Today, an overcrowded planet of some 7.1 billion people marks World Population Day, and with an ever growing number of teenagers giving birth, the U.N. has decided that the focus of this World Population Day will be adolescent pregnancy. At present, the highest concentration of young people is found in India. With an average age of just 29, the country is home to 300 million people below the age of 25. Come 2028, it will also be the world’s most populous nation. For these reasons, TIME takes a look at the state of sexual and reproductive health and rights in India. Sexual education, the tragedy of unsafe abortions and the unmet need for contraceptives will be examined in two parts. If the future of population management lies in the young, then the focus should fall on the world’s youngest country.
By way of chaste Bollywood movies, demure saris and lashings of Hindu religion, many people have formed an impression of Indians as a sexually modest bunch. Even the country’s most famous sexual text, the Kamasutra, comes with singularly unsexy injunctions to self-improvement, portraying sex as a means of spiritual enlightenment rather than physical gratification. But in a country that has been in the throes of a development boom, social change has been exponential and attitudes to sex have been no exception — particularly among the young. Three years ago, Tehelka, an Indian news website that specializes in exposés, found that “age was more than just a number to several young people — it was a ticking stopwatch in the race to outdo each other in the bedroom.” Reporters conducted interviews across urban India and “met terrifyingly sexual creatures of all shapes and sizes,” from 9-year-olds who distributed porn in class to teenagers who had made sex tapes. Unwanted pregnancies are meanwhile on the rise, so are sexually transmitted infections (STIs). A hospital-based study done over a five-year period and published last year reported a resurgence of syphilis in India and rising numbers of viral STIs. The study noted that all the evidence pointed toward a change in sexual practices.
At the same time, there are barely any resources for young people curious about sex. According to Manak Matiyani of Must Bol, a Delhi-based group that works with youth on gender issues, sexuality “is something a lot of young people want to learn about, not only because it’s new but also because it is something that is not talked about.” Only 15% of men and women between the ages of 15 and 24 reported receiving any sex education, according to a study on Indian youth a few years ago. Alarmingly, only 45% of young women and 37% of young men were aware of the possibility of pregnancy resulting from first intercourse. “Ignorance of sexual- and reproductive-health issues continues even after marriage,” said one government report. More than three-quarters of young women and 70% of young men “did not know what to expect of married life,” the study noted.
Sex education came into the spotlight after the Delhi gang-rape incident of December 2012, when a report by a committee headed by the late Justice J.S. Verma pointed to the dire need for greater gender-sensitization in India’s young. Other debilitating effects of the lack of sex education are plain, from the millions of unsafe abortions performed each year to a skewed gender ratio that sees widespread abortion of female fetuses owing to a cultural preference for boys. (The 2011 census found that there were 914 females ages 6 and under for every 1,000 males.) Even so, politicians, teachers and parents continue to oppose sex education, fearing that such programs would promote promiscuity and undermine traditional values.
The Indian government has dithered over the matter for more than two decades. It attempted to launch a sex-education program, the Adolescent Education Program (AEP), in 1999, but years went by as experts and policymakers deliberated over which topics to include and whether these would offend any “prevailing inhibitions” in society. By 2005, the AEP was subsumed in the new and supposedly improved National Population Education Project, but that too was a failure. Liberals were distressed by the program’s emphasis on abstinence and monogamy as a means of containing STIs including HIV. Conservatives found that the course material “allegedly featured offensive illustrations and classroom exercises,” as Renuka Motihar, a consultant on sexual education, puts it. The fear was that the program “would ignite the curiosity of students about experimentation, resulting in teenage pregnancies and promiscuity.” By April 2007, some of the largest states of India — Gujarat, Madhya Pradesh, Maharashtra, Karnataka, Rajasthan, Kerala, Chhattisgarh and Goa — had banned sex education, and the federal government dropped its support for it as well. A government committee report came to the startling conclusion that “there should be no sex education in schools” and that previous attempts at such education had been “quite reprehensible in view of our sociocultural ethos.” Indian youth, the committee decided, needed nothing more than bracing doses of traditional medicine and yoga to cool their ardor.
But, of course, as countless academic studies have found, abstinence-focused education does not change teenage and adolescent sexual behavior, nor does it delay the age of initiation of sexual activity. In fact, there is now clear evidence that sex-education programs actually help young people delay sexual activity by enabling them to make informed choices and teaching them about the use of contraceptives when they do start.
Looking ahead, experts say there are two possibilities for India. One is the establishment of a sex-education program that “acknowledges the changing sexual landscape, parents accept that their children must know about safe sex, even if they are unwilling to communicate with their children [on the subject], and supplies and information are available to young people,” says Dr. Shireen Jejeebhoy of the Population Council in India. The second option is maintaining the status quo. Rates of infection will jump and unintended pregnancies will rise, Jejeebhoy says.
India already has the dubious honor of being a global leader in teenage pregnancy. Around the world, there are some 16 million girls under the age of 18 years giving birth every year. Almost 4 million of them are in India. Granted, adolescent pregnancies in India are culturally complicated, given the incidence of child marriage and therefore, early childbearing. One study found that approximately 1 in 6 15- to 19-year-olds “had already given birth or become pregnant, and about half of India’s total fertility rate was attributable to those aged 15–24.” Nonetheless, early childbearing poses significant health risks for mother and baby — young teenage bodies are not mature enough to bear children — and maternal mortality rates are high.
Some easing of the situation has occurred in recent years. Various welfare programs for young women have been established, and there have been improvements in the availability of contraception. There is also yet another “conceptual framework” of a resurrected AEP, put together with the help of NGOs and containing “age-appropriate and culturally sensitive information,” according to Aparajita Gogoi, director of the Centre for Development and Population Activities. “People are coming around,” she says. But the fact remains that while initiatives are being taken in some states, the AEP, or any kind of sex-education program, has yet to be effectively implemented. Until one is, the face of World Population Day for years to come will be that of a teenage Indian mother, ignorant, exhausted and confused.
Look out next week for World Population Focus on India, Part 2: The Tragedy of Unsafe Abortions and an Unmet Need for Contraceptives.