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Health
Several government policies continue to ignore Menstrual Health Management and adolescent health programmes.
Pixabay/Image used for representational purpose only

Adolescence - that phase when a person transits from puberty to a young adult - is often described by the urban elite as a carefree time for social exploration, taking risks and discovering independence. This description remains myopic of the true situation that most of the 253 million adolescent Indians find themselves in. From a governance perspective, adolescents in India, ironically, receive little institutional policy attention and even less operational and programmatic interventions, which are generally aimed at helping them emerge as socially well-adjusted, healthy and responsible citizens.

This critical ‘make or break’ phase, which has a long-term consequence on the eventual life trajectory of the ‘end of childhood’ population, receives little or no sustained attention among policy-makers and researchers alike.

For instance, adolescents suffer from diverse health issues ranging from nutritional disorders, including malnutrition and obesity, substance abuse, high-risk sexual behaviour, stress and common mental disorders” (Public Affairs Index 2018). Most of these issues remain largely unaddressed both in terms of policy intervention and research.

How gender inequality agonises adolescent girls

The problems of adolescence are exacerbated, especially for adolescent girls, by gender inequities that manifest in myriad ways, including blinkered policies and dogmatic socio-cultural practices. While gender norms impact both male and female adolescents, the brunt of its impact is borne by adolescent girls, who then become victims of child marriage, early school drop-outs and unwanted pregnancy.

A 2017 NCPCR report points out that 39.4% of adolescent girls in the 15-18 age group are currently “not attending any educational institution, and a vast majority, around 65% are either engaged in household activities, are dependents or are engaged in begging”.

The Indian female adolescent encounters problems from the onset of menarche (the first menstrual cycle), when she has to circumvent archaic gender norms of ‘pollution’ and ‘purity’ that compel her to stay at home. Even if she does overcome them and reaches school, she is posed with a new set of challenges - poor sanitation, unusable and poor state of toilets and the lack of privacy at the toilets in school.

In the absence of a safe and neutral place, she takes recourse to what her sense of modesty dictates – she misses classes for the next five days, and worse yet, as it happens in many cases, simply drops out. A 2016 Dasra – ‘Dignity for Her’ report highlights the fact that adolescent girls tend to miss school for an average of six days a month owing to their inability to manage their menstrual cycles at school.

The gross neglect of Menstrual Health Management (MHM) from all quarters severely undermines the capabilities of adolescent girls.

Unfortunately, the situation is no better even at homes, where she is viewed as a burden or someone who ‘should be protected’ and is promptly married off at the age of 15.

The 2018 Public Affairs Index (PAI) report provides evidence of this: states like Tripura (18.8%), West Bengal (18.3%), Assam (13.6%), Bihar (12.2%), Jharkhand (12%), Andhra Pradesh (11.8%), Telangana (10.6%) and Arunachal Pradesh (10.5%) had the highest incidence of child-bearing among adolescent girls.

Female adolescents with her young, naïve mind and a body that is not ready for a child, is forced to ‘grow up’ and don a new role, that of a mother and a caregiver.

The 2018 economic survey chapter 7 on ‘Gender and Son Meta-Preference: Is Development Itself an Antidote?’ notes that women “have little control over when they start having children but only seem to have control over when they stop having children. This could affect other milestones early on in a woman’s life; for example, women may not get the same access to employment that men do.” And this certainly rings true for our adolescent girls.

How government policies failed adolescent girls

Let us recount how adolescent girls continue to be failed in a cavalier manner. In 2005, influenced by the growing concerns over HIV-AIDS, the Government of India introduced an Adolescence Education Programme (AEP). This is the first time where adolescent health was the focus under the National Adolescent Reproductive and Sexual Health Strategy (NARSHS), under which, health clinics could offer diverse services (preventive, curative and referral) to adolescents and youth.

The programme was discontinued within two years. Why? Because different states believed that contentious words like “intercourse and condoms” could promote promiscuity and destroy the cultural fabric of our country.

In 2014, a new programme was initiated called the Rashtriya Kishor Swasthya Karyakram (National Adolescent Health Programme). However, awareness about such programmes was dismal. Besides, there is no real data available on how this programme has been rolled out and the impact it has made thus far. The situation is similar in other, ‘on-paper’ programmes namely Kishori Shakti Yojana, Balika Samridhi Yojana and the Rajiv Gandhi Scheme for Empowerment of Adolescent Girls, “SABLA”.

It is noteworthy to mention here that there are six different ministries that are in charge of implementing the schemes that cater to the needs of the youth and adolescents, including the Ministry of Women and Child Development, Ministry of Health and Family Welfare, Ministry of Skill Development and Entrepreneurship, Ministry of Youth Affairs and Sports, Ministry Human Resource Development, Ministry of Social Justice and Empowerment, and the Ministry of Labour and Employment.

Interestingly, the Indian Council for Medical Research (ICMR) concedes that “despite 35% of the population being in the 10-24-year age group, the health needs of adolescents have neither been researched nor addressed adequately; particularly with respect to their reproductive health needs, which are often misunderstood, unrecognised or underestimated.”

Thus, while we still wage our battles on how to approach adolescent health in India and seek ways to develop an all-encompassing multi-dimensional approach to address adolescents and their reproductive health, our adolescent girls continue to suffer, with many likely to face the trauma of a near-death experience as she delivers.

Adolescent-friendly clinics that focus on mental health, behaviour change communication and enabling a positive social environment are imperative to ensure the full capabilities of young India. Only a community-government partnership, through informed advocacy and coordinated action, can make this happen.

Varsha Pillai is a Programme Manager at the Public Affairs Centre, a not-for-profit think tank committed to good governance.