SEXUAL AND REPRODUCTIVE NEEDS OF YOUNG PEOPLE IN ETHIOPIA
Introduction
Youth is the strongest pillar for any country to evolve and improve the future. However, currently, young people are facing several issues related to health. Sexual and reproductive health is one of the essential concerns among young people. The improvements in sexual health are required so that mental well-being improves. The young people will be aware of their own body and could be sexually active without being mentally judged. Furthermore, they could engage in sexual activity with a better mentality and approach for the concept of sex. As a result, the approach towards such a taboo topic will change through open communication in Ethiopia.
Further, there are several issues faced due to lack of promotional activities. According to Public Health Reports, key concerns within sexual and reproductive health care in areas such as immunodeficient human virus (HIV)/acquired immunodeficiency syndrome (AIDS), hepatitis, unintended teen pregnancy, sexual violence and sexually transmitted diseases (STD) (Douglas and Fenton, 2013). For instance, sexually transmitted infections cause infections which gives a reason for getting HIV or AIDS. Africa is one such country where sexual and reproductive health issues can be seen frequently (Bbc.co.uk, n.d.).
The world health organization reports that annually at least 63 million new cases for STD, e.g. syphilis, gonorrhoea, chlamydia and trichomoniasis are found in Africa among the age group 15-49 in the year 2012 (Regional Committee for Africa, 2017). Such diseases that lead to HIV/AIDS in the people suffering from above STDs.Africa, and especially Ethiopia region suffers from a sexual and reproductive health issue like sexually transmitted disease, and HIV/AIDS between young individuals. The culture is another aspect which could influence how people look up to such topics. The data reveals that after one year of marriage child be brought into couple’s lives in Ethiopian culture (Taye & Asmare, 2016). Besides, legal frameworks for promoting sexual health education skills lack in Ethiopia. Even though policies exist, there are several drawbacks for not following those rules and regulations. Hence, the purpose is to identify the significant health issue of poor sexual health among young people in the country of Ethiopia.
Background
Ethiopia is one region of Africa where sexual health is required by young people to avoid STD. However, it is first mandatory to understand what sexual and reproductive health refers too. According to the World Health Organization, sexual health considered of physical, emotional, mental and social well-being of a person (World Health Organization, 2017). Additionally, sexual health does not talk about the absence of some diseases or capabilities. Sexual health considers how a positive and respectful approach to sexuality and sexual relationships must be obtained.
Furthermore, seek pleasurable and safe sexual experience, free from rape, discrimination and another type of violence. To obtain sexual health, one must have sexual rights that respects, protects and fulfil a person’s life. From the above definition, sexual health is not just a physical problem; but people taking a positive approach on sexuality. Reproductive rights to every person should be offered through rules, regulations and other ethical frameworks. As a result, people will practise safer sex due to acknowledgement from sexual rights.
Sexual health is an important issue that must be addressed by countries immediately. One of the reasons is the exchange of pathogens from sexual activity due to the absence of protection. In other words, the unprotected sexual act will increase the possibility of infections like HIV and AIDS. According to the World Health Organization’s study, each year, 376 million new infections with 1 of 4 STIs: chlamydia, gonorrhoea, syphilis and trichomoniasis occurrence are captured (Who.int, 2019). With such an increasing rate, awareness for one’s sexuality has become a concern. It is essential to highlight that sexual health should not be taken lightly by healthcare providers.
STI’s have become a public health issue as a number of infections increases globally which is critical to both developing and developing countries; for example, UK, Africa, and the United States, and India. In the year 2005, approximately 50 per cent increase in AIDS-related deaths among the young age group of 10 to 19 years boys was found (Morris and Rushwan, 2015). These incidents are found in a developing country Ethiopia where younger population is more significant. It has maximum chances because most of the population is below 40 as well as identification and management of sexual health issues like STI published by authors Yohannes, Gelibo, and Tarekegn (2013, p. 86). Hence, STI has become an essential public concern for young people living in Ethiopia, Africa. Further, sexual and reproductive health is a concern in the small and developing country of Ethiopia because of STI sickness in 60 per cent young individuals.
Therefore, size and scope are much more significant as the Ethiopian government does not appropriately address these issues.
Discussion
Ethiopia is a country that comes under the north-eastern part of the African region. The maximum number of people are young because of early marriage practises as compared with older groups. However, there is no promotion for sexual and reproductive health in the African region. The requirement of sexual health is an important concept which is not seen due to different factors. These widely used factors that assess the necessity of sexual health promotion are cultural, legal and policies. Hence, this section covers how such aspects are responsible for sexually transmitted diseases in Ethiopia.
Cultural Impact on the Issue
Culture is the first aspect that brings awareness to be sexual and reproductive health. Ethiopia does not promote any sexual health awareness, and that leads to several problems for young people. The cultural beliefs and practices make that happens to people. For instance, as per UNFPA’s 2010 Ethiopia Gender Survey, 42 per cent women in the rural area become sexually active even before they get the first period and then coerced into early marriage making room for problems such as fistula, stillbirth and early pregnancy symptoms of low-birth weights (Bbc.co.uk, n.d.). The young girls are forced to get married at a very young age, whereas cultural practice keeps them unaware of how sexuality must be approached. Besides, rural areas do not have kind of programs that could initiate awareness for sexual health. The lack of information about consideration for sexual health brings awareness issue for the country. These leads to one of the four sexually transmitted diseases mentioned above. Men and women both in Ethiopia are unaware of approaching the topic of sex due to hesitation, shyness, fear and apprehension.
Early marriage practice affects women more through childbirth which puts physical burden. Authors Anteneh et al. (2017) reveals that bacterial STDs brings issues for young women, for example, infertility, ectopic pregnancy, chronic pelvic pain, disability and even deaths. These problems are detected in the female sex workers in Finote Selam town of northwest Ethiopia (Anteneh et al. 2017). On the contrary, young men also face many issues through STI. Men do not know the use of protection while sexual activity due to lack of sex education programs, unaffordable education fee, and unavailability at local health centres. Additionally, STI is responsible for bringing HIV and AIDS among pregnant women. As per one study in the year 2017, 2% of all global new HIV infections and 3% of global HIV related death were identified for pregnant women (Dessalegn et al., 2017). Women as per Ethiopian culture are married off early, which results in childbirth deaths. Besides, the passing of diseases from having multiple partners affects women when they went stillbirth. Therefore, the female gender suffers more due to cultural practise of child marriage.
With such customs and practices in the country such as Ethiopia, the requirement for awareness has come forward. The early marriages between two young people take away freedom. Further, gender differences also impact the whole situation abruptly because women have a lack of awareness for existence for contraceptive pills and condom protection measures.
Cultural beliefs of healthcare professionals do not support the concept of abortion. They consider it as the killing of an innocent child even if it could affect the mother’s health or create complications. Healthcare professional does not personally support the concept of legal abortion. The health issues which could a young woman is still not accepted due to true religious beliefs. As per one published study, some of the barriers with respect to cultural beliefs were found. The healthcare institutions are situated at very long distance, with no privacy, high procedure cost and availability of health workers who support abortion services (McLean et al., 2019). All these reasons determine that sexual and reproducible health awareness is required. The programs which promote good sexual practices are needed in developing countries. Ethiopia has maximum marriage rate in the younger people, which makes the possibility for STDs, HIV and even AIDS. Therefore, it is essential to prepare young people aware of how they keep well-being intact and enjoy sexual activity with better emotional balance.
Ethical and Legal Framework
Moreover, ethical and legal frameworks also have an equal impact on having sexual and reproductive health promotion. The government is equally responsible for bringing new changes in Ethiopia. There are several legal frameworks adopted by the Ethiopian government from the past several years. Their purpose to aide young people regarding safe sexual practises.
The government has aligned a separate ministry to focus on youth needs in context with needs. Some of the programs are initiated legal authorities such as the Ministry of Health, the Department of Women’s Affairs, and the Organization for Social Services for AIDS (OSSA) as well as small scale NGOs. However, such legal and ethical frameworks do not support reproductive and sexual needs for young people. The reason is no funding from the government for initiated programs. This could be a pertaining issue which could again lead to sexual diseases. As a result, young people are dying because they are unaware of how their bodies work. Female genetical cutting is being supported by government bodies rather than a ban. Still, some changes are being implemented to abort such cultural practices from rural parts of the country by providing measures. For instance, abortion is legal now that could save a young women’s life facing HIV/AIDS infection. Some of the other legal frameworks are implemented by the government to bring sexual awareness.
• Sexual Health Education Program
The Ethiopian government initially launched a small sexual health education program to inform about protection. Author Browes (2015) states that the use of contraceptives for young women and condoms for young men were made available by the Ethiopian government in his study. This program informed young people how to be safe while having sexual activities. However, it was not responded well as women were too shy to ask about pills from stores. Thus, sexual awareness was introduced in the year 2003 and did not get any acute response.
• Comprehensive Sexuality Education Program
Comprehensive Sexuality Education (CSE) is a global policy used for promoting sexual and reproductive health and rights. Approximately, 20,000 teachers were trained in life skills education and youth-friendly HIV and R.H. interventions in primary and secondary schools (the Federal Democratic Republic of Ethiopia, Ministry of Health, 2016, p. 14). This policy was implemented to make youth aware of sexual practices. These policies were indeed supported by the Ministry of health and NGOs of Ethiopia. However, cultural differences opposed this policy and restricted young people to take benefits (Le Mat et al., 2019, p. 1). Therefore, a policy such as globally acclaimed is once again unaccepted by Ethiopian government officials.
• AIDS Control Programme
Ethiopia and their government have established the AIDS control programme after detection of STDs in the year 1985 (Kloos and Zein, 2019). This programme was issued to bring awareness to young people for HIV/AIDS due to sexual activity. Further, this control programme was executed into logical steps by the Ethiopian government. The first step of AIDS was focused on bringing health into consideration. The second was the definition of National AIDS policy and National AIDS Council, and Federal HIV and AIDS prevention and Control office in the year 1998 and 2000, respectively (Assefa et al., 2019). Hence, these policies and ethical framework were made but focused on mental and physical health concept.
Complexity
Even though such legal and ethical frameworks are designed, there are different complexities. According to authors Gebreyohannes et al. (2017), antenatal care for young mother and new-born children is responded below an average of 54% in Ethiopia. The people had not responded to antenatal care because they are not well-informed. One of the complexities for young people, especially young women, is they are unaware of such ethical frameworks. The rural areas lack such information due to no education, cultural background and communication with parents on topics of periods, sexual activity, contraceptives and childbearing in young age. Comprehensive Sexuality Education (CSE) has another complexity which in no change in their curriculum. The staff appointed under this curriculum does not participate due to lack of knowledge on the subject, low wages and cultural upbringing on sex. This could impact how students approach the concept of sexuality. Another reason for the complexity is the absence of human resources in sexual health initiation. The Sexual Health Education Program and AIDS control programme bring unfriendly environments for youth. Some example includes confidentiality breach, judgmental and disapproving attitudes for sexual activity, disapproval from parents and older people to boycott cultural traditions, substance use, and discrimination (the Federal Democratic Republic of Ethiopia, Ministry of Health, 2016, p. 16). Hence, complexities in using ethical frameworks are the biggest concern for Ethiopia.
Policy Recommendations
However, even if policies, legal and ethical framework are designed, still recommendations are needed. The cultural aspects impact a lot for having a good policy for sexual health. The women are married at a very young age and do not know about anything about sex (Bbc.co.uk, n.d.). The men have many sexual partners who increase chances of STIs. Hence, a proper healthcare system is needed so that young people could understand about reproductive health. For instance, healthcare systems should be made that could provide access for contraceptives to men and women. Further, youth who is unaware about STIs can be made aware of using protection while having sexual activity. The young marriage practice is wrong and must not be followed could also be promoted through a better healthcare program. This is another recommendation for rural areas of Ethiopia. Child marriage and pressure to have children soon as well as female genital cutting is wrong and bring disease risk. This type of customs and traditions should be banned by bringing sexual awareness and promotional camps.
Another issue is that the Ethiopian Ministry of Health offers no counselling programs. The women are too shy to use contraceptives or demand from men. This could again bring HIV/AIDS problems for young people; for example, it will affect productivity and education due to lack of skilled human power in the form of a youth, removes development and increase poverty rate (Getahun, 2016, p. 8). Hence, counselling for married couples is helpful to gather how to be safe and protected from STIs bacteria. Whereas, the young people could be informed by providing them with information. In this way, the mortality rate could be improved, and a good nation with healthy youth could be achieved.
Additionally, education for young people still lacks, and the school curriculum is not informative (the Federal Democratic Republic of Ethiopia, Ministry of Health, 2016). The lack of education for girls makes them unaware of the first period, the right age for marriage and how important is being independent. Another critical concern is that lack of mass communication among rural youth. Ethiopia and its rural areas do not have access to radio, television, and internet. For example, Television advertisements on sexual and reproductive health reach a large number of audiences (the Federal Democratic Republic of Ethiopia, Ministry of Health, 2016). It changes their perspectives on how to approach sexuality. Besides, media communication will bring awareness premarital sexual activity that exposes young people from unintended pregnancy, abortion and STDs (Taye, and Asmare, 2016, p. 02). Lastly, the shortage of education among young people brings unemployment. The school and college dropouts engage in sexual violence (the Federal Democratic Republic of Ethiopia, Ministry of Health, 2016). The young men do not seem mature enough to deal with issues and take wrong decisions. Hence, the government needs to make policies which could reduce sexual violence.
Sexual and Reproductive Health Strategies
Reduce overall adolescent and youth mortality by 50% (the Federal Democratic Republic of Ethiopia, Ministry of Health, 2016, p. 21).
Reduce the rate of suicide among youth aged 15-24 years by 50% (the Federal Democratic Republic of Ethiopia, Ministry of Health, 2016, p. 21).
Reduce the incidence of HIV among youth aged 15-24 years from <0.03% to 0.01% (the Federal Democratic Republic of Ethiopia, Ministry of Health, 2016, p. 21).
Reduce the unintended adolescent pregnancy rate from 12% to 3% (the Federal Democratic Republic of Ethiopia, Ministry of Health, 2016, p. 21).
Conclusion
To conclude, youth is the most active part of any country to evolve and grow. Sexual and reproductive health is an essential concern for developing countries such as Ethiopia. Sexual health is a state of physical, emotional and mental well-being. The lack of awareness brings problems like STDs for young people. Ethiopia is a country from the northeast region of Africa. Besides a maximum number of cases for AIDS can be identified in the youth (Dessalegn et al., 2017).
Furthermore, several reasons are responsible for the lack of awareness among young people. One of the possible barriers to achieving sexual health promotion is a cultural impact. Women get married early and are pressured to have children within one year. Besides, female genital cutting is another practice that leads to sexually transmitted diseases. The culture is the biggest drawback that stops young people from seeking information about sexual health. Several ethical and legal frameworks are provided by the Ministry of Health from the Ethiopian government. However, no response from healthcare professionals and young people are found.
Additionally, people are too apprehensive about approaching the concept of sexuality. The men and women both do not know how to use a contraceptive. Even different policies cannot help them with learning about reproductive health. Comprehensive Sexuality Education (CSE), Sexual Health Education Program and AIDS control programme are an initiation taken by the government. However, lack of education, awareness, media communication and unemployment factors must be considered. The policy changes after taking the above aspects should be made. Overall, sexual and reproductive health is a significant concern that should be regarded as by a developing country such as Africa. Young people are significant for the nation as they bring productivity and development. Hence, actions for protecting sexual and reproductive health should be put effectively by the Ethiopian government for young people.
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