This post has been self-published on Youth Ki Awaaz by India Development Review (IDR). Just like them, anyone can publish on Youth Ki Awaaz.

Don’t Turn Away The Young

More from India Development Review (IDR)

By Ipsa AgnaniShruti Arora

In India, sexual and reproductive health (SRH) service seeking behaviours are low. This is especially true for young people, because of the associated stigma. Furthermore, society considers them as ‘minors’ who are inexperienced and lacking the knowledge and skills to make decisions related to their own bodies. They are therefore discouraged from visiting health facilities alone. This is more acute when it comes to women’s access to health services.

The National Family Health Survey (NFHS-4) indicates that only 29% of young women between the ages of 15-19 and 40% of young women in the age group of 20-24 are allowed to visit health facilities alone. Moreover, only 36% of married women without a living child are allowed to visit a health facility alone. NFHS-4 also highlights that 39% and 31% of currently married women between the ages of 15-19 and 20-24 respectively do not participate in decisions about their own health care

Only 29% of young women between the ages of 15-19 and 40% of young women in the age group of 20-24 are allowed to visit health facilities alone. Representational image. Photo: Ramesh Pathania/Mint via Getty Images

The above data gives us a glimpse into the multiple overlapping challenges that obstruct young women and other sexual and gender minorities’ access to quality SRH services. Some of these include:

  • Attitudinal problems within health care settings that often deny women from making decisions regarding their own sexual and reproductive health. Service providers are often uninformed, judgemental, and disrespectful when it comes pre-marital sex, abortion services, and same-sex relationships and this deters young people, especially women from accessing these services.
  • There is also an insistence on consent from the parent or guardian for accessing services at most health care facilities; this discourages unmarried young people from openly discussing their health concerns or accessing services.
  • The Prevention of Children from Sexual Offences (POCSO) Act, 2012—that seeks to protect any person below the age of 18 from sexual abuse—poses an additional barrier. The act has a provision on mandatory reporting. This makes access to SRH services for women under 18 difficult because the law views any form of sexual encounter (even if it is consensual) as violence.
    For instance, if a 17-year-old unmarried woman engages in consensual sexual activity, becomes pregnant, and wishes to seek an abortion, she will be hard-pressed to do so due to POCSO. This is because service providers are mandated to file a medico-legal case and report it to the police under Section 21 of the act if a young person below 18 seeks SRH services such as abortion or HIV testing. Medico-legal cases result in compromising young people’s right to privacy and confidentiality as the protocols require the police to get involved and inform parents for investigation. Even if the young person is successful in terminating the pregnancy, it would be at the cost of stigma-ridden comments, and her partner being accused of a sexual offence. Such provisions act as a deterrent, instil fear, and discourage young people from seeking services.
  • The Medical Termination of Pregnancy Act of 1971 (MTP) is another youth-unfriendly law. MTP legalises abortion, albeit only under certain circumstances such as foetal anomaly and instances of pregnancy arising out of sexual violence. Seeking safe abortion, then, is contingent on the decision of other medical, legal, and law enforcement professionals instead of the pregnant person themselves. Young and unmarried people seeking abortions are further stripped of their sexual agency and bodily autonomy due to the stigma attached to young people’s sexuality.
  • People with disabilities—whose sexualities and desire are often invisibilised, and usually patronised by the system—have it worse. They are automatically assumed to be unfit to make their own decisions. Furthermore, medical providers, frontline health workers, and counsellors are rarely trained and equipped to address the needs of people with disabilities. Claiming bodily autonomy in the context of pregnancy and safe abortion rights, then, becomes even more daunting yet crucial for people with disabilities who are constantly deemed as dependent by society.

The Pandemic Has Made It Worse

The pandemic and consequent national lockdown brought unique challenges that only served to exacerbate the above problems of access for young people, especially those from marginalised communities.

Illustration depicting types of medical services
Young and unmarried people are stripped of their sexual agency and bodily autonomy due to the stigma attached to young people’s sexuality.| Picture courtesy: Drishti Khokhar

With several facilities being transformed overnight into COVID response centres, and the prevalent notion that young people belong to a ‘healthy age group’, their mental and physical health was deprioritised. Further, for many young people, being confined in homes with their families meant that they could not access SRH services or products discreetly, safely, and easily.

The YP Foundation, through its vast network of young people from 25 states and 6 union territories across India, conducted a needs assessment (about 100 people) which highlighted some of these narratives of lack of access and agency. Findings from the study show that:

  • The agency of young unmarried women, queer and trans* youth, was especially impeded.
  • Young people could not access sanitary napkins. These were kept mostly at schools and Anganwadi centres and when they shut down during the lockdown, these were no longer easily available.
  • The disruption in supply chains of essential drugs such as ART, HRT, and contraceptives impacted those living with HIV.
  • Reduced access to medical facilities meant delays in detecting pregnancies, impeded access to safe abortion services.
  • Young people also had difficulty accessing mental health care services.

Recommendations

Maintain privacy and confidentiality

The taboo attached to sexual health services and the fear of social ostracism and exclusion among young people can be tackled if service providers pay attention to auditory and visual privacy protocols during consultation and examination sessions. Doors must be closed and curtains must be drawn to ensure that nobody is overhearing or overseeing. Providers and other facility staff must be trained to maintain confidentiality norms. Identity of clients should not be revealed while sharing medical records for official purposes, or while discussing medical history with colleagues, support staff, or even friends.

Encourage attitudinal change

Service providers should be non-judgmental and sensitive instead of having moralistic and judgmental perspectives on premarital sex and same-sex relationships. They ought to avoid propagating ideas on morality, practising abstinence, or myths on abortion. Instead, they should focus on enabling young people to make informed decisions. There is a need for service providers to be gender-sensitive and ensure respect and equal treatment of all their patients without any biases or discrimination on the basis of social identity including (dis)ability, gender, sexuality, caste, class, religion.

Develop disabled-friendly infrastructure and staff

The health administration should ensure that the infrastructure of the facilities is disabled-friendly. The staff, including medical service providers, counsellors, and support staff should have the skills to communicate with persons with disability.

Create an enabling ecosystem

It is also important that SRH service providers, in their practice, focus on supporting the adolescent/young client in decision making, instead of assuming that parents or guardians will take the best decision for them. Since POCSO is a huge legal barrier, the role of providers becomes more crucial here to protect the sexual autonomy of young people. If the provider gets a client who reports to have had consensual sexual activity before the age of 18 and needs an abortion or HIV testing, they could:

  • Focus on provision of the required services instead of denying access, as POCSO does not disallow providing any services such as STI testing, safe sex counselling, and abortion services.
  • Ask the client to suggest a trusted adult instead of insisting on parental/guardian consent. The medical examination can be undertaken in the presence of any trusted adult as per Section 21 (3). The trusted adult can be the client’s friend, elder sibling, teacher, or relative.
  • Support the client by building their own network with human rights lawyers and activists who are trained in providing legal and emotional support in such cases. SRH service providers can help put the client in touch with trained lawyers and activists, be non-judgemental towards the client and remember the principle of ‘doing no harm’ in their practice.

Lawmakers need to recognise that young people have evolving capacities to consent to sexual relationships. It is therefore important to review the age of consent in this context. While this is a long-term step, the Ministry of Health and Family Welfare must issue interim guidelines to ensure that POCSO does not impede access to STI testing, safe sex counselling, and abortion services for young people under the age of 18.

Rights-based civil society organisations should be consulted to formulate these guidelines. This can go one step ahead in ensuring that the POCSO Act does not take away the sexual autonomy of adolescents and criminalise consenting relationships of adolescents by using the mandatory reporting clause.

Achieving adolescent and youth-friendly SRH services and rights is a long journey. This involves simultaneously tackling the stigma and shame associated with adolescent sexuality, as well as challenging institutional practices that disenfranchise young people on the basis of identity. A holistic approach that encompasses best practices related to service provision, destigmatising societal norms on gender and sexuality as well as influencing institutional change at all levels can help improve young people’s access to their rights.

This article was originally published on India Development Review.

About the authors:
Ipsa Agnani is the programme coordinator for Safe Abortions For Everyone at The YP Foundation, with a focus on capacity building and youth-led advocacy on sexual and reproductive health and rights. She is also associated with the Young Activists Network for Abortion Advocacy (YANAA). She has a bachelor’s degree in international relations. Her areas of interest include learning about the impact of policy on people of various intersecting identities, international relations, public policy, and climate justice.
Shruti Arora is a senior programme manager at The YP Foundation and works on training, research, and advocacy in the fields of gender, sexuality, and sexual and reproductive health and rights. She leads The Access Project and has authored multiple reports, articles, curricula, and conducted trainings for sexual and reproductive health service providers on adolescent- and youth-friendly services. She is in the core committee of the Young Activist Network for Abortion Advocacy (YANAA).
Featured image is for representational purposes only.
You must be to comment.

More from India Development Review (IDR)

Similar Posts

By Ankita Marwaha

By Sara Bardhan

By Prabhanu Kumar Das

Wondering what to write about?

Here are some topics to get you started

Share your details to download the report.









We promise not to spam or send irrelevant information.

Share your details to download the report.









We promise not to spam or send irrelevant information.

An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

Read more about his campaign.

Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Read more about her campaign. 

A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Find out more about the campaign here.

A native of Bhagalpur district – Bihar, Shalini Jha believes in equal rights for all genders and wants to work for a gender-equal and just society. In the past she’s had a year-long association as a community leader with Haiyya: Organise for Action’s Health Over Stigma campaign. She’s pursuing a Master’s in Literature with Ambedkar University, Delhi and as an MHM Fellow with YKA, recently launched ‘Project अल्हड़ (Alharh)’.

She says, “Bihar is ranked the lowest in India’s SDG Index 2019 for India. Hygienic and comfortable menstruation is a basic human right and sustainable development cannot be ensured if menstruators are deprived of their basic rights.” Project अल्हड़ (Alharh) aims to create a robust sensitised community in Bhagalpur to collectively spread awareness, break the taboo, debunk myths and initiate fearless conversations around menstruation. The campaign aims to reach at least 6000 adolescent girls from government and private schools in Baghalpur district in 2020.

Read more about the campaign here.

A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

The Transmen-ses campaign aims to tackle the issue of silence and disregard for trans men’s menstruation needs, by mobilising gender sensitive health professionals and gender neutral restrooms in Lucknow.

Read more about the campaign here.

A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

Share your details to download the report.









We promise not to spam or send irrelevant information.

A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform Change.org, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on Change.org has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in Change.org’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

Sign up for the Youth Ki Awaaz Prime Ministerial Brief below