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Your baby daughter is not a baby anymore 

13 Mar 2022

  • Importance of sexuality education to prevent child pregnancies 
A 14-year-old girl was transferred to a teaching hospital from a peripheral hospital as she was suffering from a severe pain in her stomach. She delivered a baby after a few hours following admission to the hospital. Till then she was not aware about her pregnancy and the alleged perpetrator was her own brother who was 17-year-old. Later she has revealed that, they have had multiple sexual encounters without proper knowledge about the consequences. The baby was handed over to the probation authorities, while the girl was kept with the family and her brother was sent to a certified school by courts. The entire family structure was disrupted and the family had to move from their residential area due to social stigma. This scenario highlights the importance of sexuality education and reveals the gaps in the current system.  A 15-years and 11-months-old girl who had eloped with her 18-year-old boyfriend two months ago was found by the police after a complaint lodged by her parents. She was brought to the hospital for assessing alleged child sexual abuse. On assessment by the child and adolescent psychiatrist, it was revealed that she has had multiple sexual encounters with her boyfriend. Further, it was revealed that she was aware that she could get pregnant by having unsafe sex. When further inquired about the safety measures, she has said that her boyfriend was taking contraceptive pills. She was not aware that there are no male contraceptive pills in practice. This story reveals the sad situation of the lack of knowledge on contraception. This displays how easily they can get caught into fake information due to lack of knowledge and the importance of disseminating accurate information about safe sexual practices. A 13-year-old girl was brought to the hospital by a school teacher as she had a fainting attack at school. Her mother works abroad as a domestic helper and she lives with her father and older sister. At the hospital, it was found that she was four months pregnant. She had revealed repeated victimisation of sexual assault by her grandmother’s partner who is at home.  Since she was not aware that girls should get their menstruation monthly, she had not informed anyone about her missed periods.  A 14-year-old girl who used to live with her grandmother after the death of her parents had stopped attending school one year back due to financial difficulties. Subsequently, she had started living together with her 19-year-old boyfriend at his house. She had not revealed about her missing periods to anyone due to fear of getting scolded. Her boyfriend’s mother had noticed her enlarging stomach and referred her to the Public Health Midwife and by that time she was six months pregnant. She was assessed to be a very thin, weak and medically compromised girl whose life was at risk by continuation of the pregnancy. If this girl, her boyfriend or boyfriend’s mother had had any knowledge on sexual health, this incident would have been prevented.  Child pregnancies are a global problem irrespective of the level of development of the country. According to the World Health Organisation (WHO), each year approximately 21 million girls in the age group of 15-19 years in developing regions become pregnant and approximately 12 million of them give birth. In this context, about 11% of the world’s total births still come from girls aged from 12-15 years. The grimmest side of the story is that, approximately 777,000 births occur to adolescent girls younger than 15 years in developing countries.  Numerous factors contribute to adolescent pregnancies and childbirths. In least developed countries, at least 39% of girls marry before they become 18 years of age and 12% before the age of 15 years. In many societies, due to cultural reasons, girls are under pressure to get married and bear children early. In certain societies girls choose to become pregnant because they have limited educational and employment prospects and in such societies, getting married and bearing children may be the best of the available limited options for a girl to carry on life. According to the Family Health Bureau of Sri Lanka, 4.1% of the total pregnancies registered in 2020 had been teenage mothers. Although this rate is reasonable in comparison to our neighbouring countries, it is important to take every possible measure to minimise this number. In Bangladesh the percentage of teenage pregnancies is around 35%, while in Nepal and India the percentages are around 21%.  Dr. Darshani Hettiarachchi, Consultant Child and Adolescent Psychiatrist attached to the Teaching Hospital Karapitiya has done a series of case studies regarding child pregnancies and has published in an academic journal highlighting the importance of sexuality education for children. This article is based on a discussion with Dr. Hettiarachchi and quotes the stories included in her case studies.  Why do child and adolescent pregnancies matter?  Children and teenagers are not ready for childbirth in both physical and psychological perspectives. These girls are more vulnerable to face risks associated with pregnancy and birth complications than adult women as they have not reached the physical or psychological maturity to bear the physical and mental stress associated with pregnancy and childbirth.  Babies born to mothers younger than 20 years carry a higher risk for delivering preterm and low birth weight babies. Social consequences such as stigma, rejection and intimate partner violence are common among unmarried adolescent pregnancies. This invariably leads girls to drop out of school and education, jeopardising the literacy and employment opportunities.  Risk factors for child pregnancies in Sri Lanka  Globally, the knowledge gaps and misconceptions play a major role in child pregnancies. Adolescents who may want to avoid pregnancies are unable to do so due to lack of knowledge and prevailing misconceptions on contraceptive methods.  They face barriers for accessing contraception in some parts of the world due to restrictive laws and policies. Sexual violence also accounts for childhood pregnancies as some countries report, in more than a third of girls the first sexual encounter was coerced. Low socioeconomic family background, living in disorganised neighbourhoods, low educational level, living with a single parent, victimisation of sexual abuse, poor child-parent relationships and poor parental supervision are identified as the main risk factors across the globe.  Low educational level, low socioeconomic background, disrupted family setting and poor sexual health practices are identified as common risk factors for child and adolescent pregnancies in the South Asian region which includes, India, Bangladesh, and Nepal. In Sri Lanka, low educational attainment, low socioeconomic status (SES), and poor parental supervision are also identified as major risk factors for teenage pregnancies. Studies have shown that 59.4% of teenage girls who were on contraceptive pills have conceived. This indicates method failures and lack of knowledge on contraceptive practices.  Healthy sexuality  Healthy sexuality is a fundamental, enriching aspect of being human and the ability of women and men to enjoy and express their sexuality and do so without any risk of sexually transmitted diseases, unwanted pregnancies, coercion, violence and discriminations. It can be influenced by multiple factors such as racial, ethnic, religious, cultural, moral and personal concerns.  It is vital to consider healthy sexuality development as a key developmental milestone in all children and adolescents and they should receive adequate knowledge about healthy sexuality and healthy sexual behaviours. This will prevent risky sexual activities which can lead to health and social problems such as sexually transmitted diseases and unplanned pregnancies.  Sexuality education  According to the World Health Organisation (WHO), sexuality education aims to develop and strengthen the ability of children and teens to make conscious, satisfying, healthy and respectful choices regarding relationships, sexuality as well as emotional and physical health.  Sexuality education is not just giving information about human anatomy and physiology of sex and reproduction. It should provide accurate and developmentally appropriate information to children and adolescents about the biological, psychological, sociocultural, relational and spiritual aspects of sexuality. Contrary to common belief, sexuality education does not encourage teenagers to have sex. Sexuality education can be done in schools, home environments, community settings and by the health sector and should commence from a very young age in an age-appropriate manner. Current situation in Sri Lanka  Dr. Hettiarachchi elaborated the current system of sexuality education in Sri Lanka as follows;  In Sri Lanka, children get sexuality education through teachers, parents, caregivers, colleagues and healthcare workers. Unfortunately, our education system has given the least possible priority to healthy sexuality education due to multiple religious, cultural, moral and practical reasons. Hence, Sri Lankan children are not getting adequate sexuality education.  Inherently, our parents and caregivers are reluctant and shy to talk with children about sexuality and tend to divert whenever such discussions are arising. This has resulted in children and adolescents to seek information through sources such as social media, internet and peer groups. This mode of information gives access to unhealthy and potentially harmful avenues and false information. This upbringing makes adults with confusing, conflicting and negative knowledge about sexuality.   School medical education programmes conducted by primary healthcare workers, including the Medical Officer of Health, Public Health Inspectors and Public Health Midwives is one of the main sources of sexuality education received by school children.  In the clinical setting, it is evident that lack of knowledge about sexual health is one of the main reasons for victimisation of child sexual abuse and child pregnancies.  A survey has been conducted by the Ministry of Health in collaboration with United Nations Children’s Fund (UNICEF) and United Nations Fund for Population Activities (UNFPA) in 2012 to assess the knowledge, attitudes and awareness on sexual health among youth. According to the survey, only 59% of students had received reproductive health education from school and only 50% of the youth have the basic knowledge on sexual and reproductive health issues. Further, nearly 66% of girls in Sri Lanka are not aware of menstruation until menarche. The National Survey on Emerging Issues among Adolescents in Sri Lanka reported that adolescents had poor knowledge on contraception, teenage pregnancy, risk factors of sexual abuse and sexuall transmitted diseases.  Comprehensive sexuality education (CSE) CSE is a wide area which includes understanding about the human body, its development, gender, sexuality and sexualised behaviours. It also helps in improving skills related to health and wellbeing, relationships and intimacy and helps to minimise violence related to sexuality and teaches how to be safe. According to the available evidence, sexuality education has shown positive effects on knowledge, attitudes and behaviours related to sexual and reproductive health among the youth.  CSE is a curriculum-based education delivered in formal and informal settings, which is scientifically accurate, comprehensive and culturally appropriate. Formal or informal sexuality education does not influence increasing sexual activity or sexual risk-taking behaviour but control the persons with the knowledge of healthy sexual behaviour. Although Sri Lanka demonstrates a high literacy rate which is comparable to the developed world, the knowledge on reproductive health is relatively low. This is a main contributing factor for teenage pregnancies which risk the lives of teenage girls. According to the studies, more than 50% of teachers have not participated in any sexual and reproductive health training programmes and even trained teachers admitted of lacking sufficient knowledge to discuss sexual and reproductive health issues with students. Dr. Hettiarachchi concludes her case-based discussion with the suggestion to implement comprehensive sexuality education in collaboration with all stakeholders as it is a real need of the hour.  (The writer is a Medical Officer at the Directorate of Healthcare Quality and Safety at the Ministry of Health)  BOX  If you feel that you or someone you may know is dealing with a similar situation or is affected by the content in this article, the following organisations may be of assistance:  Child Protection Force: (011) 4 848 856  National Child Protection Authority: (011) 2 778 911  Police Women and Child Bureau: (011) 2 444 444   

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