Focus of this presentation... • What is SRHR? • What do we know about SRHR and child marriage in South Asia? • What are the gaps? • How do we ensure SRHR of girls and young women affected by child marriage? Presented by Azra Abdul Cader, ARROW

2. Realising SRHR to Accelerate Action
to End Child Marriage in South Asia:
Expert Group Meeting on the Evidence Base for
Accelerated Action
Azra Abdul Cader
Senior Programme Officer
26-28 September 2016
Bangkok, Thailand

3. Focus of this presentation…
• What is SRHR?
• What do we know about SRHR and child marriage in
South Asia?
• What are the gaps?
• How do we ensure SRHR of girls and young women
affected by child marriage?

4. What is SRHR?
• Includes:
– Reproductive health
– Reproductive rights
– Sexual health
– Sexual rights
• SRR are not secondary rights
– Woman’s body is hers; she is a human being and a citizen of the
state in her own right; and can exercise those rights
• No equality, no empowerment without owning your body
• Non-negotiable

5. Why SRHR?
• SRR are a prerequisite for gender equality and there
are core elements that are integral to individual
autonomy
– to decide on matters related to partnership,
sexuality and reproduction
– to have the right to consent
– to have bodily integrity
– to be free of coercion

6. SRHR integral and embedded in the right
to health
“A state of complete physical, mental and social well-
being and not merely the absence of disease or infirmity”
and “the enjoyment of the highest attainable standard of
health is one of the fundamental rights of every human
being without distinction of race, religion, political belief,
economic or social condition.”
OHCHR. 2008. The Right to Health. Fact Sheet No. 31. Office of the United Nations High Commissioner for Human Rights
(OHCHR) and World Health Organization (WHO). Accessed September 13, 2016.
http://www.ohchr.org/Documents/Publications/Factsheet31.pdf
• Determinants of health
• Entitlements

7. Adolescent Population
Country Population
0-14 years
(% of total)
(2015)*
Population of
young
people 10-24
years (% of
total) (2013)**
Adolescent
population 10-19
years (as a % of
total population)
(2013)#
% of Female
adolescents (10-19
years) currently
married or in union
(2005-2013)#
Afghanistan 44 34 26 20
Bangladesh 29 30 21 45
Bhutan 27 29 19 15
India 29 28 19 30
Maldives 27 31 19 5
Nepal 33 33 23 29
Pakistan 35 32 22 14
Sri Lanka 25 22 15 9
South Asia 30 - 20 29
World 26 25 17 -
* World Bank data, ** PBR 2013, # UNICEF 2014b

8. Adolescent Fertility
Country Total
fertility rate
(Births per
woman) in
2014#
Adolescent
fertility rate
(births per 1,000
women ages 15-
19 years) 2014#
Women aged 20-
24 giving birth
before 18 years
(%)*
Women aged 20-
24 giving birth
before 15 years
(%)*
Afghanistan 4.8 77 - -
Bangladesh 2.2 83 40 (DHS 2011) 8.8 (DHS 2011)
Bhutan 2 23 15.3 (MICS 2010) 1.2 (MICS 2010)
India 2.4 26 21.7 (DHS 2005-
06)
3.4 (DHS 2005-
06)
Maldives 2.1 7 1.4 (DHS 2009) 0 (DHS 2009)
Nepal 2.2 73 19.4 (DHS 2011) 1.4 (DHS 2011)
Pakistan 3.6 39 10.2 (DHS 2006-
07)
1.3 (DHS 2006-
07)
Sri Lanka 2.1 15 - -
South Asia 2.6 35 - -
World 2.5 45 - -
#World Bank data, *UNFPA 2013

9. Contraception
* United Nations 2015. ** UNFPA, UNESCO and WHO. 2015. # UNFPA 2013
Country CPR - % of
married or in-
union women
15-49 years
(any method)
2015
(median)*
CPR (modern
methods) % of
married
females - 15-19
years (2006-
2013)**
CPR
(modern
methods) %
of married
females - 20-
24 years
(2006-2013)**
% of unmet
need for FP (15-
19 years)#
Unmet need for
FP - % of
married or in-
union women
15-49 years (any
method) 2015
(median)*
Afghanistan 29.3 6 13 - 3.8
Bangladesh 64.2 42 53 17 (DHS ‘11) 27.1
Bhutan 67.8 30 56 27.4 (MICS ‘10) 12.2
India 59.8 7 26 27.1 (DHS 05-06) 13.1
Maldives 42 10 23 36.9 (DHS ‘09) 25
Nepal 52.4 14 24 41.6 (DHS ‘11) 23.9
Pakistan 38.5 7 15 20.2 (DHS 06-07) 20.4
Sri Lanka 71.6 - - - 7.4
South Asia 58.6 - - - 13.8
World 63.6 - - - 11.9

10. Maternal Mortality
* WHO 2015 (Regional data) and WHO 2016 (Country data) ** WHO 2015
Country Maternal mortality ratio
Per 100 000 live births (15-
49 years) 2015*
Lifetime risk of maternal
mortality (1 in d)
2015**
Afghanistan 396 52
Bangladesh 176 240
Bhutan 148 310
India 174 220
Maldives 68 600
Nepal 258 150
Pakistan 178 140
Sri Lanka 30 1580
South Asia 182 200
World 216 180

11. Knowledge of HIV/AIDS
Sources: UNICEF 2014b Notes: x different data period; y Data differ from the standard definition or refer to only
part of a country. ** excludes China
Country Comprehensive knowledge of HIV
among female adolescents (%) 2009-
2013
Afghanistan 2
Bangladesh 11
Bhutan 22
India 19x
Maldives 22y
Nepal 25
Pakistan 1y
Sri Lanka -
South Asia 15
World 20**

12. Reproductive Health Sexual Health
• Higher adolescent fertility rates and
related consequences to health
• Maternal mortality, morbidity and
disability, infant mortality/morbidity
• Lack of access to contraception and
related services
• Psychological effects of marriage,
pregnancy and caring for children
• Vulnerable to STIs including HIV/AIDS
• Effects of violence – psychological and
physical
• Bodies are not ready for sexual activity
• Engaging in sexual activity with an older
and more experienced man (10 years)
Reproductive Rights Sexual Rights
• Marriage in order to reproduce
• Pressure to reproduce soon after
marriage/discouraged to use
contraception
• Limited information on contraception and
related aspects
• Lengthening reproductive span
• Large families and no control over timing
or spacing
• Unable to express sexuality and negotiate
safe sex practices, value in virginity
• Powerlessness and restricted movement
• Domestic and sexual violence
• Marriage is not of choice/rite of passage
• Lack of access to information on being
sexually active and broader range of issues
• Not worthy of consent/coerced/no voice
SRHR in South Asia

13. Other factors
• Prevailing gender inequality and
discrimination in society
• Lack of respect for women and
girls in society
• Socio-cultural and religious
influence on women’s place in
society
• Girl’s unequal position within the
household
• Girls are considered to be a
burden and unlucky
• Dowry pressures
• Financial gain
• Source of family honour and has
to be protected in order to protect
honour

14. Effects of culture and religion on SRHR
• Traditional, cultural, religious norms affect poorer women more
• Narrow interpretations of religious texts used to justify the practice
• Broader effects - practice accepted within a private domain (family) as it
involves a number of individuals, threat to social networks, position within
the household
• Effects of these are mitigated when women have more options, educated,
and families support and recognise their autonomy
• End practice as an integral part of multi-pronged poverty reduction
strategy

15. SRHR4ALL: Improving the evidence base
to make informed decisions
• Do we know enough beyond the extent of child
marriage?
– SRHR data is mostly lacking for young people including those
affected by child marriage
– Need data girls who have been married, longitudinal data and
short, medium and long term effects
– Need data on “at risk” girls including in crisis/humanitarian
contexts
• Political will to strengthen national institutions,
resources, technical assistance for better data and
analysis
• Assessing impact of interventions and scaling up
based on context specific learning

16. SRHR4ALL: Reform, enact and enforce
laws
• Reform laws and practices that restrict young people’s
access to SRH and services
• Legislation on birth and marriage registration
• Age of marriage, including minimum age of marriage
• Remove the influence of parallel legal systems
• Impose criminal penalties on perpetrators – this could drive
the problem underground
• Countering notions of it being an internal and
personal/private issue
• Accountability of all duty bearers

17. SRHR4ALL: Changing perceptions and
practices, including ensuring SRHR
• Focus on prevention AND not leaving out girls already
affected by the practice
• Parents and caregivers - awareness raising on legal
implications, short, medium and long term effects – a
lifecycle approach
• Focus on the range of stakeholders – politicians, policy
makers, law makers and enforcers
• Engaging boys and men productively so changes include
how women are respected and treated (objectify, control…)
• Religious leaders – rights based lens, focus on equality
and non-discrimination, narrow interpretations, own
perceptions

18. SRHR4ALL: Education & Empowerment
• Universal access to education and health insufficient, address
barriers to access, related costs
• Include Comprehensive Sexuality Education (CSE) for all girls, in
and out of schools, including at primary level
– Unbiased curricula, training for delivery, dealing with attitudes of
teachers, provision in formal and informal sectors
• Protectionist vs. rights based approaches (girl as a human being
with rights vs. girl being protected by father, husband, and now
state)
• Agency of girls and young women; encouraged, recognized and
supported
• Improving availability and access to protection, without judgment,
ensuring safety

19. Last but not least, we need …
• Ensure SRHR as a non-negotiable component of
health policy and programming
• Zero tolerance
• To stop talking and act more effectively to ensure
human rights of girls and young women, including
adolescents
• Language and practices to focus on empowerment,
equality, respect and attaining all human rights,
including SRHR
• Perception to change and political will in a range of
stakeholders, not just people in communities

20. Thank You

21. Who is ARROW? www.arrow.org.my
• ARROW was founded in 1993 - need for a regional
women’s organisation for women’s SRHR.
• ARROW works with 19 national partners across 16
countries in the Global South
• Information & communications: agenda-setting for SRHR in
the global south driven by information and communications
– collection, creation, distillation & dissemination.
• Monitoring & research: monitoring international
commitments on women’s health, sexuality & rights to
ensure accountability of international bodies and national
governments
• Advocacy through partnerships: Effective advocacy at
national, regional and global venues is possible through
advocacy partnerships

22. Abdul Cader, Azra. (2016, September). Realising Sexual
and Reproductive Health and Rights to Accelerate
Action to End Child Marriage in South Asia. ARROW’s
oral presentation made at an Expert Group Meeting on
the Evidence Base for Accelerated Action to End Child
Marriage in South Asia, 26-28 September 2016,
Bangkok, Thailand, organised by UNPFA Asia-Pacific
Regional Office and UNICEF Regional Office for South
Asia.