reproductive health > features > let's talk about sex
Let's talk about sexPosted: 31 Aug 2000
by Anita Anand
Worldwide, six out of every ten teenage pregnancies is unplanned, with major social, economic and health consequences. The problem is especially worrying in a country like India where the teenage population is expected to grow from 190 million to 240 million by 2015. Anita Anand reports from Delhi on the urgent need for better sex education.
When I was growing up, no one told me about sex. I was born in a middle class home and attended a Catholic girl's school. In 1965, when I was 16, at a biology class, the doors of the classroom were closed, and a nurse was brought in. She asked the 30 plus young women present how many knew where children came from. After some moments of uncomfortable, silent deliberation, about five hands went up.
An Indian FPA counsellor with teenage client
© Mark Edwards/IPPF
In India, sex is only talked about when it has to be, and even then avoided. But as the world nudges towards a new century, concepts of women's empowerment, delayed marriage, availability of contraception, HIV/AIDS, teenage pregnancy, and more, beg the question: when should people be told about sex; how much should they be told, who should tell them, and how can they have a healthy sexual life?
Statistics, among other things, show how urgently answers are needed.
By the year 2015, the New Delhi office of the Population Council estimates, India will have a population of 240 million adolescents. Thirty-six per cent of married adolescents in India, between 13-16 years, and 60 per cent between 17-19 years are already mothers or pregnant with their first child. Given this, inaccurate or no information about sex is worrisome.
The above figures correspond to 17 per cent of all teenage women between 13-19 years. Of those unmarried, hospital records indicate that pregnancy outside marriage is rising, judging by the number of requests for abortions.
Shireen J. Jejeebhoy, a Bombay-based reproductive health researcher, in a 1996 study found that much of the available information was exploratory and recent, with little or no attention given to reproductive health.
Adolescent marriages were common, and much adolescent fertility occurred in marriage. Married young, about half of the women are sexually active by the time they are 18 and before, and one in five by the time they are 15. Over half of all women between 15-19 have experienced a pregnancy or birth. Between 20-30 per cent of all males and up to 10 per cent of all women are sexually active during adolescence, before marriage.
Sexual awareness was superficial, and social attitudes (passed on from older generations) reflected norms of premarital chastity, especially for young women. Young men have more opportunities for sexual exploration, and approve of premarital sexual relations for themselves. Married and unmarried young women are unprotected from pregnancy and prone to sexually transmitted infections. They tend to have less decision-making power in sexual relationships.
But it is only recently that young people have been asked for their views on sexuality.
Four studies commissioned by the International Centre for Research on Women (ICRW), Washington DC, between 1996-98 found that more adolescents are sexually active before marriage and outside of marriage, than was previously thought. And their desire for more information is strong.
According to a study conducted by the Tata Institute of Social Sciences (TISS), low-income college students (between 16-22 years) in Mumbai (Bombay), felt sex education should begin from Class 8 (eighth grade), continuing through college; early sex education would not lead to greater promiscuity. They wanted to know about menstruation, nocturnal emissions, masturbation, intercourse, pregnancy and contraception, sexually transmitted diseases (STDs) and acquired immune deficiency syndrome (AIDS).
Young women in the sample survey believed that condoms were pills to be used by women and men.
Teachers of the same students felt that early sex education would lead to greater promiscuity among students, and were not in favour of sex education in schools and colleges, fearing it would face opposition from parents.
The same research found that reproductive tract infections (RTIs) and gynaecological diseases are alarmingly high. The Tamil Nadu study found that one of every two married women in the sample was infected with RTIs. The consequences of undiagnosed and untreated RTIs are increased vulnerability to HIV infection, premature births, low birth weight, ectopic pregnancy, and infertility.
The study in rural Maharashtra found that 51 per cent of adolescents reported at least one type of gynaecological problem, such as menstrual irregularities and prolapsed uterus. Contraception was not used for spacing, and temporary methods (such as the 'safe' period or abstinence) were hardly used. They resorted to abortions, often using unapproved practitioners, increasing the risk of infection.
Existing reproductive health services do not serve adolescents - even married adolescents - and there is under-use of the services that do exist. Eight out of ten married adolescent women did not use these health services for postnatal care, and half did not use services for gynaecological problems.
Young women said it was not a serious enough problem, the mothers-in-law suggested home remedies, and there was general embarrassment in talking about gynaecological problems.
The ICRW studies suggest the need to provide knowledge; skills; increase availability, quality, and access to sexual reproductive health services; supportive adults; and to test and evaluate a range of interventions.
Given the situation, the new tomorrow for young women and men lies in various innovative projects.
Prerna, an NGO working with adolescents in several parts of India found that young women want income generation skills to "stand on their feet," career counselling, and assistance in planning their future.
Adolescent girls, India
© Kim Naylor/Christian Aid/Still Pictures
The Society for Education, Action & Research in Community Health (SEARCH), a Maharashtra-based NGO, found that young people want bank accounts and access to a telephone. Young women and girls come to adolescent camps, through word of mouth, bringing their mothers.
Seva Mandir, a Rajasthan-based NGO organises camps and competitions of music and dance to motivate young people and their parents to discuss, among other things, reproductive health problems. It all started when illiterate parents asked for assistance with their children's home work.
In Gujarat, Ahmedabad-based NGO Chetna holds camps for adolescents, using innovative videos to motivate young people to talk about their aspirations.
The Delhi-based Parivar Seva Sanstha (PSS) is an NGO affiliated to Marie Stopes International. Since 1979 it has provided, among things, an abortion clinic. PSS's Family Life Education programme centres on discussion groups held at the request of schools, industrial houses, NGOs and other organisations. They start with 'body mapping' or naming body parts and their functions as an ice-breaker.
The South India Trivandrum-based NGO, Sakhi, says parents feel they cannot talk about sex, are themselves ignorant and ask for help. Teachers are embarrassed to talk about sex in classrooms of 60 to 80 students.
Most health professionals in the interventions mentioned above agree that there is no way of knowing if the workshops change any lives. Yet, a start has been made by recognising that young people do need help.
Adolescence is a period of exploration, growth and change, requiring an environment of love, support, information and attention. Most important, the adults that interact with them - parents, teachers, counsellors, medical professionals and health workers - need an open and honest attitude about sharing information on sexuality and reproductive health.
Given that Indians are raised to believe that sexuality is shameful, masturbation and homosexuality a perversion, and knowledge of sex a guarantee to experiment - it's a tall order. But there is no turning away from this responsibility.
If the research is correct, then some quick work is needed to respond to the scale of the challenge. And, while small-scale interventions of NGOs are admirable, broader action is also needed. A senior Union Cabinet minister recently informed an international meeting on AIDS that India would never face an AIDS-related crisis as "we are a moral nation and don't have things like this", meaning, among other things, homosexuality, and pre- and extra-marital sex.
But thanks to HIV/AIDS an opportunity has been provided to tell the truth about sex and to discuss human relationships.
The truth is that as Indians, we do "have things like this" and I for one am proud that my nine-year-old son knows where he came from and how he got there. He knows what a condom is, what it's used for, and what AIDS is. And, he got the correct versions from me, and my husband.
Upto 60 per cent of adolescent births throughout the world are unplanned, and only about one in nine adolescents have the contraceptive protection they need to prevent an unwanted pregnancy, according to a recent report by the Alan Guttmacher Institute.
The Washington-based Institutue also found that one-third to two-thirds of young women obtain less than seven years of schooling in most developing countries and over 3,000 million cases of curable sexually-transmitted diseases occur worldwide each year, with young women especially susceptible to these diseases and bearing the most serious consequences.
"Parents, communities and governments must recognise how quickly the world is changing, and how imperative it is to direct attention to improving the situation of girls and young women. Indifference, wishful thinking and denial will not prepare their children, particularly their girls, to take their rightful place in a modernising world."
The report brings together comparable data from 53 developing and developed countries of Asia, Latin America, the Caribbean, North Africa, West Asia, Sub-Saharan Africa, Western Europe, the United States and Japan.
Into a New World: Young Women's Sexual and Reproductive Lives is available from the Alan Guttmacher Institute, 120 Wall Street, New York, NY 10005, USA.