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Assessment of Laws and Policies for Strengthening Adolescent Sexual and Reproductive Health in Bangladesh

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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.

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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
  • 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

“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

bangladesh context
  • Legal age of marriage: 18 years
  • Mean age at first marriage:

15.7 years

14.9 years

13 years

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:



Source: Bangladesh DHS 1999-2007

bangladesh context contd5
  • General fertility rate: 105 births/1000 women
  • Adolescent specific fertility rate: 126 births/1000 women
  • Poor, non-educated, rural adolescents most vulnerable

Source: Bangladesh DHS 1993-2007

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:
    • To examine the status and implications of human rights approach for adolescent health in Bangladesh
    • To study the national laws and policies related to core aspects of adolescents’ SRH
    • Review health data together with laws, policies and regulations related to adolescent SRH, in the context of human rights
    • Review and document government efforts to respect, protect and fulfill adolescents’ right in the context of SRH
    • 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
  • 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…