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References

Filrr, Dcon, Elizabtl M. King nnd t nt Prihhott (1998). Gewler Dkparlty tn South Asta:
Comparlsotu Betwecn qnd
lltthtn C,owtrtes (Weshinghn, DC, lVorld Bank, Devolopmont
ftq||rh Group on Povcrty rnd Hunnn Rercurcor).
l,i'
InEmrffinal Institutc fo Popuhtion Scicnccs (IIPS) (2000). Indla, Nattonal Fantlly Health Sumq
Wf
HS-z), I 998-99, Mumbsi.
Unitcd Nationr, Economic md Social Commicrion for Asia md iho Prclflc (ESCAP) (t996).
Wonat of Nepal: A Country hofle,
gtltirtic.l
Profiler, No. 4 (Now Yol, Unitcd Nrtlonr).
(1997), Wonen ol PoHilan: A Cowlry &o.fle, Strtlrticrl hofilcr, No. E (New York,
UnitcdNrtionr),
(1995), Yonen of Bangladuh: A Country Prul/c, Sbdrtlcrl Profilcs, No. 2 (Ncw
York, Unltcd Nations).
Unicd Nrtionc (l99l), Vonw Challenga n the Ycar 2000 (Now York, Unibd Netionr).
QW0).
Ihe World's Womcn: Tlends and Statbtlcr (Now York, Unled Nrdonr).
Visaria, I*clr md Vimrla Rrmaphrndnn (2002),
"Whtt DPEF ud othor drta soure! rcvcol',, in:
Rmrchrndrur, Y, Gender and Soclal Equlry ln Prlmaty Educatlon (New Delhi, Thc
Europcsn Comnission),
Waldmn, I (1987).
"Psttcrru md caulor of oxcou fomlo rmrtality rmong ohildren in dcvcloping
counfioc", World Heahh Slatbllcs
Quanub, vol, 40.
96 Adr-Prclf,c Populrdon Journrl Vol. 17, No. 4 Arlr-Prcllic Populrtlon Journrl, Deccmbu 1002
97
Adolescent
ReproductiW
Health
ift.,As,ia
It ls evident that the setcual ond reproductive health of
adolescents has emerged a$
qn
issue 6f sreat concern inAsta,
Thls is based on two dimographic trendblhat adst in the resion:
the widening gap between sqxual maturtU and age at marri-age,
and the continuing prevatence of ado[escmt tiarriage anf,
low contracepttvewse
during adolescence.
-
By tshakta,B,.Gubhaju'
-
The reproductive health ofadoleoccng is ofgrowing concern today. The
Programme of Action adopted at tho Internationai condrence on
population
and-Development held at cairo ln 1994, stesses thc irnportance of addrcssing
adolescent soxual and reproductive
hpalth issues and
iromoting
responsibfi
eexual and reproductive behaviour ((ftrited Nations, tr+;. rnirepmductive
health needs of adolescNrb hnvc beeil lugely ignored by.tho odstiug health
services. Thereforc, there is a need'to provide such scrviies and to unoertakc
researsh in understanding adolescent sexual behaviour and reproductive hoalth.
--. .:, .Population
Affsirl Officer, Population and Runl and Urban Dcvclopment Divisiorn,
Unitpd Nrtione Economic and Socid Cornnrisgion for Acia and the
prcific.
It is important to recognize the growing incidence of premarital sexual
activity among adolescents, owing to the widening gap between age at
menarche and age at mariage. Ar most acte of premarital sexual intercourse
are unprotected, sexually active adolescnts are increasingly at risk of
confiacting and tansmitting sexually tansmitted diseases (STDs), including
HIV/AIDS. In addition, young womcn are particularly vulncrablc to coerced
sexual intercourse as a result of gender powcr imbalances. Sexually
expcricnced adolescents arc tlpically unaware of thc consequenccs of
unprotected sexual intercoursp and are poorly informed of their soxuality and
means of protecting themselves, often leading to unwanted pregnancy and
abortion.
In some Asian countries, there is a high proportion of maniagc during
adolescencc, reeulting in a high rate of adolcscent childbcaring. Mothcrhood at
a vcry young age entails a risk of maternal mortality that far exceeds the
average, and tho children of young motherg tend to havo higher levcls of
morbidity and mortality. Early childbearing contlnuec to bc en impcdiment to
improvements in the educational, economic and cocial
gtatus
of women, It is
also known that conhaceptive use among maniod adolesccnb is noticeably
lower than among older women. ThuB, it is lmportant that information and
scrvices on reproductive health bc madc availablc to both married and
unmanied adolescents,
This papc frst highlights 0re dcmographic dimcnsione of thc scxual and
reproductive health of adolescents in Asia. It discusoos adolesccnt sexuality and
the factors that influence their sexual behaviour. It also discusses adolescent
childbearing and contraceptive use. Finally, it oxamlner tho conrequenccs of
adolcscent sexuality and childbearing and concludos with a discussion outlining
the scope for fiuther research.
Demographic dlmensionr of tdol$cent
sexual ond reproductlve health
Adolescentc ln Aslr
Adolescence is defincd as the stage of lifc during whioh individuals reach
sexual matunty; it is the period of tansition from puberty to matuity (United
Nations, 1997). The 10-19 agc group identifies the pcriod of adolcscence.
Howcvet, for the purpos of this paper, tht word "adolesc6nts" refcrs to the
15-19 age group, as data on reproductive health are most commonly available
for this particular age group, Furthermore, the reproductive bealth problcms
and needs ofadolescents tend to be more distinst than thosc ofyouth aged 20
to 24 years old,
Arla-Prclllc Popuhtlon Journd, Vol. 17, No. { Arlr-Prclflc Populrtion Journal, December 2002
X'lgure l. Porcentrge distribution of populatlon
I ngod 15 to 19: Atlao 2000
South-Erst
Aslr
th rnd
South-Wcrt
Arlr
4So/o
Sowtat Unitod Nations (2001n), llorld Populatlon Prospects, Ihe 2000 fievfrJoa, vol. I
Comprclnnrlvc faDlar (Unltcd Nrtlonl
publlcltion,
$nlos No, E,0l XII.8).
t'
Of ttro world's 6,1 btlllon popuhtlon in 2000, over onc billion peopk
(19.1 pcr cont) belongod to tlro 1g.lp,ngo group. The Asian region compriset
712 million pcoplo in this ago
s.roup.rAccording
to United Nations medium'
variant projections, the nitrnbof,of pcrnons in the 10-19 age group will continue
to gtow worldwido, reaoliing t,2sS rrnillion by the year 2025, while in Asia this
numbcr will decline to 698 rniltion by tlro year 2025 (Unitod Nations, 2001a).
The population in ttro ,15-19
,nge
group, hereaftor rsferred to
n'u
sdolcsgcnts", will also cxperienco a remarkable changc during thc pcriod 2000.
2025,In 2000, therc werc 554 million adolescents living in the worl4 of whon
48.5 per ccnt were females. Over tluec fifttts (62 por cent) of these adolescentt
belong to Asia. kr lhis region, 9 pcr cent of thc total population in 2000 wcn
adolcsccnts. Figuro I shows that the largest number of ndolescents reside ir
South and South-Wogt Asia (45 per cent) followed by East and North.East Asil
(33.6 pcr cent). According to Unicd Nations medium variant projcctions, tht
world adolesccnt population will incrpase by 40 million to 594 million b1
2010, whilc in Asia it wiil increase by 17 million to 358 million by 2010
Whilc thc world's adolescent population will continue to grow to 619 millior
South
and
Sotrth-
Wcst
Asia
t00
I
.3
E
E
6
tA
I
.l
.'
I
q
c
L
:.
a
I
r
f
B
p
E
E
E
Figure 2. Trendr in population aged 15 to 19:
world and Asia' 2000' 2010 md2025
500
2W
World Asia Esst and South-
North- East
East Asia
Asia
tr2000 02010 t20t5
Ntrth
and
Central
Asia
Source: United Nations (2001s). llorld Populatlon Prospecls, llv 2000 Raislon, vol, l,
Compreheaslve Tabl* (lJnitld Nations Publication, Salcs No, E.Ol XIILS).
by 2025, Asia will witness a fall in its adolescent population to 348 million by
2025, dr$ng to 7 per cent of the total population (figure 2),
Within Asia, the number of adolescents will continue to grow in South
and South-West Asia, from 153 million in 2000 to l8l million in 2025, while
other subregions will exhibit a decline in the number of adolescents m2025.
Age at marrlsge
There are two distinct issues concerning thc tends in age at marriage in
Asia that have implications for the sexual and reprodustive health of
adolescents. The first concems the tend towards an increase in the age at
marriage in many counties in the region. This tend has rcsulted in an
extended period of adolescence beforp marriage in these counfries. At the same
tine, a number of studics have documented the frend of a fall in age at
mcnarche, which implies an earlier onset of adolescence, sexual rnaturity and
the ability to reproduce. This tend is commonly attributed to a variety of
environmental, genetic and socio-economic factors, including improved
100 Asia-Paclflc Populadon Journel V_$?gr.*io. 4
Ath-Prciflc Populatlon Journrl, December 2002 l0t
Table 1. Percentage of wotnon rged 20 to 24 and 40 to 44 who married
by ager 15r 18 and 20, by country and year ofsurvey
Country Yerr of
ruryey
,0 to2d 40 to 44
Percentrge mrrrlcd
by rge
Percentege mrrrlcd
by rge
15 15
Bangladcrh 1996llW 46'8i
India 199?/1993 26'l
Indoncsia lWl 5,8
KazaldrEhn 1999 0.3
Kyrgyzsbn 1997 0.1
Lao Peoolc's Dernoc,r.tic 2000 7.3
Republic
Mongolia 1998 Az
Ncpal 1996 lrrl
Pskistln l990ll99l 11,4
Philippines 1998 2,8
Sri f"snka 1993 l.l
Thailmd 1987 2,4
Turlccy 1998 4,2
Uzbekishn t996 0,4
Viet Ngm 1997 0,9
68;5, 71.1
54,2 7t.4
2S,S 47.0
14,,7 54,6
2t,2 58,4
26,0t 49.5"
93.6 96.7
72.4 85.3
49.1 67.2
7.8 37.1
ts.1 46.7
23.i' 48.8"
17.7 44.8
?5.0 87.1
4.8 60.9
20.2 36,8
26.3 40,5
u.4 47.4
43.0 66.2
18,0 s6,2
t3.2 34.6
73.5
40.8
18.2
0.1
0.0
6.0
0.4
36.5
18.0
3.3
8.0
3.1
10.E
0.2
1.3
10.4 36.7
6fr'3 75,7
31.6 48.9
t4,6 27.s
lf,? n.8
20,s 37.0
23,p 42.8
15.3 ss.1
12.4 35.9
Sowcest Veriouc dcrmgaphlc rtd hod0r'rurvcys,
' By agc l?.
" By agc 19.
nutition and er(posure to modorn rocial life. As a result, young ghls arc
biologically mature enough to engage in sex and becorne pregnant at an earlier
age, althougb thcy may not bo emotionally and psychologically mature enough
to undentand the irnplications, Thc widening gap betwcen age at menarche and
age at marriage increascs the possibility that young people will engage in
prcmarital sexual activity. Moreovef, because of the senral inequallty that
prevails in many Asian societies, adolcscent girls are particularly rnrlnerable to
thc risls associated wi0r misinformed and unprotccted sxual relationships, as
well as thc adverse consquences ofadolcscent pregnancy.
The second issue relates to the high incidence of mariagc during
edolescence in some countries in the tgion, resulting in higher rates of
childbeuing. Table 1 shows thc fend in the proportions maried by ages 15, lE
and 20 between rvortrcn aged 40 to 44 and women agedlO to 24 at the time of
the suwey. This table rveals tlnt in several countries in Asia, there is a clear
Flgure 3. Women aged 20 to 24 who had sexual intercourse
and/or who married by age 18, sub-Saharan Africa
P.rcentrge
]2
"---ctn""$rt'p!*"i""'-,"|J
c
I llrdrex by rge lE @ ltlrrrled by rge lt
-fuwce.
Populrtion Rcfcrcnce Burceu (2001). Youth tn sub-Saharan Afrtca: A Chartbook
"!
lqq F-ryertence and Reproducttve Heolth (washington, DC,
po,pulation
Rcfcrcrncc
Burcau, MEASURE Cornnrunicrtior), figurc 7,p. 13,
tendcncy towards a decline in thc proportions married by ages 15, lB and 20
betwecn the older cohort of women agcd 40 to 44 and thc younger cohort of
womcn aged 20 to 24. rt is only in Kazatfistan and Kyrgyzshn that there has
been I notable incrcase in the proportioru married by ages 15, lg and
20 bctween the oldsr rnd yormgcr cohort of women. In thc Lao
people's
Democratic Republic, uzbekistan and vict Nern, the proportions manied have
rernained almost unchanged.
It is, howevcr, to be noted that despite the dccline in the proportions
married by agcs 15, l8 and 20 over time, some cormties cunently extriuit a
high
ineid66se of mariagc during adolescencc. In Bangladesh, for instance, 47
pcr ccnt of women aged 20 to 24 wcrs marricd by agc 15, and 69 pcr ccnt and
77
wr
ce'nt of thesc women werc married by agcs 18 and 20, respectively. A
similar high rate of adolescent marriagc is obeerved in India and Nepal. Among
women aged 20 to 24, over 70 per cent of wonrpn in these cormtics weri
marricd by age 20, and over half the women were manied by agc lg. similarly,
Aslr-Prclllc Populrdon Journa! Vol. lT, No i
Arlr-Paclflc Populadon Journrl, December 2(X)2
Ftgure 4. Women rged 20 to 24 who had sexual intercourse
and/or who mrrrled by age 18' by country and year of survey
Perccntrgc
"'*""b"'k":/
-,tk%-':.J
-"{-
-,f
lllrd rex by rgs 18 lMrrrled by egc lt
Sourcesz Variour dermgraphic and hcalth ourvcyg,
26 per cent of women in India and 19 pm c6nt of women in Nepal in the age
group 20 to 24 were already rnarried b-i afo 15.
Age at llrst sexurl lntercourge
ln sub-Saharon Africa" the incidencs Of premarital cex is clearly evident
from figrge 3, which shows that eorual Oxpericnce
precedeq marriage in uearly
every country sgrveyed. ln those coulltrigs, tfue proportion of young women
who fust had senral intercogrse by ngo 18 is much higher than those women
who were manied by this age (Poplllation Reference Bureau, 2001)' By
contrast, available datr suggest that premarital sex is less comrron in Asia.
According to thc dcmographic and health suryeys carried out in Asia, in six out
of nine counties the proportion of women aged 20 to 24 who had sex by age
18 is either lower or equal to the proportion of women who were manied by
this agc (figure 4). In Kyrgyzstgn and the Lao People's Democratic Republic,
the proportion of women aged 20 to 24 who had eex by age 18 is marginally
higher
than
those wonpn who were manied by this age, while in Kazalcbstaa
the proportion of women aged 20 to 24 who had scx by age 18 is substantially
highu than those womcn who were married by this age (25,5 per cent vrsus
14.7 per cent).
Adolescent sexuality
Sexual behaviour
Although national-level surveys tend to suggest that premarital,sex is less
common in Asia, more focused in-depth studies on adolescent selual and
reproductive health undertaken in some counties of Asia have revealed that it
is clearly on the riso, $urvey reeults on the sexual behrvioru ofadolescents in
Asia suggest that a noticcable percentage of adolesce,lrts are sexually
expericnced. In the Republic of Korca, for exarnple, 24 per cent of male and I I
per cent of female eccondary school students were reported to have had
premarital sexual intercourse, Among sexually experienced adolescents, the
majority of women had ttrcir first sexual intercourse with a steady boyfriend
with marriage in mind, while a significant proportion of men trad ttreir
first cxpcrience with a oommercial
gex
worker or a casual friend, In Nepal,
the RepubHc of Korea, Thailand and Viet Narq over half of the adolescent meu
had sexual intercourso with sex workers. A large number of sexually
oxperienced young mon also reported having multiple sexual partners; close to
70 per ccnt of male studeuts in the Republic of Korea and about 30 pcr ccnt of
young men in Thailand had more than two partners (Brown and others, 2001).
In India, although haditional norms oppose premarital sx, som studiee
indicate a growing hend towarde prernarital sexual activities among adolescentg
(Sharrna, 2000). Data from Bangladesh revealed a vcry high incidence of
premarital sex: 61 per oetrt of males as compared with 24 per cent of femeles
had had premarital senral activity among adolescents, and this percentage was
much higher in urban than in rural areas (Uddin, 1999). Results from a 1991
study conducted in nine districts of Nepal also found ttrat 20 per oent of young
people were engaged in premarital sex (Rai, 2001).
In the case of Myanmar, it has bcen haditionally believcd that unmanied
peoplc are not sexually active; however, many people acknowledged ttrat
unmanied people are engaged in premarital sex (Htay and others, 2000). In the
["ao People's Democratic Republic, a study among community members
revealed that sox and pregnancy bcfore marriage were common and more or
less acceptcd because of the common bclief that pregnancy outside maniage
leads to marriage (Sananikhom and others, 2000). Similar findings werc
revealed by the series ofcountry case studies on sexual and reproductive health
canied out by the UNESCO Regional Clearing House on
population
Education and Communicatior; Bangkok (scc box 1).
However, the motivations for premarital sexual intercours Bre likely to
be different for adolescent men nnd women. Young men tsrd to have the
104
Asla-Prclflc Populrtlon Journd, Vol. 17, No. { Astr-Paclflc Populatlon Journrl, December 2002 105
ffi
W
ff:i.,
$i
+!'
{:,
t;
ffi
ffi
i
Box l. Premsrltal sexual behaviour smong adolescents
Cambodia: A etudy of ganrrnt workcn rcvealcd thrt only 2 pd cent of unrnanicd
fcmalc ganncnl workers hEd had any form of rexual cxperioncc and thrt theso Scxual
encountcn had bccn with their boyfriendr, Theec young women wcre on the avcragc l8 yearc
of age rt thc dmo of thcir firtt eexual cxpaicnce, Howcvcr, mole grnncnt workcrs wcNt logs
likoly O havc had their first rcxusl cxpcricncc with their mmirgc parhtfB. Somc
,10 pcr cant
hid hsd ficir first rcxurl oxpericncc wlttr thcir giflficndr and anotlrcr 40 por cont with
cornmprcial
pcx workers (Ampomeuwannt and others,2000; 6).
Mahyeia; A otudy on tha reproductive hcelth of rdolpscontl (rged 13 b 19) rcvcdod
thrt 40 per ccnt ofrcspondcntr hrd begun deting from agc 13' By thc age of 18' 84 per ccnt
had stsfted holding hande, 85 pcr cent kiseing rnd nccking and 83 por ccnt petting. In thc
household luvey, I por csnt admittcd to having had scxuat oxporicnoe, whilc 24 pr cent
confimrcd that in thc modir eurvcy. Of thc$, 18,4 po; ccnt hed hgd tlreir firgt ecxual
intercourse bctwecn l5 rnd l8 yee6. Yct rnother study showpd thlt 45 pcr ccnt of
rerpondcntc rgcd 15 to 21 hed &tcd 6rrd 9 pcr ccnt rsportcd hrving had prpmarital rcxuel
intorcourge, Ar in moct etudiw, moro boyr tltan ghlr rcportcd hrving hrd sexuel intcrcounc,
confirming thc bolief that there ir lers prcecurc for boys to rornrin virginc or thrt thcy src
rnorc agEmcivc whcn it comcs to heving Ectt (lrc, 1999:4-5)'
Philippincsl The 1994 young adult fortility and rcxuatity ctudy showed that sotrr 18
pcr ccnt ofyoufit wcro engrgcd ln prcrnaritnl sox, witlt a highcr lcvol ofpremrrital scx, Et 26
pcr cent among mnlcs rr comparcd wittr l0 por cont sraong fcmalcs, Thio study dso rcveslod
that 0rcrp had bccn very littlo chrngc in tho lovel of prcmeritrl oex among fcmalcs ovcr thc
proviouo 12 ycan, doclining slightly fom tl's
Pr
ccnt in 1982 to 10,2 pcr ccnt in 1994. Thc
svorrgo agc at scxurl dcbut ip l8 ytarr for girb srd 18.3 yearo for boyr (Bajs' 2000:5).
Thrilrnd: Sexusl activity lr found to be much morc comnf,ln among nnte than
&rnalc adolcsccnts. In a dudy COnductcd in 21 privatc md govammcnt sccondrry echoolo, it
w6 found thrt ncarly onc third ofmnle rtudcnts in grade 12 worc rcxurlly rctlvc. In snother
etudy from rchoole, conrnrunity ccntror and orgrnizations in provincid citice, two thirds of
eingle mal6 agcd 15 to 24 rcported having had rcxual intcrcouttc. Suveys havc aleo
indisabd that betweon 36 and 45 pcr c6nt of malcs had their llret rcxual cxperiencc with e
commcrpial scx workcr. In conrpariron with malcs, fcwer female edolesccnb wcrc cngagcd in
prcmarital rcx, rmging frorn only I per ccnt of ringle fcmalos in thc school-bqscd rtudy to
obout l0 pcr ccnt of young fcmales diawn from thc broad carchmcnt 6oa (Soonthorndhads,
1996:1-2). Yat, anothcr rnrdy conductcd rmong finetyc$ sccondary school ctudents in
Suphanburi province found thrt 40.6 pff ccnt of male and 6,6 pct ccnt of &rmlc rcrpondcntr
had cxpcricnccd sexual intcrcoursc (Grey and Sartran, 199917), Thc rbovc studico etso found
that thc svcngs tgc at {irst
gcxusl intsrcou$c wae eround 16 ycen for boyr rnd l8 ycfs for
girll,
Sourcq IJNESCO Rngionrl Clearing Housc on Populatiott, Education md Communi'
catlon, Bangkok.
,
t
fr
i,
sexual debut out of curiosity or for the sake of sexual pleasure, but young
women axe more likely to have premarital sexual intercowse for love, and
associate it with marriage or a longterm relationship (Isarabhakdi, 2000;
Soonthorndhada, I 996).
Because of tlre differences in the nature of premarital sexual intercourse
bchneen men and women, the adolesccnt women often experience negative
conscguences of premarial sexual relations. A study from Free Trade Zone
communities in sri La*a reported casos of single young women who became
pregnant after having unprotected premarital sexual intercourse. These women
started their segsal rclations with their partlrs who promised to marry
ttrem ln exch{*? for sexual intercouse, Hor*ruer, after discovering ttre
parfirer's prpdffiV, the mau either disappeared or lcft for another woman. As
a resulq thes0.$i.$$g abandoned women suffered the consequences of unwanted
Fcgnancy'
irtblii$he unsafe abortions and the stigmatism of bcing a singre
mother (Hettiai4blibhy
and fcheneul, 2001
).
Adolescents,
n4flgututy
wp.lfr*qrc also more susceptible to coercive
sexual relationships.
fuc
arc
#rts
of "sugar daddy" phenomcna, which
refer to sexual relationr betwSf?pong women and older and wcalthicr mcn;
young womn have scxual infi4-cogse with thc oldcr men in oxchange for
economic gains. In addition to
'Cri.pfcion
based on the economic power oi men,
young women have been forygil'jb havc sexual intercouse by a pcrson with
authority over them. Iir ttre
&driblic
of Korea, 9 per cent oi fenulo factory
workere surveyed had been forced to have their fust sernral intercourse with
factory supervisors or colleagues (Brown and othcrs, 2001). Moreover, even in
Aslr-Prciflc Populrtlon Journrl, Vol. 17, No.4
A,clr-Prclflc Populaffon Journal' December 2002
the context of dating, young women tend to be coerced to have senral
intercoruse wilh their boyfriends. One fourth of young Thai women had their
firet scxual intercourse because ttrey corld not resist pressure from their
boyfriends. Thesc women acceptod sexual demands of 0reir boyfriends to
please them and to sustain 0ro rclationship; Young womcn in Bangkok also
admitted thc wsak bargaining power,. gf wo-mcn ovcr tho issue of scxual
intercourse (Isarabhakdi, 2000; Soonthomdhada, 1996).
Thesc risky sexual behaviours of adolescents sern to be compounded by
awidesprcad soxual double sttndsld-'in many Asian eocieties. Sucha
double standard accepts or cvsn oncorysgss, promiscuity among men, but
shictly resficts women's sexral behnvlorlf. Peer pr8sure atnong adolescent
men to havo sexual expericncoo ir ong oxsmple of thc double standard. For
examplc, approximately 40 por,cont of young'men in nrEl Thailand said they
had thcir first sexual intercourss t'ocsu0e. they wanrcd to be as experienced as
their friends (Isarabhakdi, 2000), On, tltor other hand, young womcn in
Bangkok expreesed concern nbou{,}olng,.lobslled as loose and complained
about the social norm of favotidug,:vltglnr rs malriage partrcrs, but tt
the same time encourasing nroa to bo scxually experienced (Soonthorndhada,
1996). These young womil thcrcfore fall betwecn the sexual demands of thcir
boyfriends and social prcd$ruo to be good women.
tr'octorr that lead to rloky bohnvlour among adolercenta
'
l'"
L
'
The previour sectlon idonfifled fre'qcxual and rqroductive health issues
affecting both unmamiod nnd' t$'gdolsscents. Thc factors and "barriersn'
that can lead to dW rppfoductivE hoalth-related behaviour among adolescents
in gcneral, particularly among
Upnqnied
adolescents, fall into four
main categories, which are idcntlfied bolow.
Limited access to lnformation
First, adolescents often lack nccpss to sufficint and conect information.
Cognitivc distortions and a eenso of non+usccptibility lead to uninformed
decisions, which may result in unwantcd prcgnancy and,$TDs. The notions tbat
they are "too
young to be prcgnant" and
"r:Frotccted
intercoursc
just once
sould not lead to conception or STD tansmission" are prevalent arnong
tenagprs. There is a grcat noed for rcproductive health information and
sewices targeted at sdolescents, Infonnation on the risls and prevention of
pregnancy, STDs and HIV/AIDS, as wcll as on the conseguences of unplanned
pregnancy and abortion, ie particularly ncedcd.
Peer pressure
A secotrd factor in rislcy reproductivs health-related behaviour concems
the increasing significance of peer pressurc. Growing social acceptance of
premarital sex plays a major role in reproductive health-related decision-
making among adolescenb and other young people. As adolescence is a
developmental pcriod of physical tansition and identity formation, the struggle
for individual autonomy and the social consfuct of rnasculinity or femininity
render teNragero susceptible to peer prosswe. Theinlluenceof thatpresswe
is iucrcasing in the context of thc erosion of taditional parental contol ovcr
premarital serilal behaviour and the declining role of family members,
especially grandmothers, in providing adolescent girls with premarital
instuction and advicc on appropriate sexual and marital behaviour (Gage,
1998), A study on the sexual experience of rural Thai youth found that pecr
influonce was one of the main motivations for engaging in first premarihl
intqrcourse (Isarabhakdi, 2000),
While parents are perceived to be the logical sourcc of information, they
often do not discuss sexual issues with their children because they are
embarrassed by the subjoct. Ae a result, ttre family is no longer the prime
teference group in reproductive health-related decisions, sincc teenagers tend to
value the opinions of their friends more highly.
Inadeguate access to youth-fiendly health seryices
Third, inadequate access to youth-friendly
health services is a major
banier for young people and adolescents often "falling through the cracki,'.
sinco they no longcr qualiff for paediafric services and their health problems
are not like those of adults, they require specially trained health personnel.
Health systems in most countries, particularly in Asia, generally do not
specifically addrees adolescent needs and adolescents often do not feel
comfortable visiting clinics designed for adults.
Moreover, heelth-care providers in those clinics sem unprepared to
discuss sexual issuee with adolescentg and many fear that the provision of
contaceptivos will condons premarital sexual activity, Especially in counties
with conservative valucs and raditions, nuny parents and polioy makers have
held stong views that providing confaceptivc information and servicos will
promote promiscuity atnong unmanied adolescents. However, reviews of sox
education programmes in several counbies conclude that sox education docs
not encourage early sexual activity, but can dolay first sexual intercourso and
lead to moro responsive behaviour (IINAIDS, 1997).
Hence, the lack of knowledge of confaceptives on the one hand and
access to conhaceptivc services and supplies on the other may prevent
adolescents from using confaceptives even when they want to protect
themselves from prepancy.
Economic constralnts
Finally, economic constaints can influence the behaviour of young
peoplc in somo casce. Rosource constraints affect the ability to buy
contaceptives or seek medical seniccs. Another economic dimension is
manifcstcd through youth involvement in se)$al rclations for cconomic gain.
Economic exchanges are made with pereons who are perceived to be in a
position to provide economic remuneration fof sexual favours. Adolescents are
more likely than adults to engage in such soxual behaviou as offering sex fol
money or having coercive sex. Adolescent girls are more vulnerable than adult
women to bcing involved in such cxploitotive sexual practices because of
compelling reasons to earn money for thoir own needs or for thcir familics
(Podhisita and othcrs, 1994).
Adolescent childbearing md contraceptive use
Childbearlng
This section examines ttre level and tends in adolescent childbearing in
Asia, According to the United Nations
Q00la),
132 million babies are born
worldwide each year. Close to 90 per cent of these births (l 19 million) occur in
the developing world, and slightly over tbree fifths (76 million) in Asia. Of the
total annual births in the world, about 14 million babies (10.6 per cent) are
bom to adolescent mothers. ln Asia, 6 million babies (8 per ccnt) are bom to
adolescnt mothers.
Several countrics in Asia have wihesscd a substantial decline in the total
fertility rate over the past few decades and a subsequont fall in odolescent
fertility. Howevcr, there are still a numbor of counFies in the region with fairly
high adolesccnt fertility rates. According to lhe 2001 ESCA? Population Dan
Sheet,the adolescent fertility rate in Asia is 36 birtho per 1,000 fomalos aged
15 to 19 (United Nations, 2001b). This regional averagc, however, masks thc
considcrablc rate difforences within tha oubrogions of Asia. Adolescent fertility
rates are highest in South and South-lffest Asia (57 birtt$ per 1,000) followed
by 45 births per 1,000 in South-East Asia" and 37 births per 1,000 in North and
Central Aeia. The adolescent fertility rate is lowest in East and North-East Asia
(4 birttrs per 1,000).
ii
I
t,
Ir
il
il
1t
t&
t:
l-
I
I
Acla-Paclfic Populrdon Journrt, Vol. 17, No.4 Aelr-Prclfic Populrdon Journal, Dccember 2002 109
Table 2. Percentage of women aged 20 to 24 who had had a child
before ages 15, 18 and 20, by country and year ofsurvey
Table 3. Percentage of curretfly married women of reproductive
age with knowledge and cunent uee of any dontracepfive
by rge, by country and year ofsurvey
Country Ycrr of
lurvcy
Pcrcerttrge of 20 lo 2C-yerroldr
who hrd hrd r chlld by rce
t8
Country Yerr of
turvey
Utc of contrrccptlvtr
Bangtadesh
lndir
Indoncsla
Kazrkhetan
Kyrgyzstrn
lao Pcoplo's Dcrnocratic Republio
Mongolla
Myrnmar
Ncpal
Pakistan
Phlllppiner
Sd Larkr
Tlalland
Turkcy
Uzbchetm
Vict Nsm
1996/l9n
lw2lt993
pn
t999
1997
2W0
1998
t997
1996
1990/1991
1998
1993
1987
1998
1996
1997
t4.1
5,1
1.7
0.2
0.0
t,7
0.1
1.4
1.9
3.3
0.5
0.4
0.8
0.9
0,0
0.3
46.5
28.3
14.0
6.0
4.2
t7.5
5.4
t4.s
26.2
t7.2
7.t
5.4
9.3
10.9
2.6
4,t
63.3
48.6
31,4
22,1
36.6
36.7
24.7
40.9
5t,6
30.5
20,5
16.6
23,9
26,2
25.3
18,9
t5.19 15'19 20-24 r$49
Banglrdosh
lndir
lndoncoir
Kazrkhshn
Kyrgzrtan
lao Peoplc'g Democratic
Republic
Mongolia
Myanmrr
Ncpal
Pakirtan
Philippines
Sri Lanks
Thalland
Turkey
Uzbckietan
Vlct Nam
r9w991
twzlt993
9n
t999
t997
2000
1998
r997
1996
1996/$n
1998
1993
1987
1998
t996
1997
100.0 100.0
95,1 95,8
97.3 97,2
99,6
100.0 99,8
77.7 79,4
32.9 4t.t 49.2
7.1 21,0 40,6
M.5 60.7 51,4
39.2 53.0 66.1
29.3 48,7 59,5
6.7 20,2 32.2
23.5 48,1 s9.9
21.3 30,4 32.7
6,5 t5,8 28.5
6.2 9,9 23.9
21.8 39,8 47.8
30.3 53.6 66.1
67.5
t3.6 52,9 63.9
15.8 35,5 55,6
l8.t 55,1 75.3
99,5 99.3
92,2 92,9
98,7 98,4
94.3
98.7 98.8
98,9 99.1
99,4 99.6
99,1 98.9
,3,8 95.7
97,6 98.9
99,9
94,4
94,0
99.1
65.9
97.6
87. I
96.9
96.5
96.3
99,5
98.5
85,7
97.0
Sourcel. Variour dcrnogrrphic md hcalth surryeys,
The high rates ofadolescent childbcaring found in South and South-lVest
Asia are obviously related to early age at mariage. It is evident from table 2
that Bangladesh has on of the highest lcvels of adolescent childbearing,
followed by Ncpal and India; all these counties ere charectrized by early age
at maniag for females. It is interesting to noto that in Bengtadesh about 15 per
cent of womon ag6d 20 to 24 had had a child beforc thoy reachcd 15. By the
time thcy were l8 years of age, about 47 pa cent had had a child and over
three fifths (63.3 per cenQ had had a child beforc age 20. Similarly, ovcr half
the women aged 20 to 24 n Nepal and almost half the women in 0ris age
group ln India had had a child before reaching age 20.
Controcepdve use
The study of fte usc of conhaceptives among adolesccnts reveals an issue
of key importance to this pfiicular group, namely, that adolesccnt girls may
know about oonhaceptivcs but do not ncccsgarily use thcm. Thc data presented
in hblc 3 show that l*nowledge lcvels concerning confracptives exceed 90 pcr
cent afirong adolescent manied girls survcycd in all of thc counrics cxcept thc
Lao People's Democratic Republic, Myanmar and Uzbekistail Howcver,
$i
*srces: Various dcrmgraphic md heatth survgys,
,
adolesoents' knowledge of contaception is relatively lower as compared with
women aged 20 to 24 and women aged 15 to 49. tt is also evidcnt that in
I'
countries whre the knowledgo lwel ic very high, therc is only a small
i difference in contraceptive knowlcdge betrveen femalce in the age groups 15 to
i
t, End,20 to24.
:
d higher level of knowledgc about conhaceptio& however, does not
always tanslate into a higher level of contraceptive usc, For cxample, in India
i
and Nepal, knowledge of contaception among adolescents was more than 90
i
per cent, Despitc this high percentage, lcss than l0 pcr cent of adolescent girls
wero found to be using any foml of confraceptive in thesc two counties, There
I
is a considerable difference in the use of contaceptives rmong adolescents
acrogs countics. Less than l0 per cent of adolesoNrts were found to be uring
any form of contraceptive in Indiq the Leo
peoplc's
Democratic Repubri{
Nepal and Pakistan, while contraceptivc use among adoloscents was fairiy high
(at least 30 per cent) in such countries as Bangladesh, Indonesia, KazaL:lretan,
sri Lanka, Thailand and Turkey. It should also be noted thst the use of
lt0 Aslr-Prclflc Populrtlon Journr[ Vol. 17, No.4
Acle-Prclflc Populr$on Journal, December 2002 lll
contaceptives
among adolescents
is remarkably
lower
to1-u-91q
women
aged 20 to 24 andt
""g;;;l
ug:9.15,to 49 in gcncral' The difference is
especially sfiiklng it ffigil;;tfrt
ftriUppincs' Sri Lanka' Tbrkey' Uzbckistan
and Viet Nam.
These data show that even when adoloccnt
girlo know about
contraceptives,
they uc much less likcly to bc using thcm-than oldcr womon'
indicating
a large unmet iccJror contreccptivcs
among adolesccnts, Thc above
findings coincide *itU tle ,.rultr of a ltudy canicd out by thc Unitcd Statcs of
fi;; Bureau of tho census, which found that confiacoptive
use 4mong
adolegcentgirlsinaoucropingcountiegwasmuchlowerthanthatamongolder
;;;;
ii6;r"itt
*a itil.rr] rsgol. Thc study turrhcr_revealcd
that,there were
;;;;il;t
13 miili;;';ug, eitr,
fiving-in developing
countries with an
unmet necd fo, fr",ify pf-rnning] file stuay also indicated that, in many Asian
countries, 30 per ,.o, Ji.-orr-of manied adolcscent
girls wanted to delay or
limit childbearing
but *io not cuncntly using contaTpliy:s'
The overall
unmet need omong .d.i;;;;"t,
might thcreforc be much higher if sexually
active,unmaniedteenagerswhowerenotcunentlyusinganycorrtace'ptives
wcre included.
Consequences
of sdolescent
sexuallty and childbenring
Mrternal rnd chlld herlth
Adolescentpregnancyandchildbearinghavesignificanteffectson
matcrnal and child fi."ftn. Children bom to adolescent mothers are higttly
i'*;rrr;n"ururo*uirrtr-*oight
a1d to be premature, i"iur:q at birth or
stillbom, and are associated iitt, dttinury complications
resulting in higher
mortality. the irrcrraseJ risk of infant diath to adolescent mothers is also
associated
with i**u*itr of early childbearing
and inexperience
in
.rrira*uriog,
studies have invariably shown that infant mortality rates are
;;;;it
nigner fo, Lufi* born to aiolescent mothers than for those born to
womcn in thcir 20, ;3d runited
Nations, lggg; McDevitt and others, 1996).
Bccaugeadolescentsarephysiologicallyandsgciallyimmature,health
rieks associatcd with-;;;
pttgi"ntitt ioa
"itimtuting
are more pronounced
than are ttoro anlofr-;ft;
n ot n (United Nations, 1989; Royston and
Armltong, lgsg). stdies ,"ui"*eo by the
population
RefercnceSueau
found
ttrat adoleecent *;; *ri, ,rpuri.ily vulnerable to reproductive
health
problcnr" and were *orc ritrry than oldeiwomen
to die from problcms relstcd
toprognancyandchildbirth'Mostimportantly'adolescentwomcnfacod
Flgure 5. Infant mortallty rate per 1'000 live blrths by women'$
age at chlldblrth' by country and year of survey
Vlct Nrm' 1997
Uzbrlhtrn' l99d
Thrkoy 199t
Thrllrnd' l9t7
8rl Lrnkr' 1993
Phlllppln.r,1991
Prkhlen, 1990/9t
Ncprlr 1996
Myrnmrr' 1997
Mongollr, 199t
Kyrlyzrtrn' 1997
Krzrkbrtrn' 199t
Indoncrhr 1097
lhdlr, 1992/93
Brnglrdcrh' 1996/97
0 20 40 60 80 100 120 140
Infrnt rmrtdlty rate per 1'000
Sources: Various demographic and healtlt surveyE,
incrcased risks during pregnarlcy and childbirth because thoy had lcss
information and access to prenatal, delivcry and postpafim car as compared
with older women (Ashford, 2001), Studies reviewcd by UNESCO suggest that
in Bangladesh the high incidence of tecnagc pregnancies has conhibutcd to
high maternal mortality: among adolescent girls undcr 18, the matemal
mortality rate is tluee to four times highcr than among oldor women (Uddin'
r99e).
An elcvated risk of dying among births occurring to adolosccnt womcn
cnn bo obeervod from data tabulated from the demographic and hcalth surveys
carricd out in Acia, It is cvidcnt from flgruo 5 ttrat in Bangladcsh, India, Nepal
rnd Paklrtrnr ovor I in l0 babio born to adolesccnt womcn dic before
ttz
Arlr-Prclllc Poputrtlon Journll, Vol' l7t No' 4 Arlr-Prcllle Populrilon Journrl, Docombcr 2002 113
reaching their first birthday. In all thc countrias survcyed, infant mortality rates
are higher among children born to adolesccnt womcn as compared with women
aged 20 to 29. The risk of dying during infancy is at lcaet 1,3 times higher
among births occuning to adolcscent womcn ar compared with women aged 20
to 29 n such high-mortality countics as Bangladcsh, India, Nepal and
Pakistan, Although the infant mortality rate is much lower in Viet Nam (34.E
per 1,000 live birtho) and is only modcrately high in Kazakhstan (50.3 pcr
1,000 live bhttrs) and Kyrgyzstan (66.2 per 1,000 live births), thc risk of dying
during infancy is between 1.4 ond 1,6 times highcr among births to adolescent
womcn as compared with women aged 20 to 29. These data reaffirm the fact
that in virtually all sociEties adolescent childbearing is detimental to both the
mothers and their offspring.
The risk of early childbearing to the health of moilrer and child is focused
mainly on manied adolescents, as in many Asian counhies se>nral activity and
childbearing begin within maniage and daa on childbearing are tJpically
gathered from married women, However, in several countries of Asia there is
evidence of premarital sexual relationships leading to premarital births,
although such births vary greatly across societies. Young unmanied women
who have children ue socially as well as economically disadvantaged. This
is partly because of the taditional values that stongly oppose sexual
relationships, pregnancy and childbearing among the unmanied. Most
importantly, births to unmanied adolescents are likely to be unplanned or
unwanted and above all, singlc mothcrs may bc living in povefi,In22
out of 27 countries for which data were available, 0re proportion of last
births that werc unwanted or mistimcd was remarkably higher among
unmarried adolescent mothers than among married adolescent mothcrs. These
circumstances, 0rerefore, greatly increase the poor outcomes of adolescent
childbearing in terms of the health of the mothers and childrcn (Singh, 1998).
Sexually transmitted diseases and HIV/AIDS
It has been estirnated that at the end of 2001, approximately 40 million
people worldwide were living with HIV/AIDS, of which, a total of 6,4 million
people belonged to the Asian region (UNAIDS, 2001). Young people bear a
special burdEn in the HIV/AIDS pandemic. Nearly one third of those currently
living with HMAIDS are aged 15 to 24, Adolescents are more vulnerable than
odults to unplanncd pregnancier, STDs and HMAIDS. It has been documenlpd
that although promarital sex ig less oommon iu tho Asian rogion, it is clearly
on the rise. It has been observed that when adolescents become sexually
activo, thcy tcnd to have multiple partnero and use condoms and othcr
contaccptives inconsistently. Furthcrmore, youngsr womcn arc mors
Box 2. Vulnerabllity of young girls ln the
transmlsslon of HIV lnfection
It ig thc intcrplay of biological, cultural and cconomic fictoro thtt makc young girls
puticulrrly vulncnblo to tlrc scxusl hsnomisslon of HlV. While both girk and boys engagc in
conrsnrual rcx, girlo aro mor likely than boys b bc rmlnfornrd sbout HIV, including their
own biological wlncrability to infcction if thcy rtart having rex vry youflg. Oirls ara also far
mort likoly tlran boyr to bc cocrccd, npcd or cnticed into rcx by lomconc oldcr, st'ongcr or
richor, Sorrctimcr, ttrc powcr hcld over them ie mrinly thet of grcrtcr phyricrl rbength. Somc-
tlrtr lt lr rocld prcrrurc to acquicscc to cldcrc, Somctimcr it is a combination of factoru, $
nry h thc crro with oldcr "lugar daddics" who offcr rchoolgirls gifts or money for echoot
&ot ln rrturn for rox, In thc en of AIDS, thc conrcqucncce for young girls can bc diaastrous.
Sourcc; uNAlDS (2l.t0\. Report on the Global HIV/AIDS Eptdemlc, June 2000
(Ooncvr, Jolnt Unltod Netionr Programnrc on HIV/AIDS), p.47.
vulncrrblo to forccd sox and ssx in cxchangc for gifts and money, with
incroasod rirks of contacting STDo, including Hry/AIDS (Ashford, 2001).
It har bccn found that whilc womcn, in gcneral, &rc more likcly than men
to bo infcctcd wlth HIV during unprotcctcd vaginal intercourse, the prevalence
of HIV infcction among adolescent girls is stikingly high. Biologically, young
girlr rro vulnerablo to tho rlsk of HIV fiansmission because their genital tracts
ars not fully mahuc. In addition to this biological wlnerability, there are other
cultural and oconomio factors ttrat multiply the risk of confiacting HIV
infcction Emong adoleecent girls (sec box 2).
Scxually hnnsmitted disease is a major health problem among youth in
much of Aoia, according to studies commissioned by LJNESCO. For example,
in Bangladcsh two thirds of all reported STDs occur among people wrder 25
ycars of agc and thc ingidence is much higher among women agcd 15
to 19 than among men of the same age (Uddin, 1999). Half of the
HIV/AIDS-infected persons in Vict Nam were adolescents and youth (Nga,
2000), [n China, 8.7 per cent of the HIV carrier and AIDS patients bclong to
thc 16-19 age
$oup
(Sun, 2000),
While adolescents, in generaln are especially vulnerable to HIV/AIDS,
ccrtain groups of adolcscents are more at risk of HIV infectiong than othcrs.
For example, adolescentc in nced of special protcction, including sfieet
childreq ecxually cxploited childrcn, including thoso engagcd in prostitution,
and migrant children, facc additional risks. A United Nations study suggcsts
that young migrante arc eurccptiblc to HIV infoction: on the onc hand, young
,lfl
$
ri!
.rl;.1
$il
lt
t
l14 Arlr-Prclllc Populrtlon Journrl, Vol. 17, No.4 Arlr-Prclllc Populrtlon Journrl, Drccmbu 2002 u5
male migfants tend to engage in unsafe sexual practices when they are away
from the-family, and youtrg *omtn migrants, on the other hand, may be forsed
to work as sexual workers as a mearul of survival (United Nations, 2001c).
Conclusions
From the prccoding analyeis, it is evident that the sexual and reproductive
health of adoleJcnts has emerged as on issue of great concem in Aeia. This is
based on two distinct dcmographic tends that exist in the region:
(a) The widening gap beween sexual maturity and age at marriage,
which results in premarital sexual activities smong adolescents in many
countries and areas in the region;
(b) The continuing
prevalence of adolescent marriage and low
contaccptive uec during adolcscence, rcsulting in a highrateofadolescent
fcrtility,
The advcrse health consequences of adolescent fc*ility for both mothers
and children include the high rate of matemal mortality and infant mortality.
The vulnerability of adolesccnt girls to STDg, including HIV/AIDS, and early
childbearing also have a negative impact on the educational prospects of girls,
including pregrrancy-related school dropout, thereby threatening their economic
and oveiail developmart prospects. When schoolgirls become pregnant, they
either resort to illicit abortion, which is often tmsafcn or carry ttrc foetus to full
term, which hampers ttreir o'pportunitics for socio-ecouomio advancement.
In sddition to reccnt demographic tends, the following factors influence
the sexual and rcproductive behaviour ofadolescents in Asia:
r Inadequate nccess to corrsct information
r Availability of, and access to, youth-friendly health services
r Poer pressurc and the erosion of the role of the family
r Economic constaints
While many Governments in the region have bogun to recognize the
importancc of sexual and reproductivc health iseuet for adolescents, particularly
after the adoption of the Cairo Progamme of Action in 1994' thc programmes
in thic ficld arc still at an early sttgc of dcvelopment, Important pterequisites
for
pffcctivo
reproductive health programmes for adolescents include political
commitnent, the development of sound policies and shategies and the
development of social and community support sy$terns.
116 Aria-Paclltc Populidon Journrl VoL lT' No' d
Arlr-Prcltic Populatlon Journal, December 2002
lt1
In Asia, manied adolescents are generally the target group of
reproductive health-related research, whereas in Africa and Latin America both
manied and unrnanied adolosccntg are included' Based on the recognition of
carly sexual matufi$ and
premarital soxual activities anrong adolescentg,
research should, thcreforc, focue on both married and unmarried adolescents.
Acknowledgement
The author would lik$ to thank Ms. Yoshie Moriki Durand for her
comments and suggOeiiOnO' th* otiginal versiou of the paper was prcsented at
the Intemational Unlon fOl flr* $oicntlf,rc $tudy of Population's Regional
Population Conferencc
'*$OUtk".&nAt
Aria'o Population in a Changing Asian
Context" held at Bangkok from l0 to 13 June 2002. This paper draws heavily
on the report entitle d Adole*cent Reproductive Health in the Asian and PaciJic
Region,
(,6tan fopulntfon Sf.*ld!*r $eriar, No. 156, Unitcd Nations, 2001),
, ,.'r
Aeforonce$
AmDor6uw&nna. Laddspom, $mnp6$p Trn' Tong Si Thcn and Phay Mov (2000). Case Etudy,
--
-
Co Ooan': Coniunlcathn ind'Adwcacy
Strategles, Adolescent Reproductlve and Sexual
Health (Bmgkok, Ul'l8*t0li'
'i
Ashford, Lori S, (200:!),
"liloW
populrtlon policles: advancing worpn'! health and rights",
Population Bulletin, 56(l)ll a4.
Beria. Clorinda L,
(2000)'
Cacp $fi#,
Phltlppttws: Communtcatlon and Adwcacy Stategies,
Adolescent ieprodualvc and Saual Health (Bangkok' UNFJCO)'
Brcwn, Ann Dcnlru, shinm J. trdt?,.bh!y, Iqbel shlh and Kattnyn M, Yount (2001)' $aruol
neldttons ambng Yil:ang niild1.I. ievaloptrtg Countrles: Evldencelron lyHO Case Studleg
lccneva,
nepaifnn-nt ol ncdru6Uctlvo HEilth rnd turoarch, World Haalth Organizntion)'
Gagc, Anastesia J. (1998). 'rSoxur.l tcliYilY. md conbrceptlvc usc: thc components of the dccision-
-
making procett","fltild/ru ilt Fanlly Flannlng, 29(2)tl54tl66'
Gray, Alan end Srisuman $arlrmn(tS$9)' Ccra,Sfudy, Thallail: Communlcatlon and Advocacy
'
Stnteglu, Adolesc*nt Raproduttlw and Senul Health (Bongkok' UNESCO)'
Hetti$achchy, Tilak
gnd
Stephcn tr ,Sohgnsul
(2001).
"Tho
rieks of prcgnmcy and the
consequences rmong young uffnffriod wompn working in a Frcc Trtdc Tane in Sri Lanka"'
Asta-Pac{lc Populailon Journal, l6(2)1 125'140'
Htay, Thein Thcin, Krthcrinc Ba Thikc, Michcllc Gardiner, Chrirtophcr Elias rnd Peto Fejane
(2000),
,,A
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