The Unaddressed Need- The sexual and reproductive health needs of Young People


The other day at the chemist's shop I found myself standing next to a girl not more than 14-15 years of age, nervously fidgeting with the money in her hand. She had asked for a pregnancy testing kit. The chemist handed over the kit to her with a scornful look further making the girl nervous. She sped away from the shop hanging her head in shame.

I wonder how many girls like her are dealing with the scrutiny and scornful looks, right from parents to teachers, doctors to even the chemists! How traumatic that experience could be? Why do so many girls approach the chemists looking for a means to find the reason for their missed periods? Why they are not able to practice safe sex?

It is a sad truth that teenage pregnancies are estimated to be around 6% -1 6% of total pregnancies in India by various studies. Practically it means on an average there is one teenage pregnancy for every 10 adult pregnancies!

There is a crying need, therefore, to address the sexual and reproductive health needs of adolescents. Unfortunately, this group is almost invisible in the health care system. While we have child health programmes and reproductive health programmes, adolescent clinics, counseling centers, sex education programmes are conspicuous by their absence in most parts of the country.

Studies have shown, again and again, that more and more teenagers are sexually active and IIPS study titled 'Pre-marital sexual relations among youth in India: Findings from the Youth in India, Situations and Needs Study' said that 15% young men and 4% young women indulge in pre-marital sex in India. It is also true that 47.4% girls are married before the age of 18 and according to a UN report, every year four million teenage girls in India have babies! Both the groups suffer from lack of access to quality SRH services.

The issue gets more complex when we speak of girls who end up with an unwanted pregnancy due to pre-marital sex. The social stigma attached to it leaves no option for them but to seek backstreet abortion services. I remember asking a health worker if she demonstrates condom use to girls and she said “No! Only to married women. Why do girls need to know about it?” Boys are equally ignorant about safe sex practices leading to most tragic consequences of unwanted pregnancies and unsafe abortions.

There is a resistance to sex education to adolescents on the mistaken belief that it leads to promiscuity. However, there is a large amount of evidence that says sex education and life skill development make young adults more responsible towards their partners as well as to themselves. Use of safe sex practices and contraception, understanding of the consequences of unplanned pregnancies and unsafe abortions, awareness and access to quality abortion services, counseling facilities to get information and guidance in managing relationships should form an integral part of any policy that addresses adolescents. Unfortunately, in India unmarried adolescent girls continue to be left out of the legal abortion services.

The newspapers in Mumbai were recently abuzz with statistics stating 67% increase in abortions among young girls in 2014-15. The article brought to notice the fact that more & more teenage girls were accessing abortion services and that too majorly from private clinics. The increase could be attributed to some extent to better reporting from abortion clinics which are required to report any teenage pregnancy to the police under the POCSO Act. The POCSO Act views consensual sex between to underage individuals as a crime. This further creates a new dilemma for doctors as well to conduct abortions in cases of teenage pregnancies.

As long as we do not recognize the fact that teenagers are sexually active and should be empowered to make informed decisions regarding their sexual behavior, it would not be possible to address the unaddressed needs of the vulnerable teenagers. Time we start a dialogue on this today – the International Youth Day. Write to us with your comments and views on this article.

- Anupriya Sathe,  Population First.

Do We Really Care For Women’s Health?

Even after nearly three decades of the declaration of International Day for Women’s Health at Costa Rica, the status of women’s health across the globe does not paint a rosy picture. In fact, the global concern on safeguarding women’s health rights has been on the rise with the movement gaining momentum. On May 28th every year, women’s health issues are expected to take center stage and the day is expected to serve as an occasion to celebrate the gains in women’s health status. There are nearly 25 days of activism throughout the year observed worldwide, which call out for action on women’s reproductive and sexual rights. More and more organizations are partnering with each other to put an end to the neglect faced by women with respect to their sexual and reproductive rights. It is ironic and sad, that there should be a need to mark a special day for the health rights of half the population of the world. 

The cocktail of patriarchy and poor access to health care resulted in women’s health status still being poor. In the Indian context, the health of Indian women is intrinsically linked to their status in society.  

Taking a look at some crucial indicators of maternal health, one observes that nearly half of the ever married women in India are married off by age of 18 years and give birth by the age of 19 years. While 60% women in the country are deprived of institutional facilities for child birth, only 50% have had access to antenatal care services. Further, the country which boasts of rapid development and economic prosperity has more than half of its women anemic, which is the most telling indicator of the women’s nutritional status .  Strong patriarchal values, low levels of both education and formal labor force participation lead to little autonomy and decision making power and have a negative impact on the health status of Indian women. In India only 36% women have any decision making authority in the household decision making. 

The patriarchal set up has further implications on the decisions pertaining to fertility and desired family size by women. Son preference has not only forced women to undergo multiple pregnancies but also opt for sex selective abortions in case the fetus is a female. Data shows that only 40% women having two daughters have desired a third child, which means lot many women are forced into bearing a third child against their will, hoping  for a male child. Mis-use of advances in modern technology coupled with son preference are responsible for the declining child sex ratio. A large section of women (>60%) do not have a choice with regard to deciding the family size or contraceptive choices. 

Violence against women seems to have reached an epidemic proportion in our country where 40% of women have reported to have experienced spousal violence. These statistics are merely the tip of the iceberg with lots of cases of VAW going unreported.  Women who have been physically or sexually abused by their partners report higher rates of a number of important health problems. For example, they are 16% more likely to have low-birth-weight babies, they are more than twice as likely to have an abortion and experience depression. 

It is a fact that millions of Indian women still have to risk sneaking out in the dark for the most basic need of defecation. Absence or non- availability of clean, safe and functional toilets that women and girls can use is the cause behind many avoidable health problems as well as security issues of women.

28^th May - the day to Call For Action on Women’s Health should be used to review our priorities, our policies and programmes and ask ourselves the question: Do we really value our women?

Making Mumbai Safer

Every day, national dailies across the country have glaring statistics on how crimes against women, children are on the rise. *Delhi is reported the most unsafe city for women in country, followed by Mumbai, Jaipur and Pune. Nearly one out of three rape victims in India is under the age of 18. One in 10 is under the age of 14. Most victims are aged between 18 and 30. According to statistics, a woman is raped every 20 minutes in India.

Why can’t India’s **1,585,353 strong police force not protect its women against gender related crimes? Why can’t the culprits be rounded up and brought to justice? How many more women will be violated before the police will spring into action? Are some of the questions we ask not just ourselves, but everyone around us too. 

The brutal Delhi rape of 23-year old physiotherapy intern Nirbhaya by six men on a moving bus is an incident that will remain in our memory for a long time. We often wonder what happened post the incident, what are the officials doing, has there been any change, is it even possible to make or expect any change?

Building on this concern and the outrage she felt, Vibha Bakshi, a filmmaker, decided to peep into Delhi, the city where the Nirbhaya incident occurred and translate it into a hard hitting documentary, ‘Daughters of Mother India.’  

The 45 minute - documentary begins with Vibha, the narrator, travelling on the streets of Delhi, while she narrates the incident of Nirbhaya rape. The film shifts focus to a 7-year survivor of an equally brutal rape –Gudiya. The heart wrenching story leaves the viewers asking questions and many more questions as to how come something like this can happen in a civilized society. The documentary then goes inside  the Indian society, the Government and looks at the swift and radical changes being made in the Police, the Judiciary and community groups, who are provoking for the first time, a national dialogue on the current sexist attitudes of Indian society and how to change them.

In Mumbai, the screening followed by a panel discussion -consisting of Rakesh Maria, Police Commissioner, Himanshu Roy, ATS Chief, Poorna Jagannathan, actor, Vibha Baksi, Director, and moderator Vir Sanghavi,- had an interactive voicing of thoughts and reactions about the movie and the steps taken to ensure higher safety for women.  

Maria said that currently for the police, women’s security and sexual offenses are priority number one. A few years ago, the priority was combating underworld and organized crime. For the last couple of decades it was terrorism. But now the focus is clearly on women’s safety.

Statics show that, ninety percent of crimes against women take place within the circle of trust. Statistics for the year 2012 revealed that in reported cases, the assailants were neighbours, lovers (178), husbands (9), fathers (10), cousins (5) and friends or relatives (12). Most sexual assault cases also occur in private spaces.

Maria listed four steps the police have taken to make Mumbai safe for women. They include:

Setting up a 24 hour helpline:  ‘103’ is a helpline number for reporting crimes against children, women and senior citizens in Mumbai. Once contacted, the police will be there immediately to take action. The survivor doesn’t need to go to the police station. A jeep with a lady police office will go the survivors place and record her statement in her familiar surroundings.

Women Beat Marshall System: A first-of-its-kind initiative in the country wherein armed female police personnel will patrol the city streets on bikes, specifically to tackle crime against women. The 205 female personnel have been handpicked and imparted rigorous training, including riding bikes, using firearms, unarmed combat, wire-less communication and so on. They will also keep an eye on areas consisting of girls schools, colleges, beach fronts, and at the places where women footfall is heavy. These special squads will patrol 672 areas which are vulnerable from the women safety point of view.

Helpdesk at Police Stations: There will be lady constables manning the desks. Children, women, senior citizen will not have to wait to lodge a complaint. They will be taken to the senior most officer present in the station and help will be provided as soon as possible. 

Additional security at vulnerable spots: The police have identified 272 pockets in the city where women are vulnerable to sexual attacks. Police are posted there and a mobile jeep keeps doing rounds of the vicinity, to keep the area crime free.

Maria’s presentation was impressive and unassuming. But a lot depends on how effectively the measures are implemented. As it is reiterated a number of times, immediate response and punishment is a good deterrent. This requires that each one us needs a more alert, proactive in reporting crimes , be more sensitive towards the survivors and ensure that the system functions efficiently.

We also need more storytellers like Vibha, to show us a balanced correct picture of both the sides a story.

Click here to see the trailer Daughters of Mother India Daughters of Mother India

References

*Statistics quoted from Times of India, dated 29 Dec, 2014

** Wikipedia