Commission on the Status of Women: Dr. Zakia Jahan, MD

Published on March 26, 2018

Thank you for giving me an opportunity to speak today on behalf of FEMM (an acronym for Fertility Education and Medical Management) which is a knowledge- and science-based reproductive health program for women’s health that affirms and supports the education and development of women. I am a certified FEMM teacher, currently pursuing a Masters in Public Health at George Washington University. I would like to speak in a particular way about the situation in my country, Bangladesh, and the solutions that I think FEMM can provide to the challenges we face.

Educated women contribute to the development of their families, society and the country as a whole. Women’s contributions are a necessary condition for development, although they are alone not a sufficient condition. Gender equality and women’s education are important determinants of health access, and have a profound impact on the use of individual women’s health care, as well as health outcomes for her entire family. Across the globe, girls and women are the future of every society, and are also a great resource of every nation. Women are cornerstones of the family unit, primarily responsible for child care, nutrition, and overall family well-being, as well as key determinants in the educational and health care outcomes for every member of the family. Programs that focus on the education of women are thus a critical part of the solution for human development in the future.

Bangladesh has made significant progress under Prime Minister Sheikh Hasina,   towards achieving the targets for the sustainable development agenda and women’s empowerment. The World Economic Forum recently ranked Bangladesh first in gender equality among South Asian nations for the second consecutive year. The Forum’s “Gender Gap Index of 2017” highlights Bangladesh’s success in four key areas: education, economic participation, health, and political empowerment.

The government of Bangladesh has identified adolescent health and education both as a priority and a challenge and is ready to face the challenge. Despite a policy that recognizes the strategic importance of investing in adolescents, our country is wrestling with questions about the offering of reproductive health education to very young and unmarried adolescents. This is why FEMM and its program that links human and sexual development is so important. FEMM offers a way forward for Governments to invest in women and girls, while offering them support, science, evidence-based solutions, and research-based curricula that meet their needs while respecting cultural and religious norms.  

Younger adolescents and unmarried girls are neglected in much programming today, including in my country. The Human Dignity Curriculum, and teen FEMM, can meet these needs, and provide a healthy human development to help them later form healthy relationships and families.

In Bangladesh, women struggle with a variety of unmet health and education needs. Reproductive tract infections are an important health problem that affect women of reproductive age but often remain undiagnosed and untreated in the current service delivery system. It is very common for women to “suffer in silence” either because  RTIs are common, or because they are ashamed. This culture of silence, shyness and cultural norms about women’s health and related problems in Bangladeshi society, inhibit women from seeking necessary medical care.

Lack of knowledge regarding human reproduction has caused some young people to engage in risky sexual behavior. Misunderstandings and lack of information are also evident among young people on issues related to puberty, understanding their fertile period, and understanding healthy choices related to their human dignity. Without this strong framework, unhealthy sexual behaviors, STDs and HIV/AIDS can arise. This is due to their lack of access to information, a lack of values-based education about young people and the choices they make, and societal pressure to perform as adults notwithstanding the physical, mental, and emotional changes they are undergoing. The current information and services model that is available is inadequate to the needs of adolescents as a whole, and the quality of such information and services is often poor or inappropriate for this age group. In Bangladesh, young women aged 15-24 comprise about one-fourth of the total population. FEMM and teenFEMM offer critical education, coupled with medical education and care, that is really important for this large and underserved demographic.

A recent study in Dhaka showed that among girls and women ages 15-19, they have inadequate knowledge about reproductive health, fertility knowledge of the pregnancy risk during the menstrual cycle, lack of information about adverse effects of teenage pregnancies, lack of knowledge regarding the health risks of emergency contraception and abortion, and where to access health care, information and appropriate support.

Poor reproductive health has an adverse effect on a women’s socioeconomic life. It can limit her education, limit her ability to earn income for the family, and can lead to marital difficulties.

By raising awareness and increasing knowledge of women’s health, FEMM addresses the specific reproductive health needs of adolescent girls and women.

There are many studies in Bangladesh that focus on contraceptive use, but little attention is given to the success rates linked to women’s knowledge, attitude and family planning success when informed consent and education are provided. One study found that there is wide gap between urban and rural respondents in Bangladesh regarding their reproductive behaviors as well as ensuring culturally appropriate and information driven access and user support.

The UN and its agencies recognize that poor sexual and reproductive health outcomes represent one-third of the total global burden of disease for women between the ages of 15 and 44 years.

In this situation FEMM can better meet these needs because its fertility awareness and health resources including an online app, a network of certified FEMM teachers, and trained medical providers that can provide education for young girls and women to understand their body by charting their cycle, and can identify the unfolding signs and patterns of reproductive hormones. By using FEMM’s health and education method, women can detect any alarming signs of disease or hormonal abnormality and seek medical care immediately.

As Anna described earlier, FEMM is a comprehensive women’s health program that teaches women to understand their bodies and how to recognize hormonal and other vital signs of health by using hormonal charting. It helps women to understand the importance of monitoring hormonal biomarkers, and to observe ovulation and menstruation in particular.  Women can learn to recognize patterns of health or any abnormalities. Identifying ovulation enables women to manage their fertility; FEMM Family Planning provides instruction for fertility regulation in order to achieve or avoid pregnancy. Even in rural areas, less educated women without phone access can maintain their health by knowing the meaning of a hormonal chart. With this knowledge, they will be able to manage their health, fertility and symptoms more effectively, and will be able to understand when to seek medical help. In this way, fertility awareness assistance will help women to empower themselves to succeed at their educational and economic dreams.

Fertility management with the FEMM method can be achieved without health hazards and ensures that people are safe in managing their health and fertility goals. Fertility management is a major element in ensuring safe motherhood and safe maternal health outcomes. It works with women to ensure that they understand their health and fertility. By ensuring women are informed participants in their healthcare, FEMM helps women to manage their pregnancies. In FEMM based clinics, there is a reduction in the number of unwanted pregnancies, with a resultant decrease in the total exposure to the risk as well as a decrease in the number of abortions. Management of health and fertility allows women to space their births, in order to achieve their desired family size while managing any health needs and conditions. Comparing FEMM Family Planning to methods of contraception and their mechanisms of action, effectiveness rates, and side effects, I conclude as a doctor that FEMM is not only just as effective but also more attractive because it does not risk unpleasant side effects and because it empowers women to monitor their health. An investigation of high contraceptive discontinuation rates consistently shows that women want a method that is both effective and free of side effects, two conditions that FEMM satisfies. The concept of “unmet need for contraception,” a political and advocacy construct that identifies 222 million women around the world as “in need of contraception”, ignores that many of the women who do not use contraception do not want it and do not need it. FEMM is able better to meet the needs of these 222 million women labeled by the construct, and all other women as well.

It is recommended that reproductive health education should be incorporated in the mentoring training course offered in Bangladesh and that the FEMM method training should be provided as reproductive health education in the school through these Mentors. In addition, one teacher from each school can also be trained so that he or she can guide the Mentors in providing evidence-based, scientific, and effective sexual health education. Health care workers can be trained with the FEMM chart and meaning of the colors and hormones they represent. They can reach door to door to teach less educated women and to ensure that women in rural areas, in particular, receive excellence in education and health care for these sensitive and critical needs.

FEMM medical management training can be provided to doctors and nurses at medical colleges and hospitals so they can deal effectively with women’s reproductive health. Having separate FEMM clinics for adolescents within the framework of a primary care center or a hospital may be desirable for improving access to adolescents. For any country, FEMM clinics can serve as an excellent medium, in my opinion, to inform adolescents about sexual and reproductive health issues, and to provide care to them to ensure healthy long-term outcomes. The FEMM app is also an important way to communicate with adolescents, to offer them online support, to provide answers to their questions, and to foster contact with FEMM trained doctors and medical experts as needed. Technology can help to bridge the gap between rural and urban care and access, to meet young people where they are, as well as to provide accurate, scientific information online when they search for information and support. FEMM gives access to information and services that provide privacy, confidentiality, respect, and informed consent. As a medical doctor, and soon to be MPH, I am eager to bring these effective and important programs to my country where they are so needed.

I would like to finish by extending my thanks to everyone! Thank you so much!


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