Adolescents in Uttar Pradesh have limited awareness of sexual and reproductive matters, such as how pregnancy occurs and knowledge of contraception, HIV and safe sex practices, and maternal and newborn care practices. Just 55 percent of younger boys in ages 13Â14 and 43 percent of younger girls in ages 13Â14, for example, knew that a woman cannot become pregnant after kissing or hugging; even fewer (8Â10%) were aware that a woman can get pregnant at first sex. 

Among older adolescents, only 23Â24 percent of boys and unmarried girls were aware that a woman can get pregnant at first sex, and hardly any (5Â7%) knew that a woman is most likely to become pregnant if she engages in sexual relations mid-cycle. Even among married older girls, just 58 percent were aware of even one of these facts. However, as many as 26 percent of younger boys (ages 10Â14) and 57 percent of older boys were aware of the availability of tests to determine the sex of the foetus as were 30 percent of younger girls (ages 10Â14) and 65Â68 percent of unmarried and married older girls.

These are the findings of the programme of research titled, ÂUnderstanding the lives of adolescents and young adults (UDAYA) in Bihar and Uttar Pradesh 2015-16Â, implemented by the Population Council. 

Findings pertaining to adolescents perceptions about abortions underscore that most adolescents did not favour the termination of pregnancy; one-third or fewer adolescents (23Â32%) perceived that it is acceptable for a girl or woman to terminate her pregnancy if she does not want to continue with it. Indeed, as many as 54Â64 percent of adolescents believed that it is not acceptable to terminate a pregnancy. Of those who were aware of abortion, 66 percent of boys and 51Â61 percent of girls reported that they would direct a friend or relative in need of abortion services to a provider or facility that was likely to be legal, which indicates some indirect understanding that abortion is legally available. Only very small proportions of adolescents reported that they would suggest a facility or provider not authorised to provide abortion services (2Â5%). Finally, 20 percent of boys and 12Â29 percent of girls reported that they did not know of facilities that offer abortion services.

The goal of UDAYA is to establish the levels, patterns, and trends in the situation of younger (10Â14) and older (15Â19) adolescents and assess factors that influence the quality of transitions they make. 

UDAYA uses both cross-sectional and longitudinal designs and focuses on unmarried boys in ages 10Â14 and 15Â19, unmarried girls in ages 10Â14 and 15Â19, and married girls in ages 15Â19 in both rural and urban settings in Bihar and Uttar Pradesh. These two States together constitute 25 percent of the countryÂs population and adolescents in these states account for 29 percent of the countryÂs adolescent population.

Adolescents had few sources of information on puberty and sexual and reproductive matters. Indeed, large proportions of younger boys and girls had never received any information about puberty (56% and 63%, respectively). Likewise, 69 percent of younger boys in ages 13Â14 and 83 percent of younger girls in ages 13Â14 had never received information on such matters as how pregnancy occurs or how a pregnancy can be prevented as also 37 percent, 57 percent, and 31 percent of older boys, unmarried older girls, and married older girls, respectively (adolescents in ages 10Â12 were not asked about these matters). Leading sources of information on puberty for younger adolescents were family members.

Hardly any younger adolescents listed healthcare providers or the mass media as their major sources of information. Leading sources of information on sexual and reproductive matters for boys aged 13 and above included friends (17% among younger boys in ages 13Â 14 and 48% among older boys), influential adults in the community (6% and 14% among 13Â14-year-old boys and older boys, respectively), and the mass media (2% and 14% among 13Â14-year-old boys and older boys, respectively). Among girls, while no single leading source of information was identified among younger girls, family members (24%), friends (13%), and the mass media (13%) were listed as leading sources for unmarried older girls, and family members (60%), friends (16%), and influential adults in the community (7%) were listed among married older girls.

Findings confirm that despite strict norms prohibiting opposite-sex socialising, opportunities do exist for the formation of romantic relationships among adolescents. As many as 26 percent of older boys and 16Â20 percent of unmarried and married older girls reported that they had been involved in a romantic partnership in their lifetime. Romantic relationships almost always included some form of physical intimacyÂ74 percent of boys and 54Â60 percent of girls had hugged their romantic partner, and progressively fewer reported more intimate behaviours, such as kissing their romantic partner on the lips (68% of boys and 42Â51% of girls) and engaging in sexual relations with their partner (42% of boys and 18Â25% of girls).

A large proportion of older adolescents who had reported sexual relations with a romantic partner had engaged in unprotected sex. Contraceptive use in a romantic relationship was limitedÂonly a quarter of boys and about one-fifth of girls reported that they had used a contraceptive method at first sex.

Non-consensual sexual experiences characterised the lives of a significant number of adolescents. As many as 16 percent of younger girls had ever experienced teasing and verbal harassment of a sexual nature and two percent had experienced unwanted sexual touch. Among younger boys, three percent had ever experienced non-consensual sexual touch, typically perpetrated by another boy or a man. Two percent of older boys and 8Â9 percent of unmarried and married older girls reported ever experience of non-consensual sexual touch, including attempts to force sex on them (married older girls were asked to report such experience if it had occurred before their marriage). Four percent of unmarried older girls and five percent of married older girls reported the experience of a forced sexual encounter ever in life including that perpetrated by their romantic partner/s (married older girls experiences were before marriage).

Circumstances of the first birth suggest that almost all married girls had received at least one antenatal check up. However, fewer girls had their first check-up in the first trimester (47%), while even fewer had received four or more antenatal check-ups (31%). Although 55 percent of married girls had taken iron and folic acid tablets sometimes, only eight percent had taken it for 100 days. As many as 82 percent of married girls had received two or more tetanus toxoid injections and almost all (93%) had received at least one. Giving birth in a health facility and having skilled attendance were far from universal for the firstÂand most riskyÂdelivery. Indeed, just 72 percent of married girls reported that they gave birth in a health facility and 78 percent of married girls reported that their first birth was attended by a health care personnel. 

Findings show that girls access to post-partum check-ups following their first birth was limitedÂjust 37 percent of married girls reported at least one check-up. Some 33 percent of married girls had their first post-partum check-up within two days of delivery. Almost all married girls who had received a post-partum check-up had received it from a healthcare professional. Only eight percent of married girls had received three or more check-ups within six weeks of delivery.

Breastfeeding is nearly universalÂ96 percent of married girls with at least one live birth reported that they had breastfed their first child. However, only a small proportion of married girls had initiated breastfeeding their first child within an hour of delivery (33%). 

The reach of various schemes to promote maternal, newborn, and child health the Janani Surksha Yojana (JSY), the Janani-Shishu Surakshya Karyakram, and the Integrated Child Development Services (ICDS)Âwas far from satisfactory. Just 32 percent of married girls with at least one live birth had received JSY cash benefits for their first birth; even among those who had given birth in a public sector facility, only 61 percent had received the cash benefits. Among married girls whose first birth took place in a public or private health facility, 54 percent reported that they had received at least one benefit dispensed under the Janani-Shishu Surakshya Karyakram. The reach of services through the ICDS programme was even more limited during pregnancy and the period of lactation. Just 33 percent of married girls reported that they had received food supplementation during pregnancy or the lactation period with respect to their first child, and fewer married girls reported that they had received health and/or nutrition education. Infant and child health services in contrast were more likely to have been accessed by married girls who had at least one childÂ53 percent of married girls reported that they had received various services for their first child under six years of age.

Menstrual hygiene practices were far from satisfactory, as measured by the use of sanitary napkins. Of those who had begun menstruating, 30Â35 percent reported that they used sanitary napkins, 42Â50 percent reported that they used pieces of cloth, and 16Â25 percent reported that they used both. Those who reported using materials other than sanitary napkins cited lack of affordability, difficulty in obtaining sanitary napkins, and lack of awareness about sanitary napkins as the main reasons for not using sanitary napkins.

Findings show that frontline workers (FLWs), namely, accredited social health activists (ASHAs) and anganwadi workers (AWWs) were widely known to adolescents. Among boys, 82Â91 percent and, among girls, 84Â93 percent, for example, had heard about AWWs.

Findings show that school enrolment was nearly universal among adolescents, except for married older girls, among whom a considerable proportion of married girlsÂone out of fiveÂwere never enrolled in school. Findings highlight, moreover, that differences by sex in school enrolment had disappeared and that differences between adolescents of rural and those of urban areas were modest. Although school enrolment was nearly universal, attainment of educational milestones was far from satisfactory.

Retention in school was far from universal even among younger adolescents despite the introduction of the Right to Education Act, 2009, that has made primary education free and compulsory, with 86Â91 percent of younger adolescents, 52Â63 percent of older boys and unmarried older girls, and five percent of married older girls were enrolled in a school or college at the time of the interview. Furthermore, school retention declined steadily as boys and girls transitioned from early adolescence to late adolescence, with steeper declines among girls than boys and among married than unmarried older girls. While 90Â93 percent of boys and unmarried older girls in ages 15Â19 were in school at age 10, just 69Â78 percent were in school at age 15

Data on migration experiences among older adolescents show that 19 percent of boys, 14 percent of unmarried girls, and 92 percent of married girls were migrants by place of last residence. The major reason for migration among boys and unmarried girls was family migrationÂ47 percent of boys and 68 percent of unmarried girls reported that they had moved into their current place of residence because the family had migrated. Other reasons for migration included the pursuit of education, economic distress experienced by family, and, additionally, among boys, employment. Almost all married girls who had migrated into their current place of residence cited marriage-related migration. Finally, findings show that the vast majority preferred to stay in their state, given a choice  88 percent of boys and 70Â76 percent of girls. Just 7Â12 percent preferred to migrate outside their state, while the remaining were unsure about it.

Findings suggest that large proportions of adolescents were exposed to the mass media, typically television and films (90Â92% of boys and 73Â81% of girls). Fewer adolescents had been exposed to the print media (65Â82% of boys and 48Â67% of girls who had completed five or more years of education) and to the radio (28Â33% of boys and 16Â 24% of girls). More boys than girls reported exposure to each medium, while differences by age and by marital status among girls were modest for the most part. However, a large majority of adolescents owned or had access to a family memberÂs mobile phone. Findings show that the penetration of internet and social media among adolescents was very limited, except among older boys. While as many as 42 percent of older boys had ever accessed the internet, only 5Â17 percent of adolescents in the remaining four categories had done so

Findings underscore, in general, the gender discriminatory experiences of adolescents. Among adolescents with opposite-sex siblings who were up to three years younger or older than the respondent, for example, 16Â19 percent of boys reported that their parents favoured them over their sisters and 26Â28 percent of girls (married older girls were not included), acknowledged that their parents favoured their brother over them in at least one of three practices, namely, the quantity or quality of food items given, the amount of pocket money given, the type of school in which they were enrolled, or parental aspirations for respondentÂs education. Girls who were less educated, out-of-school, engaged in paid work, belonging to poor households, and residing in rural areas were more likely than others to report gender discriminatory experiences. Adolescents family lives were marked by violence, both witnessed and experienced. As many as 20Â24 percent of boys and 26Â30 percent of girls whose both parents were alive at the time of the interview had ever witnessed incidents where their father had beaten their mother

The findings of UDAYA provide considerable evidence that family life or sex education is urgently needed among adolescents, for both those in school and those who have discontinued their education. Findings demonstrate a limited understanding of sexual and reproductive matters among adolescents, including among married older girls. Misconceptions abound on most topics: sex and pregnancy, contraceptive methods, STIs and HIV/AIDS, and maternal and newborn care practices. Where adolescents have shown awareness of sexual and reproductive health matters, many of them exhibited only superficial knowledge. While few adolescents had been exposed to family life education, key topics covered related to HIV/AIDS rather than sexual and reproductive topics more generally. Even so, those who had been exposed to such an education were more likely than those who had not been to display in-depth awareness of sexual and reproductive matters. Moreover, notable proportions of adolescentsÂone-tenth to two-fifthsÂindicated a preference for receiving information about sexual and reproductive matters from teachers, healthcare providers, or other influential adults in the community.