Sexual and reproductive health for adolescents: Where does India stand?

With adolescent comprising of one-fifth of the total population (22%), India is home to world’s largest adolescent population in the world. The World Health Organization (WHO) defines an adolescent as any person between ages 10 and 19. This age range falls within WHO's definition of young people, which refers to individuals between ages 10 and 24. The consistently high population growth of 80s and population momentum of 90s is one of the key contributing factor for the forecasted growth of adolescent population in next two decades. Despite being one of the highest sub population group, adolescents have not received the desired attention in the policy and programme sphere. The generalisation of the needs of adolescents either under child centric or youth specific schemes and initiatives, often neglects the unique evolving needs of this subgroup.

Considering the special needs of the adolescents and young population, the Committee on the Rights of the Child (CRC), which oversees the child rights convention, published guidelines on the right of children and adolescents to the enjoyment of the highest attainable standard of health, and a General Comment on realizing the rights of children during adolescence was published in 2016. It highlights states’ obligations to recognize the special health and development needs and rights of adolescents and young people. The Convention on the Elimination of Discrimination Against Women (CEDAW) also sets out the rights of women and girls to health and adequate health care . The major mortality and morbidity contributors for this group such as road accidents, mental health, HIV/AIDS and interpersonal violence often remain undetected or untreated.

As a signatory to both CRC and CEDAW, India is committed and running several ambitious programmes such as Rashtriya Kishor Swasthya Karyakram (RKSK) to bring adolescent within the ambit of public health. The Ministry of Health and Family Welfare launched Rashtriya Kishor Swasthya Karyakram (RKSK) in 2014 to reach out to 253 million adolescents - male and female, rural and urban, married and unmarried, in and out-of-school adolescents with special focus on marginalized and undeserved groups. In contrary to its initial focus limited to sexual and reproductive health, the programme now also covers nutrition, injuries and violence (including gender-based violence), non-communicable diseases, mental health and substance misuse. The RKSK programme also identified the need for establishing and strengthening the Adolescent Friendly Health Clinics (AFHC). Under its facility-based approach it aims to provide a range of clinical and counselling services to address issues specific to Sexual and Reproductive Health (SRH) to Nutrition, Substance abuse, Injuries and Violence (including Gender based violence, Non Communicable Diseases and Mental Health. Adolescent Friendly Health Services are delivered through trained service providers- MO, ANM and Counsellors at AFHCs located at Primary Health Centers (PHCs), Community Health Centers (CHCs) and District Hospitals (DHs) and Medical Colleges.

It is vital to recognise that adolescents are not a homogeneous group and the inequalities that are reflected in the access to health and information, are also due to existing deprivations owing to social and economic marginalisation that includes ethnic minorities, LGBT, refugees and indigenous adolescents. The Lancet commission study on adolescent and well being suggests that guaranteeing and supporting access to free, quality secondary education for all adolescents presents the single best investment for health and wellbeing. Participation in quality secondary education enhances cognitive abilities, improves mental health and sexual and reproductive health, and lower risk for later-life non communicable diseases. Therefore, to improve the reach and impact of existing programmes, a multi-disciplinary approach not relying only on public health systems is equally important. Considering the cognitive and emotional growth during this age group, the influence is not limited to family. The effective use of digital media and broadband technologies offers remarkable opportunity for learning, accessing correct information and services. The overall reliance of the schemes and programme on health seeking behaviour or outward readiness of the adolescents to avail existing services is another area that should be improved through popular medium of interface such as sports, fun learning, fashion and social media. Another age-old methodology is to capture what’s important, and therefore the existing health information systems need further improvement to capture the neglected parameters of adolescent health, often subsumed within the data for youth. Finally, the legal system that imposes strong measures to protect adolescent and young people, unintentionally infringe the privacy and accessibility of service e.g. contraception, POCSO act that fails to uphold the rights of young couples in consensual relationship by stating any sexual act with a girl under 18 as rape and therefore increasingly used by families as a tool to split the young couples.

Overall, the wellbeing and health of adolescents is one of the pressing priorities to ensure benefits for future adult life and next generation of children.