Adolescence is a near-universal part of human development that has far reaching determinants on one’s health: Why is the experience so different depending on where you live?
By Hamish McNamara
“We should know that the problem we are having is a natural process and not a fatal disease.”
Imagine waking up as young woman to your first experience with your menstrual cycle and not knowing what was happening to your body, worse still, that your first thought was that of disease. Your understanding of menstrual hygiene was non-existent and you were terrified to talk to anyone about it.
Adolescent Sexual Health
The World Health Organisation (WHO) defines sexual health as a state of emotional, mental and social well-being; not the absence of disease, dysfunction or infirmity. It requires a positive, respectful approach as well as having pleasurable and safe experiences, free of coercion, discrimination and violence. To be attained, the sexual rights of all persons must be respected, protected and fulfilled. Supported by definitions for sex, sexuality and sexual rights, these set the boundaries by which Bangladesh and Australia are signatories too.
Adolescence is defined by WHO as people between ten and 19 years of age. 3 A simplistic age boundary placed on humans for one of the most crucial development stages in determining health and well-being.
This is where the compatibility of adolescence sexual health ends between the two countries. The population demographic comparison sets the scene to understanding the scale of difference faced between Bangladesh and Australia.
Currently, there is no adolescence sexual health world ranking as such. Measuring sexual health is often outcome-focused including the increase of sexually transmitted diseases, unwanted pregnancies and sexual violence. However, adolescence is a near-universal part of the human life cycle that involves the transition from child to young adult incorporating the essential psychological, hormonal, physical and social changes as we become capable of reproduction. So why is the experience so different depending on where you live?
This is where the compatibility of adolescence sexual health ends between the two countries. The population demographic comparison sets the scene to understanding the scale of difference faced between Bangladesh and Australia.
Adolescent sexual health culture
As a general rule, Bangladesh does not encourage adolescents to share their views or to contribute to adult conversations regarding matters affecting their lives. In addition, sexual health remains a cultural taboo topic, particularly for females, thus increasing the incidence of and exposure to sexually risky and unwanted behaviour. The rate of child marriage is amongst the highest in the world (average age of 16.1 years amongst women) and the adolescents fertility rate of the age bracket 15 – 19 is 113 births per 1000. Parents remain uncomfortable talking to their adolescent children about sexual health, perhaps a result of what they experienced growing up as well as a lack of knowledge. The national religion of Islam has been cited as a barrier to better family planning practices, a recent analysis found only 66.8% of the population used physical contraception methods.
The National Survey of Australian Secondary School Students and Sexual Health is conducted every five years. The survey found the most common source of sexual health information was the internet (79%) and talking to a female friend (75%). The most trusted source of sexual health information rated the GP (89%), mother/ female guardian / stepmother (60%) and community health services (55%) as the top three. Overall, students were assessed as having a good knowledge of sexual health. The focus of sexual health in Australia is currently to reduce the infection rates of STIs amongst adolescents. The adolescent fertility rate of the age bracket 15 – 19 is 9.2 births per 1000. The challenge faced by Australia is the increasingly diverse population as a result of strong migration figures. As a result, the surveillance of shifting knowledge, sexual behaviours and public health messaging remains a priority. A change with regards consideration of same-sex or alternate sexual health remains a challenging.
Adolescent sexual health education and information
The Bangladesh Education Department has directed all secondary schools to provide sexual health education from January 2022. However, reports indicate that only 46 per cent of the 95 per cent who pass primary school are continuing onto secondary schools. With a drop-out rate of 14.6 per cent by year 8, the initiative starts losing value. The service delivery of sexual health support is not available to unmarried adolescents, which in turn contributes to the sexual health information vacuum. Access to internet and technology is limited and most recently sexual health brochures are being used to improve accessibility to information.
Australia’s sexual health education is state and territory owned; however, it is compulsory as part of the national school curriculum. It covers human development, puberty, reproduction, feelings, relationships and communication. A recent introduction of consent has been welcomed. It is compulsory for parents to enrol children between the age of 6 to 17 years of age at a registered school. The access to the sexual health service delivery is covered under the national Medicare scheme. National internet coverage and access provides a platform for further information as required which is free from embarrassment, stigma and supports curiosity.
Government Policy
There is no single policy or strategy document issued by the government of Bangladesh on sexual and reproductive health. The topic is covered across multiple and various policies. Several strategies incorporate future planning towards greater maternal care and the Adolescent Reproductive Health Strategy aims to provide adolescents with decision making skills, negotiation strategies and sexual education both in schools and initiatives on how to reach the population not at school; street children and the disabled.
The Department of Health and Aged Care is responsible for the sexual health of Australians. The National Strategies for bloodborne viruses and sexually transmissible infections 2021 – 2025 is the framework and agreed direction for the coordinated national response to sexual health.
Is a comparison between Bangladesh and Australia fair?
Bangladesh has a significant opportunity for change; the adolescent dominant population group will be the sexual health leaders for the following generation of adolescents. The question is how will they inculcate that change? Hopefully, with a focus on change culture, increasing communication and education boundaries at the family level (break the cycle) and influencing Government Policy through public health initiatives.
Comparing Australia to Bangladesh is fair; sexual health should be a universal experience, because being a teenager is a human trait and should not be affected by where you live.