Sexual and reproductive health information and services in Bangladesh: What do young people want?

Sabina Faiz Rashid, Dean and Professor, BRAC, BRAC James P Grant School of Public Health, BRAC University

Today we are here to discuss findings and policy recommendations from two research projects on sexual and reproductive health and rights (SRHR) education and information for young people in Bangladesh under Centre of Excellence for Gender, Sexual and Reproductive Health Rights (CGSRHR) at the BRAC James P Grant School of Public Health, BRAC University. The main aim of this roundtable is to incorporate the feedback of the discussion in our policy brief, which will then be distributed to the government and other relevant organisations.

Farhana Alam, Coordinator, (Breaking the Shame Project), BRAC James P Grant School of Public Health, BRAC University

BRAC James P Grant School of Public Health in collaboration with Radboud University as academic partner and Unite for Body Rights (UBR) and BRAC Adolescent Development program (ADP) as social partners worked on "Breaking the Shame: Towards Effective SRHR Education for Young People in Bangladesh"- a three-year long research project (2015-2018)  under CGSRHR focused on SRHR education and information for adolescents. The project was funded by NWO-WOTRO Science for Global Development, Netherlands. We spoke to adolescents (aged 13-19 years) from four urban and rural sites of the country about their unmet needs and expectations in terms of SRHR education and information. We have done a needs assessment study where we conducted around 39 in depth interviews and 24 focus group discussions with these adolescents, and also interviewed 17 male and 13 female teachers/ peer leaders. We developed three tools (animated videos, cartoon, illustration, short-drama) on three themes: myths and misconceptions around SRHR, skill based SRHR education and coping strategies to manage strong emotions based on the needs assessment. We tested the tools on a small scale and came up with some recommendations based on our findings. We also spoke to other relevant actors who work on SRHR rights in Bangladesh.

Following are some important policy recommendations based on our research findings:

• Use of an international website platform to provide SRHR information and ensure that adolescents can learn from these sources maintaining anonymity.
• For delivering sensitive topics to the adolescents, a safe, sustainable, reliable and accessible space is needed.
• Fact based information should be provided to debunk misconceptions around SRHR and gender.
• Include psycho-social skills and knowledge in school curriculum.
• Focus on different pedagogical approaches (for e.g. short dramas, texts with illustrations, animations, etc.) and alternative content (video, drama) to deliver specific type of SRHR information.
• Provide concrete skill-based SRHR education for SRHR related skills development

Bachera Aktar, Coordinator, (Digital Sister Project), BRAC James P Grant School of Public Health, BRAC University

BRAC James P Grant School of Public Health, BRAC University, in association with University of Amsterdam and Maya Apa, conducted a research project to understand how urban young people in Bangladesh use digital space to seek sexual and reproductive health (SRH) related information under CGSRHR. Under this project we also tried to find out what kind of communication tools would be easily accessible and user-friendly for this population group. We analyzed contents of 1000 randomly selected questions and answers form more than 100,000 questions posted on Maya Apa online messaging platform. In addition, we conducted 22 focus group discussions with around 200 male and female students studying in secondary schools and undergraduate level in Dhaka and Chittagong City Corporations. The research shows that young people, aged 15-24 years, mostly use Google and YouTube to find information about SRHR knowledge. But as these platforms including Facebook groups are flooded with information on SRHR, young people can be confused about what to follow. However, young people prefer anonymity when it comes to these issues, which is not possible on social networking sites like Facebook, thus, not comfortable space for them. Adolescents we interviewed suggested that audio-visual communication tools, which can be accessed through digital platforms maintaining anonymity, can be used in this regard. They also mentioned about fear of being judged by their parents or doctors when it comes to seeking SRHR services. We would like to make four recommendations based on our research findings:

• Use digital platforms to provide SRHR information to overcome the stigma and shame around SRHR issues
• Consider "reliability" of sources to effectively reach youth audiences.
• Involve parents in providing SRHR education and designing educational and communication tools.
• Maintain privacy and mainstream SRHR services to link with appropriate service provisions

Professor Md. Mokhlesur Rahman, Sr. Sector Specialist, National Curriculum and Textbook Board (NCTB)

When I was a student myself, teachers were not willing to talk about sensitive topics like wet dream. Even now, from my work experience, I saw that teachers do not want to teach sensitive topics in classroom. What is the alternative then? One strategy can be that we can use ICT-based learning so that students do not become totally dependent on the classroom. The ICT platform should have option for question-answer where students can clear their confusion. NCTB is currently working on it and we are hoping that we will be able to do it soon for the students. I have also noticed from my experience that peer learning is very effective as students cannot ask many questions to their teachers. That can be another option to start discussion about the sensitive topics. 

Professor Md. Farhadul Islam, Sr. Sector Specialist, National Curriculum and Textbook Board (NCTB)

We are working on addressing this problem about teaching sensitive topics in the classroom. The situation is much improved than it was in 2013 but there are still room for improvement. NCTB is open to receive help from the NGOs who are working on SRHR education.

Professor Dr. A K M Reazul Hassan, Member of Primary Curriculum, National Curriculum and Textbook Board (NCTB)

We are revising the NCTB curriculum now which will be completed within 2020 to 2021. Organizations who would like to work in partnership with us in this revision process are most welcome. We have already worked with Save the Children and developed a curriculum on sexual harassment and we are planning to have teachers' training for that. If BRAC James P Grant School of Public Health wants to have a partnership with us and wants to address these recommendations from their research regarding the gaps, we can work together on that. Government is always open for any learning opportunities. Bring your proposal with your research findings, we can try to incorporate that during our curriculum revision. This is the right time to do that.

Dr. Joynal Haque, Programme Manager, Adolescent & Reproductive Health, MCH-Services, DGFP.

We have formulated the National Strategy for Adolescent Health 2017- 2030, and we are currently finalising the Plan of Action. The government has also developed some communication tools targeting adolescents, and these can benefit non-government initiatives as well. We have also developed a website (adoinfobd.com), which will be launched in the next 2-3 months, where adolescents will gain information about SRHR issues. We have also developed an adolescent SRHR networking forum to connect all relevant stakeholders. The research findings presented in today's programme will definitely help our activities.

Dr. Manjur Hossain, Deputy Programme Manager, Adolescent & Reproductive Health, MCH-Services, DGFP

This ICT or e-learning platform is appropriate for the urban adolescents but we have to think about the rural adolescents as technology related facilities are not available in rural areas. We need to think about how feasible this e-learning would be for them. We have to find some ways to include our adolescents living in rural areas.

Dr. Fariha Haseen, Associate Professor, Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University

Apart from the skilled teachers, students and peer leaders, we now need to think about skilled parenting. We could also make use of our cultural heritage and norms to relay information on SRHR. I would also like to add that we need to ensure that sex education and information is reached to the girls who are married off at a young age, so that they are aware of their sexual and reproductive rights. I think this is high time we start thinking about including apps along with the text books for teaching.

Sharmin Farhat Ubaid, Coordinator, UBR

SRHR topics are included as chapters in the Physical Education book. Since Physical Education is not included in the exam, that allows teachers to skip those chapters. Government can take an initiative to include that in the exam so that these topics are taught in the classroom. Our education system is mostly number based than skill so exam is really important. Therefore, including this in the exam can be one strategy which will make teachers and students read those topics with sincerity. Also, government is considering mental health as an important issue now. DGFP is working on that. I want to suggest DGFP that instead of developing a new tool, they can use the tool on coping strategies for strong emotions developed by BRAC James P Grant School of Public Health as this tool is very relevant to the challenges adolescents face.

Shahana Siddiqui, CGSRHR, BRAC James P Grant School of Public Health, BRAC University

We have to understand that e-learning is not a separate tool rather supporting element for regular education. While we are talking about materials, developing materials is not enough without giving priority to Search Engine Optimisation (SEO). SEO refers to the maximisation of the number of visitors to a particular website by ensuring that the site appears high on the list of results returned by a search engine. That way, the tool will be more effective.

Zakia Yasmin Joarder, Deputy Director, Department of Women Affairs, MOWCA

We are establishing 4883 adolescent clubs all over the country which will cover almost 4,39,470 adolescents , with each club consisting of 20 girls and 10 boys. Apart from providing them training on various skills, the department is also making them aware about SRHR and gender-based violence. We can incorporate the communication tools, learned from this dialogue, in our awareness building activities.

Dr. Muhammed Jahangir Hossain, Director, Planning and Development, Ministry of Education and Project Director of Generation Breakthrough

Government has already been working on the issues which have been shared with us today for a long time now. They have already started Generation Breakthrough project to address this issue. For better result, we have to work on a 'Butterfly mode' where one wing of the butterfly would be "gender equity" and other would be sexual and reproductive health and rights (SRHR). We have to combine both to make it more effective. Our observation from Generation Breakthrough project is that working only on SRHR would not be effective. Another important thing is we have to work together rather having scattered interventions. We should also appreciate government for what they have done so far. 

Professor Dr. Muhammad Abdul Mannan, Director, Secondary and Higher Education Division, Ministry of Education

NCTB has started life skill-based education curriculum in 2011. Some of the topics presented here today are overlapping with that curriculum. However, some sensitive topics which are mentioned here are crucial and at the same time, there are several taboos and misconceptions associated with that. NCTB has been working on this issue for last one decade and number of teachers have been trained by NCTB as well. Nonetheless, there still some gaps remain.

I believe in "unity in diversity". Different organisations might work separately on this issue but their goal should be mutual. That should be for the welfare of our students. We have to aim for student centred classroom. Education ministry is planning for learning based education system instead of result-based education system. This approach is also very important to address the sensitive topics recommended today.

Dr. Muhammad Mahamud Ul Hoque, Additional Secretary, Secondary and Higher Education Division, Ministry of Education

One interesting thing is that new contents have been proposed for the curriculum today, while at the same time we are discussing about overburdening of the education system. This is a real challenge that needs to be resolved creatively. We have introduced a reading initiative in our secondary education development programme, which can be an effective answer to this challenge. Through this programme, students are reading a lot of supplementary materials, which help improve their comprehension and communication skills.

We can include all the essential information related to SRHR in these supplementary materials. We can also create a corner in school libraries where students will find reading materials on SRHR.

We are trying to develop digital content related to the curriculum that will facilitate overall education of students and government have plan to provide Tablet in schools. This will enable us to easily share SRHR related information through these platforms.

The government is also planning to appoint one psychologist per secondary school to address this challenge. The government is pro-active and positive about achieving SRHR related goals, as it is directly linked to the SDGs.

If we can coordinate all our policies and efforts, I believe we will be able to implement the recommendations provided today.

VOICES OF ADOLESCENTS

Sonia Akter,  Youth Organizer, Population and Service Centre,

Unite for Body Rights (UBR)

When a myth becomes a social norm, people begin to take them as facts. When girls are told that their safety is in their hands and that they need to dress 'decently' to avoid attention and sexual harassment, they begin to believe that. We get different information from different sources. Getting proper information would help us to understand that this is not girl's fault.

Jubaid Ibn Aziz Ratul, Youth

Organizer, UBR

As I live in a rural area, I can say that canvassers are one of the sources of these myths that perpetuate misinformation. I have some friends who have been told by these "experts" that wet dream is a kind of disease. Adolescents in rural areas often depend on these people for information on sex instead of doctor to avoid being judged by people.

Maria Kibaty, Peer Leader, BRAC Adolescent Development Programme (ADP) Club

Adolescents feel a sense of comfort when discussing these subjects with us (peer leaders) rather than others. I would suggest that peer leaders should be given more extensive training on how to talk about sensitive issues like sexual and reproductive health and rights with adolescents.