A Sneak Peek Into Adolescent Reproductive Health & Awareness

Adolescence –a period of transition spanning the age of 10 to 19 years- is perhaps one of the most crucial and susceptible phase of one’s life. This cross-road between childhood and adulthood opens a window of opportunity for a better preparedness towards a healthy adulthood and the possibility of procreation.

The adolescent years are marked by dynamic transitions not only physically, but emotionally, psychologically, socially, and mentally too. While the physiological changes leading to sexual maturity are the most interest- arousing, they lead to many behavioral problems too.

Undoubtedly, in a world that comprises 20% of adolescent population, anxieties are bound to be rife about one’s changing aspects of reproductive health. These anxieties are not unfounded, for with the beginning of sexual behavior, these adolescents do face many sexual and reproductive health problems, some with grave consequences too.

The Lackluster Reproductive Health & Awareness Among Adolescents

In the present day, the age of marriage has gone up while that of menarche has come down creating a “biosocial” gap or a chasm between the realization of reproductive capability and the social consents to do so. This biosocial gap coupled with the effects of globalization, rapid urbanization and the growing opportunities of socialization, has increased the risks associated with incidence of reproductive health problems.

In view of this dynamically-changing situation, not adequately arming the adolescent population with proper knowledge and services, may leave them as victims to a grave situation. In fact, it is every adolescent’s right to understand the changes that they are experiencing and to develop skills that would help them form healthy and responsible relationships.

But, despite there being an increased need for the creation of awareness about reproductive health among these vulnerable groups to protect themselves, adolescents remain a largely ignored, difficult-to-assess, and hard-to-reach population, particularly adolescent girls. Majority of adolescents still lack access to information and education on sexual and reproductive health, associated rights as well as preventive and curative services. Their awareness levels towards reproductive health issues continues to remain very low. Socio-cultural taboos and inhibitions regarding sex-related issues discourage children and even young & unmarried from discussing and expressing themselves and receiving adequate advice and guidance regarding reproductive health-related aspects like puberty, menarche, etc.

It is, thus, imperative that one understand that this education and awareness of reproductive health in girls is crucial to their health status and fertility. Adolescents should be sensitized about issues of reproductive health, as it may contribute to reducing maternal morbidity and mortality through managing the devastating outcomes of sexual behavior such as early unwanted pregnancies, unsafe abortions and the incidence of reproductive tract infections and S.T.D.s that may risk compromising future fertility.

State of Awareness: The Indian Scene

While the reproductive health needs of adolescents have been long ignored, the last decade has seen a marked increase in the emphasis on distinctive adolescent reproductive health issues such as menstrual hygiene, cancer screening, reproductive tract infections prevention, unsafe abortions, contraception, childbirth, maternal mortality and sex education, thanks to several educational intervention programmes.

In India, although premarital sex is a taboo, the recent years have witnessed a growing trend towards premarital sexual practices among adolescents. Unfortunately, even though studies exhibit an awareness and knowledge of contraception among 90% of adolescents, less than 10% of them actually make use of any form of contraceptives and this number further falls as one moves from an urban to a semi-urban and rural setting. This makes the adolescent girls more vulnerable to unprotected sex and the ensuing complications and sexual abuse.

Several studies conducted to assess the knowledge level of adolescents towards reproductive health awareness and issues associated with adolescence and their readiness to avail preventive and curative services show eye-opening results about the state of awareness among the adolescent population of the country and helps in policy formulation targeting reproductive health education and care.

For instance, there is an increased reliance on electronic media, television, and books/magazines for reproductive health information as age progresses. Again, friends are more a source of information about these issues rather than parents or teachers. While most of these young people are aware of the external (physical) changes associated with the onset of puberty, a large majority lacks knowledge of the biomedical reason for mensuration and are gripped by social taboos associated with the onset of mensuration.

Again, the awareness is found to be higher among older adolescents in India due to initiatives such as the School Adolescent Education Programme (SAEP) training held in the rural schools. But even this knowledge has been found to be inadequate, with a marked need for adolescent girls to acquire knowledge about menstruation, pregnancy, contraception and importance of nutrition & hygiene in maintaining reproductive health.

It is heartening to know, though, that the adolescent population of India has some degree of awareness towards important reproductive health parameters such as:

Malnourishment, hemorrhage and complications in delivery as causes of maternal deaths (75%, 56% and 35% respectively know of these). However, awareness towards hypertension and sepsis as causes of maternal mortality is still non-existent.
Knowledge of fertility, pregnancy and contraception among girls (19.4%, 62.7% and 64.5% respectively)
Knowledge about AIDS and its symptoms (though a very low percentage)
Knowledge of Reproductive Tract Infections (RTIs) and its symptoms such as vulvar itching, boils, lower abdominal pain, pain and/or bleeding during intercourse
Knowledge of Sexually Transmitted Diseases (STDs) (84% of girls – a big leap for a country like India where these STDs follow closely the plague of maternal morbidity)
A positive attitude towards sex education (79% exhibit a positive response)

Interventions: Taking India from Ignorance to Awareness

In the Indian context, the social structures in place fail to recognize reproductive health exclusive of sex and an inclusive part of a holistic health program that should start with early-age value education coupled with an understanding of the anatomy and physiology of one’s bodies and continue to adolescence to educate on safe access to fertility regulation method of choice and the right to appropriate healthcare services. In such a scenario, it falls on the shoulders of the polity to ensure that the policy planning and service delivery assists in the spread of the knowledge, attitude and practice of reproductive health among adolescents to address and excavate the problems related to these issues.

Undoubtedly, today, the government, together with various NGOs and international agencies, is proactively committed to educate and provide holistic health education towards ensuring a successful and healthy adulthood. Several programmes and policy initiatives directed at improving the situation have been put in place and are working on reproductive health issues. Some of the noteworthy adolescent healthcare initiatives that are making an impact include:

Adolescent Friendly Clinic (AFC) set at Small Private Clinics, with technical and financial backing of the WHO, that work as centers for adolescent health care, counselling and training & orientation of school-going adolescents in urban and rural areas.

Adolescent Sexual and Reproductive Health (ASRH) clinics at District & Private Hospitals along with the Adolescent Care, Counseling, Empowerment and Support Service (ACCESS) units at Taluk & Small Private Hospitals.

The National Literacy Mission too is dedicatedly working towards increasing Knowledge and Life skills (FLE) among Plus-2 and out-of-school adolescents.

Establishment of Anganwadi-based Teen Clubs and Adolescent Development Center (ADC) for out-of-school girls and boys at district, block and Panchayat levels.

The policy-makers realize the importance of reproductive health as a crucial factor in women empowerment and vice-versa. Initiatives like Kudumbashree, the largest female-oriented, community-based women-empowering project, are continually being formulated to help towards this.

The latest to this battery of initiatives is the Pradhan Mantri Surakshit Matritva Abhiyan that focuses on improving the quality and coverage of the Reproductive, Maternal, Neonatal, Child and Adolescent Health through diagnostics and counselling services. In fact, this scheme identifies Adolescent Reproductive and Sexual Health (ARSH) as a key strategy of the Reproductive and Child Health (RCH-II) program being run under the National Rural Health Mission (NRHM) and focuses on Family Life Education that includes:

(i) Adolescent nutrition

(ii) Maintenance of personal hygiene

(iii) Addressing identity crisis among adolescents such as body image, psycho-social competence

(iv) Life skill development

(v) Education on the ill-effects of alcohol, cigarettes, drug and sexual abuse.

(vi Awareness towards STIs, HIV/AIDS and responsible sexual behavior.

In addition to these, the government is making efforts to incorporate and promote health and sex education at school level as part of the curriculum and make such education available to as many adolescents as possible through interpersonal communication, television, health camps, broadcasting of health massages and also through counseling with the help of specialist from time-to-time.

Conclusion

Adolescence is representative of the huge human resource potential, and the human energy and creativity that they bring is not just indicative of the overall development of a nation but also provides the driving forces of the development. It thus becomes a prerequisite for social and economic success that reproductive health be treated with the same gravity as one considers general health and well-being. More focus needs to be placed on reproductive health education to help shed the social prejudices that are inevitably linked with reproductive health education and awareness.

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References:

http://pmjandhanyojana.co.in/pradhan-mantri-surakshit-matritva-yojana-details/