- The school is not an appropriate setting for reproductive health exams -

Shockingly, teenage girls are still forced to undergo a pelvic or gynecological examination at school, commonly known as “girls’ examination”, in Mongolia despite recommendations against the practice and the exam having no measurable impact on their lifestyle or reproductive health, a recent study highlights. 

Together with the Young Voices Group of Save the Children in Mongolia, 7th Asian Girl Human Rights Award winner G.Myagmarsuren, a 12th-grade student at Bayangol District’s School No. 73, conducted the “Girls’ Voices” survey last year to find out girls’ views on the compelled reproductive health examination of girls in schools. Its report was published in September 2020.

With the objective to enhance students’ right to a quality education that positively impacts their future and support better reproductive health education interventions for young girls and boys, the survey asked 22 questions from 370 girls in grades 7 to 12 from 12 general education schools in Ulaanbaatar, and Arkhangai, Uvurkhangai, Dornod, Khovd, Dornogovi, Govisumber provinces, as well as girls from special education schools in Ulaanbaatar.

The organizers noted that the survey was conducted in response to the comments and views shared by teenage girls who attended Listen to Us! 2019 Girls’ Forum, which delved into the topic of the rights of girls and discrimination. Participants had considered girls’ examination at school as the most serious violation of their rights. The study also contributes to the United Nations Sustainable Development Goals of Good Health, Quality Education, Gender Equality and Reduced Inequality, and references Article 12 of the UN Convention on the Rights of the Child, which stipulates, “children have a right to express their views on matters that affect them, and have them taken seriously”.

Local authorities have been undertaking activities to educate teenage girls about reproduction and safe practices that can help minimize risks to their health in recent years. One of these activities is the girls’ examination at school, which lawmakers believe is essential as it helps prevent sexually transmitted diseases and unwanted pregnancies among teenagers.

A study conducted in 2017 and 2019 by Princess Center revealed that around 4,000 girls give birth annually and that 74 percent of them become single mothers. UNFPA found in 2017 that 14 percent of pregnancies in Mongolia end in abortion. Local experts are also warning about the upsurge in sexually transmitted diseases among teenagers aged between 15 and 19. The data provides solid ground to support improvement to reproduction health education, disseminate relevant information to young people and draw more attention to the health of girls and boys.

However, girls’ examinations at schools is not the way. This practice is found to contradict the views of international human rights organizations that believe such examinations should only be conducted on a voluntary basis and in medical settings, so that “girls’ dignity is respected and they are protected from any form of violence”.

Founder of Princess Center for Children’s Rights Ch.Undkhar noted in an interview, “Girls’ examination is embarrassing and shameful for girls. Parents should be notified of any examination of their daughter so that they can consent to it and talk about it with their daughter. Some people think that it is necessary to get all girls checked since they will not voluntarily get checked. We need to consider this issue from an individual’s point of view. First of all, girls’ examination is conducted in a non-medical setting. Though a professional doctor carries out the examination, they don’t keep confidentiality. For example, some teachers have revealed how many girls had sexual intercourse to the whole class. This matter shouldn’t be discussed with the teacher. In terms of human rights, this practice has no standard or ethical rule and disregards the privacy of girls without thinking of the consequences of revealing such information.”

According to the “Girls’ Voices” survey, many teenage girls are offended by the practice and view that it not only violates the rights of girls to dignity and privacy but also fails to preserve the inviolability of their bodies.

“We understand that the authorities are attempting to protect girls and their health by conducting mass examinations in public schools. However, our survey results show that the examinations have no impact on young people’s lifestyle and reproductive health, nor do they appear to be effective as a preventative measure. In fact, this method appears to exacerbate gender inequality and discrimination, and to support the views that ‘women alone should be responsible for their reproductive education’ and ‘women are at fault, not the opposite sex’, attitudes that impede the development of a fair, equitable, and democratic society. An individual’s health, especially an adolescent’s reproductive health, and the work done towards it, is a topic of utmost importance to young people,” the authors wrote in the survey report.

The Directions of Activities for Specific Preventive Examinations of Boys and Girls in the Contemplative Rule of Youth Cabinets Regarding Closer Cooperation with Secondary Schools approves health organizations to conduct separate examinations for girls and boys at public schools, but no procedures or regulations have been put in place regarding the examinations. Experts also underlined that there are few opportunities to reinforce these regulations and standards, and no mechanism to monitor their implementation.

The survey showed that due to the lack of a common goal and procedures for the girls’ examination, every school has its own. Because public high schools are not appropriate settings for the girls’ examination, the right to privacy and other human rights are violated, and regulations and standards for the examination are not being adhered to.

It is essential for educational and health authorities concerned to review these discriminatory and inappropriate practices and attitudes through accelerating training and information programs for relevant duty-bearers and communities in a systematic, high quality and inclusive manner.

What is girls’ examination?

The 2017 Health Minister’s Order No. A/ 399 on Measures to Improve Youth Health Care Services details that girls will undergo a general health checkup (skin, eyes, ears, nose, throat, dental, spine, nervous etc.), breast exam, and gynecological exam.

During a pelvic exam, a doctor or nurse practitioner looks at a girl's reproductive organs (both outside and internally). This includes feeling a girl's uterus and ovaries to be sure everything is normal. The resolution instructs that internal examination be performed only when necessary – mostly for girls who have had sexual intercourse. A number of doctors commented that internal examination is usually not necessary for teenage girls.

General Coordinator of Beautiful Hearts NGO B.Oyundari said, “The girls’ examination is not appropriate for young girls of reproductive age. It’s a woman’s right to decide when she’ll be sexually active, when she’ll have a baby, whether she’ll have a baby or not. It is a woman’s sacred and uncontested right to make her own personal decisions about sexuality and reproduction. It is wrong that schools conduct these examinations. It is an assault on girls’ sexual inviolability. At the same time, while most girls don’t understand why the examination is conducted, they feel obliged to go along with it.”

“Pregnancy and sexually transmitted diseases are matters that concern the opposite sex as well, yet the same tests are not conducted for boys. According to the WHO, to conduct girls’ virginity tests is vulgar, outdated and a serious breach of human rights,” she said.

Girls’ examinations are being conducted in different grades in each school due to lack of regulations. It is appalling that this means the examination has been conducted for girls as young as primary school age.

School grades of survey participants

Girls’ lack basic understanding of girls’ examination

The survey commended that 5 out of 10 girls understood that girls’ examination is conducted to protect them and maintain their reproductive health, suggesting that over half the respondents had a basic understanding of the reason for the test.

However, 2 out of 10 girls (16.3 percent) answered that they didn’t know why the examination was conducted. On October 17, 2018 in Geneva, UN agencies officially banned testing of virginity, but 3 out of 10 girls (29.12 percent) understood it to be a virginity test.

When asked whether teachers or the school explain why they conduct girls’ examinations,  44.2 percent responded that the school did not give them comprehensive information about the girls’ examinations, while 87.3 percent of surveyed girls were examined without getting full understanding or specific information about the exam. This failure to ensure girls’ understanding of the examination violates their right to be informed on matters that affect them, according to researchers.

The survey revealed that 1 out of 10 participants (8.4 percent) were examined without participating in prior activities or training about reproductive health and 2 out of 10 participants (20.2 percent) answered that they were content with the information and training on reproductive health provided by the school. However, the remaining 79.8 percent believed that information and training was insufficient, and their comments indicated that they were not happy with the quality or content.

72.2% of girls were not asked for consent before being examined

Shockingly, 1 out of 2 participants (46.4 percent) of surveyed girls had been examined without prior notice.

“Although the fact that more than half the schools gave girls prior notice about the examination is commendable, standards between schools differ. This is due to the absence of a specific regulation concerning prior notice to allow girls to be examined,” the report read.

That’s not all, 7 out of 10 participants (72.2 percent) had not been asked for consent before being examined, which is clear indication of violation of the Ethical Standards of Medical Experts.

The Ethical Standards of Medical Experts Part 4.7 stipulates that if the customer is not of age and thus does not have legal capacity, decisions will be made by the legal guardian (father, mother, or guardian) in a written form.

Events concerning the health of an adolescent who does not have full legal status, must be approved by both the adolescent and the parents or guardian. However, only 2 out of 10 participants whose consent was asked for (18.9 percent) answered that written consent was asked of both parents and students. The disparity between schools in relation to seeking consent is due to the lack of a specific regulation about who should be asked for consent and the form it should take.

What happens if you refuse to be tested?

Two out of 5 participants (43.7 percent) answered that regardless of their decision, they would be forcefully examined. While the majority of participants thought their decision would be respected and they would be exempted from examination, respondents were worried that if their teachers and peers knew this, their decision would be misunderstood, may lead to gossip about them or experience discriminatory treatment by teachers.

Girls aren’t examined separately

The survey asked how schools conduct girls’ examination to determine if medical privacy and the individual’s privacy was maintained. However, 1 out of 2 participants (50.1 percent) have been examined with another person in the room besides the doctor.

Almost 70 percent of participants found that the girls’ examination gave them unpleasant feelings. In most cases, students don’t get any information about the doctor examining them. According to the health minister’s order, the doctor who conducts the examination has to be a doctor from the adolescent cabinet, have a medical degree no lower than a bachelor’s degree, specialized in adolescent health, and have more than three years of experience.

When asked about the doctors’ interaction with students, 2 out of 5 participants (38.5 percent) had pleasant and respectful interactions during the girls’ examination but 4.3 percent of participants said they’d experienced embarrassing and insulting words or behavior. 

Although doctors taking the examination are obliged to respect students’ privacy, 8 out of 10 participants (80.9 percent) answered that they were not confident that they would. Three out of 5 girls (62.7 percent) who said they were uncertain if the doctor would keep confidentiality had at some time heard rumors about another girl’s secret.

The survey brought attention to the hygiene standards of girls’ examinations. It underlined that students being examined by a doctor who may not be maintaining or caring about hygiene standards should be educated on receiving reliable health services, including paying attention to hygiene standards and using single-use equipment.

The survey results showed that 9 out of 10 participants (85.2 percent) do not know or didn’t notice if the doctor maintained hygiene standards. This suggests that young girls do not pay attention to hygiene and sanitation and don’t fully grasp the risk of infectious diseases.

It is notable that 29 percent of the total respondents answered that the school does not expel due to the results of the girls’ examination. Around 40 percent of participants believed that if expulsions occur, the reason would be kept secret – an alarming indication that students think it’s possible that a student’s right to education could be limited by personal health issues.

Advocate for change

The main reasons girls are being examined is to check for their normal growth and prevent the possibility of infections and unwanted pregnancy. However, it is clear from the survey findings that conducting the examination has little impact on most of the girls (68 percent) who are examined. In other words, they do not believe that this form of screening is an effective preventative measure.

Given that 1 out of 2 girls feel uncomfortable after the examination and 2 out of 3 girls don’t support the girls’ examination, authorities need to stop conducting these examinations in schools or find a better solution to helping girls prevent reproductive health risks. For instance, hospitals and schools can could work together to organize girls’ examinations at a hospital or clinic where it can be held with more privacy and better hygiene standards. The authorities should also ensure girls can exercise their right to refuse a checkup, not feel any pressure to undergo such examination, and trust doctors to keep their results confidential.

Girls are fighting to have their voices heard and it is about time the authorities and lawmakers listen to them and advocate for them for change.