Non-consensual sexual experiences of young people: A review of the evidence from developing countries

Although there is increasing evidence of risky consensual sex among young people in developing countries, non-consensual sexual experiences among them have rarely been studied and few interventions have been designed to protect them from the risks of such experiences. However, what is available suggests that coercion and unwantedness may play a considerable role in the sexual relations of young people—girls and young women but also boys and young men. The implications of non-consensual sexual experiences for young people’s rights, their health and development and the risks they pose in the transition to adulthood are enormous. This review collates what is known about non-consensual sexual experiences of young people—those aged 10-24—in developing countries, synthesises from this a profile of the magnitude and correlates of sexual coercion, and draws lessons for the implementation of appropriate programmes. Notwithstanding significant methodological limitations, the few available studies provide several common insights and have suggested that although definitions, study populations and study designs may differ, making comparison difficult, nonconsensual sex is indeed experienced by disturbing proportions of young people in all settings from which data were drawn. Non-consensual sex is experienced largely by girls and women, but also by boys and men. While studied largely among the unmarried, there is evidence that it is commonplace among married couples as well. It occurs largely among individuals who are acquainted with each other. It covers a continuum of behaviours ranging from unwanted verbal advances to unwanted touch to assault and forced sex, as well as sex in exchange for money, gifts, food or protection. The consequences of sexual coercion are formidable: they are short and long-term; and have physical, psychological and social effects. Sexual health manifestations range from unintended pregnancy, abortion and infection to risk-taking behaviours, including early onset of consensual sex, multiple partner relations and non-use of condoms. Psychological outcomes range from symptoms of anxiety and depression to suicide attempts. School performance can also be affected. A number of obstacles inhibit adolescents from protecting themselves from non-consensual sexual relations and from taking action against a perpetrator or to withdraw from a coercive relationship. Gender double standards and expectations of women and men in the sexual arena dominate these obstacles. Communication and negotiation on sexual matters, moreover, tend to be difficult and are often replaced by actions that include force and violence to resolve differences. The lack of a supportive environment and trusted adults and peers to consult on sexual health matters may also enhance young people’s (and particularly young women’s) vulnerability to coercive sexual relations. And finally, perceptions of institutional indifference—at the community, school, crime and health sector levels—can inhibit help-seeking both among victims as well as others who may wish to seek counselling on how to confront a potentially threatening situation. We conclude with a discussion of programmatic and research priorities

Sexual and reproductive health of young people in India: A review of policies, laws and programmes

This paper synthesizes the key policies, laws, and programs in India that focus on or have implications for the sexual and reproductive health and rights of young people. It includes a summary of what is known about the sexual and reproductive health situation of young people, an assessment of the salient features of current policies, laws, and programs, and a discussion of the extent to which these policies, laws, and programs have responded to the sexual and reproductive health needs of young women and men. The review by the Population Council clearly shows that there is considerable recognition of the importance of young people in defining India’s future, and a considerable commitment to meeting their needs, including those in the sexual and reproductive health and rights arenas. What is needed is a commitment to ensuring that programs do indeed reach young people, that the scope and content of programs are expanded, and that promising lessons are assimilated and scaled up

Providing maternal and newborn health services: Experiences of auxiliary nurse midwives in Rajasthan

To better understand the experiences of auxiliary nurse-midwives (ANMs) in providing maternal and newborn health services and to obtain their perspectives on Janani Suraksha Yojana (JSY), the Population Council undertook an exploratory study of ANMs in two districts of the north-western state of Rajasthan, India. Findings show that the vast majority of the ANMs were aware of best practices related to the immediate care of the newborn. Nevertheless, the findings also suggested a number of priority areas for action, including increased investment in training, encouraging provision of services on a more regular basis, making special efforts to enable ANMs to follow standard protocols of care, and raising ANMs’ awareness about the JSY program and addressing weaknesses identified by ANMs

Adolescents in Rajasthan 2012: Changing situation and needs

Several national policies and programs formulated since 2000 have underscored India’s commitment to addressing the multiple needs of youth. The Rashtriya Kishor Swasthya Karyakram (RKSK) program launched in 2014 helped provide the framework for services for young people’s health in general, and their sexual and reproductive health, mental health, and prevention and care of noncommunicable diseases, in particular. The earlier Youth in India: Situation and Needs 2006–2007 study was the first-ever subnationally representative study conducted to identify key transitions experienced by married and unmarried youth in India. Data have now become available from a repeated survey conducted in 2012 in one state, Rajasthan, about the situation of unmarried 15–19-year-old adolescents from the same sites as in the 2007 survey, offering an opportunity to assess changes in the situation of adolescents over a five-year period. In this report, the situation of adolescents in Rajasthan in 2012 is compared with that reported in 2007 in the Youth in India study. The goal of the 2012 study was to shed light on the situation and needs of adolescents and youth some five years following the earlier study

Acceptability and effectiveness of helpline services: Perspectives of women in distress and service providers—Policy brief

In Bihar, characterized by the highest prevalence of marital violence in India, helplines for women who experience violence exist in almost every district. Notwithstanding the availability of these helplines, little is known about the perspectives and experiences of women who have these services. This brief describes, from the perspectives of women who sought services from the helpline, the range and perceived quality of services received, and the extent to which these services succeeded in helping them to stop the violence; access permanent shelter, economic opportunities, and resources; resolve claims on family assets; or improve overall well-being. It also presents, from the service providers’ side, the services offered by them and challenges they faced in providing quality services

Parent-child communication on sexual and reproductive health matters: Perspectives of mothers and fathers of youth in India

This report from the Population Council study “Youth in India: Situation and Needs” presents data from in-depth interviews with mothers and fathers of youth in six states of India regarding communication patterns. The content of parent-child—and parent-daughter—communication is typically intended to ensure that young people conform to prevailing social, gender, and relationship norms. This study, one of the first from India to probe parental perspectives, suggests that parents are indeed concerned about their children’s transition into sexual life, but are constrained by traditional norms, lack of information, and limited skills from communicating with and providing them the supportive environment needed to make this transition. Programs are urgently needed that orient both mothers and fathers, and that inform parents about effective parenting styles and the need for and importance of close communication with children, and, finally, enable them to question prevailing social, gender, and relationship norms

Broadening Girls' Horizons: Effects of Life Skills Education Programme in Rural Uttar Pradesh

This report is the result of a collaborative project undertaken by Prerana and the Population Council to implement a life skills education programme for unmarried adolescent girls in rural Uttar Pradesh and to evaluate its effectiveness. The intervention programme aimed to empower unmarried adolescent girls aged 13-17 years and address their vulnerabilities by building their agency; fostering egalitarian gender role attitudes; building awareness about sexual and reproductive health matters; developing vocational skills and future work aspirations; and influencing perceptions about marriage and their ability to negotiate marriage-related decisions, delaying marriage and first pregnancy

Protecting young people from sex without consent

Over the last decade, a growing body of evidence has laid to rest any illusion that the young are protected from unwanted sexual advances or forced sex both within and outside of marriage. Studies have established the prevalence of unwanted sex within marriage among young women and its risk factors; the association between poverty and forced sex among adolescent girls in South Africa; levels and correlates of forced sex reported by young people in Ethiopia and Kenya. Evidence has established that sex without consent among the young exists in every region of the world, and that girls, as well as boys have experienced it. Questions nevertheless remain. To what extent have national policies responded to concerns about nonconsensual sex among the young? Is it possible to track the prevalence of sex without consent in national and subnational surveys? What are the health and social consequences of sex without consent? Are there promising interventions that have succeeded in preventing sex without consent? This brief presents highlights of research that has responded to these questions

Addressing women\u27s reproductive health needs: Priorities for the Family Welfare Programme

India\u27s national family welfare program has two objectives—to address the needs of families, notably women and children, and to reduce population growth rates. In reality, the program has been disproportionately focused on achieving demographic targets by increasing contraceptive prevalence. In this process, women\u27s needs have been overlooked, in terms of poor reproductive health (RH). There is a need to reorient program priorities to focus more holistically on RH needs and on woman-based services that respond to health needs in ways sensitive to the sociocultural constraints women and adolescent girls face in acquiring services and expressing health needs. This report presents a profile of substantive needs in the area of women\u27s RH. It contains a brief overview of the demographic situation and the thrust of the program in India, points out gender disparities and constraints women face in acquiring quality health services, focuses on the RH situation and highlights the gaps between needs and available services, and sets out priorities for policy. It raises the need for greater attention to RH and services that are more focused on women, both adult and adolescent, in India, and discusses activities appropriate for further support

Injectable contraceptives: Perspectives and experiences of women and health care providers in India

This report is the result of a study that aimed to shed light on the feasibility and acceptability of making injectable contraceptives more widely available to women in India. The study focused on injectable contraceptive users, new method adopters, and healthcare providers drawn from the facilities of a range of reproductive health. Healthcare providers were, for the most part, in favor of offering injectable contraceptives, however, they argued strongly for certain prerequisites, such as comprehensive and sensitive counseling and effective follow-up. Findings further suggest that there is a demand for injectable contraceptives among women, and that both women and healthcare providers perceive a number of advantages associated with the method. We conclude that the inclusion of injectable contraceptives in the basket of methods offered under the national program, along with appropriate emphasis on healthcare provider training and on ensuring informed choice, will expand women’s contraceptive choices and help to ensure their reproductive rights