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Adolescents in Bihar Aware of Availability of Sex Determination Tests

A considerable proportion of adolescents in Bihar are aware of the availability of tests to determine the sex of the foetus. As many as 31 percent of younger boys (ages 10–14) and 67 percent of older boys, and even more girls—39 percent of younger girls (ages 10–14) and 72–76 percent of unmarried and married older girls—were aware of sex determination tests. 

Findings pertaining to older adolescents’ perceptions about abortions underscore that most adolescents did not favour the termination of pregnancy; only 23–36 percent of older boys and girls perceived that it is acceptable for a 15 girl or woman to terminate her pregnancy if she does not want to continue with it. Indeed, as many as 58–61 percent of adolescents believed that it is not acceptable to terminate a pregnancy. Of those who were aware of abortion, 64 percent of boys and 53–58 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 (2–4%). Finally, 23 percent of boys and 11–22 percent of girls reported that they did not know of facilities that offer abortion services.

These are some of the findings of a research programme titled, ‘Understanding the lives of adolescents and young adults (UDAYA) in Bihar and Uttar Pradesh’ done by Population Council, A total of 35,586 households were selected for interview; among these, interviews were successfully completed for 33,900 sample households. A total of 10,433 adolescents were interviewed.

While most older adolescents had heard of contraception, in-depth awareness was limited. Thus, 84 percent of boys, 65 percent of unmarried girls, and 86 percent of married girls had heard of at least one selected modern method of contraception—oral pills, condoms, and emergency contraceptive pills—suitable for adolescents. However, specific knowledge of at least one modern contraceptive method was reported by considerably fewer—63 percent of boys, 18 percent of unmarried girls, and 43 percent of married girls. Specific knowledge of at least one contraceptive method increased with the respondent’s educational attainment level, current enrolment in school/college, as well as his/her mother’s educational attainment level and the household’s economic status.

Findings show that school enrolment was nearly universal among adolescents other than married older girls, but particularly so for younger adolescents; however, a considerable proportion of unmarried and married older girls—nine percent of unmarried older girls and 29 percent of married older girls—were never enrolled in school. Findings highlight, moreover, that differences by residence in rural or urban areas in school enrolment were modest. Although school enrolment was nearly universal, attainment of educational milestones was far from satisfactory.

Data on activity status during adolescence among older adolescents show that school enrolment declined across all groups as they transitioned out of early adolescence into late adolescence; for example, school enrolment declined from 94 percent to 85 percent among older boys and from 88 percent to 79 percent among unmarried older girls at the ages of 10 and 15, respectively

Data on migration experiences among older adolescents show that 18 percent of boys, 10 percent of unmarried girls, and 87 percent of married girls were migrants by place of last residence. Boys migrated largely for education-related reasons (34%), family migration-related reasons (26%), and work-related (20%) reasons. Among unmarried girls, the leading reasons were family migration (56%), followed by education-related reasons (29%). Some 17 percent of boys and 12 percent of girls cited economic distress experienced by family. 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 — 89 percent of boys and 75–79 percent of girls. Just 6–14 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 (83–91% of boys and 61–82% of girls). Fewer adolescents had been exposed to the print media (61–81% of boys and 41–66% of girls who had completed five or more years of education) and to the radio (26–32% of boys and 10–13% of girls). More boys than girls reported exposure to each medium.

However, a large majority of adolescents owned or had access to a family member’s 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 39 percent of older boys had ever accessed the internet, only 1–13 percent of adolescents in the remaining four categories had done so. Very few adolescents, except older boys, had ever accessed social media—27 percent of older boys and 1–4 percent of adolescents in the remaining four categories. As expected, a larger proportion of urban than rural adolescents had ever accessed social media.

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, 19–20 percent of boys reported that their parents favoured them over their sisters and 33–42 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, amount of pocket money given, the type of school in which they were enrolled, or parental aspirations for respondent’s education.

Findings related to adolescents’ plans for the immediate future, that is, for the three years following the interview, show that the vast majority of younger boys and girls (88–89%) reported that they would like to continue/get back to their studies. In contrast, and not surprisingly, a large proportion of older boys and unmarried older girls expressed that they had both plans to continue/get back to their studies (66% for each) and plans related to livelihood generation (56% and 48%, respectively). Married girls, on the other hand, were interested in livelihood-related plans (45%) and plans to become a mother (17%) or assume the role of a homemaker (40%).

Findings clearly highlight the limited agency of adolescents and the striking gender divide in all the dimensions of adolescents’ agency. Adolescent girls were far more disadvantaged than adolescent boys. Differences by sex, for example, were evident among both younger and older adolescents across all domains of decision-making, with boys more likely than girls to have some say in decisions such as choice of friends, level of schooling they want, whether to work or not.

Findings also underscore adolescents’ limited awareness of sexual and reproductive matters, such as how pregnancy occurs and knowledge of contraception, HIV, safe sex practices, and maternal and newborn care practices. Just 56 percent of younger boys in ages 13–14 and 44 percent of younger girls in ages 13–14, for example, knew that a woman cannot become pregnant after kissing or hugging; even fewer (9–10%) were aware that a woman can get pregnant at first sex. Among older boys and unmarried older girls, only 27–28 percent were aware that a woman can 14 get pregnant at first sex, and hardly any (4–5%) knew that a woman is most likely to become pregnant if she engages in sexual relations mid-cycle. 

Even among married older girls, just 53 and 12 percent, respectively, were aware of these facts.

Findings highlight the limited awareness of maternal and newborn care practices among older adolescents, including among married girls (younger adolescents were not asked about these matters). Just 22–28 percent of boys and girls for example, knew that a pregnant woman should have at least four antenatal check-ups, and 68–71 percent of boys and girls knew that a woman should go for post-partum check-ups even if she is feeling well. Similarly, 30–43 percent of boys and girls knew that a newborn should be breastfed within an hour of birth, 39–50 percent knew that colostrum should be fed to the newborn, and 28–48 percent knew that an infant should be breastfed exclusively for six months. 

Finally, 62 percent of boys and 34–39 percent of girls reported that a newborn should not be bathed on the first day of birth. Awareness levels increased systematically with the respondent’s age, his/her belonging to general castes, educational attainment level, his/her mother’s educational attainment level, and the household’s economic status.

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 (57% and 53%, respectively). Likewise, 70–72 percent of younger boys and girls in ages 13–14 had never received information on such matters as how pregnancy occurs or how a pregnancy can be prevented, as also 25 percent, 44 percent, and 30 percent of older boys, unmarried older girls, and married older girls, respectively.

Leading sources of information on puberty for younger adolescents were family members (15% of boys and 38% of girls), particularly parents, followed by friends (12% of boys and 6% of girls) and influential adults in the community (9% of boys and 7% of girls), particularly teachers. Hardly any younger adolescents listed healthcare providers (less than 1%) or the mass media (2% or less) 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 13–14-year-old boys and 59% among older boys), influential adults in the community (11% among 13–14-year-old boys and 15%, among older boys), and the mass media (3% among 13–14-year-old boys and 18% among older boys). Among girls, family members (20% among 13–14-year-old girls and 36–58% among unmarried and married older girls) and friends (4% among 13–14-year-old girls and 17–18% among unmarried and married older girls) were the leading sources of information.

Findings confirm that despite strict norms prohibiting opposite-sex socialising, opportunities do exist for the formation of romantic relationships among adolescents. As many as 19 percent of boys and 13–14 percent of girls reported that they had been involved in a romantic partnership in their lifetime. Romantic relationships almost always included some form of physical intimacy—74 percent of boys and 52–55 percent of girls had hugged their romantic partner, and progressively fewer reported more intimate behaviours, such as kissing their romantic partner on the lips (64% of boys and 43–47% of girls) and engaging in sexual relations with their partner (41% of boys and 17–18% of girls).

A large proportion of adolescents who had engaged in sexual relations with a romantic partner had engaged in unprotected sex. Contraceptive use in a romantic relationship was limited—just 31 percent of boys and 17 percent of girls reported using a contraceptive method at first sex. Even more limited was consistent contraceptive use—only 28 percent of boys and 7–11 percent of girls reported that they/their partner had always practised contraception. The majority of those who practised contraception in romantic relationships had used condoms.

Non-consensual sexual experiences characterised the lives of a significant number of adolescents. As many as 22 percent of younger girls had ever experienced teasing and verbal harassment of a sexual nature and seven percent had experienced unwanted sexual touch. Among younger boys, one percent had ever experienced non-consensual sexual touch, typically perpetrated by another boy or a man.

Circumstances of the first birth suggest that almost all married girls had received at least one antenatal check-up (98%). However, fewer girls had their first check-up in the first trimester (47%), while even fewer had received four or more antenatal check-ups (36%). Although 44 percent of married girls had taken iron and folic acid tablets, only six percent had taken it for 100 days. As many as 89 percent of married girls had received two or more tetanus toxoid injections and almost all (95%) had received at least one. Giving birth in a health facility and having skilled attendance were common for the first delivery. Indeed, 79 percent of married girls reported that they gave birth in a health facility and 84 percent of 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 limited—just 39 percent of married girls reported at least one check-up. Some 36 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 nine percent of girls had received three or more check-ups within six weeks of delivery

Breastfeeding is nearly universal—96 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 within an hour of delivery (47%) and 80 percent had initiated breastfeeding within the first day of birth.

The reach of various schemes to promote maternal, newborn, and child health— the Janani Surksha Yojana, the Janani-Shishu Suraksha Karyakram, and the ICDS—was far from satisfactory. Just 43 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 72 percent had received the cash benefits

Menstrual hygiene practices were far from satisfactory, as measured by use of sanitary napkins. Of those who had begun menstruating, 20–28 percent reported that they used only sanitary napkins, 43–52 percent reported that they used only pieces of cloth, and 21–27 percent reported that they used both. Those who reported using materials other than sanitary napkins cited lack of affordability of sanitary napkins, difficulty in or shyness about obtaining sanitary napkins, and lack of awareness about sanitary napkins as the leading reasons for not using sanitary napkins.

The findings of UDAYA provide considerable evidence that family life or comprehensive sexuality 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 the 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 adolescents—one-tenth to two-fifths—indicated a preference for receiving information about sexual and reproductive matters from teachers, healthcare providers, or other influential adults in the community, the study says.

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