Almost 31 per cent of Indians fall within the youth (15-24 years) and adolescent (10-19) categories. The National Family Health Survey-2 (1998-99) shows that the median age of first marriage for girls is 16 years in India. Pregnancy and child bearing occur before adolescent girls are fully developed, exposing them to great health risks. Research also indicates, that about 15 per cent of ever-married adolescent girls are stunted and nearly 20 per cent have moderate to severe anemia.
Increasingly in India, youngsters (both urban and rural) are becoming vulnerable to HIVAIDS and sexually transmitted infections (STIs). Does the government see adolescents and youth as a cohesive group that needs separate attention? Union Health and Family Welfare Minister Sushma Swaraj shares her views.
Q. In India, 61 per cent of all women are married by the time they are 18. And several suffer during pregnancy and childbirth, especially in rural areas. How can their health be protected and improved?
A. To safeguard the health of pregnant women, the government is promoting institutional deliveries, which take place with the help of trained personnel. We are also training professional birth attendants in every village so that deliveries conducted in the village are safe.
Financial assistance for dais (midwives) has also been proposed to secure their active support for promoting institutional deliveries.
The government has also launched the Janani Suraksha Yojana (Safe Motherhood Scheme) to extend financial assistance - at the rate of Rs 500 per pregnancy - for the first two live births to women below the poverty line. This scheme also attempts to bring about an attitudinal shift, as the quantum of benefit provided to a woman on the birth of a girl child increases if she opts for an institutional delivery.
Q. While abortion is legal in India, several girls and women continue to go to quacks and risk their lives. Both for rural and urban women, what kind of infrastructure is available - or will be available - to reduce risks of death due to abortion?
A. Unsafe abortions still account for 8.9 per cent of all maternal deaths in the country, according to the Sample Registration System of the Registrar General of India (1998). This is not an acceptable situation. There are more than 9,000 approved MTP (medical termination of pregnancy) clinics in India. The government is now training medical personnel, other than gynecologists, in the Manual Vacuum Aspiration (MVA) technique in primary health centers. As the name suggests, this abortion is done manually and does not require electricity or any gadget except a special syringe.
So far, MTP facilities are not available to several women. But hopefully with the MVA technique, a clean, simple, safe abortion facility will be available to many. Two districts in eight states (Rajasthan, Madhya Pradesh, Orissa, West Bengal, Tamil Nadu, Andhra Pradesh, Uttar Pradesh and Uttaranchal) have been identified for the pilot project.
Q. You are aware of the sex selection abortions taking place in the country. What steps have you taken as Minister for Health and Family Welfare to stop this misuse of technology?
A. The government has made vigorous efforts to counter this problem. The parliament has already enacted the Pre-conception and Pre-natal Diagnostic Techniques (Prohibition of Sex Selection) Act. Advocacy campaigns - involving the Indian Medical Association, NGOs, religious and political leaders - have also been launched to help change people's perception towards the girl child. We have roped in tennis star Sania Mirza as our brand ambassador. This year the Republic Day tableau for the ministry was on our 'Save the Girl Child' campaign. Hopefully people's mindsets will change and this inhuman practice be eliminated.
Q. Increasingly in India, youngsters are becoming more vulnerable to HIV/AIDS and sexually transmitted infections (STI). Do you have a strategy to address this issue at a national and local level?
A. Adolescents are vulnerable to HIV/AIDS and STIs because they are highly impressionable. And in many cases, they lack access to information and services about reproductive health and safe behavior. Over 35 per cent of all reported AIDS cases in India occur in this group. But it is the young people who hold the key to prevention and control of AIDS.
The National AIDS Control Organization (NACO) project, called School AIDS Education Program, is focusing on raising awareness about HIV; helping teenagers resist peer pressure to participate in risky behavior; and helping them develop a safe and responsible lifestyle. Teachers and peer educators are trained to conduct these programs. A special module, 'Learning for life', has also been developed by NACO and distributed to all states running this awareness program. About 50,000 secondary and higher secondary schools are currently implementing this program.
Q. There are an estimated 300 million young people in India. Does the ministry see them as a cohesive group that needs separate attention?
A. Young people are very important to the ministry. They are the main focus of our efforts to stabilize population and control various diseases. Both the Department of Family Welfare and NACO have distinct schemes for young people.