The other half of the coin: increasing access to contraceptive services.

Nine percent of all unsafe abortions in Asia occur among girls aged 15-19 and 23% are among young women aged 20-24. (1) Clearly, such data discussed in the Editorial indicate that overcoming the barriers girls and young women face in accessing safe abortion services should be a priority for governments, non-government groups and donor agencies. To be able to fully address young women's needs and enable them to realise their reproductive rights, however, preventing unintended and unwanted pregnancies should also be a main concern. (2) Aside from provision of comprehensive sexuality education, increasing young women's access to contraceptive services is key to this.

Contraceptive use tends to be low among young women compared to adults, even among those who are married (see Table 1). Moreover, difference further exists within this age group--married adolescent girls in Asia are also less likely than married young women to use modern contraceptives (no data was available for the Pacific). Modern contraceptive use among those aged 15-19 ranges from a mere 2% in Pakistan to 47% in Indonesia (compared to 20% and 57% usage among all married women in Pakistan and Indonesia, respectively). For all seven countries with available data, use increased in the 20-24 age group, with the highest increase occurring in the Philippines, India and Bangladesh. (4) On the other hand, data on contraceptive use and sexual activity among unmarried youth are not captured in national health statistics systems and demographic surveys. There are few privately funded national studies as well, although it is known that sexual activity among young people is increasing even as women are marrying at a later age compared to their mothers' generation. (5) Given this lack of full understanding and acceptance of youth sexuality outside of marriage in Asian-Pacific societies, it is not surprising that of the eight countries studied by ARROW to monitor ICPD, only in China can unmarried youth access contraceptives in primary health care facilities. Cambodia reportedly does not prohibit providing contraceptives to unmarried youth, but health providers were reported to be reluctant to provide these services. (6) The same culture and policy environment that hinder unmarried young women's access to safe abortion services impede their access to contraceptives.

Considering that the youth aged 10-24 comprise one-third to one-half of the total population in Asian-Pacific countries, and a significant percent of young women aged 15-19 are married or in consensual unions, (7) they are an important target group both from rights-based and public health perspectives. Married young women's low contraceptive use and the lack of data for unmarried women raise critical questions for policy makers, sexual and reproductive health and rights (SRHR) activists and programme implementors.

Are young people really seen as an important target group? Do policies and programmes for youth consider differential needs within various groups of young people? Do these address reasons for low contraceptive use, including structural ones, such as gender differences, young married girls' low status and limited income and mobility, and societal expectations to have a first child immediately after marriage? Is programming guided by evidence, and are strategies to overcome barriers critically assessed to show what works with whom and when? For example, do "well-proven" strategies--such as the "Abstinence, Be Faithful, Use Condom" model--really work or do they further drive young people to risky behaviors? Do youth programmes accept adolescent sexuality or do they just pay lip service, stopping at information? When providing contraceptive (and abortion) services, are they really available, accessible, acceptable and appropriate for young people? Lastly, do young women have a say in how these policies and programmes are crafted and implemented?

Endnotes

(1) Shah, I.; Ahman, E. 2004. "Age patterns of unsafe abortion in developing country regions." Reproductive Health Matters. Vol. 12, No. 24 (supplement), pp. 9-17.

(2) Note, however, that there will always be a need for terminating pregnancies for various reasons, including contraceptive failure and sexual coercion.

(3) Such sexuality education should provide adolescents and young people accurate, scientific and comprehensive information on body functions, sex, reproduction and safer sex, as well as build life skills for interpersonal communication and decision-making. It should also be rights-based and take into account gender relation issues, as well as other concerns such as abortion, diverse sexualities, and sexual coercion.

(4) Population Reference Bureau (PRB). 2006. "The world's youth: 2006 data sheet." Washington, DC: PRB. Available at www.prb.org

(5) Although child marriage is still widespread, particularly in South Asia. In PRB.

(6) ARROW. 2005. Monitoring Ten Years of ICPD Implementation: The Way Forward to 2015-Asian Country Reports. Kuala Lumpur: ARROW. 384p. The research covered Cambodia, China, India, Indonesia, Malaysia, Nepal, Pakistan and the Philippines.

(7) 9% of young women in the Philippines are married, 13% in Cambodia, 15% in Indonesia, 21% in Pakistan, 34% in India, 42% in Nepal, and 48% in Bangladesh. In PRB.

By Maria Melinda Ando, Programme Officer, ARROW

Table 1. % of Married Women Using Modern Contraceptive Methods
by Age Group in Selected Asian Countries

                         Bangladesh    Cambodia     India    Indonesia

Ages 15-19                   34           7           5          47

Ages 20-22                   47          12          21          59

All Married Women            47          19          43          57

                            Nepal     Pakistan    Philippines

Ages 15-19                    9           2          13

Ages 20-22                   21           9          30

All Married Women            35          20          33

Sources: Population Reference Bureau (PRB). 2006. "The world's youth:
2006 data sheet." Washington, DC: PRB Available at www.prb.org & United
Nations Department of Economic and Social Affairs Population Division.
2006. World Population Policies 2005. New York: UN. Available at:
www.un.org/esa/population/publications/WPP2005/Publication_index.htm

Note: Table made from bar graph.