Change is the primary theme of adolescence. There are rapid bodily changes, emotions run high and society suddenly views you as an adult! Curiosity, excitement and urge for independence takes control but these changes can also be confusing and uncomfortable if adolescents are not guided and heard.
India has the world’s largest teenage population. There are 253 million adolescents comprising nearly one-fifth, i.e. 22 per cent, of India’s total population, belonging to a heterogeneous group of people. They vary in age, marital status, economic status, cultural background, religious beliefs, etc. In India, especially in low-income groups and rural India, adolescence is not a concept. At one point, you are a child and on attaining puberty (menarche or spermarche), you are declared an adult who is ready to be conformed according to societal rules, responsibilities, and procreation. This attitude is the reason that many adolescents in the country are out of school, are married early, work in vulnerable situations, are sexually active, and are exposed to peer pressure.
This opens them to a high risk of exposure to unprotected sex, harmful sexual practices, RTI/STIs (Reproductive Tract Infection and Sexually Transmitted Infection), and HIV/AIDS. This situation is further exacerbated due to inadequate knowledge and a lack of access to health facilities combined with cultural taboos, myths, and misconceptions, that restrict adolescents from asking for advice, seeking medical attention, etc.
What is it that comprehensive knowledge around sexual health and well-being entails?
To help adolescents gradually grow into adults who are responsible, aware and in-charge of their future, there is a need for comprehensive adolescent reproductive and sexual health (ARSH) education. ARSH equips adolescent boys and girls with age-appropriate sexual health knowledge to empower their decisions regarding health, rights, and safety; develop respectful social and sexual relationships, and understand that their choices affect their well-being and that of others.
Lack of information: a grave concern
Adolescent girls are the most to suffer as they have restricted access to SRH (Sexual and Reproductive Health) services which exposes them to the dangers of poor menstrual hygiene practices, non-consensual sex, and unsafe pregnancies and abortions. According to National Family Health Survey 4 (NFHS) in India, 40 per cent of women in between the age of 18-24 years reported having had sexual relations by 18 and 47 per cent were married before 18 and among them, only 13 per cent used contraceptives. Through my years of experience as an ARSH implementer, I have observed that ARSH education to these young girls empowers them towards better menstrual health and increased agency over their health, education and bodies. While ARSH education affects girls more, boys too have benefit from ARSH education as they understand their bodily and emotional changes, learn about contraceptives and prevention of RTI/STIs, and understand consent and sexual rights so that they too become champions working towards gender equality.
Safe Space and Friendly Faces
The conspicuous silence around adolescent sexual health has been a household feature of Indian families and communities since forever. Any mention of sex is tabooed. The prevalence of these taboos in government set-ups also prevent adolescents from seeking guidance or treatment because they fear judgement, ridicule and ostracism. Friendly faces, provision of safe spaces and non-judgmental support has been observed to help them reach out in timely manner. Peer educators are at the biggest support-system to promote sound sexual health and reproductive practices among young people. Friends find comfort in sharing their thoughts and issues with friends. I have seen how trained peer educators are able to provide adolescents in their communities with a safe space, knowledge, and guidance on sexual and reproductive health, promote healthy sexual behaviors, link them to important government services and enhance gender equality using communication material like videos, short films, etc. Equitable access to sexual health related education can also be achieved through new age communication medium should be used to support adolescents such as e-counselling, communication via social media and other information, communication and technology (ICT) platforms such as radio podcasts, televisions. Furthermore, prejudice-free sexual and health counselling should be provided to the younger population to ensure that they have access to right information. Adolescent friendly health services should be provided in communities to ensure that regular checkups are conducted. Lastly, reproductive, and sexual health education should be made compulsory in schools.
Way forward
Adolescent health is a multi-stakeholder undertaking by the Government of India, which covers the Ministries of health, women and child development, education and Youth Affairs and Sports. A government sanctioned research observes that since the onus of safe-guarding adolescents isn’t focused on one ministry, the importance and urgency of the matter loses essence. This, coupled with dearth of budget, man power and supervision has resulted in a great vision but poor implementation. Also, there is always the threat that programmatic focuses can change along with governments. To maintain sustainability of ARSH’s progress in the society and for generations to come, it is imperative that the communities step in. While youth are educated on ARSH, for equality, we need to intervene on all fronts. More and more boys, girls and community members need to come together to share information about ARSH and menstruation among the community. The communities need to be trained as change agents so that adolescents can lead a dignified and healthy life where they can make informed decisions.
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