M. GUPTA ET AL.
the 11th five-year plan document mentions MoYaS as the nodal
ministry for youth and adolescent, though with some reserve-
tions: “The MoYaS is the nodal ministry for development and
empowerment of youth and adolescents in the country. MoYaS’
role and responsibilities in this context are still not clearly de-
fined, which affects its schemes and programmes in terms of
their monitorable deliverables and outcomes on the one hand,
and dovetailing them in an integrated framework with programs
of other ministries” (Planning Commission, 2007). Among the
stakeholders interviewed for this research there is consensus
that MoYaS lacks the power to fulfil this nodal role. The
MoYaS is not a member in the Mission Steering Group and the
Empowered Programme Committee—the highest policy mak-
ing and steering institution under the National Rural Health
Mission (NRHM), which includes ministries such as Health and
Family Welfare, Rural Development, Panchayati Raj and Hu-
man Resources Development (GoI , 2005).
Highlighting NRHM as an opportunity to initiate inter-sec-
toral collaboration in ARSH a senior government officer re-
marked: “As NRHM is the umbrella programme for all health
issues and stresses on inter-sectoral collaboration to achieve its
objectives, it may be useful to view ARSH policy development
as an important inter-sectoral activity under NRHM.”
But in the third year of NRHM (2008-09), ARSH accounted
for only 0.4% (less than 1%) of the total expenditure under
RCH/NRHM7.
Multi-sectoral nature of adolescent health becomes even
more complicated because of the non-homogeneity of adoles-
cents as a group. Adolescents could be boys and girls, married
and unmarried, with diverse sexual preferences, in-school and
out of school, working and unemployed, migrants and those at
home, of various castes, cultures, religions and economic strata.
Programmes and schemes of most ministries and departments
cater to some, but leave out too many.
The parliamentary committee looking into what has been
termed the “sex education controversy” has expressed dissatis-
faction on the total lack of coordination amongst various agen-
cies in formulating and implementing the Adolescent Education
Programme (AEP). The Committee would like the Ministry of
HRD to oversee the process of revision of AEP under its super-
vision, direction and control (ibid). The AEP reaches only the
school children, and not the large segment of out-of-school
boys and girls8. In Gujarat, Mamta-Taruni addresses out-of-
school girls, but leaves out the out-of-school boys. MoYaS
caters to rural youth through its Nehru Yuva Kendras, but its
focus is more on nationalism and sports and not on ARSH.
Many NGOs are trying to cater to the adolescents, but their
reach is limited in scope and coverage.
The policies at both federal and state levels either belong to
specific sectors like health, education, population, nutrition,
HIV/AIDS etc. or the policies address specific population seg-
ments like youth, women, and children, and therefore the em-
phasis on adolescents gets diluted (MAMTA, 2001).
The Context Trap
Complexity of socio-cultural and politico-religious factors
adds on to the complicated interplay of actors. To start with, the
concept of “adolescent” has not been a common one in India,
where traditionally childhood has been seen as leading directly
to adult life. As one of the respondents voiced, “Problem is
more serious for people who are illiterate and their children
who do not go to school. When the children turn 13 or 14 years
their parents think that they are into adulthood, and they should
work. By 18 they must get married”.
An INGO respondent synthesized: “A child suddenly be-
comes adult after marriage”.
Government services delivery fails to recognize the transition
through adolescence, particularly in the case of married teenag-
ers. As an INGO respondent commented “A married adolescent
for a provider is quite like an adult, in the adult role. Whether
the communication capacity of the client has evolved or not,
whether the decision-making capacity of the adolescent client is
of adult level or not, the provider is not aware”.
Socially, married girls are most vulnerable. Within a patriar-
chal family structure, women have relatively little power, but
young and newly married women are particularly powerless,
secluded, and voiceless. As one of the respondents from an
INGO who has worked extensively in the field of adolescent
health said:
They (married girls) are more at risk. They are less likely to
be allowed out of house and so less likely to access services.
They have very little decision-making power. They probably
don’t have much communication with their husbands, nor does
any health care provider even worry about them until they have
a child. An adolescent married girl is socially isolated and has
very little contact with her parental home.
As argued by several of our respondents, there is tremendous
societal pressure on girls for marrying early and having a child
early. In fact, there are strong pressures on women to prove
their fertility as soon as possible after marriage: social accep-
tance and economic security in the marital home are established
largely through fertility, and particularly through the birth of a
son (Jejeebhoy, 1998). Adolescent girls have little choice about
whom and when to marry, whether or not to have sexual rela-
tions, and when to bear children. A proposal that was intro-
duced to reduce the legal age at marriage for boys from 21
years to 18 years probably would have put still more pressure
on girls, but has been rejected (UNI, 2009).
In India, the politico-religious context has played a very sig-
nificant role in determining policy and the content of education
to be provided to the youth. While parents articulate a need to
provide reproductive and sexual health education to their chil-
dren, political and religious leaders have tended to decide what
is good for the youth. Those who apparently have the least say
are the key stakeholders: the adolescents themselves. Adoles-
cents have found it difficult to voice their needs. When it comes
to reproductive and sexual needs it becomes all the more diffi-
cult: sex is a taboo subject. Even the subdued adolescents’ de-
mand seems to be only marginally taken into account in the
policy process. As stated by a policy-maker the government
does not pay much attention to the adolescents’ perspective in
formulating ARSH policy:
The formal approval of any government policy (central or
state government) requires that the policy draft document is
tabled in the parliament (or the state legislature) for debate and
discussion, or taken to the cabinet for its approval when the
parliament (or the state legislature) is not in session. It is up to
the parliamentarians (legislators) to get inputs from their con-
7With increased focus the expenditure on Adolescent health has increased
to 2.5% in 2011-12 of the total expenditure under RCH/NRH M.
8School dropout rates for girls are 19% and 66% in the age groups 11 - 14
years and 1 5 - 19 year s resp ectively ( IIPS, 1999). Th e corresp onding statis-
tics for boys are 20% and 51% respectively. In addition to school dropouts,
an average of 22% of girls and 7% of boys in the age group 15 - 19 years
never atte n ded school.
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