Despite the high political priority given to the health of women, children and adolescents in Kazakhstan, gaps exist in the delivery of health services to young people, according to a new report from WHO/Europe. The COVID-19 epidemic in the country has accentuated some of these challenges and has pressed health professionals to find new ways of providing much needed health services to adolescents.
Breaking the stigma around sexual education for adolescents
The new WHO/Europe assessment of sexual, reproductive, maternal, newborn, child and adolescent health in the context of universal health coverage in Kazakhstan found that the country has made considerable progress in this area in the last 10–15 years, particularly in bringing down maternal and under-5 mortality.
Government policies support the full coverage of health services for pregnant women, women in delivery and postpartum, and children aged 0–18 years. However, in practice there are challenges in ensuring the availability of quality sexual and reproductive health services for these groups, especially for adolescents.
Addressing stigma and negative attitudes towards sexual education in schools are a crucial part of the process of ensuring better sexual and reproductive health services for young people, says Laula Brik, a psychologist at the Zhas Asyl youth health centre. “Unfortunately, many people don’t fully understand why it’s important that our youth are taught in a competent and confidential manner about these topics. They think it’s incorrect and vulgar,” says Ms Brik. “Sexual and reproductive health issues are essential for adolescents’ health and education, because they affect not only the individual’s health, but also have a multifaceted impact on the nation’s health and the country’s development.”
The Zhas Asyl youth health centre, one of 128 such centres in Kazakhstan, offers counselling, training, testing and consultations on sexual and reproductive health and mental health through their team of specialists. Psychologists, a gynaecologist, a urologist and a dermatologist work at the clinic. One of the recommendations made in the WHO/Europe report is to establish more such centres, where services are specifically tailored to fit the needs of adolescents.
Digital technologies ensure continued health services for youth
A global WHO survey conducted in 105 countries showed that sexual and reproductive health interventions, such as family planning and contraception, were among the most frequently disrupted because of the COVID-19 pandemic. Like every other country around the world, in the past months Kazakhstan has had to make difficult decisions to balance the demands of responding directly to COVID-19, while simultaneously doing strategic planning and taking coordinated action to maintain essential health service delivery. “Quality health services are critical for women, children and adolescents, and disruptions may lead to unintended pregnancies, sexually transmitted diseases, and increased health risks for mothers and their newborn babies, and for children and adolescents,” says Dr Nino Berdzuli, Director of the Division of Country Health Programmes, WHO/Europe.
Ms Brik also emphasizes the importance of uninterrupted support and services for young people during the epidemic. Because of COVID-19, the Zhas Asyl youth health centre’s team has had to adapt its ways of working. “At the peak of the epidemic, most of the centre’s staff worked remotely, replacing in-person communication with communicating through social networks and instant messaging apps. We focused our work on health literacy,” says Ms Brik. Health literacy is about improving people’s access to health information, and their capacity to use it effectively.
The staff working at the Zhas Asyl youth health centre noticed how adolescents went through different emotional stages during the epidemic, starting with mistrust and feelings of rejection towards the new regulations, to later feeling indifferent or depressed. “Psychological support was needed for both the adolescents and medical workers themselves,” says Ms Brik, explaining how the youth health centre had to adjust its ways of working during the epidemic.
Addressing Regional challenges in sexual and reproductive health
Kazakhstan is not the only country in the WHO European Region struggling to provide young people with sexual and reproductive health services that are tailored to their needs. “Although much progress has been made in the Region in terms of reducing abortion rates, and we can see a decline in teenage pregnancies, a lot still needs to be done,” says Dr Berdzuli. A WHO/Europe assessment showed there are either no or very few sexual and reproductive health services for adolescents in most of the six assessed countries in eastern Europe and central Asia. “This leaves young people with little support and few ways to access information,” says Dr Berdzuli. “Going forward, it will be important to escalate our efforts to bridge these gaps. Engaging youth in this process is critical.”
The WHO European Programme of Work 2020–2025 strongly emphasizes sexual and reproductive health and rights. The programme advocates for closing equity gaps and upholding rights related to the sexual and reproductive health of the most vulnerable and marginalized, including young people. “To provide access to comprehensive sexual and reproductive health services and information for adolescents, a broad range of partners must be involved,” emphasizes Dr Caroline Clarinval, WHO Representative to Kazakhstan.
In line with the outcomes and recommendations of the WHO country assessment, Ms Brik affirms that sexual and reproductive health education should be introduced to the general curriculum in schools and taught according to a standardized methodology, by certified specialists. “Teenagers need information about the issues that interest and concern them. We need to talk about these issues honestly”.
On 20 and 22 October, WHO/Europe and the United Nations Population Fund (UNFPA) Eastern Europe and Central Asia Regional Office will host a subregional consultation on sexual and reproductive health with central Asian republics.