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.


Couple charged with murder after allegedly aborting, burying five-month old foetus

The Criminal Court has charged a couple from Seenu Atoll with murder after they allegedly aborted a pregnancy and buried the five month-old foetus on the beach of Maradhoo-Feydhoo.

Twenty-one year-old Aminath Shaahee Aalam was 20 weeks pregnant when she gave birth on December 12, 2012, according to local media. Shortly after she gave birth, her husband, 26 year-old Ibrahim Wisam, stands accused of placing the foetus in a plastic bag and burying it on the beach.

Police discovered the foetus buried on a Maradhoo-Feydhoo beach after local witnesses reported a motorist acting suspiciously in the area on the evening of December 14, according to local media. Abortion in the Maldives is illegal unless it is proved the conception is the result of rape, or that the pregnancy is a threat to the mother’s health.

The Prosecutor General’s Office forwarded the couple’s case to the Criminal Court on May 2, however a trial date has not yet been scheduled.

The young married couple from Maradhoo-Feydhoo – an administrative district of Addu City – are both being charged with murder, Criminal Court Spokesperson Ahmed Mohamed Manik confirmed to Minivan News today (May 5).

The prosecution accused Aalam of taking abortion pills, and alleged the couple did not seek medical care during the woman’s pregnancy, labour, or after giving birth to the five month-old foetus.

Police have stated that the buried foetus was found with its heart beating, but later died after being taken to the hospital, Manik explained.

Police said the couple had said they chose to bury the foetus because they did not want to have a child at that point in time, according to local media.

A medical authority in the Maldives informed Minivan News that a five month old foetus would be incapable of surviving outside the mother’s body.

In previous similar cases in the Maldives, a lack of post-mortem services and an absence of visible wounds on the body was observed as making it difficult to prove charges of infanticide without a confession from suspects.

In 2006, the Juvenile Court acquitted a woman from Dhabidhoo island, who police alleged had killed her newborn and disposed of the body in the lagoon, ruling that her three confessions contradicted each other. The woman gave birth out of wedlock in 2008.

Desperate measures

Cases of abortion, infanticide and discarded infants have been widely reported in local media over the past two years, particularly a spate of discoveries over several weeks in May 2011. One foetus was discovered in hidden in a milk tin, while the other was found at the bottom of Male’s municipal swimming pool area.

Later the same month, the corpse of a newborn infant was found discarded in some bushes with underwear tied around its neck.

A further two newborn children were discovered abandoned but alive the same year, and were placed under state care.

In December 2012, a newborn was found abandoned on a pavement in Male’, while in June the same year police recovered the body of a newborn infant buried in the outdoor shower of a house on Feydhoo in Shaviyani Atoll. The baby’s mother was identified as a 15-year old school student, who had allegedly been abused by her stepfather.  The girl’s stepfather was himself later charged with child sexual abuse and premeditated murder.

The 15 year-old meanwhile confessed to an unrelated instance of premarital sex during the police investigation and was sentenced by the Juvenile Court in February 2013 to 100 lashes and eight months of house arrest for the crime of fornication.  At present, the minor will be lashed once she has turned 18.

The girl’s case has garnered international attention and a petition by Avaaz for the government to appeal the sentence and issue a moritorium on the flogging of women for extramarital sex.  The petition has so far reached over two million signatures.

Social stigma

Birth out of wedlock remains heavily stigmatised in the Maldives. An unreleased 2007 study by the International Planned Parenthood Federation (IPPF) found that the stigma of having a child out of wedlock compels Maldivian women and girls to opt for abortions, and while a taboo subject, the practice was found to be widespread.

Some of those interviewed for the study said they knew of girls as young as 12 who had undergone abortions, and each knew at least one person who had terminated a pregnancy.

Abortion is illegal in the Maldives except to save a mother’s life, or if a child suffers from a congenital defect such as thalassemia. Many women unable to travel to Sri Lanka resort to illegal abortions performed by unskilled individuals in unhygienic settings, or even induce abdonminal trauma or insert objects into their uterus.

Other studies focusing on HIV have identified associated risk factors contributing to unplanned pregnancy including high levels of promiscuity and limited use of contraception.

The Centre for Community Health and Disease Control (CCHDC) has described these incidents, as well as the figures detailing an increase in the rate of sexually transmitted diseases, as evidence of a sexual health crisis in the Maldives.

Nazeera Najeeb, who leads the reproductive health unit of the CCHDC, told Minivan News in an 2012 interview that the centre was witnessing an “alarming” increase in cases of underage and unplanned pregnancies, where some girls are getting pregnant “without even knowing it”.

“These unwanted pregnancies are subsequently resulting in more unsafe abortions, baby dumping or infanticide,” she noted.

To curb these perceived problems, Najeeb stressed the need for implementing a comprehensive sex education curriculum in and outside educational institutions to create greater awareness on sexual and reproductive health subjects.

Though the concept of sex education is widely supported by health authorities, including Health Minister Dr Ahmed Jamsheed, efforts to implement such practices nationally have been limited.