According to a report from UNICEF, there are around 1.2 billion people aged between 10-19 years across the globe. While most of this population is healthy, there are substantial premature deaths, injuries, and illnesses adolescents are facing today. Marriage of girls before age 18 years, early and unplanned pregnancies, alcohol or tobacco use among boys, and exposure to (or) experiences of violence not only affects adolescents currently, but also in their adult ages and their future children. The adolescent population of today, the generation to lead healthy world in the immediate future, are also facing several other sexual and reproductive health risks, including HIV/AIDS and sexually transmitted infections and unsafe abortions. Adolescents living in some geographies are more vulnerable than those in other geographies. For example, in most of the developing countries, around one out of three girls get married before the age of 18. The UN Population Division puts the adolescent fertility rate in 2017 at 46 births per 1000 women among low and middle income countries (42 in the world), with vast majority of the global births taking place in these countries. One of the health goals of Sustainable Development Goal (SDG 3) is that by 2030, the world should ensure universal access to sexual and reproductive health services, including for family planning and education. This article argues for better access to contraceptive information and services for adolescents to reduce the number of girls becoming pregnant at very young age, with focus on India.
Every 5th adolescent in the world lives in India, and every 5th person in India is an adolescent. They are predicted to be the driving force for India’s development in the coming years. However, adolescents of India, particularly girls are facing major sexual and reproductive health risks. The data from National Family Health Survey – 4 (2015-16) indicates that 8% of teenage girls have already begun childbearing, and only 10% of married adolescent girls are using modern methods of contraception. The recent report by Family Planning Association of India (FPAI) indicated that unsafe abortion practices are responsible for 50 percent of maternal deaths in girls aged 15-19 years. The question is, do the Indian adolescents know fully about contraceptive methods and do they have access to contraceptive services?
The findings of Population Council’s project UDAYA in the states of Uttar Pradesh and Bihar (a home to more than 72 million adolescents) reveals the low comprehensive knowledge and contraceptive method use among adolescents. For instance, in Bihar, 14 percent of unmarried boys and 6 percent of unmarried and married girls aged 15-19 years reported pre-marital sex; of these, 30 percent of boys, 5 percent of unmarried and 27 percent of married girls had engaged in premarital sex with multiple partners. Whereas, only 20 percent of boys and between 1 to 8 percent of unmarried and married girls in the age group of 15-19 had always used a condom. UDAYA’s findings showed, moreover, that awareness of contraceptive methods remained superficial among adolescents. For instance, in Uttar Pradesh, while 63 percent of unmarried adolescent girls were aware of contraceptive methods (oral pills, condoms, emergency contraceptive pills), only 17 percent had the correct knowledge about at least one of these contraceptive methods. In terms of adolescent pregnancies, the findings highlighted that 46 percent of married girls in Bihar and 39 percent of married girls in Uttar Pradesh who were pregnant at the time of survey reported that their current pregnancy was either unwanted or wanted at a later time. This calls for better accessibility to contraceptive information and services for adolescents.
To ensure holistic development of adolescent population, the Rashtriya Kishor Swasthya Karyakram (RKSK) scheme was launched by the Ministry of Health and Family Welfare in 2014. The scheme covers six thematic areas – sexual and reproductive health, nutrition, injuries and violence (including gender-based violence), prevention of non-communicable diseases, mental health and substance misuse. Since the initiation of RKSK programme, several strategies have been used to provide information, counselling and services to adolescents through convergence, integration and partnerships with multiple stakeholders. While these efforts are underway, there is a room for improvement in program planning and strengthening based on the data that are made available on adolescents in India. For example, the findings from large scale surveys such as the National Family Health Survey and UDAYA project highlight the need to provide comprehensive knowledge about contraceptive methods to all adolescents, with particular focus on addressing the vulnerabilities of married adolescents. Within RKSK and other related national health programmes, family planning should be given a priority to respond to the diverse needs of adolescents across different regions of India – with a cultural understanding of what adolescents need and at what time points. On the eve of World Contraception Day, the onus should be on greater investments in strengthening sexual and reproductive health awareness initiatives for adolescents to develop them into a healthier and productive population that contributes to India’s growth and development.