Critically evaluate the issues related to sexual and reproductive health of the younger generation of Sri Lanka. (2012)
Issues:
Could be to both male/ female
Patient issues
Pubertal/ menarche
Who doesn’t want to conceive: contraception needs- emergency, planned/teenage pregnancy/ rape/ abuse/ domestic violence
Who wants to conceive: preconceptional counselling/ subfertility/ PCOS/ STI/ pain disorders- endometriosis
Social issues
sex education/ social stigma- virginity/ unrestricted social media/ free access to adult content
Sri Lanka is a developing middle income country with a maternal mortality rate of 30 per 100000 live births, high literacy rate and gender equality.
However there are many aspects which should be evaluated and improved.
There are many myths and beliefs regarding puberty and menarche. Girls are kept away from school and sports and there are dietary restrictions as well. Poor menstrual health occur due to poor toilet facilities in schools and communities and the cost of sanitary pads. Discssion regading menstrual problems are taboo.Dysmenorrhoea is regarded as normal and analgesics are regarded as harmful. Children miss school and dysmenorrhoea is not treated causing suffering. As medical advice is not taken early endometriosis can be missed. Heavy menstrual bleeding and frequent and infrequent irregular bleeding can occur and may not be treated resulting in anaemia. Obesity and PCOS may not be treated causing prolonged exposure to oestrogen and infertility and endometrial carcinoma in later life.
Delayed menache may be regarded as normal and not treated till late. It is associated with social stigma which prevents girls from seeking treatment. Due to lack of counseling the problem may not be revealed till after marriage resulting in serious problems.
There is very little emphasis on sexual education which is not included in the school curriculum. Adults do not discuss such matters with children due to cultural taboos Younger generation are not aware of the dangers of casual premarital sex including pregnancy and STD. They have limited knowledge regarding contraceptives and safe sex. There are no counselling services by the MOH, schools or religious organisations for young girls. There are restrictions to obtain contraceptives for unmarried young people due to availability mainly at MOH clinics and social stigma which prevent them from attending such clinics .
Rape and sexual abuse are prevalent and are not reported in most instances due to social stigma. Even in reported cases legal procedures are expensive and prolonged and the offenders escape in most cases. Pregnancy and STI can result.
Children from broken and single parent families have less protection. Such children are employed in tourism and prostitution. Underage marriages occur in poor socio economic class and in certain ethnic groups resulting in teenaged pregnancies
Unwanted pregnancies with a heavy social stigma occur as a result of casual premarital sex and rape. Contraceptive failure can occur even in married women. Teenaged pregnancies are also unwanted in most cases. As abortions are not legalised these women seek illegal terminations with resultant sepsis and subsequent chronic pelvic infection, chronic ill health, infertility, ectopic pregnancies and even death.
Premarital or preconceptional clinics are attended only by a few women due to ignorance social taboos and non- availability. Young women have little knowledge about diet and prefer to eat fast food and mainly carbohydrates. Obesity is regarded as healthy by most women though it can result in GDM, hypertension, metabolic syndrome and PCOS. Anaemia is common due to poor nutrition and poor sanitation but can be missed till the woman is pregnant. STD may be prevalent due to lack of knowledge regarding safe sex but is not screened except at the antenatal clinics. Women with symptoms do not attend STD clinics due to social stigma. Major disease conditions such as heart disease and juvenile diabetes can be missed due poor school medical services.
Well woman clinics are attended only by women over the age of 35 years. Recently HPV vaccination was included in the immunisation schedule.
Dyspareunia is common among newly married couples due to poor sex education. Infertility is common due to tubal factors caused by sepsis, PCOS, dyspareunia and infrequent intercourse due to living apart for employment. Infertility has a social stigma and can cause depression. Advanced methods of Treatment is costly and available only in a few centers.
False belief regading virginity and bleeding at first intercourse can cause marital disharmony depression and even suicidal tendencies.
The problem of large unsupervised tuition classes should be attended as children form relationships and find opportunities to leave home resulting in sex and pregnancy.
Social media is freely available and is a path to forming relationships. Drug addiction also affects the sexual and reproductive health.
The trend for delaying marriage and conception has caused an increased incidence of fibroids and endometriosis among young women.
All the above problems can be reduced or prevented by proper education and clinical surveillance. Sex and health education should be a subject at school for teenaged children. School medical inspections should be strengthened to detect children with anaemia, heart problems, asthma, allergies and other illnesses early.
Young women should be educated regarding sex, contraception, diet and screening facilities for diseases by lectures at MOH clinics and workplaces. Posters, flyers, and advertisements in the mass media and social media are essential. Contraceptives should be available without restriction and it should be possible to screen for sexual health problems at the MOH clinic.
Parents should watch the movements of the children, restrict the use of mobile phones and internet. Parents , teachers and authorities should form a body to supervise tuition classes.
There should be an islandwide operation to arrest those selling drugs.
Probation , education , health, police and social service departments should address all the above issues to improve the sexual, reproductive and other health problems of the younger generation.
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