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Expanding Indian Youth's Access to Contraceptives

Strengthening Services and Improving the Quality of Care

In 1999, the world's 6 billionth baby was born in Bosnia. Last October, Baby 7 Billion took her first breaths in the Philippines.

While the 7 billionth baby was chosen symbolically by the United Nations, statistics suggest that he or she was most likely born in India. India is the second most populous country in the world and home to the highest number of babies born every minute—more than 50. In Uttar Pradesh State alone (the most populous in the nation), 11 babies are born each minute—a figure that is surpassed only by China as an entire nation. As a result, the Indian population today is close to 1.2 billion, about one-quarter of whom are adolescents, aged 10 to 19.

For girls in India, adolescence is all too often the window for marriage, when their options in life diminish rather than expand. In Jharkhand State, for example, approximately half of all girls are married by the age of 16. Moreover, one girl in four between ages 15 and 19 is either pregnant or has given birth.

Once married, girls are under immense pressure to prove their fertility by becoming pregnant, which puts their health at considerable risk. Without the availability of reproductive health counseling or services, few girls—or their husbands and families—fully understand the risks of early pregnancy. Even if they do, few have access to family planning services that would enable them to delay or space their pregnancies, thereby protecting their health and well-being.

EngenderHealth is working in Jharkhand State to improve the health and rights of adolescents, by improving the quality of sexual and reproductive health services there. Previously, health clinics did not adequately meet the unique needs of youths. Some facilities were open at hours that were inconvenient for adolescents, and health providers harbored cultural biases that hampered the provision of quality services, even for young married couples who may not have had their first child yet.

In a recent study, 40% of youths in India said they do not seek out contraception because they are too embarrassed to ask for it. The study also revealed a general low level of knowledge about sexual health in India and a lack of empowerment to obtain more information.

To improve health among youths as part of the Adolescent Reproductive and Sexual Health (ARSH) program, EngenderHealth works with local health clinics to adapt their services to make young people, married and unmarried alike, feel welcome and comfortable. EngenderHealth also trains "master trainers" who have the capacity to train others to provide youth-friendly services, such as Dr. S.P. Singh, a dedicated medical officer and trained ARSH provider in Jaynagar.

Before receiving EngenderHealth training, Dr. Singh was hesitant to speak with elders in the community about adolescent reproductive and sexual health, as he feared how they would react to talking openly about such issues. But after receiving EngenderHealth training, he felt empowered to speak out and make health services available to youth.

Today, Dr. Singh answers questions from the community on unprotected sex, unsafe abortion, as well as the health risks related to early marriage and pregnancy, such as anemia. As a local expert, Dr. Singh understands the many important cultural and social factors at play in his community, making him well-positioned to meet the needs of its youths.

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