Authored by AIF Fellow Dnyaneshwar Surwase
India has about 253 million adolescents. And the Indian nation strives to benefit these 253 million adolescents in the country by making them safe, healthy, educated, and equipped with information and life skills to support the country’s continued development socially, politically, and economically. World Health Organization (WHO) defines adolescence as a phase of life between 10-19 years of age characterized by physical growth, emotional, psychosocial and behavioral changes.
The National Health Mission India launched Rashtriya Kishor Swathya Karyakram on 7th January 2014. The objective of this program is to reach out to the adolescents – male and female, rural and urban, married and unmarried, in and out-of-school adolescents with special focus on marginalized and underserved groups.
The program provides services for various issues of adolescents including sexual and reproductive health, nutrition, injuries and violence (including gender-based violence), non-communicable diseases, mental health and substance misuse. The strength of the program is its health promotion, prevention and reaching adolescents in their own environment. Key approaches of the program are providing and facilitating community-based, school-based, and facility-based interventions.
Seba Jagat has been implementing adolescent health program i.e., Rashtriya Kishor Swathya Karyakram under public-private partnership with the support of National Health Mission Odisha in 14 blocks of Balangir district since 2021.
As an AIF Banyan Impact Fellow, I joined Seba Jagat Kalahandi for a public health project. My primary task is to handle documentation, reporting and development. My host organization has always given me more space to explore beyond my primary project in the field of education, livelihood, environment etc.
As a part of innovation and exposure, my organization gave me a chance to facilitate sessions on Sexual and Reproductive Health Rights organized by Research Academy for Rural Enrichment, Sonepur at Gudvela, Balangir. This was my second time working with adolescents. I had experience working with adolescent boys from some underprivileged communities on gender sensitivity.
Also, last year, I had conducted sessions on two topics: first, creating awareness about safe and hygienic menstrual health practices; and second, understanding gender and sexual identity to create a safe space with co-workers and other community stakeholders. I spent a significant amount of time reading and preparing to facilitate the sessions, increase the participation of adolescents, and spread as much awareness as I could.
According to WHO, “Sexual and Reproductive Health (SRH) encompasses dimensions of physical, emotional mental and social wellbeing in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity.
On the day of session, I was assuming it will be a mix group of girls and boys but when I entered into the training hall there were only girls. We started with introduction and ice-breaker but soon I realized there is some language barrier. I had a small observation while working in rural and tribal areas of West Bengal and Odisha: it is difficult for women from rural areas to speak Hindi or English, whereas some men can get it sometimes. I think perhaps it is because men have easy access to technology, like mobile phones, the internet, and education; they travel more; and they access public spaces more than women.
I could not speak Odia but I can understand it and the participants in the session could not speak Hindi but they could understand it. So I asked them to speak in Odia and the block supervisor helped in translating. It was not easy to make them talk. At first, they would listen quietly, then when I occasionally asked them to share their experiences or thoughts, they would just laugh or whisper among themselves.
This was not new to me, but gradually, I started sharing my experiences of tackling adolescent period and stories my friends. After making sure it was a safe space for them to talk and express themselves, many of them raised their voices more prominently concerning themselves, their non-school-going friends and boys too. My supervisor and another colleague who was with me helped a lot. As expected, sharing lived experiences was worthy.
The primary observation was that there is a lack of access to information on issues affecting their lives and have limited space to develop competencies crucial for active participation. In general, adolescents are vulnerable to nutritional disorders and anemia, sexually transmitted infections, HIV/AIDS, unwanted pregnancies, and unsafe abortions. trafficking, sexual abuse, stress, and related consequences.
The vulnerability of adolescents is affected by a number of factors like physical, psychosocial, and sexual changes, the absence of abstract thinking, a lack of knowledge and skills, negative portrayal by media, adolescents with special needs (physically and mentally challenged adolescents, orphans, and street children), environmental factors, exceptional circumstances (like natural disasters, terrorism, and wars) and accessibility and availability of health services.
Starting with understanding adolescence, we covered different aspects of it: the period of change, development stages like physical, cognitive, psychosexual, social, and moral-spiritual development, characteristics, and challenges. In discussing sexual and reproductive health and rights, we talked about healthy menstrual practices.
Many of the adolescent girls shared their experiences of daily living, especially when menstruating, where they are exposed to multiple layers of vulnerability due to noxious social norms affecting the value of girls. How it affects their ability to move freely and to make decisions affecting their education, health and social relationships. A positive thing was that all of them shared that they use sanitary napkins, but they want sanitary napkin vending machines and safe spaces in all the public spaces.
Though some of us romanticize rural and tribal cultures these days, the girls here face multifaceted socio-cultural challenges, which create more complexities in their lives. With the pressure on the girls to preserve their “purity” and traditional female gender norms, they are often faced with many socio-cultural and ecological barriers in their pursuit of a decent womanhood. It is still prevalent that during menstruation many of them are not allowed to enter in the kitchen or touch anything in the house.
In 2017, the Government of Odisha launched the Khushi Scheme, similar to the Menstrual Hygiene Scheme, to provide free sanitary napkins to school-going girls across the state to promote health and hygiene and reduce school dropouts. Some of them get the sanitary napkins under this scheme from schools, whereas some girls shared that their school does not provide this facility or implement the menstrual hygiene scheme properly.
During the discussion, they shared different problems like lack of access to education, child labor, early marriages, early pregnancy, physical, mental and sexual assault, malnutrition, other health problems, menstruation, addiction, trafficking, etc. Sexual and reproductive health rights are the right to access reproductive healthcare-related information and services, including family planning, abortion, maternal, and other reproductive health services to achieve healthy life, free from discrimination, coercion, exploitation and violence. Access, availability, and utilization of these rights are influenced by various cross-cutting and intersectional socio-political, cultural, economic, geographical, and identity inequalities.
I tried to understand their views and practices during menstruation, but they were too shy to answer or openly speak about them. But interestingly, after some time, they became fearless about the norms and restrictions in menstruation, but none of them questioned them.
It shows an example of strengthening gendered roles from generation to generation. It also shows how we were conditioned to grow up just worshipping and not questioning in life. No doubt, in India, sex, sexuality, and sexual-reproductive health continue to remain caged in the private space and connected with stigma and shame.
They said there are noxious subtle gestures made intentionally or unintentionally in the form of stares, insensitive language, direct and indirect comments, jokes, taboos, and stereotypes towards girls. A participant said, “Though the government is aiming to institutionalize adolescent participation through formal and informal platforms at various levels, it is important to mandatorily implement and monitor such programs. Also, to strengthen adolescent participation, an equal number of girls and boys must participate; why make only girls the flag bearers?”
Teenage pregnancy, lack of safe contraception, unsafe abortions, unsafe sexual practices’ and sexual assaults have adverse outcomes affecting the health of adolescent girls, and contribute to maternal mortality and morbidity, transmit RTIs and STIs, including HIV/AIDS, and mental health issues. The existence of social taboos regarding SRH (sexual and reproductive health) means that adolescent girls and women often forgo health services.
The girls get their basic traditional knowledge about SRH from their mother and female relatives. So parental and peer supervision played an important role in current health practices’ among them. That indicates that parenting issues are critical to adolescent activities. The lack of knowledge about health increases various risk-taking behaviors, affecting their mental as well as physical health. Hence, a holistic SRH education is necessary, which will empower them to adopt a healthy sexual and reproductive lifestyle.
In India, sexual and reproductive health is caged within the four walls of Indian households, and it is assumed that as a private or personal subject, understanding the political context behind it has to be normalized as a part of public or political debate; as the feminist argument goes, ‘Personal is Political’.
It is challenging and critical to create and spread awareness on sexual and reproductive rights to emphasize, highlight, and tackle the challenges that women face due to unequal access to reproductive health services and information. We need intersectional approaches by considering different socio-cultural, geo-political-economical situations to reduce the various risks that Indian adolescent girls face. We hope that this intersectional approach will help to empowerment of women and promote gender equity.
A participant said “there should be a mandatory course in schools about sexual and reproductive health.” While another girl mentioned that “parents should also be involved in the awareness sessions; they have to be sensitized about the health and rights of their children, and they should not feel ashamed to talk about sexual and reproductive health. Parents should help their children break the barriers, stigmas, and taboos and not blindly support and transfer them to the next generation.”
Since it was an interactive session, when we asked them to suggest a solution, they suggested the following:
1. Educating girls according to their choice
2. Sessions should not always focus exclusively on life skills training and talk about sexual and reproductive health but also include how to challenge gender norms and discriminatory social norms.
3. Forming a girls-only peer group and mentors
4. Creating a safe space
5. Increase economic opportunities that can reduce parental opposition to education and encourage people to join the workforce.
6. Easy access to public spaces.
7. Respect our choices and voice.
One of the taproots of problems in the development of adolescents is the culture of silence around many issues. one of which is the silence around sexual and reproductive health, and it has to be addressed by breaking the silence. Talking with them, I understood we should normalize talking about sexual and reproductive health and take it out of the private sphere.
Unless we bring this issue into the public space, we will not be able to work on it positively and effectively. We need to invest in adolescents’ development not only for health and economic advancements to the nation but also as duty and responsibility to secure their human rights.
We all know social change, when it comes to voluntary action and not by law or rule, is a slow-process because people have been conditioned since birth, and challenging it is not everyone’s cup of tea, but proactive efforts and inclusive participation would definitely help to achieve positive change.
This experience has been an eye-opening reminder of how important it is to have a space to have a dialogue about topics like sexual and reproductive health, which are considered personal and connected with shame. I feel facilitating informal and candid discussions with the adolescent is indeed a value addition and has helped me critically revisit my own way of conducting sessions.
Such types of conversations can provide us with valuable insights and immediate feedback that helps us understand the group’s unique needs, motivations, and challenges. Also, exploring new things beyond my project deliverables helped strengthen my potential and leadership skills, which is the key objective of this Fellowship.
References:
https://nhm.gov.in/index4.php?lang=1&level=0&linkid=152&lid=173
https://www.unicef.org/india/what-we-do/adolescent-development-participation
Parida SP, Gajjala A, Giri PP. Empowering adolescent girls, is sexual and reproductive health education a solution? J Family Med Prim Care. 2021 Jan;10(1):66-71. doi: 10.4103/jfmpc.jfmpc_1513_20. Epub 2021 Jan 30. PMID: 34017705; PMCID: PMC8132820.