It’s a hard reality today that adolescents do not know much about their bodies and sexual health. There is a dire need to clear misconceptions and educate them
The number of girls enrolled in Bohramal middle school in the Belsand block of Sitamarhi district in Bihar outnumbers those of boys. But these numbers don’t reveal the real story. By the time girls reach Class VIII, their absence becomes conspicuous. Parents pull them out of school and get them married even before they can complete the academic year. Gulaichi Kumari, a 14-year-old student of class VIII at this school, knew she wouldn’t be able to finish her education since she was engaged to be married in March, just before her final examinations. Although the alliance of Pinky Kumari, also in Class VIII, was to be in April, she wasn’t going to sit for the exams because her parents had told her there was no need since she was getting married. Neither girl was sure whether she would be able to study further; although they both wanted to.
Gulaichi and Pinky are not the only ones whose dreams have been cut short. About 1.5 million girls in India are child brides. A majority of them can be found in Bihar, which tops the list of States in the country for child marriages with over 42.5 per cent being married before 18 years. So it comes as no surprise that major decline in school completion levels in rural Bihar occurs between Classes VIII and IX for unmarried girls. In fact, two in five married girls discontinued their education because they got engaged or married, according to a 2016 study on adolescents in Bihar by Population Council, a not for profit working on health.
Adolescents comprise 22 per cent of Bihar’s population. How many of them have accurate knowledge about their bodies? How many are equipped with reproductive and sexual health information? Are they aware of contraception or how pregnancy occurs? Not many, found the study. Of the 10,400 adolescents interviewed in 36 out of 38 districts in Bihar, only 44 per cent of girls between the ages 13-14 and 56 per cent of boys aged 13-14 knew that a woman could not become pregnant after kissing or hugging. And only nine to 10 per cent knew that a woman could get pregnant at first sex. Although 27-28 per cent of the older boys and unmarried older girls (15-19 years) were aware that a woman could get pregnant after the first sexual encounter, only four to five per cent knew that a woman was most likely to become pregnant if she engaged in sexual relations mid-cycle. Even among married older girls, just 53 and 12 per cent, respectively, were aware of these two facts.
The study also found that 14.1 per cent of unmarried adolescent boys and 6.3 per cent of unmarried adolescent girls had premarital sex, and of them, 22 per cent boys and 28.5 per cent girls had premarital sex before 15 years. Further, a large proportion of adolescents in sexual relations with a romantic partner had engaged in unprotected sex. Contraceptive use in a romantic relationship was limited — just 31 per cent of boys and 17 per cent of girls reported using a contraceptive at first sex. Even more limited was consistent contraceptive use — only among 28 per cent of boys and seven to 11 per cent of girls. This could be because 70-72 per cent of younger boys and girls (13-14 years) had never received information on how pregnancy occurs or how a pregnancy could be prevented. Neither had 25 per cent of the older boys (15-19) and 44 per cent of the unmarried older girls.
Adolescents are shy in seeking sexual and reproductive health services and it is not hard to understand why. Where do they go and who will provide information and services, confidentially and without prejudice? Adolescent-friendly health clinics and peer counsellors were supposed to address these concerns under the Rashtriya Kishor Swasthya Karyakram (RKSK). Launched in 2014 by the Ministry of Health, the RKSK aimed to reach out to the adolescents and improve their health-seeking behaviour in six strategic areas including nutrition, sexual reproductive health and gender-based violence. But in Bihar, where RKSK was rolled out in 10 high priority districts, the study found that hardly any adolescent had heard about adolescent-friendly health clinics (one per cent of boys and two to five per cent of girls) or received services from them. Further, gaps in the health delivery system, shortage of skilled human resources and medical counsellors as well as women doctors have undermined its implementation.
According to the United Nations Population Fund (UNFPA), India will continue to have the biggest national adolescent girl population until 2030. That adolescent fertility rates are high is clear from the fact that one-third of India’s population is born to adolescent mothers. In Bihar, which has the highest total fertility rate (3.4) in the country, girls constitute 46 per cent of the State’s adolescent population. All these numbers tell a story — if no one is to be left behind, urgent strategic investments in schooling and retention, comprehensive sexuality and life skills education, greater access to contraception and family planning choices, and safe abortion services is imperative.
(The writer is a senior journalist)