Maldivian youth need access to sexual reproductive health education, services: Department of National Planning

Maldivian youth need sex education and access to reproductive health services, given high numbers of unsafe abortions, rising infanticide, as well as increasing risk factors that contribute to the spread of sexually transmitted infections and HIV/AIDS, a Department of National Planning study has found.

The study examined how much human development progress has been achieved in the Maldives in terms of population and development, reproductive health and rights, gender equity, equality and empowerment of women as well as education during the period 1994 – 2012.

The thematic Programme of Action (PoA) goals were established during the 1994 Cairo International Conference on Population and Development (ICPD) and adopted by 179 participating governments, including the Maldives. Thus, the “Maldives Operational Review for the ICPD Beyond 2014” study was conducted under the supervision of the Department of National Planning (DNP) in collaboration with the United Nations Population Fund (UNFPA).

Overall the study found that the Maldives has “accomplished remarkable progress” in achieving the ICPD PoA goals, with “impressive advancements in all development areas… and notable achievements in sexual and reproductive health.”

However young people and women continue to lack access to quality services, particularly in regard to sexual and reproductive health, which is putting their health at risk.

Youth comprise the largest population group in the Maldives and “[with] the number of young people entering their reproductive years on the rise, special attention to ensure that adolescents and youth are provided with sufficient knowledge about their anatomies, sexual and reproductive health, contraceptives and sexually transmitted diseases is needed,” stated the study.

“Access to contraceptives is limited to the married population despite overwhelming empirical evidence suggesting the need to provide contraceptive information and access to the youth population,” the study noted.

“Information must also be provided on the risks of getting pregnant in young age and of unsafe abortion,” the report continued.

“Simultaneously, it is also essential to establish more comprehensive and confidential reproductive health services which are more accessible and affordable,” the study found.

The report repeatedly noted that although information regarding reproductive health, HIV and sexually transmitted infections (STIs) are technically “available to everyone regardless of age, gender and marital status…access to reproductive health services are still limited to the married population.”

However, even the married population is not always ensured access to accessible, affordable and confidential reproductive health services, according to the study’s findings.

Contraceptive use among married couples is “relatively low”, with “Only 27 percent of married women using modern methods”.

“With regard to reproductive rights, men often control decisions regarding women’s reproductive health, often based on religious and cultural grounds,” the report noted.

“[Furthermore,] the sudden growth of religious fundamentalism and conservative thinking is an emerging challenge, particularly for women and young girls,” the study stated. “There have been increase towards certain trends such as preference for home schooling and refusing vaccination and other medical services for women based on religious beliefs.”

Sex, drugs, and reproductive rights

The report highlighted the “clear indicators of the imperative need to provide access to information on sexual reproductive health and reproductive health services to the sexually active adolescents and youth population.”

High numbers of unsafe abortions – mostly through injections and pills – were noted as “one of the main causes of preventable maternal deaths in the country.”

Infanticide also appears to be increasing, as demonstrated by media reports of “several new born babies and few premature babies found in parks and/or buried in secluded places and/ or thrown into the sea,” said the report.

“These are clear indications for the need of life skills programmes and reproductive health education,” the study suggested. “Access and utilisation of contraceptives to avoid unwanted pregnancies must also be advocated to minimise these issues.”

The lack of reproductive health rights and services for women and girls have also lead to observed increases in non-communicable diseases such as breast cancer and cervical cancers, according to the study.

Meanwhile, male reproductive health issues are often ignored, while “family planning and use of contraception is largely considered a woman’s responsibility.” Therefore, the study recommended strengthening awareness information and access to male reproductive health services.

In order to create the awareness needed about reproductive rights and reproductive health, the report suggested using “Carefully targeted programmes using innovative and youth friendly tools such as social media and text messaging.”

An interrelated issue includes widespread drug use and substance abuse among Maldivian youth, with cases reported to the Maldives Police Services increasing from 195 cases in 2001 to 1,160 cases in 2010, noted the study.

“The high level of drug usage coupled with the increase in commercial sex workers imposes great risks for HIV/AIDS and other sexually transmitted infections and reproductive tract infections,” said the report.

The lack of sexual reproductive health access and awareness combined with risk factors including sharing needles to inject drugs, sexual activities among adolescents and youth, extramarital sex, and commercial sex workers, “could contribute to an increase in the incidence and prevalence of STIs and HIV/AIDS,” the study found.

“It is therefore crucial to educate the population on the risks of STI’s and HIV/AIDS through carefully designed behavioural change communication strategies,” the report recommended. “It is equally important to promote awareness on the availability of voluntary counseling and testing services and contraceptives such as condoms in Male’ and in regional level.”

The report recommended giving special consideration to “identify these high risks groups and provide them with the necessary information, treatment and services.”

Age appropriate sexual and reproductive health education needs to taught in schools to combat the increasing “sexual health illnesses” in the Maldives, according to the Centre for Community Health and Disease Control (CCHDC).

In 2012, CCHDC’s Public Health Programme Coordinator Nazeera Nazeeb revealed that studies have found high risk behaviors – including “unprotected sex, drug and alcohol abuse, homosexuality and prostitution” – are putting young people at high risk of sexually transmitted diseases and HIV.


“Worst fears over HIV coming true”: Health Minister

Minister of Health Dr Ahmed Jamsheed Mohamed has expressed concern about the risks of HIV spreading rapidly in the Maldives, stating that “our worst fears seem to be coming true.”

Jamsheed said that although the Maldives had remained on the HIV less-prevalent category since the first HIV positive case was found in 1991, “all the habits that may lead to the spread of HIV is excessively in practice here,” stating that it was only through “incredible luck” that the disease had not already spread widely throughout the country.

At the press conference on Sunday, Jamsheed said: “What has always worried me most is that there is a large drug community, and that the virus might find its way into this group, especially the IV drug users. Once it does, it will spread like wild fire.”

“I don’t think this is too far off now. We have already identified one IV drug user who has been infected with HIV. What’s left is to see how much this has spread,” Jamsheed revealed.

Jamsheed further cautioned against assuming that the HIV virus would stay within the injecting drug user circle, pointing out that some drug users do so in secret, and that many are married to non-drug users who could just as easily be infected with the virus.

Minister of State for Health Lubna Zahir Hussain, who heads the National Drug Agency (NDA) and Centre for Community Health and Disease Control (CCHDC) Director Maimoona Abu Bakr said that both their departments were taking preventive measures against the spread of HIV.

Jamsheed, too, said the NDA’s efforts to help drug users out of their addiction is a preventive measure against HIV as drug users are most at risk.

Meanwhile, the CCHDC is working with civil society groups like Journey, Society for Women Against Drugs (SWAD) and regional NGOs to spread awareness about STIs and HIV, and to encourage the public to change their habits to ways that present less risk of contraction.

Practical action or the moral highground?

Jamsheed said that he believed there were issues which needed to be opened to a “national debate” in order to move forward and take stronger preventive measures.

“We can simply stay inactive and keep talking for any amount of time by assuming the moral highground,’ Jamsheed said at Sunday’s press conference.

“That is to claim that we are Muslims, and by living in a Muslim state in Muslim ways we are doubtless protected from this disease. But that is never the reality anywhere in the world,” he said.

Jamsheed said it was unrealistic to assume all Muslims to live as “perfect Muslims”, and that even if they were, there was still a chance of infection. He stated that HIV is not transferred through sexual activity or visits to prostitutes alone.

“This is an argument I do not accept,” he said. “I presume that those among us who are already infected are also Muslims, being Maldivians. Of course, there are certain protections that being in a Muslim community affords us. For example, all of us men have been circumcised, which is proven to provide protection against STIs. To put it short, we need to work on more practical forms to prevent the spread of HIV.”

Sexual promiscuity elevating risks

The minister further spoke of the risks of promiscuity in the society, referring to the 2010 case where police arrested an HIV positive prostitute. He stated that the same prostitute had been identified in the Maldives as being HIV positive in the year 2009 as well, emphasising the risks to the spreading of HIV that such events presented.

Prior to his appointment as Minister of Health, Jamsheed had written about his concerns regarding the spreading of HIV in his personal blog, speaking about the “sexually active” lifestyle of the Maldivian people, which created a higher risk of infection.

“Maldivians have always been a sexually very active and promiscuous community. We have a very high divorce and remarriage rate, which increases the number of sexual partners any individual has over their lifetime. It is also a known fact that despite being a Muslim community, a lot of Maldivians have multiple extramarital relationships,” he had written then.

CCHDC’s Maimoona Abu Bakr also highlighted that “undesired sexual acts”, prostitution, injecting drug users and homosexuality proved to be some of the greatest challenges to preventing the spread of HIV.

In 2011, a total of 18 HIV positive cases were reported, out of which one was of a local. Between 1991 and 2011, 15 HIV cases were reported among Maldivians, while 168 cases of expatriate workers were also filed. Two out of the 15 cases were female, and all patients cited heterosexual transmission as the cause of infection.


Health Minister says compassion can cure sector’s ills

Minister of Health Dr Ahmed Jamsheed has told local media that 80 percent of the problems in the healthcare sector could be resolved if patients were spoken to in a more compassionate manner.

“We have to keep in mind that patients are usually worried. They don’t go to the doctor for fun. We have to provide patient-focused services,” he told Sun Online.

He said that one bad experience by a patient can affect an entire community.

Referring to issues regarding the payment of salaries in the sector, Jamsheed said that these concerns were related to problems in the Finance Ministry.

“Problems with receiving salaries should not affect their work. That should not be the attitude of health sector employees,” he said.

Sun Online also reported that Minister of State for Health Lubna Zahir had stated that the HIV spreading behaviour was on the rise in the Maldives.

Speaking at the closing of the Enhancing the Response to HIV/AIDS in the Maldives project, Lubna said that the risk was highest amongst drug users.

“We have collected information that shows that behaviours that contribute to the spread of HIV are increasing at an alarming rate. The risk of HIV spreading fast in the Maldives is extremely high,” Lubna is quoted as saying.