Through Puberty to Adolescence

How has COVID-19 affected sexual and reproductive health services for adolescents and young people?

Amidst the renewed surge of the COVID-19 pandemic and unrelenting pressure on health systems, I spoke with a group of student volunteers from Pratisandhi about their concerns regarding the impact of the pandemic on sexual and reproductive services for adolescents and young people. This was the second in a series of discussions on the challenges of understanding and managing sexual and reproductive health by adolescents and young people.

The outcome of the first ‘Through Puberty to Adolescence’ discussion is here.

There is great distress among the volunteers regarding the outcomes of the resurgent pandemic and its impact on people. With the cancellations of the examinations and closure of schools, these volunteers have mobilised through social media to respond to the humanitarian crisis by facilitating medical help, coordinating access to lifesaving services, and support. Much of their work is selfless with great sacrifice.

The volunteers proposed a discussion on the impact of COVID-19 on sexual and reproductive health services for adolescents and young people. This was of concern given issues of freedom of movement, issues of privacy during the lockdown, maintaining healthy relationships, and anxiety and mental stress. It was a privilege for me to have a frank conversation with the volunteers and be surprised by the depth of their insight.

Conclusions and agreements from the discussion.

  1. Characteristics of effective adolescent and youth sexual and reproductive health services: They should be free of ‘service provider bias’. Service providers should not be morally judgmental and stigmatize those seeking sexual and reproductive health services. There should be no ‘moral policing’ if sexually active adolescents and young people seek information, support, and help. Services should be sensitive and responsive to the needs of adolescents and young people and protect their privacy. Their access to services must be cost effective and affordable.

  2. Benchmarks for effective adolescent and youth sexual and reproductive health services: Availability of help and support through the provision of sexual and reproductive health services should help reduce unwanted pregnancies and misadventure. Information and prophylactic contraception should be freely available in institutional facilities such as washrooms. Counselors available to talk about pills, their side effects and management, and provide accurate and practical information. More guidance and helplines on where to go for information and help for advice on sexual and reproductive health.

  3. Issues of access to services: Inadequate number of gynecologists and counsellors sensitive to the sexual and reproductive health needs of adolescents and young people. There is a lack of information on modern methods of contraception and where they can be accessed. Constraints in accessing information and services include restrictive social norms (taboos, incorrect information, myths and beliefs, traditional and cultural values), non-responsive health systems and services, poor implementation of policies and programs (RKSK, CSE), and issues which marginalize and discriminate against young people, especially girls. Following the lockdown, young people and adolescents find it difficult to pay for health and reproductive services from private providers.

  4. Impact on Services: With the lockdown and restrictions on mobility, accessing gynecologists and related counseling services has proved increasingly difficult. Accessing remote consultations and support through digital means is constrained because of the lack of privacy in homes. Although SRH and abortion services have been declared as essential services within lockdown guidelines, services have been curtailed and there is difficulty in accessing SRH products, especially for menstrual hygiene and contraception. With schools and colleges closed much of the teaching on sexuality education and counselling is being provided through digital interpersonal communication but online peer-based learning and interactions have been affected.

  5. Maintaining relationships: With the lockdowns and restrictions on mobility, managing relationships, and maintaining physical and sexual intimacy has become difficult for young people. Increasingly adolescents and young people are exploring possibilities and options of exploring sexuality through the internet. ‘Screen time’ for young people and adolescents has increased and there is a potential for false and misinformation to increase. ‘Sexting’ has become common, as is the use of social media platforms for communication with partners and managing relationships. These forms of communication put adolescents and young people, especially girls, at risk and increase their vulnerability. There is a need to increase cybersecurity and ensure measures of protection and safety. A solution is for young people to work with lawmakers and regulators to improve the safety of digital spaces and cybersecurity. Following the lockdown, many young people have moved from urban areas to their hometowns and villages. While sexual intimacy has significantly reduced, anxieties and emotional burdens have increased. This coupled with other stressors is affecting mental health and psychosocial wellbeing.

  6. LGBTQI+: Young people and adolescents who are from the ‘trans power’ communities face physical and mental abuse under lockdown circumstances and have difficulty in contacting and making use of support networks and mechanisms. They have limited options to seek counselling and access to psycho-social support. This is a priority for service providers and organizations working with young people. Databases of counsellors are available and should be posted on social media.

Some Solutions

  1. Strengthening the safety of cyberspace and social media platforms to reduce the vulnerability of adolescents and young people to exploitation and abuse. This will allow them to maintain relationships remotely with privacy and safety and reduce anxieties and emotional stress.

  2. Using existing spaces for discourse, discussion, seeking advice, and counselling. Platforms provided by initiatives such as the YP Foundation, Agents of Ishq, Love Matters, Prathisandhi and C3 are accessible and helpful. Information on such platforms could be amplified. Use social media to provide accurate information on counsellors and sexual and reproductive health service providers.

  3. Design, formulate, and implement initiatives to provide parents of adolescents and young people with the support to help them have conversations with their children on issues of sex and sexuality, help in understanding relationships as well as providing their children with emotional support.

  4. Strengthen the capabilities of teachers, counsellors, and medical professionals to be more effective in providing guidance and counselling to adolescents and young people on sex and sexuality. They should also be able to provide adolescents and young people with correct and accurate information so they can derive conclusions to decide regarding their sexual and reproductive health.

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