Last week, the Bureau of Health Promotion responded to the theme of this year’s UN World Population Day on Adolescent Pregnancy. It said that the roots of the issue could be found in poverty, gender inequality and violence, as well as in insufficient educational, support and protection systems. These factors not only threaten the health of pregnant adolescents, but also deprive them of their rights and the opportunity to receive an education.
The UN pays particular attention to the issue of adolescent women’s sexual and reproductive health.
On average, a woman dies somewhere in the world every minute from complications due to pregnancy, childbirth or abortion. Ninety-eight percent of these deaths occur in developing countries, mostly in India and Africa. The maternal mortality ratio for adolescent girls in Africa is 830 per 100,000 live births. This is 100 times higher than the rate in Taiwan.
The surviving women often suffer from vesicovaginal or rectovaginal fistulas, which means that urine or feces can escape through the vagina. These women are often rejected by their husbands and ostracized from society, forcing them to make a life on their own somewhere else.
Sexual and reproductive health among adolescent women in Taiwan presents another image of discrimination.
When the bureau quoted the results of a study of several thousand adolescent’s sex habits, the somewhat unexpected conclusion was that “although sexual activity among adolescents has increased, the number of adolescent pregnancies and abortions has decreased as a result of the increasing use of contraceptive measures.”
This is a subjective and not at all reliable deduction, but that has not stopped the bureau from repeating it.
The credibility of any questionnaire or telephone interview must be checked and questioned.
A Canadian study has pointed out the frequent mistakes of such surveys: When researchers asked about height and body weight in a questionnaire and telephone interviews, and then immediately measured these values, they found that the men had added a few centimeters to their height, while women had reduced their weight quite significantly. Cautious researchers should question the credibility of studies using small samples to represent large population groups.
Although Taiwan lacks reliable abortion data, the bureau is not considering improving the situation. Instead, it makes populist statements, saying things such as: “More than 8,000 adolescent women have an abortion every year,” and “adolescent women should avoid becoming pregnant and having abortions.”
Abortions have been legal for a long time, providing pregnant adolescent women with an important right to make a reproductive choice.
The bureau’s abortion-related statements have long been discriminatory. They use data from research supported by the bureau without trying to avoid conflicts of interest, and even make unsubstantiated deductions, such as that the ratios of adolescent pregnancies and abortions have gone down to brag about the success of the bureau’s policies.
By comparison, Ministry of Justice data regarding the birthrate among adolescent women show that for Taiwanese women between 15 and 19 years of age, it has dropped to 4 in 1,000 last year from 10.89 per 1,000 a decade ago.
This is one of the lowest figures in the world, and far lower than the US’ 39 in 1,000 and the UK’s 29 in 1,000. The data shows that sexual activity and births among Taiwanese adolescents are among the lowest in the world. If sexual repression were a virtue, the logical thing would be to praise Taiwan’s young.
However, what Taiwan should consider is why former legislator Yen Ching-piao’s (顏清標) 16-year-old daughter-in-law could hold banquets for thousands of people, including hoards of government officials, to celebrate her pregnancy and wedding, while other adolescents choose to commit suicide when they become pregnant.
Why do so many adolescents give birth in washrooms and immediately abandon, or even kill, their newborns? Why is the birthrate 22.7 per 1,000 among adolescents in Taitung County and 21.4 in Hualien County? Why is the birthrate among Aborigines five times higher than the national average?
Many researchers have said that adolescents in poorer families have their first sexual encounter earlier and have more partners than others; that adolescent pregnancy is higher in poorer areas; that sexual and contraceptive education is lacking in these areas and so it is more difficult for adolescents in these areas to obtain contraceptives and access abortion services.
What Taiwan has done to support adolescent women? Abortions are one “contraceptive,” but women have to shoulder all the costs for abortions, birth control pills, contraceptive devices, morning-after pills and condoms.
Sexual health policy in Taiwan, the world’s second-most densely populated country, remains clearly biased toward encouraging childbirth and against subsidizing contraception.
This only goes to show that the authorities’ concern for women’s rights is nothing but lip service and moralist discrimination.
Chiang Sheng is an attending physician in the Department of Obstetrics and Gynecology at Mackay Memorial Hospital.