A 2015 UNESCO report on “Emerging Evidence, Lessons and Practice in Comprehensive Sexuality Education” (CSE) suggests that CSE has far-reaching benefits for SRH, particularly in reducing STI’s and unintended pregnancies.
By Vandana Chavan, Member of Parliament
India, with the second largest population in the world of 1.3 billion, is also home to the world’s largest adolescent and youth at 365 million. Over 50 per cent of the country’s population is under the age of 25. An analysis of the United Nations World Population Prospects 2017 by Bloomberg revealed that by 2027, India with its current increase in the proportion of working age people, also known as the demographic dividend, will have the largest workforce in the world.
This window of opportunity that has the potential to reap in huge benefits for the economy and society, will last for approximately three decades. However, to truly take advantage of the demographic dividend and boost productivity, the health, well-being and education of this future cohort of workforce entrants need to be prioritised while framing development policies. As the future of the country looks bright with its potential to produce the largest workforce in the world, the country, unfortunately, lags behind with the highest number of child brides and teenage pregnancies. Data from the latest National Family Health Survey (NFHS IV) shows that nearly 14 million Indian girls are married before they turn 18 years.
Over half of currently married women aged 15-19 years have begun childbearing and 38 per cent had sex by age 18. Decisions pertaining to early marriage and pregnancy are usually not a result of one’s individual choice, rather the lack of it, caused by societal norms, poor or lack of access to reliable information and healthcare services. As a result, young girls remain vulnerable to pregnancy-related complications such as sexually transmitted infections (STI’s), cervical cancer, unsafe abortion, poor health outcomes and mental health-related issues. All of which can prove to be life-threatening. Therefore, it is important, now more than ever, to channelise investments, efforts and resources towards ensuring that the country’s young population has access to sexual and reproductive healthcare (SRH).
It is first and foremost imperative to empower the youth to be able to make healthy and conscious decisions for themselves. This can be made possible only when they have access to accurate, reliable and unbiased information from credible sources. In traditional societies such as India, young people are confronted with barriers to accurate information on SRH, plagued with taboo and shame. As a result, they resort to the abundance of unfettered misinformation available on the internet, as well as information passed on by peers.
A 2015 UNESCO report on “Emerging Evidence, Lessons and Practice in Comprehensive Sexuality Education” (CSE) suggests that CSE has far-reaching benefits for SRH, particularly in reducing STI’s and unintended pregnancies. Providing age-appropriate CSE will not only reinforce a responsible approach to sexual behaviour but also protect the young and vulnerable by allowing them to identify and report inappropriate behaviour.
However, simply having knowledge of SRH is not enough – it is important to take a step further to ensure that youth-friendly services are in place for easy and uninterrupted access. According to NFHS IV, only 15 per cent of currently married women and 17.6 per cent of sexually active unmarried women in India, between ages 15-19 years, use any form of the contraceptive method. This low uptake of contraceptives, coupled with a high unmet need for family planning has resulted in a sharp rise in unintended pregnancies. “The incidence of abortion and unintended pregnancy in India, 2015” a study conducted by the Guttmacher Institute and Population Council revealed that almost half of all pregnancies in 2015 were unintended and one-third (15.6 million) resulted in abortions. While safe abortion is a reproductive right, using abortion as a proxy for contraception results in repeated abortions, which then takes a toll on their health.
To avert these high numbers, as well as the health risks associated with them, young citizens need access to modern contraceptive methods and should be encouraged to delay marriage, as well as first pregnancy and space childbirths. Birth spacing not only has positive health impacts for mothers and children but also helps women remain gainfully employed and therefore, an active part of the workforce. Since unintended pregnancies can be both a cause and a consequence of dropping out of school – spacing childbirths allow women to continue and complete their education.
Youth-friendly services need to be equitable, accessible, acceptable, appropriate and effective. While healthcare providers play a critical role in ensuring that adolescents and youth can access healthcare services, they are often biased because of social and cultural norms. It is important to be mindful of the fact that a negative experience can potentially hinder young people from approaching providers. Therefore, it is vital that healthcare providers maintain high levels of privacy and confidentiality, along with a non-discriminatory and non-judgmental attitude. In addition, services need to be affordable and within reach. Unfortunately, in the current Indian healthcare scenario, several of these key components are missing, which is why there is an urgent need to re-think and re-evaluate healthcare policies and strategies so as to make them conducive to the healthcare needs of youth and adolescents.
Focusing on improving SRH services for young people is not merely beneficial in terms of development; it is a smart economic investment as well. Projections from the ‘Cost of Inaction in Family Planning in India: An Analysis of Health and Economic Implications’ study commissioned by Population Foundation of India (PFI) projected that effective family planning interventions can contribute an additional 13 per cent to the country’s per capita Gross Domestic Product (GDP) by 2031. The study also estimates that if family planning programmes are optimally implemented over the 15 years (2016-2031), savings from delayed marriage and childbirth will be up to Rs. 5,500 million in Rashtriya Bal Swasthya Karyakram and Rs. 790 million in adolescent health programmes.
Time is of the essence and facts stare us in the face – do we want to continue pushing SRH behind a veil of secrecy or begin working towards securing the future of our youth? After all, Good health and well-being’, i.e. Goal 3 of the Sustainable Development Goals (SDGs) is the cornerstone to unpacking young India’s full potential, and can only be achieved when youth-friendly SRH policies are implemented.
The author is Vandana Chavan, Member of Parliament. Views expressed are the author’s own.