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
“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
 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
BANGLADESH CONTEXT
 Legal age of marriage: 18 years
 Mean age at first marriage:
15.7 years
18
14.9 years
16
14
Age
10-14
15-19
20-24
12
13 years
10
8
BDHS 93
BDHS 96
BDHS 99
BDHS 04
BDHS 07
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:
Age
30
25
18.7
18.4
1999-2000
2004
19
19
20
15
10
5
0
2007
Source: Bangladesh DHS 1999-2007
BANGLADESH CONTEXT (contd.)
 General fertility rate: 105 births/1000 women
 Adolescent specific fertility rate: 126 births/1000 women
200
196
192
180
188
192
173
160
ASFR/1000
140
140
147
144
135
120
126
10-14
100
15-19
80
20-24
60
40
20
0
4.6
BDHS 93
13.0
BDHS 96
9.8
4.8
BDHS 99
BDHS 04
BDHS 07
Source: Bangladesh DHS 1993-2007
 Poor, non-educated, rural adolescents most vulnerable
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:
1. To examine the status and implications of human rights approach for
adolescent health in Bangladesh
2. To study the national laws and policies related to core aspects of
adolescents’ SRH
3. Review health data together with laws, policies and regulations
related to adolescent SRH, in the context of human rights
4. Review and document government efforts to respect, protect and
fulfill adolescents’ right in the context of SRH
5. 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




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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
CHALLENGES
 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…
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Assessment of laws and policies for strengthening adolescent