কিশোর-কিশোরীদের প্রজনন স্বাস্থ্য: না বলা কথা

রবিঠাকুরের বিখ্যাত ছোটগল্প “ছুটি”-র ফটিকের কথা মনে আছে? সেখানে বয়ঃসন্ধিকালীন বয়সের প্রতিভূ চরিত্র হিসেবে ফটিক সম্পর্কে যা বলা হয়েছিলো তা যেন আমাদের কিশোর-কিশোরীদেরই মনের কোটরবন্দী কথা, “তেরো-চৌদ্দ বছরের” ছেলেমেয়েরা “সর্বদা মনে-মনে বুঝিতে পারে, পৃথিবীর কোথাও সে ঠিক খাপ খাইতেছে না… অথচ, এই বয়সেই স্নেহের জন্য কিঞ্চিৎ অতিরিক্ত কাতরতা মনে জন্মায়।“

এই ফটিকের মতই প্রায় সাড়ে তিন কোটি কিশোর-কিশোরীর বসবাস এই ছোট্ট দেশে যাদের বয়স ১০ থেকে ১৯ বছরের মধ্যে। এই সংখ্যাটা নেহায়েত কম তো নয়ই বরং এই সংখ্যা আমাদের সমগ্র জনসংখ্যার ২১ শতাংশ। স্বাভাবিকভাবেই দেশের সামগ্রিক মাপকাঠিতে এই জনগোষ্ঠীর ভূমিকা খুবই গুরুত্বপূর্ণ। সেরকম কিছু কিশোর-কিশোরীর সাথে আমরা কথা বলি “জেন্ডার এন্ড এডোলেসেন্স: গ্লোবাল এভিডেন্স”, সংক্ষেপে GAGE প্রকল্পের আওতায় চলা গবেষণার সময়।

বয়ঃসন্ধি হচ্ছে ১০-১৯ বছরের বয়সসীমার মাঝে জীবনের এমন একটি ধাপ, যার মাধ্যমে একটি শিশুর প্রজনন ক্ষমতার পাশাপাশি শরীর ও মনে কিছু পরিবর্তন আসে এবং সে ধীরে ধীরে একটা পূর্ণবয়স্ক মানুষে পরিণত হয়। ২০১৮-তে GAGE প্রকল্পের অধীনে ঢাকা-র তিনটি বস্তিতে একশোরও বেশি বয়ঃসন্ধিকালীন কিশোর-কিশোরী এবং তাদের পরিবার ও পারিপার্শ্বিক সমাজকে নিয়ে চালানো গবেষণায় উঠে আসে কিছু গুরুত্বপূর্ণ ও চমকপ্রদ তথ্য।

তাদের সাথে কথা বলে দেখা গেছে, স্কুল পাঠ্যক্রমে যৌন ও প্রজনন স্বাস্থ্য সম্পর্কে ঠিকভাবে শেখানো হয় না। এই কিশোর-কিশোরীদের বয়ঃসন্ধির ব্যাপারে যথেষ্ট ধারণাও নেই। শতকরা ১৭ ভাগ কিশোর ও ২৭ ভাগ কিশোরী ঠিকমত কোনো জন্মনিয়ন্ত্রণ পদ্ধতির নাম বলতে পেরেছে। ১৫ বছর বয়সী কিশোর রফিক (ছদ্মনাম) আমাদের জানায়, “ক্লাস সিক্সে উঠে শারীরিক শিক্ষা বই থেকে আমরা জানতে পারি বয়ঃসন্ধি সম্পর্কে।“ আদতে তাদের স্কুলের বইতে শুধু একটি অধ্যায়েই কৈশোরকালীন শারীরিক অবস্থা নিয়ে আলোচনা রয়েছে, তাও কেবল মাসিক ও বয়ঃসন্ধি নিয়ে আলোচনাতেই সীমাবদ্ধ।

মজার ব্যাপার হচ্ছে, শিক্ষকেরা যখন ক্লাসে মাসিক নিয়ে পড়ানো শুরু করে, তখন ছেলেদের ক্লাস থেকে বের করে দেওয়া হয়; যার ফলে তারা এ সম্পর্কিত জ্ঞান থেকে দূরেই থেকে যায়! এমনকি একজন কিশোরের সাথে কথা বলে জানা যায়, ছেলেদের ক্ষেত্রে শারীরিক পরিবর্তন নিয়ে বাবা কিংবা মায়ের সাথে আলোচনা করার বিষয়টিও ঘটে না লজ্জা ও সংকোচের কারণে। ছেলেদের ক্ষেত্রে তাদের মনোদৈহিক পরিবর্তন ও প্রজননস্বাস্থ্য নিয়ে আলোচনা বা জানার বিষয়টা সীমাবদ্ধ মূলত বন্ধুদের সাথে আলাপ কিংবা স্কুলের শারীরিক শিক্ষা বইয়ের সেই একটি অধ্যায়ে সীমিত জ্ঞান। মায়েরাও তাদের কন্যাসন্তানের সাথে খোলাখুলি আলাপ করতে স্বচ্ছন্দবোধ করলেও ছেলেসন্তানদের সাথে আলোচনা করতে মোটেই স্বচ্ছন্দ নন। একই কথা প্রযোজ্য কিশোরীদের ক্ষেত্রেও। তাদের অনেকেই বড়জোর মায়েদের সাথে প্রজনন স্বাস্থ্য বিষয়ক আলাপ করে থাকে। শিরিন (ছদ্মনাম) নামের এক কিশোরী জানায়, কেবল বাবা-মা নয়, স্কুলের শিক্ষকরাও তাদেরকে প্রজনন স্বাস্থ্যবিষয়ক শিক্ষাদানের ব্যাপারে সংকোচবোধ করেন।

গেইজ-এর গবেষণায় দেখা গেছে, জরিপ চালানো ৩৯ শতাংশ কিশোরীর স্কুলে ঋতুকালীন সুবিধাগুলো পাওয়া যায়, যেই হার প্রয়োজনের তুলনায় অপ্রতুল। মেয়েদের প্রজননবিষয়ক স্বাস্থ্যসেবার জন্য এলাকার ঔষধের দোকান বা ফার্মেসীর ডাক্তারই প্রধাণ ভরসা। দুঃখজনক হলেও সত্যি যে, অধিকাংশই জানায় যে তাদের এলাকায় ধারেকাছে এমনকি ৫ কি.মি. দূরত্বের ভেতর কোনো প্রাথমিক স্বাস্থ্যসেবার জন্য হাসপাতাল বা ক্লিনিক নেই। কেউ কেউ দূরের সরকারী হাসপাতালে যায় তুলনামূলক কম খরচে ভালো স্বাস্থ্যসেবার জন্য। কেউবা রঙধনু সরকারী কমিউনিটি ক্লিনিকে কিংবা মেরি স্টোপ্স ক্লিনিকে অথবা এনজিও-পরিচালিত ক্লিনিকে যায়।

অর্থাৎ কিশোর-কিশোরীদের যৌন ও প্রজনন স্বাস্থ্যসেবা সরবরাহের প্রতুলতা দূরে থাক, সার্বিক প্রজনন স্বাস্থ্য সম্পর্কে তাদের পরিষ্কার ধারণাই নেই। নেই সচেতনতা সৃষ্টির পর্যাপ্ত প্রয়াস, কিংবা স্কুল ও স্কুলের শিক্ষকদের সে সম্পর্কিত যথাযথ উদ্যোগ। মাসিক বা ঋতুস্রাব ও প্রজনন স্বাস্থ্য যেন এক ধরণের ট্যাবু।

ফটিকের মতই শিরিন ও রফিক কিংবা অন্য সব কিশোর-কিশোরীরা বয়ঃসন্ধির সময়টায় একরকমের জটিল পরিবর্তন প্রক্রিয়ার মধ্যে দিয়ে যায়। গোটা দেশের এই সাড়ে তিন কোটি জনগোষ্ঠী তাদের কৈশোরকালীন সময়টা যখন পার করে, তখন কিন্তু তারা ঠিক আর শিশুদের কাতারেও পরে না, আবার প্রাপ্তবয়স্ক হিসেবেও তাদের গণ্য করা হয় না। তাদের জীবনের এই পর্যায়টা একটি সংবেদনশীল অধ্যায়। তাই তাদের প্রয়োজন একটুখানি যত্ন, উন্নত স্বাস্থ্যসেবা, যৌন ও প্রজননস্বাস্থ্য সম্পর্কিত যথাযথ জ্ঞান, সেইসাথে মেয়েদের মাসিক স্বাস্থ্য ব্যবস্থাপনার উপযুক্ত সুবিধা। উন্নত স্বাস্থ্যসেবার বিষয়টি এসডিজি অর্জনের সাথেও ওতপ্রোতভাবে জড়িত। মোট জনসংখ্যার এই গুরুত্বপূর্ণ অংশকে বাদ দিয়ে দেশের উন্নয়নের পথে সাফল্য কঠিন হয়ে দাঁড়াবে।

Photo credit: Sulekha.com licensed under CC BY-NC 2.0

How Technology is Exacerbating

How Technology is Exacerbating the Class Divide during the Pandemic: The Case of Children’s Education in Bangladesh

The world has always been an unfair place with winners and losers. Technology is making lives better for everyone as a whole, but it is also responsible for exacerbating the inequality between the rich and poor. Relentless, exponential technological progress of our times is widening the class divide like never before. Now COVID-19 is ruthlessly laying bare this uncomfortable reality of ‘technological inequality’. In this blog, I will try to explain why the poorer children in Bangladesh are likely to lose more than the richer ones because of the COVID-induced school closure, and how technology is making it worse.

In many cases, the unfairness of technological inequality during the pandemic is blatantly obvious. Blessed by Meet, Zoom, and the like, most ‘office-goers’ have turned their homes into offices, albeit with a few hiccups. On the other hand, a vast swath of  ‘working class’ people have found their customers disappearing or have been laid off by their employers because of the lockdown and the resultant economic shock; they are also disproportionately exposing themselves to the virus as they are crucial to running the essential economy. But then there are cases where the effect of technological inequality during the pandemic has remained insidious. One of such cases is children’s education.

There is evidence that prolonged school closure, such as 3-month summer vacation in the west and as an aftermath of a natural disaster, has a strong adverse impact on learning, though the evidence on whether poorer children suffer more is not so clear. Because of the pandemic, education of all children will be hampered, no doubt. But is the effect going to be the same for all children, rich or poor? If not, why? What role is technology playing in this inequality?

It is well-known that rich children all over the world have better educational outcomes than their poorer peers, and for obvious reasons. To start with, rich children are far less likely to be malnourished during their formative years, giving them a head start in cognitive development. Their parents are likely to be more educated and resourceful, thus better able to guide and support their children’s pursuit of education.

Studies have found that poor people spend a minuscule share of their small income on children’s education, as the majority of the poor children go to public schools, typically free and also that provide lower-quality education. Ill-educated poor parents cannot properly assess how well their children are learning; those who can, often take their children out of public schools and enrol them in private schools. But it turns out that the private schools for poor children are also of low quality.

And then there is this whole question of parental aspiration. Paradoxically, educated (hence richer) mothers spend significantly more time in childcare, including education, even though they often spend long hours working outside. And the ‘opportunity cost’ of spending time with their children is higher than that of their less educated, poorer counterparts. Is it because they aspire higher for their children? Maybe. For an educated mother, it is difficult to imagine that her children will not get proper education. She would thus work accordingly.

On the other hand, besieged by many urgent problems of life, with too many obstacles to jump over, and without relatable, close-to-home educated role models to look up to, poor parents have low aspirations for their children’s education and rationalize spending less time and money on this affair.

What does it mean for children’s education during the ongoing lockdown and school closure? ‌ It is obvious that the less educated, poorer parents would not have the incentive to spend close to enough time homeschooling their children. Struck by the loss of livelihoods, they are drowning in worries about how to feed their families. It is understandable that children’s education would be the least of their worries. Even if they did, a low level of education among poorer parents means that they may not be very effective in home-schooling. In contrast, educated, wealthier parents working from home may be able to and would want to spend more time in ensuring that their children would not fall behind in education because of the lockdown.

But what about technology? Can it help the poor children close the gap in learning with the wealthier ones during lock down? It is hoped that technology is the magic wand, which can close this great divide in education, if not eliminate it. In fact, ‌technology does have unlimited potentials. For example, Khan Academy and endless other free online resources have brought international-quality education to anyone with a basic smartphone and a reliable internet connection. Can the poor children take advantage of these online resources during normal times, and especially now?

Quite unsurprisingly, poorer parents, and by extension, their children have limited access to technology. Even in rich countries like the USA, shortage of computers in the homes of poor children, who now require to take classes and do homework online because of the pandemic, ‌is creating an uproar.

In Bangladesh, the wealthier private schools have started offering online classes. The government is also broadcasting classes for children on the national television and online. In a recent unpublished nationally representative survey in Bangladesh, we find a serious disparity in access to  technology. Even though the ownership of mobile phones is almost ubiquitous, about 15-20% of the poorer households do not have one. Only about 59-77% of the poorer households have any kind of access to television. Almost every richer household has access to both. Only a small fraction of poorer households use the internet, the rate sharply rises with household income. To make matters worse, for the poor, often these technologies are shared by multiple members or even multiple families. So, a large number of poorer children are automatically left out of the television and internet-based education.

Figure 1: Unpublished survey (2020) by BIGD, BRAC University

But, even if poorer children have access to technology, can they use it as effectively as the richer children? Eminent Harvard Professor of Public Policy, ‌Robert Putnam, describes “Compared to their poorer counterparts, young people from upper-class backgrounds (and their parents) are more likely to use the Internet for jobs, education, political and social engagement, health and newsgathering, and less for entertainment and recreation.” It is not because the poor are lazy and stupid, it is because wealthier, more educated parents are better aware of the pros and cons of letting a child have a smartphone or a computer, they know what is available online and are more invested to make sure that their children use it well. Thirty percent of the rural mobile phone users in Bangladesh cannot even read a message on their phone, let alone do any other activity; this rate goes up with decreasing per capita income. It must be true in cities as well, even if to a lesser degree. How can we expect these parents to use technology for their children’s education?

Even during normal times, richer children have a better chance of using technology for education because of parental awareness. Now that their are parents are home, these children are more likely to be exposed to all types of educational and cognitive development contents online, on top of attending the distant classes offered by the government or schools .On the other hand, many poorer children are simply deprived of their regular classes because they do not have access to television or internet. Even when have an access, they may remain absolutely clueless about how to harness its power to learn and grow because their parents cannot afford to stay home, have other pressing worries, or do not know how to guide the children.

For sure, COVID-19 is disrupting the learning for all children. But, powered by technology, the richer children can at least hope to close in. And, the poorer children are drifting further apart, partly because of all the reasons why they are poor, but also because of the technological inequality, the new reality of their generation.

Nusrat Jahan is the Head of Business Development and Knowledge Management at BIGD, BRAC University. 

Photo © Dominic Chavez/World Bank licensed under CC BY-NC-ND 2.0

Fear Of Uncertainty An Unexpected Common Ground

Fear Of Uncertainty: An Unexpected Common Ground

Young researchers from the GAGE program realise they are in the same boat as their adolescent peers from the urban slums of Dhaka—but they are not facing the same storm.

“If people are stuck in their home then they won’t be able to eat properly. Even missing a month’s work is a huge deal for us poor people. People like us have to go outside and work hard to earn money, right?  If this continues, we’ll just have to starve to death” (Female, age 19)  

Over the last two months, the pandemic has spread into Bangladesh and morphed to the community transmission stage, with the number of cases rising at an alarming rate.  COVID-19 spares no-one; it does not heed the socially constructed bindings that separate us by gender, status, age, education or wealth. However, even at the hands of this nondiscriminatory disease, the least privileged are the ones suffering the most.

As researchers, we have the privilege of working from home, living our lives as routinely as possible. We’re worried about the world and our loved ones, some facing the mental health issues that come with being stuck at home. However, people without a stable income or formal employment are at an unfair disadvantage that is far worse. For these vulnerable populations, they have to deal with tension and stress on a day-to-day basis. While we bemoan our boredom and ‘Instagram’ our work-from-home struggles, the working-class population can’t ‘afford’ to be bored or take their mental health into consideration.

In the narrow alleyways of the slums in Dhaka, basic utilities are rare. If some houses are lucky enough to have access to electricity, gas or water, the services are rarely uninterrupted. The idea of social distancing is almost laughable in these settlements, where families of six or eight are packed into single rooms. With several households sharing a common bathroom and kitchen, quarantine and isolation is an alien concept.

During the pandemic, adolescents in the GAGE programme are experiencing a different reality compared to their privileged peers. These adolescents are having to grow up far too soon, fast-forwarding through a critical phase of development. The impact of COVID-19 on their education and mental health is of great concern.

Our local team of researchers embarked on a journey to tackle this issue, focusing on adolescents facing the COVID-19 pandemic, located in low-income settlements in three areas of Dhaka – Rupnagar, Gazipur Sadar, and Mohammadpur. We had a list of 31 contacts from a baseline study conducted in 2018, from which we reconnected with 16 adolescents. This research was different for us, given the circumstances. However, we made the best out of the situation by utilising digital tools to coordinate remote working, using services such as Google Sheets, WhatsApp and Google Hangouts.

We thought we wouldn’t have much time during our phone interviews with each of the adolescents – leaving only a narrow window in which they could open up. However, to our surprise, most of the respondents were quite eager to talk, as they already had a rapport with the researchers from the previous baseline study. One challenge we did face during the interviews was finding a separate space devoid of external interruptions and noise, as ‘private space’ is not a “choice” but a luxury that most of the respondents could not afford. However, we tried to make the interviews as accommodating for the respondents as possible, keeping the questions simple and short.

The older adolescents we communicated with were quite well-spoken and aware of the COVID-19 pandemic. They knew that it was an infectious disease, and that they needed to maintain hygienic practices to prevent it. In contrast, the younger ones did not seem to understand the situation at all and were just following their parents’ instructions. One female adolescent (age 16) expressed her annoyance about not being able to go to school, “I don’t like staying at home all day because I can’t talk with any of my friends.  My neighbours are boys, so I cannot interact with them either since it is not accepted in our house. If I was attending school or coaching classes now, I would have fun and hangout with my friends. But the lockdown has made everything boring.”

Nearly all the respondents expressed their frustration and anxiety about the situation, worried about how their families would stay afloat in this economic crisis.  Being stuck at home for so long, not meeting their friends, is taking a toll on their mental health. They were also stressed about their families’ health, and felt quite helpless. A 15 year old boy told us, for example, how anxious he feels about his family members leaving the house. He said, “Every time my brothers come back from the bazaar, I panic. What if they catch the disease and it spreads to the family? They maintain hygiene, but they go out frequently and don’t always wash their hands every time. My mom and I keep telling them, but they say nothing will happen. I feel annoyed during these times, because they aren’t taking it seriously.”

Most of the respondents’ families were completely dependent on the income earned by their parents or siblings, which had come to a halt. Three of the adolescents in our sample had started to work after dropping out of school, but were compelled to stop due to the lockdown. This means that buying groceries, paying rent and getting by in the upcoming months is going to be very difficult. Although the government has been distributing aid, most of the respondents stated that help was yet to reach their households. One of them even shared concerns about corruption, referring to cases of local government representatives distributing relief only to their relatives.

Most of the respondents were getting information related to COVID-19 from the TV and through local “miking”, with few relying on online sources like Facebook and YouTube. Some of the adolescents stated that they did not have access to the internet at all, and not everyone in their class had a phone. Previously, school or extra classes were their only form of interaction with peers. In fact, none of the respondents were happy about schools being closed or exams being postponed. They are stressed about not being able to study, falling behind in their work, and performing poorly in their exams.

Most of the underprivileged adolescents had not been given any work at home and were trying to study by themselves. However, they all stated that they could not concentrate due to the pandemic, with thoughts of people dying and worries about the future. Moreover, most of the school-going adolescents do not have any support or guidance from their teachers. None of their family members are educated enough to help them with their studies, although their families are quite supportive.

Although we were offering a Tk.100 phone top-up to respondents as gratitude for giving us their time, we realised that simply getting the chance to open up about their anxieties was a much needed release for them. This was when we felt like the researchers and respondents were in the same boat, but fighting different storms. Perhaps, the acknowledgement that on some level, we shared the same hopelessness, despair, and fear in the face of a global disaster is what made the rapport building easy.

We are facing unprecedented times due to this pandemic. Researchers worldwide are conducting remote research, acquiring real time insights on the impact of the virus. As we continue our fight against COVID-19, we must always keep in mind the vulnerable adolescents who continue to bear the brunt of the crisis.

*This blogpost was originally written for the GAGE Programme*

Photo credit: “Mitaly” by Ricci Coughlan/DFID under CC BY-NC 2.0 license