Data on the indicator for married or in-union women of reproductive age who have their need for family planning satisfied with modern methods (%) was available for nine countries in the Region.
Data on the indicator for married or in-union women of reproductive age who have their need for family planning satisfied with modern methods (%) was available for nine countries in the Region (Table 5). Women in Samoa have the lowest levels at 39.4% while the proportion was 80.5% for women in the Marshall Islands. The data however is limited in its age (data available from 2007 to 2014) and representativeness. For example, the major data sets on this issue have until recently asked questions of women and young women (usually) in a union rather than men or young men. This is changing with the MICS and DHS surveys including questions for males (see (15,17,19,22,32)). However, it underlines that both this measure and the way family planning data is collected reflects gendered norms and a bias in public health. This potentially reinforces messages about contraception being a woman’s health issue and responsibility and one only to be asked of adult women who are married or in a union. It also makes it a challenge to identify unmet need and address gender issues for boys, young men and men around sexual and reproductive health (see Box 10).
Unsafe sex is a significant risk factor for STIs and unwanted pregnancies. Gender norms often impose on men the expectations to be risk-takers, initiate sex and have multiple partners. Wearing a condom can be considered “unmanly” (195). A systematic review of cost as a barrier to condom use among men who have sex with men (MSM) found that decreasing the cost of condoms, and providing them for no cost, appears to increase their utilization amongst MSM and possibly reduces the burden from HIV and other STIs. However, inequality and stigma remain important barriers to MSM accessing and using condoms particularly LMICs (196). Women, on the other hand, are expected to assume passive roles. This, combined with their weaker bargaining power and often lower financial resources, can limit their ability to negotiate safe sex. A study of the sexual and reproductive health of young people in Asia and the Pacific found that 95% of new HIV infections occur among young key populations including young female sex workers, MSM, transgender and people who inject drugs (41).
Higher risk behaviors for HIV, including early sexual debut, multiple partners, unprotected sex (including transactional sex), and sharing injection equipment, often commence from an early age (41). Studies from some of the countries in the Region (the Philippines, Cambodia, Lao PDR, China and Viet Nam) describe high rates of multiple partners and low condom use, as well as sexual violence, STIs and abortion among young women who sell sex. Among the factors contributing to higher risk sexual behavior and poor SRH outcomes among young key populations are socio-cultural norms and taboos concerning premarital sexual behavior.
Young people may also be more vulnerable to exploitation, coercion and violence contributing to higher risk behaviors such as non-use of condoms. In the Philippines, for example, adolescent female sex workers (aged 14-17 years) were more than three times less likely to negotiate condom use with their clients than adult sex workers, Furthermore, young people in the Region also experience substantial stigma and discrimination (including within health facilities) and legislative barriers (linked to socio-cultural norms) preventing access to essential information and services to support good SRH (41). Young people living with a disability reporting in the Region report that they often face additional barriers to accessing information and services and/or experience violations of their sexual and reproductive health rights (41))
Differences in access to information, including information about sexual and reproductive health, can influence the extent to which men and women are empowered to access services and make decisions about their health. For example, in Samoa, the percentage of women who read the newspaper at least once a week is 47% compared to 44% of men, while men are more likely to watch television or listen to the radio at least once a week (18). Analysis of sex-disaggregated data on access to information can refine efforts to increase health-related knowledge. Limited information not only makes men and women vulnerable to a number of health risks; it also influences their health-seeking behavior, delaying or preventing access to care.
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