fingers”  Finding persons with experience of both legal analysis and sexual and reproductive health  Extensive tool  Limited country capacity

LESSONS LEARNT  Sensitization and de-mystification needed on human rights and the added value for the field of health  Government  WHO staff

 National adaptation of tool crucial for:  Understanding  Ownership  Future use of the report

 Countries need to find their own purpose for conducting the assessment:  Bangladesh: door opener, stimulate dialogue, advocacy for AH

 Takes time…