This article was written by S. Ram Aravind and originally published by PRIA. The views expressed in this article are of the writer and not attributable to SHLC.

Adolescents face the largest burden of sexually transmitted infections and non-communicable diseases, all over the world. However, the burden is disproportionately borne by those living in low- and middle-income countries.

One of the major reasons for health concerns among adolescents is the low rate of utilisation of healthcare systems. Poor levels of awareness, both about diseases and health services, act as a barrier to responsible health-seeking behavior. In this blog, Ram Aravind, Research Associate at PRIA, looks deeper into urban adolescent health through the findings of a survey, conducted in informal settlements in Gurugram, as part of a larger participatory research study. Even though certain health indicators show promising improvement, the journey to holistic development and closing the gap in health-seeking is still many miles away. A bottoms-up health policy developed from the perspective of adolescents would serve to cement the glaring gaps in health-service delivery.

A review of research studies conducted on adolescent health in the past decade indicates that adolescence is often overlooked in health policy and urban planning. The lack of sufficient evidence on adolescents’ needs and aspirations to inform public policy could be attributed to their minimal participation in the process of planning and a lack of awareness surrounding adolescent health. It was essential to understand urban adolescent health from their perspective and to understand the implications of social determinants on their well-being.

Does education have a positive impact on the health of an adolescent?

If not the doctor, whom do youth prefer to turn to when they need to consult on sexual health?

Are the current health policies adequate to address health needs of India’s 245 million adolescents?

Conducting the mobile survey. Credit: S. Ram Aravind

study conducted by PRIA, with adolescents in urban informal settlements in Gurugram, sheds light on the prevailing situation of health, health-seeking behavior and healthcare preferences of the youth living in under-resourced settings. The majority of the adolescents had identified their mothers, female school teachers, and peers as preferred sources of information on matters related to sexual and reproductive health. The medical doctor and the frontline health workers ranked much lower in preference. Is this indicative of poor outreach of the health system or are other social factors influencing adolescent health-seeking behavior?

The health system’s low level of engagement with the adolescents was evident from the poor knowledge of Sexually Transmitted Infections (STI). A staggering 89% of the adolescents were unable to identify even one symptom of STI. The poor outreach of the health systems notwithstanding, this gap in knowledge could also be linked to hesitancy and stigma attached to engaging with the topic in families or in schools. Around half of the participants rated their ability to initiate discussion on issues related to sex with their parents as ‘very difficult’, even though preference still leaned towards the mother, who is the primary care-giver and the most accessible. The survey findings also highlight a glaring gap in health communication with regard to nutrition and sexual health needs. While nine in ten adolescents reported not having attended any training session on nutrition-related issues, a similar deficit with regard to sexual and reproductive health communication was also observed.

Training from external sources aside, the survey findings attest to the ability of the educated individual to exercise responsible health practices. The majority of the surveyed adolescents were educated and hence better placed to implement, for example, improved menstrual hygiene management. 91% of the adolescent girls reported using branded or locally-made sanitary napkins, with awareness of hygienic modes of disposal of menstrual waste. However, social taboos and restrictions continued to be imposed on girls during their periods. Even though culturally-sanctioned norms were enforced, parental support in enabling menstrual hygiene for their daughters was indeed an indication of change, especially in low- and middle-income countries where mortality due to poor menstrual hygiene management is high. Menstrual hygiene is one part of adolescent health; they are yet to engage on other topics like contraception, pregnancy, abortion, and HIV, suggests the survey.

The cumulative finding of adolescent health survey puts the spotlight on India’s flagship health scheme for adolescents, Rashtriya Kishore Swasthya Karyakram (RKSK), and the exclusive health facility, Adolescent Friendly Health Clinics (AFHC). RKSK, which guarantees treatment, referral, and anonymity to young health-seekers, is a novel cost-effective intervention. Unfortunately, it has found few takers. A low level of awareness of such facilities among adolescents in Gurugram, as evidenced from the survey, lays bare the necessity to increase outreach among youth if such services are to reach the intended beneficiaries. The clinics, known as ‘Mitrata’ (meaning ‘friendship’ in Hindi), unfortunately exist estranged from the adolescent population.

As the survey findings seem to indicate, adolescent health is not a phenomenon to be seen in isolation, but as a phenomenon influenced by various social determinants and warrants understanding consistent with the ground reality. Adolescent health has increasingly been reported and analysed from the perspective of the ‘expert’ researcher and the arm-chair policy maker. Conventional bio-medical research from the Global North would reject any behavior from the community which doesn’t conform to established medical practices or literature as unscientific and indicative of poor health status. Increasingly, there are calls from researchers and civil society, especially based in the Global South, to re-think such a narrative and to report on health from the standpoint of the target population. With our study in Gurugram, we have attempted to do exactly that.

Adolescents designing their health policy and demanding reform from the State based on the survey findings that were validated by them; that is democracy in health.

The project was led by Participatory Research In Asia (PRIA).

This research project ‘Healthy Cities for Adolescents: Participatory Research in Gurugram, Haryana, India’ was funded by the Centre for Sustainable, Healthy and Learning Cities and Neighbourhoods (SHLC)’s Capacity Development Acceleration Fund. SHLC is funded via UK Research and Innovation as part of the UK Government’s Global Challenges Research Fund.