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.


High-risk behaviour leaves Maldives at risk of HIV/AIDS “explosion”

A new report has revealed that the health authorities detected 18 HIV positive cases and over 400 cases of Sexually Transmitted Infections (STIs) in last year – a “significant” finding which has highlighted the need for additional research to understand the prevalence of STI’s and HIV in the Maldives.

The report, “Annual Communicable Disease 2011” from the Centre for Community Health and Disease Control (CCHDC), revealed that among the 31,016 people tested under the Voluntary Counseling and Testing (VCT) program last year, a total of 438 cases of STIs were reported, out of which 97 percent affected females.

The report says among the 426 females with STIs, 395 involved vaginal discharge cases and 31 ulcers. Meanwhile, males with STIs were reported significantly low at 12 – eight cases of urethral discharge and four cases of ulcers. The report does not specify the age group, however all participants in the study were volunteers.

CCHCDC director Director Moomina Aboobakuru told local media that the authorities are deeply concerned about the increased detection of STIs such as chlamydia and gonorrhea – both conditions that can cause infertility if left untreated.

As the surveillance is limited to the number of people volunteering to take the tests, and with no nationwide survey, Aboobakuru believes that more people are likely to be living in with STIs “undetected”.

Meanwhile, Dr Ahmed Jamsheed, public health expert and former Director General of the CCHDC, argued that it could not necessarily be deduced from the report that the sexually transmitted diseases are on the rise in the Maldives.

He explained that as this was the first published general finding on STIs in the Maldives, there was no reference to determine whether cases were on the rise nationwide without previous data to compare it with.

“But certainly there is an urgent need for additional research for STI’s , including HIV to understand the prevalence of these diseases in the country,” Dr Jamsheed asserted.

Risk of HIV/AIDS ‘explosion’

Jamsheed and CCHDC officials fear that increasing rates of “high risk behaviour” risk the historically low rate of HIV prevalence in the Maldives, putting selective groups such as drug users, resort workers and people travelling abroad at greater risk.

Meanwhile, a total of 18 HIV positive cases were reported last year alone – including 17 expatriates and one local.

Between 1991 and 2011, 15 HIV cases were reported among Maldivians, compared to 168 among expatriate workers. Of the Maldivian cases 13 were males, and two females, and all patients cited heterosexual transmission as the cause.

Despite the country’s conservative exterior, Dr Jamsheed wrote on his blog in June 2011 that Maldivians have always been sexually very active: “High divorce and re-marriage rate, which increases the number of sexual partners any individual have over the lifetime. It is also a known fact that despite being a Muslim community, a lot of Maldivians have multiple extramarital relationships.”

Human trafficking for purposes including sexual entertainment has put more locals at risk, while in 2010 police arrested an HIV-positive prostitute.

Further risk factors include falling rates of contraceptive use, Dr Jamsheed wrote, particularly among high risk groups.

“The condom prevalence rate in the Maldives is very low and on a negative curve, though this data comes from married couples. Studies also show that condom use by the high-risk groups (commercial sex workers, men having sex with men, clients of sex workers) is also very low. Condom is the most effective preventative tool we have to protect from HIV transmission through sexual intercourse,” Dr Jamsheed wrote.

Furthermore, “However much we deny, there is a significant number of gay men in the Maldives, a lot of who are married and having bisexual relationships. There is also reason to believe that the gay community in the Maldives is increasing and becoming more organized and open about their sexual orientation,” he wrote.

Without any formal sexual education in schools and a general stigma around purchasing condoms, the basic defenses against HIV transmission are low.

“With all these extremely high risk factors, it could be said that we are sitting on a ticking bomb for an explosive HIV epidemic,” Dr Jamsheed warns.

“It’s [only] a matter of time for the virus to be introduced to the high-risk circle, especially the IV drug users. Unless we escalate our preventive efforts and introduce new and more effective measures, the low HIV prevalence in the Maldives might change to a very high prevalence in no time.”