Married off at age 16, forced to drop out of school, or put at risk of anaemia, unintended, high-risk pregnancies, chances of unsafe abortions, or worse – these are some of the threats Pratima (name changed) may have had to face during adolescence. However, thanks to her access to comprehensive sexuality education, she flipped her story instead. All of 19-years-old today, she is continuing her education and even volunteering with a civil society organization in Rajasthan’s Karauli district to raise awareness and empower girls. “Learning about my body, and understanding that I was not physically or mentally prepared to marry or have children, encouraged me to take a stand for myself and not be married off forcefully,” she said.
The organization she works with partners with Population Foundation of India to raise awareness and provide comprehensive sexuality education for adolescent girls and boys in the district. Ever since she started volunteering with them, Pratima has reached out to more than 300 adolescent girls, via her networks and peer groups, to talk to them about issues ranging from menstrual health and hygiene to the need to adopt improved sexual and reproductive health practices.
Seventeen-year-old Hansraj and his wife live in Bundi, another district in Rajasthan where Population Foundation of India has been implementing its comprehensive sexuality education program through partner Shiv Shiksha Samiti. Thanks to the organization, the couple have been able to take informed decisions regarding family planning.
We did not understand the nuances of marriage, relationships and family planning when we got married at 15. Joining the project helped us understand the complexities of sexual and reproductive health and also to open up to each other. Today, we both respect and consensually take decisions regarding our future, Hansraj said.
While there is no doubt that comprehensive sexuality education can have far reaching benefits for young people, barriers to access can lead to long-term impacts on reproductive and sexual health outcomes, as well as increase the propensity for gender-based violence and adverse mental health issues. The physical, psychological and emotional changes they experience during this time can be confusing. Without the right guidance, adolescents may find it difficult to navigate issues such as getting married or planning a first child at a suitable age, avoiding unintended pregnancies and accessing safe abortion services. Comprehensive sexuality education is also critical in reducing intimate partner violence, handling peer pressure and reporting abuse. The absence of accessible, adolescent-friendly information, counselling and services can affect young girls and boys struggling to comprehend the complexities of puberty.
Despite its obvious benefits, comprehensive sexuality education in India has been presented, in the past, as being at odds with the country’s social and cultural values. Inhibitions and fears coupled with misconceptions and stigma around sexual and reproductive health, especially for the unmarried, have fostered an environment of uncertainty. Today, with more and more people awakening to the real importance of equipping young people with the knowledge, skills, attitudes and values they need to determine and enjoy their sexuality—physically and emotionally, individually and in relationships. Comprehensive sexuality education helps young people to acquire accurate information on sexual and reproductive rights, information to dispel myths, and references to resources and services. It helps young people develop life skills including critical thinking, communication and negotiation, self-development, and decision-making; sense of self; confidence; assertiveness; ability to take responsibility; ability to ask questions and seek help; and empathy. Furthermore, comprehensive sexuality education nurtures positive attitudes and values, including open-mindedness, respect for self and others, positive self-worth/esteem, comfort, non-judgmental attitude, sense of responsibility, and positive attitude toward their sexual and reproductive health.
In India, adolescents comprise 21% of the total population (Census 2011) and despite the legal age for marriage being 18 years in India, the fourth National Family Health Survey (NFHS-4, 2015-16) revealed that 27% of all women between 20 and 24 years of age were married before 18. The same survey also shows that 8% of women aged 15-19 years were already pregnant during the time of the survey. While only 10% of currently married women aged 15-19 years, and 16% of sexually active unmarried women in the same age group used any modern contraceptive method. This increases young women’s chances of getting pregnant, even before their bodies are fully developed and healthy.
Alongside the risk of early, unintended pregnancy, gender-based violence is another pervasive threat to young people in India. The percentage of women aged 15-19 who had ever been married and experienced emotional, physical or sexual violence stood at 21.2 per cent. Exposure to family and community violence has consistently been linked with violent behaviour among young men. With adolescents forced to stay home, where their exposure to domestic, gender-based violence has the potential to increase, the impact of the COVID-19 lockdown could be far bleaker than we would like to imagine. Of the 650 million girls and women alive today who were married in childhood, half live in India, Bangladesh, Brazil, Ethiopia and Nigeria. According to the United Nations, 10 million additional girls are at risk of child marriage due to COVID-19.
Several national programs are currently in place to provide information and services to adolescents in India. The Rashtriya Kishore Swasthya Karyakram (RKSK), for example, aims to reach adolescents with comprehensive health services and information including sexual and reproductive health and the School Health Programme, under the Ayushman Bharat, initiative has been launched by the government to make advances towards correct and age-appropriate information on Sexual and Reproductive Health and Rights (SRHR). However, there remains a lot to cover. In the case of the RKSK program, while the model has great potential for ensuring adolescents’ wellbeing, the gaps in its implementation potentially undermine the program’s success. With the disruptions in services during the COVID-19 pandemic, these gaps are likely to increase.
In the current context, it is imperative that adolescents are provided the counselling and resources required to not only navigate the usual challenges of puberty but also cope with the stresses of the pandemic and its associated lockdowns. In this changing landscape, it will be more and more critical to find innovative ways to reach out to adolescents, by bridging the digital divide in order to take conversations online. It is more important than ever that gatekeepers, such as parents, teachers and health providers are sensitized and equipped to sensitively share correct information with adolescents. We need to end the culture of silence around sexuality education and help the Pratima’s and Hansraj’s in India to flip their stories.
(The article was co-authored by Monica Wahengbam, Programme Manager, and Riya Thakur, Senior Manager (Youth and Adolescence), at Population Foundation of India.)
Disclaimer: The opinions expressed within this article are the personal opinions of the author. The facts and opinions appearing in the article do not reflect the views of NDTV and NDTV does not assume any responsibility or liability for the same.
NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.
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