Our world is home to . The majority of these 10 to 24-year-olds live in Asia, with 48 million alone growing up in Bangladesh.  

And many of these young people are having sex. Bangladesh has one of the highest adolescent fertility rates in all of South Asia, coming in at . This is compared to a figure of 71 for Afghanistan and Nepal, which share the next highest adolescent birth rate in the region. In the US, this number stands at 21, in the UK, 14.

In Bangladesh, this high birth rate is driven by girls . Nearly three quarters of married Bangladeshi women become wives before turning 18 – compared to fewer than 3% of men. Media Action carried out research with adolescents, parents and teachers to better understand why. 

Outside of everyone’s comfort zone

We found that children and adults alike struggle to talk about sexual and reproductive health (SRH) in Bangladesh, .

Teenagers are embarrassed to seek out advice from their elders, due to social stigma and shyness. We also learned that parents don’t start these conversations either – aside from the heart-to-hearts mothers have with their daughters about periods.

SRH is a taboo topic, which parents feel is inappropriate to bring up with adolescents before they get married. Our research revealed that adults believe that telling teenagers about contraceptives promotes promiscuity.

As for teachers, they are often evasive and are known to sometimes skip the chapters on sexual and reproductive health in textbooks. Those we interviewed said they faced social barriers in discussing sex with students of the opposite gender to themselves. They also didn’t feel properly supported by their colleagues and management to have these kinds of conversations.

Educators are also discouraged by students’ reluctance to discuss sex with them in the classroom. Some NGOs run SRH programmes in schools but teenagers we spoke with said that these paint an incomplete picture of what they need to know.

Recognising these issues, by providing universal access to information and services. Girls are being taught . But this isn’t enough.

Getting the lowdown

Adolescents are unsurprisingly hungry to know more about the experiences they all have, but which are never spoken about.

This is where the radio show (Crossroads at 10 to 19) comes in. Combining drama, songs and interviews with both experts and ordinary teenagers, Dosh Unisher Mor aimed to give young people the comprehensive lowdown on SRH they crave. 

The show helped teenagers come to terms with the physical and psychological changes that go with puberty, by presenting these as natural and nothing to be ashamed of. Adolescent listeners said they learned new things from the show, particularly about the physical changes they were experiencing. For example, the programme corrected the mistaken belief, held by many of the boys we spoke to, that wet dreams are a disease.

The show also helps adolescents realise just how traumatic early marriage can be for girls. Listeners came to understand that getting pregnant at a young age puts mothers – and their babies – at risk of health complications and even death.

Some explicitly said that Dosh Unisher Mor led them to see early marriage as a damaging social convention they had the responsibility to protest against. One girl was even driven to stop a child marriage from happening – telling her parents about it, who in turn informed the police.

Filling the information gap through entertainment

Teenagers appreciated that Dosh Unisher Mor was not only educational, but also entertaining. They saw it as a show with the power to change attitudes and influence people by facilitating open and natural discussions, informed by detailed and comprehensive explanations.

As for parents, many said the show encouraged them and their children to speak more openly about these issues. Though we did interview some who explicitly said they were happier for their children to listen to Dosh Unisher Mor than have to have an embarrassing conversation!

Clearly there’s still a real information deficit to fill around SRH and early marriage in Bangladesh. Yet our adolescent listeners told us that Dosh Unisher Mor was the only radio show out there exclusively focused on SRH. This shouldn’t be the case. Shows like Dosh Unisher Mor have so much to offer young people and there should be more programmes out there like it.

is a development professional with a background in qualitative research, specifically in the areas of public health and communication.

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While the election of as the next director general of the World Health Organization (WHO) has been , I’ve been heartened by one of his top five priorities for when he assumes his new post. Dr Tedros has pledged to put the .

This ambition reflects the times we live in. The organisation Dr Tedros will soon lead has revealed that more than . The top five killers in 2015 were road accidents, lower respiratory infections (like pneumonia and bronchitis), self-harm, diarrhoeal diseases and drowning. 

Look deeper and you’ll see differences by country, age and sex

These mortality trends hit certain parts of the world and particular segments of society harder than others. Over two-thirds of these teenage deaths happen in the Global South, mainly countries in Africa and South East Asia. Teenage boys are more likely than girls to drown, who instead have a lot to fear from pregnancy-related complications. Younger adolescents lose their lives to lower respiratory infections. As they get older, they’re more likely to die at someone’s hands – including their own.

Clearly, adolescents are not a homogenous group. They face different risks that reflect the rapid physical, sexual and emotional changes, which are the hallmark of the teenage years. Not only that, they must also contend with challenges that stem from the roles they are given by the societies, communities and families they live in. To ensure that communication responses are as relevant as possible, these should be fine-tuned to suit the age group and gender of particular concern.

Thinking beyond the Global North

In addition to recognising that the needs of an 18-year-old girl as distinct from those of a 10-year-old boy, we also need to be careful not to assume that ‘Western’ afflictions aren’t more universal.

To take just one example, we now know that suicide isn’t just a serious public health problem among . Almost half of teenagers who take their own lives globally do so in lower middle income countries in South East Asia: over 10% of 13 to 15 year olds in say they've tried to kill themselves.

And yet services and support are often scarce in these settings. Even when support is available, teenagers and their families are unlikely to seek help because mental health is poorly understood and not openly discussed.

Talking about self-harm and , whether through drama, street theatre, factual programmes or through face-to-face conversations, can address gaps in people’s knowledge and their fear of stigma. Getting people informed and talking about these issues can in turn make it as normal to seek treatment for mental illness as getting a cast for a broken arm.

Fortunately, countries are starting to make progress in this area. India recently launched its . Ethiopia’s – when he was his country’s health minister – marks the need for targeted mental health prevention and support programmes for adolescents.

So what can media and communication do to help?

The helpfully runs through the evidence on how to keep adolescents alive and well, sharing 50 case studies from across the globe to help inspire us all. However, the unique role that media and communication can play, whilst mentioned, isn’t well explored. This is where organisations like ours can fill in the gaps.

Let’s take pregnancy as an example of an area where Media Action and other NGOs like it can make a big difference. Some girls get pregnant because they plan and want to have a baby. But considerable numbers of girls don’t know how to avoid getting pregnant and if they do, they often . In addition, many very young adolescents have their first sexual experience . Given the risks of pregnancy, especially at a young age, this lack of awareness and autonomy is incredibly worrying. Fortunately, the media can help inform young people and empower them to act on what they know.  

A number of media programmes around the world are tackling these challenges, like our very own (Let’s Talk!) in Zambia and (Crossroads at 10-19) in Bangladesh. Both shows provide an honest and safe space for adolescents to ask questions and voice their misgivings about safer sex, allowing them to make informed choices about effective contraception. They can also be directed towards trusted services and sources of support. Recent but unpublished research shows that listeners of Tikambe were more likely to: know more about contraception, have visited a health centre and feel more supported by the key people in their lives when it came to sexual health.     

On the communication front, the a decade-long British strategy, which ultimately led to a halving in teenage pregnancy rates over 16 years, in other countries. The communication part of the normalised conversations about sexual health between adolescents and their parents, showing that communication can help pave the way to record lows in teenage pregnancies.  

But we’re just scratching the surface of what media and communication can achieve for teenagers around the world. Given the myriad of threats facing young people today, it’s vital that we leverage all manner of approaches to help them cope. Fortunately for the generations coming up, these challenges are far from insurmountable; media and communication can be a key part of the toolbox of preventative measures.

 is a Health Adviser with ±«Óãtv Media Action. She tweets as .

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