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To transform India, young people’s sexual and reproductive health needs to take centre stage

For India’s youth to lead, they first need investment to get their health in order.

Edwin Thomas |

It is not uncommon to hear the oft-quoted (and tired) phrase, “The youth are the leaders of tomorrow” being spouted at public gatherings blandly stated in policies and used in a multitude of reports/articles/documents. The numbers point in that direction: India is now home to more than 365 million young people in the age bracket of 10 – 24 years, with a growing youth population (15-24 years). But there is work that needs to go in for this demographic to truly actualize itself.

Plagued by intergenerational poverty and volatile economic cycles, the stark reality is that young people in 2018 find it hard to survive and thrive: they continue to deal with issues such as child marriage, stigmatization surrounding bodily changes, early & unplanned pregnancies, unsafe abortions, sexually transmitted infections (STIs) and physical, sexual & emotional violence.

Policies not in tandem with what data says

Case in point: according to NFHS-4 data, even though contraceptive awareness is 93% among girls aged 15-19, only 15% and 18% of married and sexually active unmarried girls in this group used a contraceptive at least once. Early marriage and low contraceptive uptake continue to drive pregnancy among adolescents which lead to adverse pregnancy outcomes like maternal and infant morbidity and mortality. Additionally, physical or emotional or sexual violence was reported by roughly 21% of married adolescent girls. On another front, only about 15% of young men and women between the ages of 15-24 reported having received sex education, leaving them more vulnerable to violence, unprotected sex, STIs, etc.

Yet, young citizens are expected to break the mould, join the workforce, increase economic productivity and ultimately, lead the nation. The fallacy is at its greatest. Unfortunately, while there are targeted and non-targeted policies and programmes, young people are usually treated as a homogenous monolith with the same set of needs & concerns.

Moreover, rigid socio-cultural norms, barely any representation in the Parliament below the age of 40 lack of political will and misconceptions & misunderstanding on our needs complicate matters even further. Traditional top-down approaches to reorient the public health system towards young people do not appear to have had the desired impact on critical outcomes partly due to insufficient engagement with young people in the planning and implementation of programmes and policies.

“Adolescent health should take center stage”

The periods of adolescence and youth are transitory – but they have the potential to be transformative as well. Interventions should be made during the age period of 10-24 years through adolescent and youth-friendly sexual & reproductive health (SRH) services in addition to empowering individual agency. This can not only address SRH issues, but directly contribute to forming positive attitudes and behaviours. Adverse outcomes caused by and leading to lack of knowledge & awareness, low school retention rate, unmet need for contraception, early/unplanned/unwanted pregnancies, maternal and infant mortality rates can be prevented with timely interventions.

Adolescent health needs to take center stage in Governments’ priorities by effectively implementing existing national policies and programmes in their full scale and strength. The government’s existing flagship health programme for adolescents (10-19 years) launched in 2014 referred to as the ‘Rashtriya Kishor Swasthya Karyakram (RKSK)’ has not been rolled out in its entirety across all parts of the country.

Moreover, existing policy provisions and/or structures on convergence between government agencies must be implemented and/or strengthened in order to allow for intersectoral collaboration, necessary linkages and to avoid duplication of efforts. Additionally, increased investments are required into social & behavioural change communication (SBCC) that will drive demand generation based on informed choice.

Governments have the responsibility and resources at their disposal to address barriers in the way of young people accessing sexual & reproductive healthcare through policies that are responsive to them and respectful of them.

What it means to truly realise youth leadership

When young people’s sexual & reproductive health & rights (SRHR) are protected and strengthened, they can access health information and services and make informed decisions free from violence, discrimination and coercion, which will enable them to complete schooling and seek skills that will enable them to become productive citizens of the country. The gains made in health, well-being and education can lead to greater inclusion in the workforce, lower health inequalities and overall contribution to the demographic dividend.

Leading these efforts at the forefront should be the intended users of these policies/programmes themselves: young people. Young people need to be meaningfully involved and included in the planning, designing budgets and implementation of programmes and policies that serve them. The recently concluded 2018 PMNCH Partners’ Forum in New Delhi served as a platform to bring together the variety of voices working on these issues but it will take concerted efforts to sustain the excitement & exchange of ideas and work towards a larger movement that reminds adolescents of the tremendous joy and hope that they can live and look forward to.

The choice is clear: we can either proceed with business-as-usual while we wait and watch as a fifth of the world’s young population falters under unresolved conditions; or we can use this moment to listen to their needs, learn from their experiences, meaningfully involve them, build capacities towards meaningful youth leadership and enable conditions for young people to attain their highest levels of health and well-being. Time is of essence: tomorrow is here, tomorrow is today – tomorrow is right now. It’s time to act.

The writer is Fellow at Population Foundation of India PFI