Authors: Saloni Killedar, Project Statecraft, Rijul Alvan Das, Project uP
The Current State of SRHRs in India
India has more than 50% of the total population under the age of 25. A quarter of our population is below 14 years of age (Kedia et al, 2018). Adolescents (those between 10-19 years of age) make up 20% of our population. Young people ought to be provided with quality education and healthcare, among other things. While a lot is said about education and skill development, young people’s health is an issue that demands more attention. Even of the limited attention that the issue of health gets, certain aspects of it are brushed under the carpet. One such aspect in our country is that of sexual and reproductive health. As per the United Nations Population Fund, good sexual and reproductive health implies that people are able to have a satisfying and safe sex life, the capability to reproduce, and the freedom to decide if, when, and how often to do so. It is an indispensable part of universal human rights and has been enshrined in various policy documents and international conventions such as ICPD Programme of Action(1994), Convention on the Elimination of all Forms of Discrimination Against Women(1979).Sexual and reproductive health involves features like accessibility, availability, awareness etc. regarding it.
In Indian society, it is considered a taboo to discuss issues pertaining to sex and reproduction. It is highly contextual with regards to the culture and tradition of any geographical area. Hence, topics such as sexual well-being, reproductive healthcare and other allied matters have usually stayed absent from regular policy discourse. Due to the lack of proper support, be it institutional or otherwise, a large proportion of our population is unaware of the necessity of an individual’s SRHRs. In a study, it was found that only 15% of people within 15-24 years of age have received sex education (Guttmatcher,2014). This is a serious concern that needs to be addressed since the future demographic structures crucially depend on the actions of the present. It is absolutely imperative that the young people of India have adequate information and access to facilities so that they can exercise their right to well-being.
An essential subset of reproductive health is menstrual health. In India, only 64% of women in urban areas and 45% of women in rural areas use sanitary hygiene products. The current scenario has exacerbated the situation. There is no specific plan on how to tackle the lack of access to menstrual health care. This leads to period poverty which is a state where women don’t have access to safe and hygienic-sanitary products and are unable to manage their periods because of community stigma and sanctions.
People’s mindsets and customs come in the way of getting menstrual health care. Schools and colleges do not provide adequate support regarding information and accessibility of menstrual health products. Availability and accessibility of menstrual products is also an issue. Poor menstrual health can lead to many issues which women are oblivious about. For instance, Dysmenorrhea, which is painful menstrual periods caused by uterine contraction. Primary dysmenorrhea is when women experience recurrent pain, while secondary dysmenorrhea is when there is a disorder in women’s reproductive organs. Many women who suffer are unaware of these and do not discuss it candidly because of the prevalent stigma. Additionally, few campaigns have been conducted in order to create awareness about this. However, the few campaigns conducted (by the State and non-profit organizations) to create awareness has failed to reach the vast majority. For instance, a social media campaign of “Padman challenge” was taken up by celebrities to spread awareness about menstrual hygiene, where they uploaded pictures on social media with sanitary napkins. This campaign was ineffective as most of the population lives in rural India who have no idea surrounding the issue of menstrual hygiene.
Due to the stigma around menstruation, women are restricted from entering temples, kitchens, schools, etc.. Some women are forced to stay in secluded places because of mythical beliefs that menstruating women emit some kind of smell and rays. All these social myths can be traced back to a regressive society where men understood that menstruation is a women’s issue and dismissed its importance. However, these barriers are subtly fading because of various NGOs like Sukhibhava Foundation, Not just a piece of cloth etc, who work with rural and urban communities to improve menstrual health practice. Additionally, movies like Padman have made a breakthrough as it addresses real suffering of women where they use unclean clothes or rags repeatedly and stay isolated due to which the likelihood of contracting diseases like cervical cancer, reproductive tract infection etc. increases. This movie succeeded in spreading an appropriate message to the society.
Let’s not “whisper” but, rather brazenly sensitize.
Problems
One of the most fundamental problems that lie in this aspect is a lack of concerted political will. There are a few programs that seek to address these concerns of SRHRs when it comes to young people. One of the most popular programs in this regard is the Adolescent Reproductive and Sexual Health (ARSH) Clinics set up in 2006. This was amongst the first time that due policy focus was given on young people’s SRHRs.[1] However, as research suggests, these have not been as effective as they should have been. While some say that the registration in these clinics was not convenient, others point to the behaviour of staff in these clinics. In addition to these, issues about privacy also arise in a lot of cases (Tiwari et al, 2015) (Population Council. 2014). Another program that specifically focuses on adolescents’ health is the Rashtriya Kishore Swasthya Karyakaram (RKSK) that was launched in 2014. A heavy focus of the scheme is on the sexual health of adolescents. The scheme is promising since it focuses on issues such as making reproductive services and healthcare accessible to adolescents etc. A feature of this program is to have Adolescent Friendly Health Centres (AFHCs) in every district which would encourage young people to come out and seek guidance, counselling and be informed about their SRHRs. However, due to faulty implementation, it has not reached all parts of the country. Moreover, the scheme calls for youth leadership in decision making. However, young people are often absent in policy discussions regarding the issue.
Lack of awareness is another serious hindrance that ought to be taken care of. The best illustration of the problem is the ineffectiveness of sex education which youngsters receive. A massive challenge to sex education comes from society’s orthodox members who consider it to be gross and ‘inappropriate’ to talk about sex to young people. Often is the case that adolescents are exposed to sex, sexuality etc. by their peers and not qualified medical practitioners and teachers. One of the major reasons for the same is the absence of a comfortable environment at home or school where healthy conversations could take place (Vaidyanathan, 2020). In a survey conducted for adolescents, most participants said the reason they did not consult a doctor for their problems is that they did not find them “serious enough” (IANS, 2018). This shows how ineffective our existing sex education program is since it doesn't equip learners with the tools to correctly analyse what is and what is not serious enough for their health and well-being. The problem also lies with the curriculum on sex education.. School curriculum doesn’t have a rights-based approach which would inform people about their rights and responsibilities when it comes to sexual health, reproductive care etc. Consent as a concept is almost absent from the sexual education programs in most schools.
Coupled with a lack of awareness is the issue of child marriage. The legal age for marriage in India is 18 years for girls while it is 21 years for boys. Nearly 27% of girls are married before the minimum age. As a nation, India leads the world charts when it comes to the number of children, mostly girls, getting married (End Child Marriage, 2020). Poor socio-economic condition is a primary reason. Intergenerational poverty can lead to early marriage as girls who marry young are unlikely to receive the education required to live an empowered life, they start a family early with minimum education and exposure, which in turn leads to the cycle of poverty as this is followed by generations. It also implies not having the access to knowledge of safe sexual and reproductive practises. Due to this, a very high proportion of them face the risk of experiencing unsafe practises combined with physical, emotional and sexual violence. Another issue with child marriage is the lack of agency of the woman in the union. Due to this, even if they have the knowledge, they are deprived of their decision making power and freedom of choice.
Solutions
Awareness and knowledge about SRHRs is an essential component for the holistic growth and development of an individual, particularly young people. It does not just benefit the person, but also enhances the society and nation. This is especially true in countries like India where young people form a large proportion of the entire population. Furthermore, the youngsters of today will drive the population growth as per a report (UN, 2019), since they will be the ones who enter reproductive age brackets in the future. Hence, it is necessary to ensure that they make informed choices about their sexuality, preferences, family planning etc. For this, it is necessary that the hindrances that lie in the realization of SRHRs are obliterated.
In order to achieve that goal, a good place to start would be schools. It is absolutely necessary for young adults to have a comprehensive understanding of the issue. For this, a revised curriculum should be prepared which would address all aspects of human sexuality. This includes information in complete biological processes, along with their emotional and psychological aspects. In addition to this, proper training must be given on consent, gender identity, interpersonal relationships etc. Due focus must also be given on rights such as the right to seek abortion amongst other essentials. However, mere information is not enough; steps must be taken to make sure that the curriculum is implemented across states. We have seen how opposition to comprehensive educational plan by states regarding adolescent sex education has in fact led to bans. For instance, the Adolescent Education Programme, released in 2007 by the Central Government, got banned in 12 states because it deemed inappropriate and would promote “risky” sexual behaviour in adolescents (Chowdhury, 2020). Instead of a one-size-fits-all approach, sex education must be contextualised so that the following twin objectives are achieved.:
(i) acceptance in the society
(ii) effectiveness of sex education
The engagement of all stakeholders in the development and implementation of the curriculum would be highly instrumental in this regard. A need for inclusion of physicians and paediatricians in policies and programs is essential as they can help people, especially the rural poor, who do not have proper access to healthcare facilities. Therefore, prevention programs need to be launched which should include-
1) Knowledge related to sexual and reproductive health, and accessibility to education of contraceptives in remote regions.[2]
2) Medical and psychological support to adolescent girls who are pregnant. Also, there should be prenatal care which helps women in medical, social, educational, nutritional needs and child care training etc.
3) Discussions on sexuality and reproductive issues should be encouraged by the physicians and full access to information and services should be given at the local level
Furthermore, in order to cater to socio-economic issues, public interventions are imperative. Interventions focusing on increasing marriageable age, accessibility to contraceptives and education will make a significant difference in improving the overall sexual and reproductive health. The presence of subnational policies and programs targeting early marriage and early childbearing is essential as issues can be addressed at the grassroots level. Even though child marriage is prohibited by law, there are nearly 1.5 million child brides in the country. Stricter punishments for those who contravene the law should be placed. Additionally, parents should be incentivised to send their daughters to schools instead of focusing on their marriage. In addition to this, continued investments in areas where early marriage and early first birth of the first child birth would yield high benefit-to-cost ratio as it will reduce adverse effect on reproductive health and will lead to a secured future. There is also a requirement for community sensitization, comprehensive sexual education and enrolment of girls completing their entire education.
Another crucial intervention would be that of our government and political forces. One way of showing political will is via budgetary allocations. Implementation of schemes like RKSK requires inputs such as financial resources and a trained and dedicated staff to redress the issues brought by people, among others. Most of the existing policies are implemented and acted upon by people who are not in the demographic group whose issues they seek to solve. Hence, it is essential that young people are adequately represented in the decision making process so that their interest is truly reflected in the programmes. Another important role of the government is to ensure that existing laws and regulations are sternly implemented. Monetary and social benefits along with regular sensitization campaigns could go a long way in alleviating the problem.
Therefore, proper and effective interventions with deep understanding of the root cause of the issue is the key to solving problems pertaining to sexual and reproductive health of the youth.
Conclusion
We have seen the challenges and possible solutions that pertain to adolescent and young people’s SRHRs. With this article, we seek to initiate a discussion in the society on this issue. While there are some positive aspects regarding India’s case such as the abolition of 12% tax on sanitary pads, a lot of work needs to be done. This is all the more true given the fact that COVID-19 is ravaging the world, which could potentially undo all that has been done to secure the limited SRHRs that adolescents and young people have.
For starters, there have been reports that a large number of child marriages could follow in the coming decade primarily due to the pandemic. The primary reason for the same is cited to be the economic situation of the family. Due to lack of information, unsafe practises and ill-informed decision making could take place as a consequence. Since India has the largest numbers of child brides in the world, the effects could be more pronounced here. There are already cases of severe domestic and sexual violence in Indian households. Currently, the focus is on mitigating the pandemic which therefore is compromising the attention required for SRHRs. Due to the pandemic, people might not be able to access reproductive services, essential child care etc., which could potentially put millions of people at risk. For this, due public action and government support is required so that this hidden calamity of the pandemic is tackled successfully.
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