In 2017, Rajasthan’s Dholpur district launched a programme titled ‘Udaan’ to educate adolescents about their sexual health and quickly ran into some stiff opposition. The immediate reactions were captured in remarks like: “You are spoiling our girls…,” or “there is no need of teaching them everything in such detail” and “we won’t allow this”. Such responses were quite common. One of the block coordinators reported that they were threatened by school faculty and the local community. Many sessions could not be conducted as a result. 

The process of change in the area of sexual health was slow but persistence, persuasion, empathetic listening and constant counselling were able to build a safe zone to deliver some of the learnings. As classes began, it also helped address doubts, clear myths and transform resistance to acceptance. As one of the schoolteachers who had initially opposed the programme said later: “I had my reservations as these sessions were in (graphic) detail. I thought it will mislead the students and girls might get active sexually. But when I attended the sessions, I understood how important it is to learn about these issues. We ignore adolescent health, but learnings in a school setting helped make our students future-ready.” 

The entire Dholpur school district covered a total of 282 secondary and senior secondary schools to reach out to about 78,000 adolescents. 

Sexual health 

Dholpur is a less known success story but it holds important lessons for the rest of India -- and even perhaps South Asia -- and offers ideas and pathways which can help break barriers and broach a topic that is sensitive and often considered not desirable in the social context and prevailing attitudes on sexual health. 

The importance of sexual and reproductive health education for adolescents cannot be stressed enough as this is a crucial but extremely confusing time for young people. Investing in their health and wellbeing has the potential to shape their future. It is in recognition of this that the Central government launched the Rashtriya Kishor Swasthya Karyakram (RKSK or National Adolescent Health Programme) in 2014 hoping to comprehensively address the health and development of 243 million adolescents (the population then). The objectives included improved nutrition and improved knowledge, attitudes and behaviour in relation to sexual and reproductive health (SRH). Not much has been heard of the programme since then. But the government of Rajasthan has set out an example that India can and must follow. 

Adolescence 

Let us consider how Rajasthan achieved this. Young people between the ages of 10 and 19 years comprise about 23 percent of the Rajasthani population. Adolescence is a phase that is marked by both biological changes and mental maturation, both of which need attention. The state government simultaneously focused on their mental and physical health. Small investments at this critical time like this carry the potential to shape an entire life of the person and of a nation eventually. 

In the area of health, the government has implemented a number of structural interventions under the RKSK. These include, for example, the launch of adolescent focused “Ujala” health clinics, the weekly distribution of iron and folic acid supplements, and ensuring the easy availability of free sanitary pads. However, while these structural interventions are very important, their impact can be fully experienced only if they are coupled with well-designed behavioural interventions which specifically focus on the sexual and reproductive health of these young people because often, even when these health services become available, their utilization is low because of, among other things, social norms.   

Evidence shows that the knowledge levels of even the older adolescent regarding sexual and reproductive health issues are low and often inaccurate, and that behavioural intervention has the power to not only inform but also change behaviour relating to early pregnancies, gender norms and sexual health in general. This time period is associated with several life-altering changes in the lives of these young people. If their concerns are not properly understood and addressed, this can lead to inappropriate behaviour, depression, acceptance of sexual abuse and even attempted suicide. 

Overcoming concerns 

While there are several venues at which these interventions may be delivered, schools represent a safe, trusted and effective space within which they can be offered.  Before schools can be chosen as an effective location for communicating these messages, there are a few barriers that need to be overcome, the most important one being the concerns of teachers, parents and the community at large at how appropriate this type of education would be for these young minds and what effect it is likely to have. It is well known and reported that programmes like these do not lead to, for example, increased sexual activity but instead, by addressing their natural curiosity in a matter-of-fact way, it takes away some of the fascination with these issues that can lead to inappropriate experimentation and behaviours. This evidence needs to be shared with caregivers. 

High-quality school-based sexual health education programmes are taught by well-trained teachers and school staff, using strategies that are relevant and engaging for all students. They can help connect students to healthcare services, and effectively engage parents and the community.   

Happy students 

There are examples of successful school-based programmes right here in India. Arpan, a Mumbai-based NGO, for example, working with teachers as educators, offers an effective Personal Safety Education programme in about 250 schools and shelter homes in three districts of Maharashtra. Evaluations have pointed out that the internalization of these messages by the children receiving them, boosted their self-esteem and feelings of comfort with their own bodies and their personal safety. Dholpur remains a classic study in the same context, achieved with the help of the non-profit, Manjari Foundation. 

The boys and girls who have participated in this programme have reported a higher sense of comfort with the natural changes occurring in their bodies, reduced feelings of inadequacy and depression, and a stronger sense of empowerment and agency allowing them to express their views more forcefully and with greater conviction. When asked, one of the boys said: “I learnt that my sister cannot live on my leftover vegetables and pickles. The programme widened my perspective.” 

That may be a good message to take to all our young boys and girls across India.  (The Billion Press)

(The author is a former director of NABARD and former India Country Director of the Bill & Melinda Gates Foundation. Views are personal. He can be contacted at  editor@thebillionpress.org)