Family Planning in Asia and the Pacific - International Council on ...

<strong>in</strong> CPR. Likewise, contraceptive use behaviour <strong>in</strong> Maldivesis quite different from <strong>the</strong> patterns commonly observedelsewhere. For example, contraceptive prevalence <strong>in</strong>Maldives decreased while education was <strong>in</strong>creas<strong>in</strong>g: useof modern methods was recorded at 36 per cent amongwomen with no education; among women who had receivededucation beyond secondary school, <strong>the</strong> figure stood at21 per cent. Much of <strong>the</strong> differential is attributed to <strong>the</strong>higher reliance on female sterilization among women withno education. Interest<strong>in</strong>gly, while use of <strong>the</strong> pill decl<strong>in</strong>edwith <strong>in</strong>creas<strong>in</strong>g education, condom use <strong>in</strong>creased with<strong>in</strong>creas<strong>in</strong>g education. Unlike many o<strong>the</strong>r countries, <strong>the</strong>differences <strong>in</strong> contraceptive prevalence by wealth statusor urban-rural residence are not substantial (MOHF-MDHS, 2009).Adolescent sexual <strong>and</strong> reproductivehealth <strong>and</strong> access to contraceptivesMaldives does not have an explicit policy on access tocontraceptives among adolescents, youth <strong>and</strong> unmarriedcouples/<strong>in</strong>dividuals. As a result, a large number ofadolescents do not have access to FP services despiteevidence show<strong>in</strong>g this group’s <strong>in</strong>creased sexual activity <strong>and</strong>risky behaviour.Several surveys <strong>and</strong> reports have shown <strong>in</strong>creasedvulnerability of Maldivian adolescents <strong>and</strong> youth to riskybehaviours (Narcotics Control Board, 2003; M<strong>in</strong>istry ofYouth <strong>and</strong> Sports, 2005; UNDP <strong>and</strong> MOH, 2008; <strong>and</strong>President’s Office, 2009). A rapid situation assessment ofdrug abuse <strong>in</strong> Maldives (Narcotics Control Board, 2003)reported that, by age 21, 75 per cent of youth have had atleast one sexual experience. Many of <strong>the</strong>se sexual encounterswere unprotected, mak<strong>in</strong>g <strong>the</strong>m <strong>the</strong> most at-risk group forrapid transmission of HIV/AIDS. A situational analysisof adolescents (M<strong>in</strong>istry of Youth <strong>and</strong> Sports, 2005)showed that only about 40 per cent of adolescents livedwith <strong>the</strong>ir parents. Approximately 27 per cent of youthaged 10-14 are not liv<strong>in</strong>g with <strong>the</strong>ir biological parents. Thepossible impacts of this situation are limited opportunities<strong>and</strong> stunted life skills development. The same study notedthat 14 per cent of males <strong>and</strong> 5 per cent of females under<strong>the</strong> age of 18 admitted to be<strong>in</strong>g sexually active. With accessto condoms for unmarried adolescents rema<strong>in</strong><strong>in</strong>g a barrier,many of <strong>the</strong>se young people did not use condoms.A fur<strong>the</strong>r study noted that, even though <strong>the</strong> Indira G<strong>and</strong>hiMemorial Hospital distributes condoms free of cost, manypotential users do not obta<strong>in</strong> <strong>the</strong>m from <strong>the</strong> hospital,preferr<strong>in</strong>g <strong>in</strong>stead to buy <strong>the</strong>ir supplies from pharmaciesfor <strong>the</strong> sake of confidentiality <strong>and</strong> br<strong>and</strong> availability (Ajmal,2003). The same study noted that, of <strong>the</strong> total buyers, only6 per cent were adolescents, a figure which pharmacistsacknowledge is below <strong>the</strong> actual number of users.Maldives conducted <strong>the</strong> first ever Demographic <strong>and</strong>Health Survey (DHS) <strong>in</strong> 2008/09. Prelim<strong>in</strong>ary resultsof <strong>the</strong> survey <strong>in</strong>dicated that knowledge (heard) of HIV/AIDS is almost universal among <strong>the</strong> Maldivian population(MOHF, 2009). More significantly, after receipt of <strong>the</strong> firstever <strong>in</strong>put for HIV/AIDS received from <strong>the</strong> Global Fund,<strong>the</strong> country’s first biological <strong>and</strong> behavioural survey wasconducted among <strong>the</strong> five most at-risk groups (seafarers,men hav<strong>in</strong>g sex with men (MSM), adolescent youth,commercial sex workers (CSWs) <strong>and</strong> <strong>in</strong>ject<strong>in</strong>g drug users,which showed that Maldivian youths are vulnerable toHIV/AIDS.The survey report noted that unprotected sex withmultiple partners is prevalent among <strong>the</strong> high-risk groups<strong>and</strong> that <strong>the</strong> shar<strong>in</strong>g of unsterilized needles <strong>and</strong> syr<strong>in</strong>gesis common among <strong>in</strong>ject<strong>in</strong>g drug users. The study alsofound risky behaviours among <strong>the</strong> 15-17-year-old <strong>and</strong>older age groups: buy<strong>in</strong>g <strong>and</strong> sell<strong>in</strong>g of sex; sex with nonregularpartners; premarital sex; group sex; <strong>and</strong> <strong>in</strong>ject<strong>in</strong>gdrugs. However, <strong>the</strong>se behaviours are not consistent with<strong>the</strong> self-perception of risk. The majority of respondentsbelieved <strong>the</strong>y would not get HIV from such behaviours.Some 3-6 per cent believed that <strong>the</strong>ir religion alone wouldprotect <strong>the</strong>m from HIV (UNDP <strong>and</strong> MOH, 2008). Youthseek<strong>in</strong>g counsell<strong>in</strong>g services are <strong>in</strong>creas<strong>in</strong>g 1 but <strong>the</strong> servicesare limited ma<strong>in</strong>ly to Malé. In 2009, Maldives participated<strong>in</strong> <strong>the</strong> Global School-based Student Health Survey, whichsubstantiated some of <strong>the</strong> f<strong>in</strong>d<strong>in</strong>gs of <strong>the</strong> above-mentionedsurveys <strong>and</strong> studies. The Survey found that <strong>the</strong> prevalenceof alcohol use among school students was 6.7 per cent.Alcohol use among boys was 9.1, whereas for girl students,it was 4.2 per cent. Among those who used alcohol, 66 percent of <strong>the</strong>m had used it prior to turn<strong>in</strong>g 14 years of age(Education Development Center <strong>and</strong> WHO, 2009).To address <strong>the</strong> sexual <strong>and</strong> reproductive health (SRH) careneeds of adolescents, UNFPA has been support<strong>in</strong>g <strong>the</strong><strong>in</strong>tegration of population <strong>and</strong> life skills education activities<strong>in</strong>to school curricula. However, <strong>the</strong> <strong>in</strong>troduction of thoseactivities has rema<strong>in</strong>ed modest <strong>and</strong> conf<strong>in</strong>ed mostly to <strong>the</strong>Malé area. The modules <strong>and</strong> tra<strong>in</strong><strong>in</strong>g have been very muchappreciated but ow<strong>in</strong>g to lack of support it has not beenpossible to reach out to <strong>the</strong> most vulnerable populationgroups – out-of-school adolescents <strong>and</strong> youth.To fill <strong>in</strong> <strong>the</strong> gaps <strong>in</strong> SRH services for adolescents <strong>and</strong>youth, particularly out-of-school youth, UNFPA <strong>and</strong>WHO jo<strong>in</strong>ed h<strong>and</strong>s to establish <strong>the</strong> Youth Health Café<strong>in</strong> Malé, which was a step forward <strong>in</strong> creat<strong>in</strong>g a conduciveenvironment for improv<strong>in</strong>g adolescents’ access to SRHservices. However, <strong>the</strong> <strong>in</strong>itiative did not produce <strong>the</strong>required momentum for a number of reasons. “Ownership”of <strong>the</strong> programme was lack<strong>in</strong>g. Institutionally, <strong>the</strong> Café ishoused <strong>in</strong> <strong>and</strong> run by <strong>the</strong> M<strong>in</strong>istry of Youth <strong>and</strong> Sports,but <strong>the</strong> services were to be provided <strong>and</strong> coord<strong>in</strong>ated162