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| Sunday, 27 January 2002 |
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Features |  |
| News Business Features Editorial
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Reproductive health problems of the adolescent: Be open and honest by Carol Aloysius When your daughter aged five asks you, "How do girls have babies?" what do you tell her? A quarter century ago most mothers would have related the usual stork story and evaded a direct answer. But not now. Today, your daughter's typical reply to such a bizarre explanation would be, "Then how come the TV program I just watched told us that babies come from their mother's stomach? How come we were told that the baby grew in its mother's stomach from a seed planted there by its father?" A quarter century ago, if your ten year old asked you, "Is it true that girls bleed every month when they reach a certain age", her mother would have probably said "Yes" but refused to discuss how and why. Not because she did not know any better, but simply because she was too embarrassed to explain the facts of life to her own daughter! Today, twenty five years later, that scenario has changed. Not because parents are no longer too embarrassed to sit down and frankly discuss matters relating to sex with their children; but because the children themselves have found most of the answers to such questions from their school teachers, their peers; from the television shows they watch, or from porn magazines and newspapers surreptitiously sold on pavement book stalls. But, says Dr Mrs Kanthi Ariyaratne, Director Health Education Bureau which is currently spearheading an awareness program on Reproductive Health for adolescents," a little knowledge is always a dangerous thing, and the so called 'facts' they have learned could easily have dire consequences on their health and even their lives if the information they have received is misleading and incorrect." Read any newspaper today and the stories you read of rape, incest and unprotected sex leading to illegal abortions with fatal results are endless and will bear out Dr Ariyaratne's statement. Take the case of 13 year old Rupa who became pregnant even after faithfully following her classmates advice to "jump up and down immediately after having sex", and later died from septic poisoning after inserting the end of a pineapple stem into her uterus, again on the advice of her friends, when she wanted the baby aborted. Which is why the subject of reproductive health in adolescents and its related problems has now emerged as a priority subjects in our education system, Dr Ariyaratne says. As she points out, the sharp rise of teenage pregnancies in this country as elsewhere in the world, along with the constant exposure to sex related images on TV and the internet as well as newspapers has led to a growing demand for more information and knowledge on sexuality by today's youth. Today, both teachers and parents are constantly faced with such questions as, "Why do only girls' breast increase in size as they grow older?", "What is virginity?" "What is masturbation?", "Where is the hymen found?" - questions for which immediate and truthful answers are demanded by their pupils and children. "To answer such questions our campaign not only targets students but includes adults as well - parents, teachers and the community. The Health Education Bureau of the Ministry of Health with UNFPA support conducts awareness classes on the request of teachers and principals in schools, and also distributes questionnaires to assess the extent of knowledge of students on reproductive health. The answers to these questions as well as the questions that students commonly ask us have revealed that despite their high exposure to sex related topics, the youth in this country are still very ignorant about the real facts of life", she reveals. Typically, at these talks the following questions would invariably surface; "Who is a virgin?" Does every woman have a hymen? Can you damage your hymen by riding a bike or playing a game of netball? So what is the response of this Health Education official when confronted by such questions? Says Dr Ariyaratne, "When a girl asks me " Who is a virgin? my reply is that a virgin is a woman who has not been sexually active. I also tell my male students that proof of virginity does not necessarily mean that a woman's hymen is in tact, and that she bleeds during the first act of sexual intercourse. For there are instances (albeit rare) when the hymen is so elastic that penetration can take place without it being damaged. This means that although technically a girl with such an elastic hymen is a virgin because her hymen has not been ruptured, she could in actual fact have been sexually active without displaying the obvious signs. As for their question on the possibility of damaging their hymen when playing a strenuous game like netball or riding a bike, I tell young people that while such damage is possible, it is not common. Damage to the hymen usually occurs only with penetration". When discussing questions like virginity, this lady doctor says that she invariably links the subject to that of gender disparity to drive home the fact that while a bride is forced to prove her virginity on her wedding night, her husband is not required to prove that he had been loyal to her before marriage, thus getting off scot free, even though he may have been a man of loose morals. Another favourite question she is often confronted with both by male and female students is "Masturbation." Male students usually want to know if masturbation is a sin or a disease. My reply is that it is neither. I also tell them that masturbation is not limited only to males although it is much more common in males. Students also want to know why they masturbate. My answer to this question is that it is a defence mechanism and that it was better for them use this method than having sex with unknown females who could infect them with sexually transmitted diseases (STDs)", Dr Ariyaratne says. Other questions that frequently come up for discussions with students are: At what age is it advisable for a male/female to marry? At what age should a girl/boy become a mother/father? What do we do when we feel attracted to people who are gay or lesbians? Can a girl with small breasts be able to nurse her child? "To all these questions we try to give the students honest and simple replies because we know that they are being asked not merely because of curiosity but because they are questions that concern them personally and cause them anxiety. As Health workers it is our duty to allay those fears with honest answers," stresses this health official. As a mother of two adolescent children, a girl and boy, this woman doctor however shares the opinion of a large majority of the public, that sex education must first begin in the home." If parents are close to their children and become their friends and confidantes, and are willing to discuss the facts of life with their children, it is much easier for a child to discuss such questions with his mother or father rather than try to learn them from his school or his peers or worse still from porn literature found on pavement shops." A mother describing her daughter's first period said, "I had already prepared her for it for we had discussed the subject before hand. So unlike most of her classmates she was not afraid when she spotted blood on her underwear for the first time". Dr Ariyaratne is also of the opinion that parents should closely observe the physical changes in their children and look out for signs that indicate the onset of puberty. "A young girl on the brink of womanhood will need to wear a brassier when her breasts develop. If her mother turns a blind eye to her need, she may become the butt of ridicule among her schoolmates. Similarly a young boy whose face has just begun to sprout hair may need to shave. If his father insists he is too young to shave, he too may become an object of ridicule among his playmates. Children may be too embarrassed to ask their parents for such items as a bra or a shaver. It is up to the parents to look out for the signs that indicate their children's needs", she points out. Equally, she is concerned that teachers now handling large classes may miss out on signs indicating physical needs of adolescent students which could be brought to the attention of their parents. "In adolescence one experiences physical changes such as sudden growth of the body, facial hair in the case of boys and voice changes, and in the case of girls, the development of breasts, slimmer hips and other changes linked to the pituitary glands. Such changes are influenced by the environment, by hereditary factors and by nutrition. Under-nutrition can lead to stunting, and in the case of girls can lead to malnutrition and low weight babies. In adolescence, a girl or boy may also experience changes in their mental outlook, and problems that may have been ignored in their childhood could be blown out of proportion. Young people with mental problems often commit suicide for trivial reasons on account of this fact. Hence it is important that in our discussions on Reproductive health we consider all these facts," Dr Mrs Ariyaratne says. In order to encourage students to discuss matters relating to sexuality more freely, the Health Education Bureau has recently introduced a pilot project with the co-operation of the Education Ministry to train groups of students as voluntary peer counsellors on sexual and reproductive health matters. "Even if other students are reluctant to discuss such matters with their peers, still the students who have received this training will have a high level of awareness on the subject," she adds. |
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