With one in five persons being an adolescent (10-19 years) and every third a youth (15-24 years), India is a young country today. The sheer size of the adolescent and youth population reflects the wealth of human resource in our country.
However, in order to optimize this demographic advantage, we must ensure that our young population is equipped to make a meaningful transition into adulthood. Efforts to this end include ensuring easy and universal access to education, skill development, employment generation, quality health services including sexual and reproductive health, nutrition and a supportive environment both at home and in the community.
The COVID-19 pandemic has underscored the importance of investing in young people’s sexual and reproductive health as well as mental well-being. Even prior to the pandemic, young people faced several barriers in accessing sexual and reproductive health services including, but not limited to lack of awareness, stigma due to negative cultural attitudes to premarital sex and geographical inaccessibility, mainly due to insufficient availability of youth-friendly health clinics.
To assess the impact of COVID 19 on young people, in May 2020, Population Foundation of India (PFI) conducted a rapid assessment in three states of Rajasthan, Uttar Pradesh and Bihar. The young people expressed the need for mental health care services as they reported feeling depressed, frustrated and irritable due to economic anxieties and job insecurity.
The National Family Health Survey 4 (2015-16) reports that there is a much higher unmet need for family planning at 22 percent among young currently married women (15-24 years) as compared to the overall unmet need of 12.9 percent among currently married women (15-49 years).
This trend indicates that a large number of young women wish to delay or avoid pregnancies but do not have access or agency to use family planning methods.
Young people need greater access to quality family planning services and spacing methods of contraception which would require greater budgetary investments in family planning. Despite a growing young population, the current budgetary allocations for family planning activities do not align with our demographic needs. The budget allocation has remained at four percent of the National Health Mission budget since 2014-15 and only 60 percent is utilised.
The limited resources for family planning also make it difficult for states to adopt a rational distribution of the available budgets resulting in skewed allocation of resources. About 82 percent of family planning budgets are directed towards permanent methods and incentives, which include compensation to beneficiaries of female sterilisation, male sterilisation, adopting spacing methods, and ASHA incentives for family planning.
Other critical family planning-related services such as provision of spacing methods for young population, capacity building of service providers and behaviour change communication activities take a back seat due to limited fiscal resources available after accounting for permanent methods and incentives.
Close to 40 percent of the approved budgets for family planning remain unspent due to inadequate capacity of the states to utilise funds, delays in transfer of funds to the implementing units and inadequate monitoring mechanisms to track the flow of funds and its utilization.
Ensuring sufficient funds for family planning is even more important today, in the context of the disruptions in provision of health services caused by COVID-19, which threaten to have severe consequences on the sexual and reproductive health of women and young girls.
Similarly, there is a definite need to increase budgetary allocations for strengthening and scaling up the Rashtriya Kishor Swasthya Karyakram (RKSK) across all states.
Budgetary allocations for RKSK have declined across most states during the pandemic period. The decline in allocations is more evident for Delhi wherein the allocations for 2021-22 have declined by 55 percent as compared to the previous year. Jharkhand and Rajasthan have witnessed a decline 32.5 percent and 24.5 percent decline respectively.
Analysis of the composition of RKSK budgets reveal that the allocations for different components within the programme are not rational. For instance, in Rajasthan, more than half (51 percent) of the adolescent health budget was allocated towards procurement of sanitary napkins in 2021-22. Budgets for adolescent health trainings have been reduced to half from 18 percent in 2020-21 to nine percent in 2021-22.
Analysis of expenditure for RKSK in 2016-17 reveals that only 43 percent of the total budgets allocated are spent.
There are also huge interstate disparities in the coverage of adolescent friendly health services through the Adolescent Friendly Health Clinics (AFHCs). For instance, in Rajasthan, only 3-4 percent of adolescents have registered at Ujala clinics to avail clinical and counselling services in 2019-20, despite the huge unmet need for sexual and reproductive health services among adolescents.
A study by Population Foundation of India titled “Returns on investments in Adolescent Reproductive and Sexual Health in Rajasthan”, estimates that in order to meet the unmet need for sexual and reproductive health care services, the state government would have to provide contraceptives to an additional 2,53,165 users (adolescents) and comprehensive abortion care services to 75,000 users over the next five years (2021–2025) at an estimated cost of Rs 412 million.
The benefit-cost ratio from such investments is about 3:1, i.e., Rs 100 invested to meet adolescents’ unmet need for contraceptives will result in a return of Rs 300, indicating a very high value for money from this investment. Potential health gains from these interventions could avert 1,45,696 unwanted pregnancies, 1,46,838 unwanted births, 14,043 unsafe abortions and deaths of more than 7,000 infants and 300 pregnant women between 2021 and 2025 in Rajasthan.
Going forward, there is an urgent need to place adolescents at the center of government policies, investments and interventions. Convergence between ministries of health, education, women and child development, youth and sports affairs, labour and employment, social justice and empowerment, rural development and Panchayati Raj is critical for ensuring a holistic approach to reaching every young person in the country on a range of issues impacting them.
For India to achieve its development goals, greater investments in young people’s health and well-being must be a priority.
Poonam Muttreja is the executive director of Population Foundation of India. J Pratheeba is a health economist at the Population Foundation of India.