As a person under the age of 25, I represent a demographic containing half the people on our planet. While it’s a cliché to say that young people are the future, it stands true that our beliefs and decisions about sexual behaviour and reproductive health are the very choices that determine and define humanity’s future. With nearly 1.8 billion aged 10-25 today, we represent history’s largest generation of adolescents, and about 85 per cent of us live in the developing world.
The onset of adulthood marks a period of time when there’s simply a lot going on physically, mentally and socially in one’s life. Thus, in an ideal world, access to sexual and reproductive healthcare (SRH) to the youth would be a given, especially in a world marked by the onset of modern technology and advancements in medical science. It was very recently, just a few months ago, that India was officially declared polio-free. Until the early ‘90s, India was classified as hyper-endemic for the disease, with an estimated 500 to 1000 children getting afflicted daily. Polio was a reality that my generation grew up with, and I have friends and relatives of my own age who continue living with the condition. It seemed too far-fetched a dream to protect the largest generation of the second most populous country in the world from such a rampant disease. And yet, we did it. If we can manage to protect young people from polio, surely providing them with SRH should be a low-hanging fruit in comparison. But it isn’t.
What makes sexual and reproductive health issues challenging, especially in the developing world, is the stigma attached to adolescent sexuality. This is a time when most people explore new relationships as well as their own sexuality. Although most people become sexually active during adolescence, they are often flat-out denied access to the health services and education they need. Cultural taboos against youth sexuality and gender equality often translate to pockets of opposition to access to SRH information and services for fear of promoting promiscuity among the age group.
And as misinformed and hazardous to society as these attitudes are, they end up wielding enormous influence over the public dialogue and on politicians and policymakers. Most adolescents in India who went through the school education system never encountered SRH awareness, and any new efforts immediately see opposition from groups protesting “westernisation” and promotion of “immoral” behaviour. If a 25 year old cannot even utter the word ‘condom’ without palpitations in the chest, how can he ever be expected to buy or use one?
We can similarly look at the spread of sexually transmitted infections (STIs), and how the youth is denied protection from them because our institutions fail to treat the issue with seriousness and regard for their wellbeing. Africa, for example, has been particularly plagued by HIV/AIDS, and Uganda once had the worst incidence of the condition across the world. Attempting to address this epidemic while keeping in check with the Church’s priorities regarding messaging to the youth, an ‘ABC campaign’ was launched, ‘ABC’ being “Abstinence, Be faithful, Correct use of condoms.” This was a commendable initiative, since abstinence can be an effective way of not getting STIs. But so is usage of condoms, which also prevents unwanted pregnancies, in line with the Church’s pro-life stance. Nevertheless, religious authorities still disapproved of it, and Pope Benedict XVI, who as the leader of the worldwide Catholic faith can vastly impact communities globally, said that condoms ‘increase’ AIDS epidemic in Africa, thus putting hundreds of millions of youth across Uganda and the world at risk. Even though the Church did try to improve upon their position on contraception in later years, youth sexuality is still treated as an area of ‘moral concern’ and not as a significant public health issue, especially in the developing world.
Developed countries do not have it any better either. The United States recently saw massive opposition to affordable public healthcare, mainly directed at clauses that called for provision of sexual and reproductive health services. This discussion even brought out abhorrent attitudes towards female sexuality such as victim blaming for sexual assault and other forms of ‘slut-shaming’. Does it come as a surprise that this purported superpower and beacon of development and industrialisation sees nearly 13 million adolescents give birth each year? Young Americans (ages 15 to 24) account for 40 per cent of new HIV infections, and sexual and gender-based violence against youth is widespread.
All this goes to show that if we want to address population issues; gender equality; combat maternal deaths, sexual violence and exposure to HIV/AIDS; and give young people a good, healthy start on their lives, our right to sexual & reproductive health and family planning information and services must be promoted, because SRH is no child’s play.
The above is a slightly longer version of my submission to the 2014 Akili Youth Health Post-2015 Essay Competition, organised by the Akili Initiative, a New York-based global health advocacy network, in partnership with the United Nations and several leading youth health organizations around the world. The idea was to ensure that youth voices are represented in shaping the post-2015 agenda, and the competition thus looked for pieces (500 words or less) in response to the question: “What is the most important health problem facing youth in the world today and why?”
Despite getting one of the lowest public voting figures, my essay, titled ‘My Right to Sexual & Reproductive Healthcare’ was adjudged as the best among 800+ entries by a jury of global health experts and development practitioners. As a result, I was presented the Essay Grand Prize at the World Conference on Youth in Colombo, Sri Lanka between May 6-10 and participated in the process of setting the next global development agenda along with other youth leaders and policymakers from over 160 nations around the world. More on that very soon.
Another version of the piece appeared as an op-ed column (“Let’s talk about the birds and the bees”, EDIT page, Saturday, 10 May 2014) in the Pioneer, one of India’s oldest English daily newspapers, famous for having employed Rudyard Kipling and Winston Churchill in the past. Predictably, comments and letters to the editor discuss how the issue need not be taken seriously, and why the blame rests on the ‘Immoral West’.
What do you think?