The secrets of young people. Exploring sexuality and health among adolescents in rural Bangladesh

108 Pages·2010·3.19 MB·English

Amsterdam Master's in Medical Anthropology
crets of young
58
~-.~·
.
xploring sexuality and health among adolescents
rural Bangladesh
By
Mohammad Didarul Alam
Supervisor- Prof. Dr. Sjaak van der Geest
eo-supervisor- Prof. Dr. Corlien Varkevisser
Thesis submitted for the Master's Degree in Medical Anthropology
Medical Anthropology Unit
Faculty of Social and Behavioural Sciences
University of Amsterdam
The Netherlands
2001
Acknowledgments
This thesis work has been undertaken as part of fulfillment of the requirement of the Master's
degree in Medical Anthropology at the Medical Anthropology Unit, University of Amsterdam,
The Netherlands. ·
The people, whom I am indebted in the first place, are the youngsters who form the
center of the study. They include informants, key informants and community members of
Shaharbil union of Chakaria Thana, under Cox's-Bazar district of Bangladesh. I remain ever
grateful to them for their trust in me through out the course.
I express my heartiest thanks and respect to Prof. Dr. Sjaak van der Gees!, my
supervisor, for encouraging me to work on this topic, guiding and supporting me throughout the
process. Beside, I remain ever grateful to him for his cordial attempt to install the medical
anthropological instinct in me throughout the course.
I am indebted to Prof. Dr. Corlien Varkevisser for her cordial support and guidance
during developing the research proposal. I pay my respect and thanks to her.
I would like to remember my teacher, Dr. Rosalia Sciortino, who encouraged me to
conduct research on adolescents' sexual health during her teaching and provided me some
relevant books and information, which later helped me a lot to get an idea about the field. I
remain grateful to her for her cooperation and advice.
h
lt is Dr. Ria Reis and Ms. Trudie Gerrits, both of AMMA staffs, to whom I am grateful for
their suggestions and guidance during developing the research protocol. Special thanks to
Prof. Dr. Pieter Streefland and Dr. Anita Hardon for their cooperation and guidance during the
course.
Dr. Abbas Bhuiya, Head of the Social and Behavioral Sciences Program of ICDDR,B
Center for Health and Population Research and my organization- ICDDR,B gave me the
chance to attend the AMMA course. I pay my heartiest respect to them.
I further thanked to Dr. K. M. A. Aziz, Dr. Quamrun Nahar, Ms. Papreen Naher, Mr. A. A
Neeloy of ICDDR,B and Dr. Mohammad lqbal, Mr. Nurul Islam, Mr. M. A. Hanifi, Mr. Ariful
Moula and the other staff of Chakaria Community Health Project for their cooperation,
information and encouragement.
My sincere and heartfelt thanks to Mr. Shafiq-ud-Dowala, Mr. Saiful Islam, A. S. M.
Safiur Rahaman Sadeque, Mr. Junaid for their assistance throughout the fieldwork. Many
thanks to the teachers of As-Safa Foundation, BMS High School, Shaharbil Anower Ulum
Senior Madrashaw for their cooperation to me during field work.
Many thanks to Maise Dagapioso, Jennifer Fagan, LeAnna Fries for their help in editing
an earlier version of the thesis. I would also like to thank Ms. Kenetha Chy. and Ms. Sabrina
Rashid for their comments and suggestions.
Last, but not the least, I would like to acknowledge a great debt to my wife, Ms. Nasima
Akhter Lovely, who supported throughout my time of absence and helped me transcribing
interviews. I thank her and my son Shahir-AI-Shabab Ebna Didar, for their patient waiting for
me.
Thanks to all.
University of Amsterdam Mohammad Didarul Alam
17 August 2000
Table of contents
Acknowledgments
1
Abbreviations and acronyms
11
Table o contents
111
List of Tables
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List of figures
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Executive summary
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Chapter- One
Introduction:
1.1 Statement of the problem 1
1.2 Literature review 3
1.3 Objectives ofthe study 6
1.4 Main research questions 6
Chapter-Two
Research methodology:
2.1 Studytype 7
2.2 Study population and sampling 7
2.3 Data collection 9
2.4 Problems encountered during data collection 11
2.5 Data processing 12
2.6 Data analysis 13
2. 7 Ethical considerations 13
2.8 Limitations ofthe study 13
Chapter- Three
Study area:
3.1 Selection of the study area 14
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3.2 Area, location and population 14
3.3 Houses, families and society 14
3.4 Gender relation 15
3.5 Social, cultural and religious functions 16
3.6 Educational institutions 16
3.7 Communication and mobility 17
3.8 Recreational activity for youth 17
3.9 Youth and adolescents organizations 18
3.10 Health facilities 18
Chapter- Four
4. Sexual experiences and practices:
4.1 Love relationships: ' 20
4.1.1 Love among adolescents 20
4.1.2 Process of developing love relationship 20
4.1.3 Age or time of initiating love 22
4.1.4 Actions to satisfy lover 22
4.1.5 Problems/ Obstacles in love: Adolescent boys' 22
reaction and actions
4.1.6 Boys' reaction and actions after sacked by lover 24
4.1.7 Discussion 25
4.2 Sexual arousal: 26
4.2.1 Subjects arouse sexual desire as perceived by 26
adolescents
4.2.2 Response to arousal 29
4.2.3 Actions proposed by respondents to control sex 30
arousal subjects
4.2.4 Discussion 30
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4.3 Wet dreams: 31
4.3.1 Local terms and meanings 31
4.3.2 Experiences 31
4.3.3 Perceptions about causes of wet dream 31
4.3.4 Perceptions about effects of wet dream 32
4.3.5 Remedy or care taken 32
4.3 .. 6 Perception about girls' wet dream 33
4.3.8 Discussion 34
4.4 Masturbation: 35
4.4.1 Local terms, their meanings and scope of application 35
4.4.2 Who practice it 35
4.4.3 Frequency of practicing masturbation 36
4.4.4 Places of practicing masturbation 36
4.4.5 When and why masturbate 37
4.4.6 How communicate 37
4.4.7 Perceptions about girls' practices of masturbation 38
4.4.8 Effects of masturbation as perceived by adolescents 39
4.4.9 Seeking care 40
4.410 Discussion 40
4.5 Homosexual practice: 41
4.5.1 Local terms and their meanings 41
4.5.2 homosexual practice in the study area 43
4.5.3 Understanding homosexuals 44
4.5.4 Influencing factors 45
4.5.5 About homosexual practice among girls 45
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4.5.6 Effects on health and society 45
4.5.7 Discussion 46
4.6 Heterosexual practices: 48
4.6.1 Local terms, their meanings and application 48
4.6.2 Heterosexual practice in the study area 51
4.6.3 Sexual partners 52
4.6.4 How they cormnunicate and meet 58
4.6.5 Role of family, society and peers 61
4.6.6 Conception, contraception and abortion 63
a) Boys' perceptions about conception 63
b) Boys' perceptions and practices of contraceptives 63
c) Boys' perception and practices regarding abortion 64
d) Discussion 65
Chapter- Five
Effects on health and heath care seeking
5.1 Perceptions about effects on health and well-being: 69
5.1.1 Introduction 69
5.1.2 Identifying and ranking effected areas 70
5.1.3 Description of effects on each area 71
5.1.4 Discussion 89
5.2 Health care seeking behavior: 91
5.2.1 Sexual health problem faced 91
5.2.2 Visiting health care personnel 92
5.2.3 Coping mechanism 94
5.2.4 Health facilities for adolescents 95
vi
5 .2.5 Suggestions/ expectations of adolescent about health 95
service
5.2.6 Discussion 96
Chapter- Six
Discussion and conclusion:
6.1 Overall Discussion 97
6.2 Conclusion 101
6.3 Recommendations 102
6.4 Suggestions for research 102
Appendices:
1 Detailed Questionnaire !Interview guidelines for
Narrative writings, FGD, In-depth interview, etc.
2 Background characteristics of respondents
3 Map of study area
4 References
List of Tables:
1 Categories of adolescent respondents 7
2 Categories of respondents on the basis of personal
income, father's education, father's profession, lodging
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status.
3 Categories of respondent have had sex 66
4 Table showing the effected areas mentioned by the 72
respondents
5 Table showing the rank given by participants on 73
severity of effects
6 Comparing effects of sexual behavior as perceived by 77
adolescents
Figure:
1 Diagram on developing love relationship 21
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Summary
Adolescent population of Bangladesh is approximately one third of its total populations of
122 million. In spite of their large number, they are over looked by governmental and non
governmental organizations in the field of health especially sexual health. At present adolescents
lives are threatened as they continue to practice unsafe sexual behavior which lead to STDs,
including HIV /AIDS. If young people's lives are threatened, the whole nation will face a bleak
future. Western countries have conducted a lot of research on adolescent sexual health and started
different programs to improve their condition. Recently in Bangladesh, the government also started
planning for programs to improve the health of young adolescents. Research on adolescent sexual
behavior is urgently needed in this context.
The reason that so little research has been carried out on adolescents' sexual health in
Bangladesh is undoubtedly related to the difficulty in conducting research on such a sensitive issue
in a conservative culture like Bangladesh. Although some research was conducted in the past, the
adolescents' own perceptions with regard to their sexual behavior and its effect on their health is
remained mostly unexplored. lt is very important to understand adolescents' sexual behavior from
their own viewpoint. Taking this into account, I have carried out research among adolescent boys of
Shaharbil union of Chakaria Thana ( sub district) under Cox's- Bazar district of Bangladesh. The
research was an exploratory and anthropological in nature. Data were collected from 38
adolescents boys using different qualitative data collection techniques such as : in-depth interviews,
narrative writings and focus group discussions. Field observations were carried out to see closely
the adolescents' interactions related to the subject. In addition to the adolescents boys, data was
also collected from: their parents, social leaders, youth organizers, community health workers,
health personnel of governmental and non governmental organizations (GO/ NGO), traditional
healers and some other community members. Adolescents from different socio-economic
backgrounds were interviewed separately. These include high school, college and religious school
students and adolescents, with no formal education. Having six years experience in an international
organization working with young people, I was able to win their trust and have open conversations
with them. After data collection and initial processing, preliminary results were shared with some
respondents and a group of researchers who have six to seven years experience working with
young people in the field of health. Later the findings were shared with three key informants who
have conducted research on adolescent sexuality and they also agreed with the findings. Different
articles and a few research reports that were available on adolescent sexual behavior in
Bangladesh supported the findings.
lt was found that the media especially 'naked books',' naked magazines', sex related
advertisements 'and' blue films influenced the sexual behavior of adolescent boys'. Filrns or
television programs sexually aroused some adolescents.
Common sexual behaviors and experiences among adolescents were masturbation, wet
dreams, homosexual, and heterosexual practices. Boys had a lot of misinformation and
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misconceptions about these practices. Many boys felt worried after practicing masturbation or
experiencing wet dreams as they perceived that these sexual experiences seriously affect their
health. Most of their concerns were centered around semen. They perceived semen as an important
body fluid that was necessary for maintaining good health, energy, and sexual power. The loss of
semen signified the loss of health and power (sexual power and power as a man) and the loss of
energy. lt was their perception that through each episode of wet dream and masturbation, they lost
five to ten times more semen than a heterosexual inter course. When they frequently experienced
wet dreams or practiced masturbation, they felt anxious about losing physical strength and health
on one hand and on the other hand, they were afraid of losing sexual power and masculinity, which
might affect their sexual life.
Their tension was also associated with sin and guilt. Although boys experienced sexual
pleasure after engaging sexual practices, such as masturbation, homosexual or heterosexual
intercourse, they also perceived that they had done something " wrong" or bad or sinful afterwards.
This led the feeling contradiction" about their own sexual behavior. Sin and guilt feelings were
associated with social norms and religious values of the society, which either condemned or ignored
their sexuality. In the eyes of society, their sexual practices were considered "anti-social"; therefore,
the boys were afraid of losing prestige and facing social stigma while they engaged in those sexual
behaviors.
The boys had a lot of misconceptions about pregnancy. They believed that sex for a few
times or infrequent sex with an adolescent girl might not lead to pregnancy. In most cases boys
were reluctant to use condoms. They saw it as the girls' responsibility to take the contraceptive pill.
This leads to unwanted pregnancy and later unsafe abortion seriously affects the girls' health. Boys
also think that they would experience more sexual pleasure without condoms. Many boys were
ignorant about the causes or mode of transmission of STDs. Many sexually active boys did not use
condoms, even with sex workers. As a result most of them (among the sexually active) had STDs
and are susceptible to HIV/ AIDS. Many of them hide their STDs and did not seek treatment.
Suffering from the disease for long period of time, may seriously hamper their physical and sexual
health in later life.
All of their sexual health problems either related to the ignorance or negative social attitudes
towards their sexuality. There is a big gap between 'what we call normative or social prescribed
behavior' and actual sexual practice among young people. The research has shown that sexual
activity during adolescence is far more common than is usually assumed. Definite figures about the
occurrence of the various form of adolescent sex in Bangladesh are not available, but the
information collected in the Shaharbil union suggests that adolescent boys have frequent sexual
experiences, but due to repressive culture keep this experience secret. lt is this secrecy and
repression, which causes numerous problems and turns sexual activity into health risk.
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Abbreviations and acronyms
BRAC -Bangladesh Rural Advancement Committee
CCHP -Chakaria Community Health Project
FWC - Family welfare Center, a union level government
health center.
ICDDR,B -International Center for Diarrhoea! Diseases
Research, Bangladesh
ICPD - International Conference on Population and
Development
IPPF -International Planned Parenthood Federation
MBBS - Bachelor of Medicine and Bachelor of Surgery
NGO - Non Government Organization
PRA - Participatory Rapid Apparisal
STD - Sexually transmitted diseasess
Thana - Sub district, consisting a few unions.
THC - Thana Health Complex
TV -Television
UNDP -United Nation Development Program
UNESCO - United Nations Education Scientific and Cultural
Organizations
UNICEF - United Nations Children Emergency Fund
Union - Small administrative unit of local government,
consisting a few villages
VCP - Vedio Cassettee Player
WHO - World Health Organizations
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