© Plan Presented by: Dr Mahbubul Islam, PM-ARH Enhancing Adolescent's Potential in Pakistan Date: 26 to 27 June 2008 Best Western Hotel, Islamabad Situation of Adolescents in Bangladesh

Presenter: Dr. Mahbubul Islam. Project Manager, ARH Importance of Adolescents issues Adolescents (10-19 yr) constitute 23% of the total population Also period of rapid growth and development Marked by critical events -Marriage/childbirth -Initiation into work/earning -change in educational status Adolescents are the future of the nation

Presenter: Dr. Mahbubul Islam. Project Manager, ARH POPULATION PYRAMID - BANGLADESH

Presenter: Dr. Mahbubul Islam. Project Manager, ARH Socio-cultural situation Early marriage, early pregnancy 11% girls aged are married 46% girls aged are married 78% girls are married by 18 years 60% adolescents become mothers before 19 Inherent risks of early pregnancy – MMR four times higher in adolescents Fertility rate of year olds one of highest in the world -135 per 1000 women

Presenter: Dr. Mahbubul Islam. Project Manager, ARH Socio-cultural situation Unmet need for contraception among married adolescents is about 15.1 percent Only 48.7 percent adolescent mothers receive ante natal checkups CPR among adolescents: age group: 21.9% age group: 34.1%

Presenter: Dr. Mahbubul Islam. Project Manager, ARH Socio-cultural situation Rising trends in risky sexual behavior Lack of awareness and access to resources Sexual exploitation including trafficking Girls are especially vulnerable Lack of Choice for safer sex increase in violence against women and girls Long waiting times, odd clinic hours, judgmental attitudes, Low utilization

Presenter: Dr. Mahbubul Islam. Project Manager, ARH Socio-cultural situation Although in prime of life, 1.7 million adolescents die every year– from accidents, violence, pregnancies, illness Gender Discrimination is often prominent -Employment -Marriage -Social mobility -Food allocation 50% adolescent mothers are acutely malnourished (BMI <18.5) Disparity between urban and rural adolescents Role of elders: gatekeepers rather than facilitators

Presenter: Dr. Mahbubul Islam. Project Manager, ARH Initiatives on Adolescents issues Efforts to create a supportive policies Supportive legal environment such as Nari o Shishu Nirzaton Ain Projects and intervention in Government and NGO sectors in Health: HNPSP, GFATM etc Education: Stipend programme NEARS: is a platform to provide assistance to the adolescents on gaining reproductive rights and having reproductive health services, and to expand the existing reproductive health opportunities

Presenter: Dr. Mahbubul Islam. Project Manager, ARH Initiatives on Adolescents issues Adolescent reproductive Health Strategy Milestone for promoting reproductive health among adolescents Strategy approved in 2006 ARH strategy developed with comprehensive participation of all stakeholders

Presenter: Dr. Mahbubul Islam. Project Manager, ARH Strengthening Adolescent Reproductive Health in Bangladesh

Presenter: Dr. Mahbubul Islam. Project Manager, ARH Project Rationale: Bangladesh has made important commitments to the international community. - Signatory to the ICPD, Cairo Signatory to the ICPD+5, Child rights convention, - And MDGs Small improvements in ARH status of adolescents can actually trigger an accelerated achievements of the other goals and targets Majority do not have information on contraceptives or STI, HIV and RH issues. A national ARH strategy just developed Link with GOB, UN agencies and NGO’s to implement the National Strategy

Presenter: Dr. Mahbubul Islam. Project Manager, ARH Project Rationale Contd.. Grass roots adolescents voices are brought to national dialogue Meeting targets of MDGs: -To reduce MMR by ¾ by To reduce under 5 mortality rate by 2/3 by To combat HIV / AIDS -To reduce maternal malnutrition to less than 20% by Increase median age of marriage by 2 years

Presenter: Dr. Mahbubul Islam. Project Manager, ARH Project Summary: 5 years project Total Budget $5,450,000 Target group of 700,000 ► 200,000 direct beneficiaries (married/unmarried, in/out of school, garment workers, sex workers, and minority groups) ► 500,000 indirect beneficiaries (parents, teachers, health care providers)

Presenter: Dr. Mahbubul Islam. Project Manager, ARH Project Sites Target urban and rural poor, and underserved areas Southeast: Chittagong Northwest: Dinajpur, Lalmonirhat and Nilphamary Central: Dhaka and Gazipur

Presenter: Dr. Mahbubul Islam. Project Manager, ARH Project Goal: The goal of the project is to improve reproductive health of poor, vulnerable and underserved adolescents in the selected areas of Bangladesh and to increase their access to services.

Presenter: Dr. Mahbubul Islam. Project Manager, ARH Project Purposes: The purpose is to develop capacity of the health care provider and undertake advocacy to meet the reproductive health needs of adolescents in selected areas of Bangladesh through partnership with Government, UN agencies, NGOs and communities, in accordance with the National Adolescent Reproductive Health Strategy.

Presenter: Dr. Mahbubul Islam. Project Manager, ARH Expected Outcomes of the Project Outcome 1: Enhanced capacity of adolescents in target areas to make informed decisions regarding their SRH through a participatory approach. Outcome 2: Increased capacity of service providers and adolescent girls and boys to demand and obtain effective adolescent reproductive health in the selected areas. Outcome 3: Successful implementation of national ARH strategy within the HNPSP framework in target areas through partnership with Government, UN and other stakeholders.

Presenter: Dr. Mahbubul Islam. Project Manager, ARH Project Components: Policy Dialogue and Networking to Implement Adolescent Reproductive Health (ARH) Strategy Strengthening Capacity of ARH service providers Delivering Adolescent Friendly Health Services (AFHS) Evidence based Research and Dissemination

Presenter: Dr. Mahbubul Islam. Project Manager, ARH Implementing Partners: Partners Site Radda MCH-FPDhaka City Corporation (DCC) PSTCDhaka City Corporation (DCC) MSBDhaka & Chittagong DSKGazipur (Sreepur) LAMBDinajpur (Khansama & Chirirbandor) CWFDNilphamary (Jaldhaka), Lalmonirhat (Hatibandha) YPSASelected rural areas of Chittagong Population Council Research and Evaluation

Presenter: Dr. Mahbubul Islam. Project Manager, ARH Management and Coordination Plan Canada Plan Bangladesh Project Steering Committee Technical Advisory Group (TAG)

Presenter: Dr. Mahbubul Islam. Project Manager, ARH Thank You