1

AWRENESS ABOUT
REPRODUCTIVE HEALTH
BEHAVIOUR AMONG YOUTH WITH
SPECIAL REFERENCE TO AN
URBAN SLUM

Dissertation submitted to the

INDIRA GANDHI NATIONAL OPEN UNIVERSITY

for the partial fulfillment of the requirement of the

Post Graduate Degree Examination

On

Social work
By

Jyotirmaya Biswal
Roll No-135296595

Under the Guidance of

Mr. Basanta Kumar Swain

IGNOU study centre JKBK Govt. College, Cuttack, Odisha

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PROFORMA FOR SUBMISSION OF MSW PROJECT

PROPOSAL FOR APPROVAL FROM ACADEMIC
COUNSELOR AT STUDY CENTRE
Enrolment No. :

Date of submission
Name of the study centre
Title of the project
:
: IGNOU STUDY CENTRE, JKBK
Govt. COLLEGE, ODISHA
: Awareness about Reproductive
Health Behaviour among youth with
special reference to an Urban Slum

Signature of the student :

Approved / not approved
Signature : …………………………
Name and address of the guide Name and address of
the student
…………………………………….

DECLARATION
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I do here by declare that this dissertation entitled “Awareness about

Reproductive Health Behaviour among youth with special reference to an Urban
Slum” submitted by me under Indira Gandhi National Open University,
Bhubaneswar under the guidance of Mr. Basanta Kumar Swain.

The dissertation containing the results is an authentic and original investigation

and hasn’t been presented for any other degree or distinction of this or any other
university.

Place-

Date- Signature

Researcher

CERTIFICATE

This is to certify that Mr.Jyotirmaya Biswal student of MSW, Enrollment

no. 135296595  from Indira Gandhi National Open University, New Delhi was
working under my supervision and Sundance for her project work for the course
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MSWP-001 project work entitled “Awareness about Reproductive Health

Behaviour among youth with special reference to an Urban Slum”

Which he is submitting, is his genuine and original work.

Place
Signature……………………………

Date Name………………………………..

Address of the Supervisor

………………………………………

………………………………………

………………………………………

Phone No.:………………………….

                                                                                      
                       ACKNOWLEDGEMENT
I express my deep sense of gratitude and indebtedness to my dynamic and extremely
committed guide, Mr. Basanta Ku.Swain, faculty supervisor, M.S.W Department,
J.K.B.K College for her guidance, constructive suggestions and timely advice in the
preparation of this work.
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I express my sincere thanks to my course coordinator of study center J.K.B.K Govt.

College his timely support and guidance made easy to complete this dissertation.

I am thankful to the employees of BMC from where I have got my secondary date
regarding the Subash Nagar Slum.

Last but not the least; I would like to thank all my respondents without whose
cooperation this work would have never been materialized.

Place: Cuttack Jyotirmaya Biswal

Date:

CONTENTS
CHAPTERS PAGE NO

Certificate
Declaration
Acknowledgment
List of tables

Chapter I Introduction
07
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Chapter II Review of Literature

26

Chapter III Research Methodology

29

Chapter IV Demographic Profile of the Area

33

Chapter V Data Interpretation and Analysis

36

Chapter X Summary and Suggestions

45

Annexure

 Bibliography

 Interview Schedule

INTRODUCTION
The cliché, “health is wealth”, becomes a reality when health is defined as a state of optimum
mental, physical and spiritual wellness of every individual. Wellness of the individual, as outlined,
allows a person to be maximally productive, capable of creating opportunity and making use of
such opportunity. Spiritual and mental health not only allows for individual productivity but also
produces social harmony, resulting in healthy communities. Productive individuals, living in healthy
communities, produce a strong nation; thereby creating maximum attainable wealth. Put another
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way, health is not merely the absence of disease and health service is not merely the treatment of
sickness.

Health is the ability to achieve the maximum quality of life regardless of the physical,
mental, social or spiritual condition of an individual and health service is the participatory delivery
of this holistic care to human beings. We recognize that health demands a multi sectoral approach.
We understand that all sectors of the country have an impact on and are impacted by the health
sector. We cannot truly address health issues unless every ministry, agency and individual
understands their role in promoting health. We intend to address health issues with the involvement
of every sector since this appears to be the best, if not the only, path to sustainable development of
the health sector. To underline the scope of multi sectoral teamwork, consider the impact of violence
and crime on every sector in the country, now, ask how should it be tackled? The answer lies in a
multi sectoral approach with the health sector intimately involved in management at all levels of the
process. Health should be involved:

 in teaching life-skills to cope with conflict and anger management

 in teaching and reinforcing self esteem, care for others and social responsibility
 in early identification of persons at risk and directing appropriate interventions to prevent
violence
 In mitigation of the effects of violence and rehabilitation of individuals affected both victim
and perpetrator.

This quick and superficial overview of Health’s role in violence and crime management
shows clearly the close relationship required between the different sectors and agencies that should
be involved in addressing this national crisis. These include Health, Human Services, Gender
Relations, Education, Legal Affairs, Police, the Judiciary, community based organizations etc. If
any democratic Government’s mandate was to be encapsulated in one phrase it should read, "Our
objective is to improve the quality of life of our people". Health, as defined above, is paramount, if
we are to improve the quality of life of the common person. Reforming health is only useful if it
will deliver a service that can do this. In order to reform to achieve the objectives of universality,
quality and integration we need to recognize the human condition.

Reproductive health is a state of complete physical, mental and social well-being and not
merely the absence of disease or infirmity, in all matters relating to the reproductive system and to
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its functions and processes. Reproductive health therefore implies that people are able to have a
satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide
if, when and how often to do so. Implicit in this last condition are the right of men and women to be
informed and to have access to safe, effective, affordable and acceptable methods of family
planning of their choice, as well as other methods of their choice for the regulation of fertility which
are not against the law, and the right of access to appropriate health care services that will enable
women to go safely through pregnancy and childbirth and provide couples with the best chance of
having a healthy infant. In line with the above definition of reproductive health, reproductive health
care is defined as the constellation of methods, techniques and services that contribute to
reproductive health and well-being by preventing and solving reproductive health problems. It also
includes sexual health, the purpose of which is the enhancement of life and personal relations, and
not merely counseling and care related to reproduction and sexually transmitted diseases.

The reproductive health approach represents a major paradigm shift from previous thinking on
population and development. While the commitment to slowing population growth as a goal
remains, there has been a significant shift in the strategies to achieve this goal - an emphasis on
meeting the needs of individual women and men rather than on achieving demographic targets. This
emphasis is clearly consistent with the ultimate goals and strategies of health systems and health
reform; in fact, it fits much better than a more narrowly focused "demographic targets approach".
The results of a health system and health sector reform are ideally measured in terms of health and
reproductive health outcomes such as morbidity, mortality and malnutrition, client measures of
quality, and a balance of equity and efficiency concerns.

Since the reproductive health approach is a move away from demographic targets to meeting the
reproductive health needs of individual women and men, it would seem preferable to defend certain
reproductive health priorities in equity terms, such as decreasing unmet need for contraceptives or
other reproductive health services in poorer or under-served households or for adolescents, than in
terms of declines in fertility rates AND this equity argument is likely to carry more weight with
those designing and implementing health reform. Furthermore, by insisting that the range of
reproductive health services is provided through the primary health care system, reproductive health
efforts are deliberately linked with efforts to improve the health system in general, which is also
consistent with health sector reform goals.
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India’s population, which crossed one billion in 2000, is characterized by a sex ratio that continues
to be unfavorable to females, a large rural population, heavy reliance on agriculture and widespread
poverty with significant proportions living below the poverty line. Some current demographic and
reproductive health indicators are reflected in Table 1.3

Table 1.3: Selected demographic and reproductive health indicators

Sex ratio, 2001 (females/1,000 males) 933

Child sex ratio, 2001 (0-6 years) 927
Infant mortality rate (1994-98) 67.7
Total fertility rate (1996-98) 2.85
Young Women
Women aged 20-24 married by 18 years, 1998-99 (%) 50
Estimates of premarital sexual activity among females 15-24 years (%) 0-9
Estimates of premarital sexual activity among males 15-24 years (%) 15-30
Married adolescents 15-19 years using contraceptives (%) 8
Contraceptive Use Dynamics
Contraceptive prevalence rate 48
Unplanned pregnancies (%) 21
Currently married women with an unmet need (%) 16
Sterilized women as a proportion of all couples using modern methods (%) 84
Currently married couples using male or couple-dependent methods (%) 10
Maternal Health and Care
Maternal mortality ratio (per 100,000 live births) 540
Neonatal mortality rate, 1994-98 43
Skilled attendance at delivery (%) 42
Women receiving all recommended antenatal services (%) 20
Non-institutional births receiving a check-up within two months postpartum (%) 17
Induced Abortion
Prevalence range for sex-selective abortions (%) (community-based studies) 3-17
Maternal deaths resulting from unsafe abortion, 1998 (%) 9
Estimated number of total abortions (million) 6.7
Estimated number of abortions at approved centers (million) 0.6
Infertility
Women aged 40-49 years currently married estimated to be childless (%) 3.8
Sexually Transmitted Infections (STIs)
Estimated new STI infections annually (million) 40
Estimated new HIV infections annually, 2001 (million) 0.11
People who seek STI services in the public sector (%) 5-10
People who are aware that consistent condom use prevents HIV transmission (%) 59
HIV prevalence range among antenatal women, 0-1.75
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HIV prevalence range among STD clinic patients, 0-26.6

Domestic Violence
Ever married women beaten by husbands (%) 19

Reproductive Rights:
• The right to decide about marriage and no. of children
• The right to well being throughout life, for all matters relating to reproductive system
• The right to a responsible, healthy safe and satisfying sex life
• The right to have unrestricted access to information in order to make informed choices
• The right to have safe, effective, affordable and acceptable family planning methods of
choice;
• The right to safe pregnancy and birth;
• The right to be free from sexual violence and assault; and
• The right to privacy in relation to Reproductive Health
• A wanted pregnancy
• A responsible and empowered young man
• A respected elder, including spiritual leaders, parents etc
• Respect initially for oneself and then for other people
• Reproductive Health Rights are not possible to achieve alone, it is a partnership with one
and more people
• For these aspirations to be achieved there is a need to improve ones’ individual
development, boosting the inner viability and potential within an individual.
• To achieve this there is need for successful communication and understanding between the
different groups.

About 315 million people in India—nearly one-third of the country’s population—are young people
aged 10–24 (RGI 2001). Compared to earlier generations, the situation of young people in India has
considerably improved; they are healthier, more urbanized and better educated than ever before.
Nonetheless, the majority continue to experience major constraints in making informed life choices.
It is generally acknowledged that significant proportions of young people experience risky or
unwanted sexual activity, do not receive prompt or appropriate care, and experience adverse
reproductive health outcomes. Indeed, youth constitute a large proportion of the HIV-positive
population; it is estimated that over 35 percent of all reported HIV infections in India occur among
young people 15–24 years of age (www.unaids.org.in). Clearly, the extent to which the current
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cohort of young people engages in risky or safe behavior will determine the trajectory of the
epidemic in the coming decades. India has articulated its commitment to promoting and protecting
the sexual and reproductive rights of adolescents and youth through its policies and in several
forums. The National Population Policy 2000, the National AIDS Prevention and Control Policy
2002, the National Youth Policy 2003 and the Reproductive and Child Health (RCH) Programmes
(I and II) 1997; 2005 are key examples of the recognition that the sexual and reproductive rights of
adolescents require urgent attention. This commitment has been reinforced at various international
forums. India has, for example, endorsed the International Conference on Population and
Development (ICPD) and the ICPD+5 Programme of Action, and made a commitment to “protect
and promote the right of adolescents to the enjoyment of the highest attainable standard of health”
(UN 1999). India was one of the first countries to ratify, in 1992, the Convention on the Rights of
the Child. India has also signed the Convention on the Elimination of All Forms of Discrimination
against Women that reinforces the rights of adolescent and young females. It is also evident that the
realisation and sustainability of the Millennium Development Goals rests, to a considerable extent,
on the sexual and reproductive situation of young people.

WHAT WE KNOW ABOUT THE SEXUAL AND REPRODUCTIVE BEHAVIOR

AND HEALTH OF MEN IN DEVELOPING COUNTRIES

For years, data existed only on married women of reproductive age, but in the past 10 years or so
nationally representative surveys of men aged 15–54 have been carried out in about 40 developing
countries. These surveys were undertaken mainly in response to the global challenges created by the
HIV/AIDS epidemic, based on an understanding that the epidemic could not be addressed without
attention to men. The Demographic and Health Surveys (DHS) provide a wide range of quantitative
information about men’s sexual and reproductive knowledge and behavior, information that can be
compared across regions and countries. These data have their limitations. The surveys do not
include boys younger than age 15, many of whom are already sexually active. The samples exclude
many men living in situations that make them particularly vulnerable to sexual health risks (men in
the military, in prisons, displaced men, migrants and those living in refugee camps). The few
surveys carried out in Asia, the Middle East and North Africa tend to leave out unmarried men, a
disadvantage given the fact that most men do not marry until their 20s and that most single men are
sexually active, often with more than one partner. And perhaps most importantly, the data collected
in the DHS are an imperfect basis for examining the links between men’s social and economic
status and their sexual and reproductive behavior where we know there are significant gradients
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among women. Nevertheless, the surveys provide good data on men in the prime of their sexually
active and fathering years, of a type and quality unavailable until the early 1990s. This section
draws heavily from a review of these data conducted by the Alan Guttmacher Institute. Here are the
bare bones of what these surveys tell us about men’s sexual and reproductive behavior and
knowledge.

Qualitative research and small-scale local studies in a number of developing countries reveal the
range of problems related to men’s relationships with women, their sexual lives and their roles as
fathers. In a favela of Rio de Janeiro, a majority of young men participating in focus group
discussions report incidents of men being violent toward the women in their homes. Ethnographic
studies in 186 societies finds that only 2 percent of father have ‘regular’ close relationships with
their children during infancy, and that poverty only militates further against this relationship, as
fathers are compelled to migrate in search of work. Changes in work opportunities and women’s
status affect men’s sense of their own masculine identity and sexuality.

Qualitative work can tell us about men’s views of their sexual and family roles and practices. In
Gujarat, India, a program attempting to involve men in an effort to reduce high levels of maternal
mortality found that men believe that a man must not be present during his wife's labor. Also, all
family members, including women, are reluctant to have men donate blood for their wives— even
in critical situations—for fear that this will physically weaken the husbands. A study in rural Kenya
found that sexual debut occurred at a very early age, even as young as 10, and that sexual
experience was perceived as an integral part of initiation into manhood. Failure to have sex carried
a risk of being looked down upon by one’s peers. Among an urban, low-income population in Porto
Alegre, Brazil, 28 percent of men, compared to 8 percent of women, practice anal sex, not as a
means of contraception but for increased male pleasure. In an area of Nepal abutting India, a study
of men 18–40 having had casual sex in the past 12 months (26 percent of residents and 33 percent
of non-residents) cites one participant, an 18-year-old unmarried student, saying: “I have had sex
with many girls and . . . some may have had relations with others . . . I never used a condom as the
brain does not work while enjoying sex.”

Studies like these suggest the need for more research into the cultural, social and economic factors
associated with men’s sexual and reproductive behaviors, in all parts of the world.
Information is particularly lacking on men’s attitudes toward sex, marriage and reproduction, as
well as their motives for some behaviors—for example, frequenting sex workers without using
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condoms in settings where STIs (including HIV/AIDS) are prevalent. Few studies exist on the
extent to which men use condoms correctly and consistently; documenting these aspects of condom
use matters greatly in the search for effective methods of disease prevention. We know
17 little about men’s experience of coercion and sexual violence, either as victims or perpetrators.
Men’s roles in decision-making regarding pregnancy and abortion, their roles during the prenatal
period and their roles in raising their children, as well as whether and how these roles are changing,
are also essentially undocumented. We are relatively uninformed about men who have sex with
men, very young men, and sexually active older men. And we still know very little about men’s
sexual and reproductive behavior, knowledge and attitudes for a large proportion of the world’s
population, including China, much of the rest of Asia, the Middle East and North Africa.

Reproductive health outcomes

Pregnancy and childbearing
Pregnancy and childbearing characterise the experiences of a number of young women in India.
Adolescent fertility rates are high: roughly 107 births take place per 1,000 girls aged 15-19 and the
fertility of this age group makes up 19 per cent of the nation’s total fertility rate (IIPS and ORC
Macro, 2000). Over one in five give birth by age 17 and the median age at first birth is 19 years,
suggesting that significant proportions of women undergo pregnancy at ages below which obstetric
risks are particularly elevated. Not only does childbearing occur early among married adolescents,
but subsequent pregnancies also tend to be more closely spaced than among adults (Santhya and
Jejeebhoy, 2003). The experience of early and closely spaced childbearing is particularly risky for
adolescents because large proportions are anemic and may not have reached physical maturity –
nearly 15 per cent of ever-married adolescent women are stunted, and about one fifth have moderate
to severe anemia (IIPS and ORC Macro, 2000).

Early childbearing has resulted in adverse health consequences, including damage to the
reproductive tract, maternal mortality, pregnancy complications, peri-natal and neonatal mortality
and low birth weight (Kulkarni, 2003). Evidence from community- and facility based studies
reiterate that maternal deaths are considerably higher among adolescents than older women.
Estimates derived from a community-based study in rural Andhra Pradesh indicate that in the 1980s
the maternal mortality ratio experienced by adolescents was almost twice that of women aged 25-39
years (Bhatia, 1993). Hospital-based studies reiterate these differences. A national study conducted
by Indian Council of Medical Research of 43,550 women in 10 facilities reports that maternal
mortality among adolescents was 645 per 100,000 live births, compared to 342 per 100,000 births in
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adult women aged 20-34 years (Krishna, 1995). Similarly, a study in Mumbai indicates that while
the maternal mortality ratio among women aged 20-29 was 138 per 100,000 live births, adolescents
experienced considerably higher ratios – 206 per 100,000 live births (Pachauri and Jamshedji,
1983). Neonatal mortality, a key outcome of unsafe pregnancy conditions, is significantly higher
among adolescent mothers than among those aged 20- 29: 63.1 and 21.2 per 1,000 live births,
respectively (IIPS and ORC Macro, 2000).
95.

NFHS 2 data indicate disparities between the large northern and eastern states and the rest of India
with regard to neonatal mortality: such states as Bihar, Madhya Pradesh, Orissa, Rajasthan and
Uttar Pradesh continue to experience exceptionally high rates of neonatal mortality among
adolescent (and older) mothers. State-wise variation is less marked in the case of other key
indicators such as median age at first pregnancy and extent of anemia among married adolescents,
although it is Kerala that reveals the highest median age at first pregnancy and lowest proportions of
anemic adolescents.

Induced abortion
As abortion is such a sensitive topic, levels of induced abortion are difficult to measure directly.
However, small studies suggest that a substantial proportion of adolescents, both married and
unmarried seek abortion services. It is estimated that between 1 and 10 per cent of abortion-seekers
in India are adolescents (Ganatra, 2000), though a few facility based studies report that the
proportion of adolescent abortion-seekers is as high as one in three (Chhabra et al., 1988;
Solapurkar and Sangam, 1985). An analysis of data from NFHS 1998-99 shows a lifetime induced
abortion ratio of 1.1 among married adolescents nationally (Pachauri and Santhya, 2002b). Among
unmarried abortion-seekers, adolescents constitute a disproportionately large percentage of those
who seek abortions. At least one-half of unmarried women seeking abortions are adolescents, many
of whom are below 15 years (Jejeebhoy, 2000a). A community-based study in rural Maharashtra
reports that young women aged 15-24 constituted over half of married abortion-seekers in the area
(Ganatra and Hirve, 2002b). Findings of this study suggest, moreover, that adolescents have
considerably less decision-making authority than older abortion seekers, are more likely to be
coerced into an abortion, or conversely, to face opposition from their families, and are more likely
to report post-abortion morbidity.

Reproductive tract and sexually transmitted infections

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Few studies have specifically addressed RTIs or STIs among young people. The National
Behavioural Surveillance Survey of the National AIDS Control Organisation indicates that
approximately 3 per cent of young males and 5 per cent of young females reported the experience
of symptoms of infection (STIs or RTIs more generally) such as discharge, ulcers or sores in the 12
months preceding the survey. These figures undoubtedly reflect considerable under-reporting
(NACO and UNICEF, 2002). A community-based study of RTI prevalence among married women
aged 16-22 in rural Tamil Nadu underscores the extent to which infections go unnoticed in this
outwardly ‘lowrisk’ population. Forty-nine per cent of women in the study reported experiencing
symptoms of RTIs, while clinical and laboratory examination diagnosed 18 per cent with an STI
(Joseph, Prasad and Abraham, 2003).

A significant finding is that husbands’ behaviour may transmit infection to their wives, which could
have serious implications given that many infected women are asymptomatic and are unlikely to
seek care even when symptoms appear (Joseph, Prasad and Abraham, (2003). In several settings
HIV rates among 15-24-year-olds are equal to or in excess of those estimated among adults. In
India, for example, rates for young women exceed those for 96 both young men and adults (0.96 per
cent, 0.46 per cent and 0.80 per cent respectively) (UNICEF, UNAIDS and WHO, 2002).

Underlying risk and protective factors

A host of factors may inhibit young people from achieving good sexual and reproductive health.
Many are structural, such as poverty and malnutrition, patriarchy, early marriage and inadequate
educational and health systems, and, in turn, influence risk and protective factors at the individual
level. The range of obstacles observed to prevent young people from achieving good health and
exercising informed choices are outlined below.

Limited awareness of health promoting behaviours

While awareness of contraception and infection may be almost universal at a superficial level, in-
depth awareness of sexual health issues, health promoting actions and risky sexual behaviour is
limited among young people. A study reports for example, that although a large proportion of
adolescent girls and boys had heard of STIs (66 per cent and 87 per cent, respectively) and
contraception (91 per cent and 94 per cent, respectively), only 2 per cent could name an STI apart
from HIV/AIDS, and only 37 per cent of girls, compared to 84 per cent of boys, were aware that
condoms can provide protection against infection (Sebastian et al., 2002a).
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The NACO National Behavioural Surveillance Survey discloses that although 90 per cent of young
men and 80 per cent of young women aged 15-19 had heard of HIV/AIDS, state-wise variations are
considerable, particularly among females. For example, fewer than 40 per cent of rural women
(particularly those aged 15-19) in such states as Bihar, Gujarat, Jharkhand, Madhya Pradesh and
Uttar Pradesh were aware of HIV. This awareness did not translate into in-depth knowledge of
symptoms, modes of transmission or methods of prevention. In general, only 60 and 54 per cent of
urban and rural males aged 15-19 and 56 and 45 per cent of females could accurately identify two
modes of prevention, and only 58 per cent of young women and men were aware that there is no
cure. Awareness of STIs and their links to HIV was even more limited: 28 per cent of young men
and 29 per cent of young women had heard of STIs, and only 21 per cent and 18 per cent
respectively were aware that STI patients have a higher risk of HIV infection than others. Again,
state-wise variations are evident. Significant disparities are also observed by education and marital
status. As expected, better-educated youth are consistently more aware of HIV and protective
factors than are others. The unmarried are more likely to be aware of HIV than the married,
suggesting that married women may be particularly poorly aware and vulnerable (NACO and
UNICEF, 2002).

Misconceptions are common. Many young people believe that women cannot become pregnant at
sexual debut; that symptoms of infection go away on their own; that one can clearly identify an
infected person by their appearance; that pregnancy can occur through physical embrace; or that
infection is transmitted through everyday activities or can be prevented by proper personal hygiene
(Brown et al., 2001). Among young women aged up to 24 years in India for example, while 37 per
cent have heard of AIDS, only three in five could identify such risk factors as multiple partner
relations (57 per cent) or irregular condom use (58 per cent). Also disturbing is that only one quarter
(26 per cent) are aware that a healthy looking person could be HIV-positive (UNICEF, UNAIDS
and WHO, 2002). Indeed, the National Behavioural Surveillance Survey reports that only 28 per
cent of young men and 26 per cent of young women harbour no misconceptions about transmission
(NACO and UNICEF, 2002). Indeed, the NACO National Behavioural Surveillance Survey reports
that only 30 and 22 per cent, respectively, of urban and rural males aged 15-19 and 32 and 20 per
cent, correspondingly, of young females harbour no misconceptions about the transmission of HIV
(NACO and UNICEF, 2002). State-wise variations are evident. Correct awareness of three leading
misconceptions – that mosquito bites and sharing a meal with an infected person do not transmit
HIV/AIDS, and that a healthy looking person can transmit HIV/AIDS -- was limited among
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adolescents in all states, but appears to be particularly limited among those residing in the northern
and eastern states. Gender disparities remain narrow in each state.

Adolescents are poorly informed about the physiological changes associated with maturation
(Joseph et al., 1997; UNESCO, 2000; VNESI, 1999). In school settings, where programmes on
population, family life and sex education exist, they focus more on biological and scientific
information than broader issues of sexuality (Chakrabarti, 2003). Young people are also unlikely to
be aware of services available to them or of their right to avail these services. For example,
adolescent abortion-seekers in Pune tended to believe that abortion services were not legally
available to unmarried women (Ganatra and Hirve, 2002b). Gate-keeper attitudes ensure that young
people remain poorly informed; gatekeepers typically (mis)-perceive that deliberate withholding or
obfuscating of information are protective strategies.

Television, peers and erotic literature are by far the most commonly cited sources of information on
sexual and reproductive matters although the information they provide is not always accurate. For
example, among low-income college boys in Mumbai, erotic materials were the main source of
information (Abraham, 2001). A study of adolescent girls aged 13-17 in Haryana reports that for
almost all, the leading source of information was television (73 per cent) and/or radio (37 per cent)
(Singh, Devi and Gupta, 1999).

The NACO National Behavioural Surveillance Survey suggests that by and large, young people are
relatively unexposed to the large range of media providing messages on HIV/AIDS: while 76 per
cent were exposed to such messages on television, far fewer (between one-third and half) were
exposed to messages through the radio or newspapers/magazines, and between 6 per cent and 12 per
cent through billboards, pamphlets or films. In contrast, even fewer – about 15 per cent of males
and females -- were exposed to inter-personal communication on the topic (NACO and UNICEF,
2002).

Sensitive interventions have succeeded in raising awareness of risky behaviours and dispelling
myths concerning protection among adolescent girls and boys (Awasthi, Nichter and Pande, 2000;
Sebastian et al., 2002b). An intervention among adolescent girls in Allahabad reports that 94 per
cent were able to name an STI at the midline compared to 67 per cent at the baseline; 98 per cent
knew that pregnancy occurs through sexual contact whereas only 44 per cent knew this at the
baseline (Sebastian et al., 2002b). Among adolescent boys in a Lucknow slum, exposure to an
 18

innovative education programme dramatically increased knowledge (Awasthi, Nichter and Pande,
2000). However as evidence from other settings warns, improved awareness by itself is insufficient
in changing behaviour, but is only one of several necessary actions.

Limited self-efficacy, negotiation, life and livelihood skills

Gender double standards and power imbalances shape adolescents’ lives and often undermine their
ability to make informed sexual and reproductive choices both in marital and premarital
partnerships. The high priority placed on preserving young women’s chastity before marriage can
constrain girls’ education, access to services, and age at marriage, autonomy and mobility. Young
females have a limited voice in matters relating to their own lives – whether to continue schooling,
decisions on when and whom to marry, physical mobility and sexual relations. Young men are
affected by a different set of gender-based expectations, including social pressure to have sex at an
early age, often under conditions that place them at risk of infection. Gender power imbalances are
observed in both and marital and premarital partnerships. In many cases, male partners, parents or
in-laws play a leading role as decision makers.

Among the unmarried

A number of studies highlight the persistence of widespread gender-based double standards in India
with regard to female chastity and premarital sexual activity. Adolescent girls are acutely aware of
the restrictions that are imposed on them, whether on dress, speech or mobility. For example, girls
may even be asked to discontinue attending school when they reach puberty, or not to go out alone
(Mehra, Savithri and Coutinho, 2002). Arranged marriage and extensive dowries continue to
characterize marriage across the country. Young women rarely have any say in marriage decisions;
indeed, some are married early against their will at the behest of their parents. Young people
themselves often accept – and even justify – double standards that condone and even encourage
premarital relations for men but not for women (Mehra, Savithri and Coutinho, 2002). Many young
people feel that society condones premarital sexual activity among boys and even puts social
pressure on boys to become sexually active at an early age (Mehra, Savithri and Coutinho, 2002;
Sodhi and Verma, forthcoming).

Premarital sexual relations among adolescent girls are characterised by unequal power relations.
Young women are much more likely than men to report love and commitment as leading reasons for
engaging in sexual relations; the fear of losing a partner, incurring his anger or jeopardizing the
 19

relationship are important factors inhibiting young women from exercising choice over whether and
when to have sex and whether to use condoms (Sodhi and Verma, forthcoming).

Among the married

Within the age and gender-stratified family structure that characterises much of India, young, newly
married women face major constraints on their autonomy in the marital home. The average
adolescent bride is unlikely to have had a say on whether or not to have sexual relations, or when to
bear children. On the contrary, society often places strong pressures on women to prove their
fertility and, in many settings, bearing sons is the only means by which young women can establish
social acceptance and economic security in their marital homes. Married girls often have limited
access to health care or decision-making authority (Barua and Kurz, 2001; Kulkarni, 2003; Santhya
and Jejeebhoy, 2003). Further analysis of NFHS data shows, for example, that although decision-
making authority is limited among women in general, married adolescents are particularly unlikely
to participate in household decisions, whether those relating to major purchases or their own health
care. Age has been found to play a more powerful role in enhancing decision-making authority than
other socio-demographic factors, including education (Santhya and Jejeebhoy, 2003).

There is emerging evidence, though limited, of young girls negotiating wanted outcomes and
making decisions on whether to engage in a partnership, when and whom to marry and matters
affecting their own lives (Mehra, Savithri and Coutinho, 2002). A recent study has documented
increases in self-efficacy and autonomy among out-of-school adolescent girls who participated in a
comprehensive education and service intervention. The intervention provided non-formal, family
life and vocational education as well as service provision, opportunities to learn how to use banks
and public transport, to participate in recreational activities and to receive leadership training. Those
who participated in the programme were, for example, more likely to display autonomy and self-
confidence, and more likely to make independent decisions, such as decisions on marriage (25 per
cent vs. 7 per cent), and to have gone to a health centre alone (25 vs. 6 per cent) in the last six
months. These differences in autonomy were significant even after controlling for education of girls
and their parents. In terms of reproductive health seeking behaviour, as Figure 6 suggests, those
who had married in the interval (n=292) reported significantly more positive behaviours compared
to married controls (n=269) in a host of indicators related to reproductive health and child survival:
they were more likely to have married at age 18 or later, to use contraception and to have sought
pregnancy-related care if they became pregnant (Levitt-Dayal et al., 2003).
 20

Limited communication, interaction and support on sexual and reproductive health matters
Lack of communication, interaction and support characterise relationships between parents and their
adolescent children in matters relating to sex and reproduction. Sex and reproductive issues are
taboo subjects within families (Masilamani, 2003; Mehra, Savithri and Coutinho, 2002). In many
cases, parents believe that talking to adolescents about these matters would imply approval of
sexual activity (Masilamani, 2003). Concern for the sexual security and chastity of daughters
appears to dominate parental relationships with adolescent girls. While parents closely supervise the
activities of adolescent daughters in an attempt to inhibit sexual activity, they often condone the
sexual activity of their sons. However, relationships in which parents take on a policing role may
not always safeguard against risky sexual behaviour: intimate non-sexual and even sexual relations
does indeed occur, and unwanted pregnancy and resort to abortion are not unknown,
notwithstanding parental perceptions (Mehra, Savithri and Coutinho, 2002). There is evidence
however that parents increasingly recognise the importance of raising awareness among their
adolescent children but are inhibited by lack of in-depth knowledge and embarrassment to do this
themselves (Damayanthi, 2003; Sebastian et al., 2003; Subba Rao, 2003).

Few studies have explored the links between parental support and protection from risk. Those that
do hint that family support may be key in influencing safe sex behaviours. For example, a study of
low-income college students in Mumbai reveals a positive relationship between perceived
authoritarian family relationships and early sexual debut among young males (Abraham and Kumar,
1999). Another study of 16-year-old students in Goa suggests however those adolescents –
especially girls -- who experience unwanted sexual relations are more likely than others to report
lack of communication and support in the relationship with their parents (Patel and Andrew, 2001).
And a recent study of adolescent abortion-seekers suggests that fear of parents, fear of disclosure of
pregnancy status and lack of perceived parental support may have led many pregnant adolescents to
delay an abortion or to seek an abortion from unqualified providers (Ganatra and Hirve, 2002b).

Lack of youth-centered and youth-led programmes on sexual and reproductive health

Although there are a host of laws and programmes that seek to protect aspects of young people’s
sexual and reproductive health and ability to exercise their rights, these have rarely been
implemented in ways that address the needs of adolescents, whether married or unmarried. Though
there is a law stipulating the minimum age at marriage, it is not strictly enforced. Large proportions
of young women continue to marry and bear children in adolescence and exercise little autonomy
over their sexual and reproductive lives. There are limited programmes that make concerted efforts
 21

to delay early marriage or address married adolescents as a distinct group. Hence, while the adverse
consequences of pregnancy in adolescence are well known, adolescents are not more likely to
receive antenatal or intrapartum care than adult women are (IIPS and ORC Macro, 2000; Santhya
and Jejeebhoy, 2003). Almost one-third of adolescents who gave birth in the three years preceding
NFHS 2 received no antenatal care; 31 per cent delivered in an institution and 42 per cent were
delivered by a trained attendant. Of those delivering at home, only 18 per cent were followed up in
the post-partum period. By and large it is the northern states in which pregnancy-related care of
adolescents is particularly limited – in such states as Haryana, Rajasthan, Madhya Pradesh, Uttar
Pradesh and Bihar for example, 40 per cent or more recently delivered adolescents had received no
antenatal care, fewer than one-quarter had delivered in an institution, and fewer than one-third were
delivered by a trained attendant. In contrast, in Punjab, and the western and southern states,
considerably larger proportions have received pregnancy-related care – even so, care is by no means
universal (IIPS and ORC Macro, 2000).

Few programmes attend to the needs of married young women for care of gynaecological disorders.
For example, only 49 per cent of married young women who experienced a gynaecological problem
in rural Maharashtra, India and 9 per cent of those experiencing RTI/STI symptoms in rural Tamil
Nadu sought care (Joseph, Prasad and Abraham, 2003). Access to abortion services is considerably
more limited among young females compared to adult women, and is particularly poor among the
unmarried. Evidence suggests that adolescents—particularly unmarried adolescents--are more likely
than older women to seek abortions from unqualified or untrained providers, to have delayed
abortions and undergo second trimester abortions, and to suffer complications. Lack of access to
services and other resources are factors contributing to adolescents’ reluctance to seek safe and
early abortions on the one hand, and seek care in case of complications on the other. Unqualified or
traditional providers are frequently preferred because they are perceived as providing prompt and
anonymous care. There is evidence that, in some cases, providers charged unmarried women more
for their services (Ganatra and Hirve,
2003).

While unmarried adolescents are technically eligible for all services offered to the married under the
family welfare programme, in practice they have little access to these. Evidence suggests that
adolescents want to know more about their bodies, about relationships, sex and reproduction; yet
neither counselling, nor knowledge on sexuality reaches them. Unmarried adolescent abortion-
seekers are more likely than other women to delay abortion beyond the first trimester and choose
 22

home remedies and unqualified providers (see for example, Ganatra and Hirve, 2002b). Findings of
irregular use of contraceptives reported in studies of premarital sexual partnerships suggest that
access to condoms and contraception is likewise limited (Abraham and Kumar, 1999). As reflected
in the NACO National Behavioural Surveillance Survey, care-seeking among this group of married
and unmarried youth is not universal. Fewer than half of all young men and about one third of all
young women sought medical care for their symptoms (NACO and UNICEF, 2002).

Factors impeding use of services by unmarried youth are poorly studied in India, but as in other
settings are likely to include a range of provider- and facility-based obstacles – limited accessibility,
high costs, lack of privacy and confidentiality, poor counseling skills, threatening provider attitudes
and indifferent quality of care (Senderowitz, 1999). While the need to provide ‘accessible’ and
‘friendly’ services to youth is acknowledged, there is less clarity about what these terms imply. It is
evident that young people want access to confidential services without fear of discovery by family
or community members; that are available at convenient locations and times, do not require long
waits, are affordable, and most important, provided by staff that are non-threatening, non-
judgmental and willing to respect confidentiality. There is some evidence that where anonymity is
assured (e.g. telephone hotlines or the letter-box approach to communication and counseling),
adolescents do take appropriate steps to obtain information. Interventions – for example ‘youth
friendly’ services established in a dedicated space in a government hospital in New Delhi—have
been implemented that will shed light on the extent to which adolescents access these services or perceive
them as non-judgemental and confidential (Mehta, 2003). Lessons learned from a similar experience in
Thailand suggest that hospital settings may not attract young people however friendly the services;
rather there is a need to house services at more acceptable locations such as department stores,
youth centers and colleges (Poonkhum, 2003). A study that sought the views of adolescent girls
reports that girls did indeed express the need for a separate clinic for young people that would be
served by female providers (Joseph et al., 1997).

Sangath’s adolescent and family programme in Goa is one example of services provided to
adolescents in a safe and private setting. Services are based on the recognition that educational
needs, access to appropriate services and parental communication are key to healthy adolescence,
and are delivered in ways that accommodate young people’s stated priorities: “a welcoming facility,
where I can drop in and be attended to quickly”; “where there is privacy and confidentiality,”
“where staff treat us with respect and do not judge us” (Godinho et al., 2002).
 23

Changing policy and programme environment

Over the course of the 1990s, the policy environment has begun to shed its ambivalence on the need
to address the sexual and reproductive health needs of young people. At the international level, the
International Conference on Population and Development (ICPD) and ICPD+5 have reiterated the
importance of providing information, counseling and services for youth, achieving universal access
to primary education, closing the gender gap in primary and secondary school education; and, more
generally, respecting the reproductive rights of adolescents and youth. Indeed, by 1999, the
recommendations of ICPD+5 included the recognition of young people’s vulnerability to HIV and
recommended attention to reducing prevalence in this age group. Other notable conventions ratified
by India that have implications for addressing the reproductive and sexual rights of young people
include, most notably, the Convention on the Rights of the Child (CRC) and the Convention on the
Elimination of All Forms of Discrimination against Women (CEDAW).

At the national level, these commitments to meeting young people’s sexual and reproductive health
needs and rights have been acknowledged. The National Population Policy, 2000 recognizes, for the
first time, that adolescents constitute an under-served group with special sexual and reproductive
health needs that have remained unmet. The Policy advocates special programmatic attention to
delay marital age, provide free and compulsory education up to the age of 14 and provide
nutritional services. It specifically recommends the need to “ensure for adolescents access to
information, counseling and services, including reproductive health services, that are affordable and
accessible,” and to “strengthen primary health centers and sub-centers to provide counseling, both
to adolescents and also to newly wed” (MOHFW, 2000).

The recognition of the spread of the HIV/AIDS epidemic among young people has resulted in a
greater openness in addressing issues relating to sex among young people. The National AIDS
Policy, 2000, for example, focuses on the population between 18 and 40 years, and discusses more
directly, measures to address risky sexual behavior, although it does not identify adolescents as a
special group. The draft National Youth Policy, 2000 addresses the needs of those aged 13 to 35. It
stresses the need for a multi-sectoral approach to youth, with a focus on ‘youth empowerment,’
notably education, skills building and leadership as well as nutrition and equal opportunity. While it
discusses the need for access to health services among young people, particularly women, and cites
the need for reproductive health “guidance,” population and family life education, its primary focus
is nutrition and education rather than sexual and reproductive health.
 24

In connection with the preparation of the Tenth Five-year Plan (2002-07), a working group for the
Welfare and Development of Adolescents was established to provide input into the Plan. Its report
makes recommendations pertaining to all aspects of adolescent life. It notes the need for more
meaningful education (formal and non-formal, life skills and livelihood training). It advocates
changes in the conditions of working adolescents and attention to the kinds of work those
adolescents “can and cannot” do. It stresses gender issues and the different needs of boys and girls.
It highlights the health and nutrition needs of adolescents and the need for counseling, a supportive
environment and youth participation in development planning. Finally, it pays attention to issues of
national integration, and sports and adventure, and notes the needs of adolescents in difficult
circumstances. The Working Group advocated that the most appropriate location for issues of
adolescence is the Ministry of Youth Affairs and Sports, but recognized the need to substantially
strengthen this Ministry to expand its mandate to address adolescents in a meaningful way. It
recommended moreover a decentralized approach focused on municipal, taluka and panchayat
levels (Planning Commission, 2001). Several programmes have been undertaken at the national
level that translates the recommendations of these policies into action. The Reproductive and Child
Health Programme, whose second phase is about to be launched, made a paradigm shift in the mid-
1990s, from contraceptive targets to a client-centered focus on health needs, better quality gender-
sensitive information and services, and ensuring access. While the programme recognizes that youth
are a special population with special needs, specific measures to ensure their sexual and
reproductive health and rights have not yet been advocated. The Ministry of Youth Affairs and
Sports undertakes programmes, under the broad umbrella of the Nehru Yuvak Kendras, to raise
health awareness and adopt health promoting practices, particularly with regard to issues relating to
sexual and reproductive health. Activities also include the development of livelihood skills and
training in self employment. Programmes are being implemented unevenly across states (see for
example the assessment of the Working Group for the Welfare and Development of Adolescents,
Planning Commission, 2001).

At the state level, a number of innovations have been initiated. Several states have introduced
specific programmes for youth, including in school and community settings. For example, in
Andhra Pradesh, the Education Department launched a successful four day AIDS education
programme with a life skills focus in school settings. The programme experience concluded that
adult gatekeepers – parents and teachers in particular –may pose a significant challenge in
promoting school-based awareness. There was considerable demand for the programme among
young people, which was perceived by them to be an appropriate mechanism through which sexual
 25

and reproductive health awareness can be imparted. Considerable demand for an extension of such
programmes has been generated both among students and out-of-school youth (Damayanthi, 2003).
A number of programmes in different parts of the country do not focus directly on the sexual and
reproductive health of young people, notably girls, but attempt to build skills and livelihoods,
provide training and education, or more generally, empower girls in ways that may have a bearing
on their sexual and reproductive health awareness and exercise of reproductive choices. For
example, the Indira Soochana Shakti Yojana, the Balika Samriddhi Yojana, the Kishori Shakti
Yojana, the Shagun Scheme (Punjab), and schemes operating under the Integrated Child
Development Services (ICDS) programme offer girls training in thrift, credit services, health, and
hygiene and so on. Other schemes – notably the Apni Beti, Apna Dhan scheme and the Rajalakshmi
scheme of Unit Trust of India--offer families monetary incentives for delaying the marriage age of
their daughters beyond 18 years; under these schemes, insurance policies are drawn up in the girl’s
name and mature in her name if she has not married by age 18. While an array of schemes exists,
however, they have a limited reach, and have rarely been evaluated.

REVIEW OF LITERATURE

The present study is dedicated to make a survey of existing literature related to the topic under
treatment. The review is expected to give some ideas on the dimensions of analysis, on the proposed
hypothesis and it will provide some impressions on the universe that can be undertaken under study.
In the present chapter the researcher has made a sincere effort to collect all the possible research
studies on the subject. In this context the researcher has taken recourse to the research articles
published in recent journals, books, dissertations and has done extensive browsing on the internet to
get some relevant literature pertaining to the topic under study. The researcher has tried to combine
the reviews of some articles published in international as well as national journals.

Adam Sonfield (2002): in his study of “Looking at Men’s Sexual and Reproductive health
Needs” has concluded that although policymakers are beginning to focus on men's roles as fathers
 26

and husbands, little attention is being paid to men's sexual and reproductive health needs. Available

data illustrate that those needs are substantial and long­term: For much of their lives, men need a

range of medical and, in particular, educational and counselling services to protect their own health

and well­being, as well as to equip themselves to be good partners and fathers. There are real

barriers, however, toward meeting men's needs, including the lack of awareness that their needs

exist.

Kate M Dunn, Susmita Das and Rumeli Das (2004):  A paucity of information about

male reproductive health and a perceived interest in involvement among local men provided the

impetus for carrying out a village based male reproductive health camp. The aim was to investigate

men's willingness to participate in such camps, and to describe reproductive health problems in

men. This study highlights the interest of men in their reproductive health, but also highlights the

high proportion of men with problems. In addition, a number of men with clinically diagnosed

problems had not reported them in the interviews, illustrating either the reticence to report or the

lack of knowledge about symptoms of reproductive health problems. Recommendations for future

programmes and research in this field are given. 

Margaret E. Green, Manisha Mehta, Susheela Singh, Julie Pulerwitz, Akinrinola

Bankole and Deirdre Wulf (2007): The critical perspective that has led to calls for greater
male involvement in sexual and reproductive health has often described men in rather negative
terms. Thus the main objective of this paper has been to communicate that all policies and
programs, information and services need to reflect the social realities of how men and women
relate, and how this affects their health. It is a simple message, but it is one of the major
contributions of the Cairo Programme of Action. This thinking shifts the focus of our analysis of
health away from simply biomedical, clinical, or technical responses to the social relationships that
shape health outcomes. Increasingly, the common denominator of successful programs is that they
pay attention to the relational components of sexual and reproductive health. There is an obvious
clinical rationale for providing services to both men and women. But the more clearly we
understand health outcomes as resulting from social and economic relationships, the more all of our
program responses can address these first causes rather than just the clinical “symptoms” of poor
sexual and reproductive health.
 27

Dr Ashok Sahni (2001): Approximately 36 million (35% of the total population of 1025
million) in the country, consists of youth (between 15-24 years as per WHO definition). In 1981, the
youth population was approximately 125 million and 171 million at the beginning of 1991. It was
over 230 million at the beginning of 2001. Keeping in view the important role which the youth can
play towards national development as well as the emerging health problems of the youth, WHO
declared 1985 as the International Youth Year. In the last few years, due to socio-economic and
political factors, there have been increasing health problems among the youth: unemployment,
suicide, alcoholism, sex-related offences and general adjustment problems in the youth. Today, the
youth in India form one of the most vulnerable groups, who on the one hand are expected to be the
leaders to determine the destiny of India, and on the other hand, are an exploited and confused
group. This paper outlines the major stresses which the youth in India experience. It outlines some
suggestions which the society and the youth could use towards better adjustment, productivity, and
health of the youth. It also outlines some suggestions for schools and parents for creating an
environment at home and schools for adjustment of the youth.
Shireen J. Jejeebhoy and Mary Philip Sebastian (2003): This review highlights the
huge gaps in knowledge that remain. To make informed policy decisions, we need more social
science and operations research to understand how the situation and needs of different groups of
adolescents—married and unmarried, girls and boys, older and younger. Equally, we need to better
understand whether and why their sexual and reproductive health needs remain unmet, why
informed choice continues to elude them and how services should be structured to overcome the
social, cultural and economic constraints they face.

KG Santhya and Shireen J Jejeebhoy (2007): This paper presents an overview of key
policies and government programmes intended to reduce HIV vulnerability and improve sexual and
reproductive health among young people in India, and identifies the extent to which these policies
and programmes have addressed the gamut of unique sexual and reproductive needs of young
women and men. It also explores the extent to which programmes have been adapted to
accommodate state-level differences in the sexual and reproductive vulnerability of youth; the
review takes the examples of two states, namely, Andhra Pradesh, characterised by both early
marriage and high HIV prevalence, and Madhya Pradesh, characterized by early marriage and low
rates of HIV. The review focuses on four programme dimensions: awareness building, service
provision, reducing gender disparities and developing a supportive environment. Findings suggest
that significant strides have been made in articulating a commitment to addressing many of the
sexual and reproductive health needs of adolescents and youth. However, there remains a
 28

considerable schism between the commitments made in policies and programmes, the
implementation of these commitments and the reality of young people’s lives in India. At the state
level too, the implementation of programmes to meet these commitments varies considerably.

IIPS and Population Council (2007): The objectives of the Youth Study were
to identify key transitions experienced by youth, including those pertaining to education, work force
participation, sexual activity, marriage, health and civic participation; provide state-level evidence
on the magnitude and patterns of young people’s sexual and reproductive practices in and outside of
marriage as well as related knowledge, decision-making and attitudes; and, finally, identify key
factors underlying young people’s sexual and reproductive health knowledge, attitudes and life
choices. Findings from the study are expected to guide policy, programmes and advocacy on youth
issues, enable programmes and policies to recognize the heterogeneity of youth in India, and
provide important base-line indicators against which the long-term impact of programmes may be
measured. The Youth Study focused on married and unmarried young women and unmarried young
men aged 15–24 and, because of the paucity of married young men in the younger ages, married
men aged 15–29, in both rural and urban settings. The study was conducted in Andhra Pradesh,
Bihar, Jharkhand, Maharashtra, Rajasthan and Tamil Nadu; these states were purposively selected to
represent the different geographic and socio-cultural regions within the country (see Figure 1.1).
Indeed, these six states together represent 39% of the country’s population. This report focuses on
the consolidated findings from youth interviewed from all six states.
 29

RESEARCH METHODOLOGY

The behavioral revolution in social science no doubt a new awareness among the
sociologists to undertake empirical study to substantiate the ground theory enunciated by them.
Since then there is a continuous attempt to resort to empiricism. As empiricism itself demands the
use of systematic well designed method, sociology in due course has developed an array of methods
that provide validity to observation as well as ensure accuracy to the conclusion. The present
chapter therefore concentrates and delineates the methodology adopted in the present research
work.

Methodology is a systematic procedure through which the researcher has proceeded to arrive at
some valid conclusion. It basically spells out the objective of the researcher, the hypothesis taken,
the scope of the study, the universe taken, the sampling adopted and the method of data collection.
These elements clearly reflect the intention of the researcher and the intensity of the study. The
methodology of the present work is delineated in the following style.

OBJECTIVES OF THE STUDY

The objective is an integral part of any research project. It helps the researcher in prefixing the
area which needs to be ventured into. It makes the study systematic, economical and less time
consuming. Viewed from such perspective the following objectives are delineated:
 To trace out the socio- economic affiliations of the sample youth of urban slums.
 To locate the degree of awareness of the respondents’ about Reproductive Health
Programme( Knowledge about Reproductive Health)
 To trace out the magnitude and patterns of young people’s sexual and
reproductive practices in and outside of marriage as well as related
knowledge, decision-making and attitudes.
 To identify key factors underlying young people’s sexual and reproductive
health knowledge, attitudes and life choices.
 To solicit opinion and suggestions of youth relating to their ideas to revamp the reproductive
health programme and make it more youth oriented programme.

SCOPE OF THE STUDY

 30

Scope refers to the area and the arena of analysis. Scope delimits the study area and the dimension
from which the analysis can be made. So it is always desirable on the part of the researcher to
decide the contours of the research otherwise right from the beginning the research will become
haphazard, time taking and uneconomic in character. The scope of the present study can be divided
into two parts:
1. Intellectual Scope
2. Geographical Scope

As for as the intellectual scope of the topic is concerned, the focus in on the issue of youth reproductive
health in slums.

The geographical scope of the present study is limited to the urban slums in Bhubaneswar, the
capital city of Orissa. To be more focused the study is concentrated to the Buddha Nagar Slum.

HYPOTHESIS
The present study is based on the following hypothesis.
 The educational qualification and empowerment of the youths contribute to increase the
level of awareness regarding Reproductive Health
 Mass media plays an important role for increasing the level of awareness about
Reproductive Health among the youth
 Government need to be more focused in terms of reaching out to people for awareness
generation and implementation of different health related programmes specially with the
involvement of the youth

UNIVERSE AND SAMPLING

The entire area that the researcher selects for analysis and research is known as the universe of the
study. In the present study Buddha Nagar Slum, Bhubaneswar has been taken as the universe.

A sample design is a definite plan determine before any data are actually collected for
obtaining a sample from a given population. This present study can be sample by the method of
purposive sampling and random sampling and the case participant are inevitably scattered about
diverse points of congruence. In the random sampling procedure the researcher took 30 sampling
from the Subash Nagar slum.
 31

RESEARCH DESIGN
Research Design formulates one of the cardinal requirements of any project. It is an outline of the
plan from collection and analysis of data. It spells out the method to be collected during the study
with the minimum expenditure of time, money and power. Research design always helps the
researcher to proceed in a systematic direction for data collection and its efficiency lies in helping
the researcher in collecting the most effective data needed for the purpose of study.

TOOLS AND TECHNIQUES OF DATA COLLECTION

The present study took recourse to both primary and secondary method. But generally the tools and
techniques of data collection have to be decided according to the objectives and nature of research
as well as the recourse at disposal.

The researcher made an initial start with the secondary method of data collection that gave an
extensive idea to the researcher to formulate the schedule and to imagine and to go into the various
dimensions and aspects in the field study. The secondary method mainly pertained to making an
extensive literature revision on the topic of the study as well as making an analysis of the statistical
recorded in various governmental offices. The review is made from existing books, journals, and
also internet sources.

In the present study primary data collection was done by two methods namely observation and
interview method. The purpose of resorting to the interview schedule was to get more realistic
response from the respondents. Its preparation was done through a pre-study that gave a primary
idea of the perspective questions to be included in it. Accordingly the schedule was prepared and
designed.
The researcher has also taken recourse to the method of observation because many a times
observation with keen insight of the nearby surroundings and the personal experience and the
gesture of the respondents work effectively to reach at the truth and drawing effective conclusion.

BUILDING RAPPORT WITH THE RESPONDENTS

For the purpose of collecting reliable and genuine data it is imperative that there exist good
communication and rapport between the respondents and the investigator, particularly in case of
interview method. The possible effort should be made to establish proper interaction of the
 32

respondents. The investigator should have within him/her the patience to listen to the respondents.
He/ she should ensure that his/her presence is not intimidating to the respondents and it does not
make them uncomfortable. If that happens, then the respondents become uncooperative thus
hampering the entire research.

In the present study researcher went about his task very carefully so as not to alienate them in any
way. He has managed to carefully analyze the case of respondents and succeeded in collecting
reliable data from them.

LIMITATIONS OF THE STUDY

Despite doing careful analysis of various aspects of Reproductive Health several hurdles and
limitations marred the researcher. These limitations are as follows

 Though the study pertained to the study of youth of slums in Bhubaneswar, the researcher was
compelled to confine his study only to a limited area
 There is a paucity of data and earlier studies relating to the problems of slum youth regarding
reproductive health in Bhubaneswar.
 The study is very broad and complex one but owing to time constraint it was severally confined and
limited.
 Perhaps the greatest limitation was the fact that cooperation forms the respondents was not
forthcoming. Extracting cooperation and information from them proved to be difficult for the
researcher.
 Most of the respondents were hesitant in answering the questions as they thought these things need
not be discussed in public
 The sample 30 respondents were also not adequate for studying such a vast and complex problem of
Reproductive Health among slum youths

DEMOGRAPHIC PROFILE OF THE ARE

 33

Before proceeding to address the problem under study and its manifestations in the empirical setting
it becomes pertinent to introduce the state and the area that is in focus in the entire study process
because in many occasions it is noted that the context conditions, attempt includes the study area
and to highlight on the study area itself.

In the attempts to provide the demographic profile certain key factors are led stress upon. They are
the geographical locations, the demography, the economy, the polity, the infrastructural
arrangements, the socio- cultural environment etc

About slum:
A slum is overcrowded part of the city. People come from different places
and communities for their income business education and stays at the slum. They
build their houses out of loose bricks, slicks bamboo or metal sets polythine etc.
Newly there are 7 slums are created in the town Bhubaneswar. The total
slum in Bhubaneswar will around we worked at Budhanagar slum from 3 months
described from Budhangar slum.
1. Population :
Budhanagar is a well famous slum in Bhubaneswar. The population of the
Budhanagar 16,000 and the number of house hold are 2500. Budhanagar is not
build in a day according to the councilor of Budhanagar. It is established near about
50 years ago people of different communities, religion, caste have come and settled
here minimum have come from Andhra Pradesh, Ganjam, Berampur etc.
2. Religion :
Religion composition in an important component of the society. Different
person belonging to different religions.
3. Educational status :-
Slum people are more conscious about the education of their children but
there is no facility of government school. Children are facing many problems. Most
of them are reading in the school, which are provided by the NGOs. The maximum
people are daily wage laborer. So they are unable ot send their children in higher
studies, but they cannot, due to lack of money. In spite of low income some send
their children for higher studies to the institutions the KIIT, NIIT, B.K.B. College,
Vanivihar, and Ramadebi College etc. Due to lack of government support the
problem arises for dropout.
 34

4. Occupational structure:-
Occupational structure is an important to find out various modes of income
attached to society for the national economic survey the person within the age 15-
59 are categories under force community. Occupation is an important parameter to
find out various modes of income attached to society for the national economic
survey the survey the person within the age group 18-51 are categorized under
working force community. The various modes of occupation reported during out
data collection highest number of both male and female and daily labour.
5. Location :
The “Budhanagar Slum” is located at Kalpana Square, Bhubaneswar. The
proper location of the slum is situated behind the Bhubaneswar Railway station.
The geographical area of the slum up to the starting paint of station Bazar. This
slums is nearer the Railway track.
6. Housing pattern :
In Budhanagar various house pattern can be found. Houses are made up of
brick wall which is jointed with mud and roof is covered with palm leaf and
polythene. There are also building used have been identified. In most of cases
houses are covered by tarpaulins . The main reason behind this pattern is to get
protected from the heat of the slum the doors are low in height where as in some
cases.
Problem of the slum dwellers:
Life in a slum is very hard to imagine over crowding means that provably is
impossible water supply and sanitation virtually non existence some major
problems of slum dwellers are discussed below :
(A) Unsuitable land for settlement :
Slum colonies usually settle on the land which are un-suitable for live
drainage facility is poor and piles garbage’s are found in the studies of around. The
land can also easily boggy and covered in mud.
(B) Black of proper medical facilities :-
The slum dwellers of Budhanager also face the problem of medical facilities.
They suffer from many respiratory diseases. But due to lack of medical facilities
and poverty then often avoid going for a doctor. The mother also does not know
how to communize the small baby and when to give preventive does.
 35

(C) Unhealthy environment :-

The physical environment also causes problems. There is a serious shortage
of basic amenities of drains are not properly covered and so stagnant water
connects. Forming a breeding ground of malaria and dangerous fever. This create
unhealthy environment of slum dwellers.
(D) Drug addiction :
Drug addiction is the main problem in slum area. There is high concentration
of drug abuser, alcoholics, criminals and juvenile deliguency.
(E) Lack of family planning awareness :
Due to poverty, illiteracy unawareness and superstitions towards family
planning method people of slum don’t agree to accept the problem they facing.
(F) Health condition :
There is no proper drainage system. Slum people throw their waste products
not only at the side of luster but within the any where in periphery of the area.
Utilization of waste water creates unhealthy condition and harmful diseases like
malaria, jaundice cholera etc.
(G) Lack of water :
Through B.M.C. provided water supply for slum dwellers of Budhanager till
they face many problems. Because tap system of water don’t continue its actual
flew in a day as result during the stopped water supply period they wait till starting
period. The previously stored water in their respective houses does not fulfill water
requirement.
(H) Drainage wter :
There is no proper drainage system provided by B.M.C. as a result water
does not flow properly and it stores in low level land as it creates many harmful
dangerous disease is like creates malaria, chickengunia, chickenpox dangue,
Jaundice etc. It also unhealthy environment.
(I) Lack of electricity :
People are facing low voltage of electricity. There is no proper light facility
provide by the Government. People are facing may difficulties on light. There is no
street coordinated in slum road side.

DATA INTERPRETATION AND ANALYSIS

 36

One of the elements of our social structure is caste system. This caste system has not only ordained
a differentiated social structure on the basis of astrictive criterion of birth but it has also prescribed a
rigidly defined pattern of social interaction, commensality, reciprocity and mutual obligation. The
distribution of the respondents on the basis of caste are made under four categories such as General
caste, Scheduled caste, Scheduled Tribe and Other backward Class in the following table
Table No- 5.1
Distribution of respondents on the basis of category N-30
SL.
NO. CATEGORY RESPONDENT PERCENTAGE(%)

1 GENERAL 18 60

2 SC 7 23.33

3 ST 2 6.67

4 OBC 3 10

TOTAL 30 100

From the above table it is found that 60% of the respondents belong to the general caste whereas 23.33% of
the respondents belong to Scheduled Caste category followed by 10% from OBC category and 6.67% of
Scheduled Tribe category

EDUCATIONAL QUALIFICATION:

Education is one of the major tools which provide individuals the necessary qualification to
fulfill economic roles and consequently improve their socio- economic status. In case of women
education, particularly higher education has much importance as it provides them not only requisite
equipment and training for their future economic participation, but it also acts as a revolutionary
force which is expected to liberate them from their subjugation and exploitation. Hence more
number of educational qualifications will better the overall health status of the respondents and their
family. Thus the educational qualifications of the sample women and their husbands’ have been
stated in the following tables.

Table no- 5.2

Distribution of Respondents on the basis of Educational Qualification

N-30
 37

QUALIFICATI RESPOND
SL. NO. ON ENT PERCENTAGE (%)

1 PRIMARY 2 6.67

2 SECONDARY 3 10

MATRICULATI
3 ON 4 13.33

UNDER
4 GRADUATE 5 16.67

ABOVE
5 GRADUATE 16 53.33

TOTAL 30 100

The above table shows that 13.33 percent of the respondents were matriculate as against 6.67
percent who have completed their primary education, 10 percent respondents have completed
secondary education, 16.67 percent are undergraduate and 53.33 percent of the sample youth are
graduate and above

TYPOLOGY OF FAMILY:

Family plays an important role in a country like India. Here the types of families are taken as joint
family, nuclear family and in case if the respondents are staying alone which is shown in the Table
no- 5.3

Table No- 5.3

Distribution of Respondents on the basis of Type of family

Sl. No Type of Family No. of Respondents Percentage

1 Nuclear family 15 50
2 Joint family 12 40
3 Single Headed 03 10
Total 30 100
 38

The above table shows that 50 percent of the sample respondents reside in nuclear families whereas
40 percent respondents live in joint families and 10 percent of the respondents live alone.

OCCUPATION:
In modern urban society occupation and income are two very important factors in the determination
of an individual’s status. Not only is the nature of occupation and amount of income but even
individual’s specialization in it the important contributing factors in deciding the socio- economic
status. Here under the occupational structure the categories have been made by taking the
occupation, sector of work of both the sample women and their husbands in the following tables.

Table No- 5.4

Distribution of respondents on the basis of their Occupation
N- 30

Percentage(
Sl. No Occupation No. of Respondents %)
EMPLOYEED 15 50
1
UNEMPLOYED 15 50
2
Total 100 100

From the above table it is clear that 50 percent of the respondents are employed whereas only 50
percent of youth

MONTHLY INCOME:

Money is the basic need of everyone’s life for basic sustenance and also for maintaining a good
standard of living. The monthly income of a family determines its economic well being and access
to different facets of life. Here the monthly income of all the sample household and also those
sample women, who are working have been recorded under the following tables.

Table No 5.5
Distribution of respondents on the basis of their Monthly Income

N- 15
 39

Monthly
Sl.No Income No. of Respondents Percentage
BELOW 10000
1 05 40
10000-20000
2 09 60
20000-30000
3 00 0

Total 15 100

The above table has come up with the following results

 Out of the sample youth interviewed 15 respondents were found to be working among
whom 60 percent respondents have income in between Rs. 10000- Rs. 20000

 40 percent respondents have income in between below Rs.10, 000 which shows that most of
the youth do not have very high monthly income.

Table No- 5.6

Distribution of respondents on the basis of Accessibility to television

N- 30

RESPONDE PERCENTAGE (IN

SL. NO. TV SHOWN NT %)

1 YES 24 80

2 NO 6 20

TOTAL 30 100

This table shows that 80 percent of the respondents have accessibility to television where as there are still 20
percent of the respondents who do not have this facility

ACCESS TO ANY MEANS OF MASS MEDIA

In the present day society mass media plays an important role in influencing the behavior of the youth in
terns of exposure through different programmes and advertisements. In the present study 30 respondents
 40

have been interviewed regarding the access to any means of mass media and the frequency of use of those
means which is shown in the following tables

Table No- 5.7

Distribution of respondents on the basis of access to different means of mass media

N-30

RESPOND
SL. NO. MAS MEDIA ENT PERCENTAGE

1 YES 28 93.33

2 NO 2 6.67

TOTAL 30 100.00

Table No- 5.8

Distribution of respondents on the basis of frequency of use of the mass media

N-28

USING MAS RESPOND PERCENTAGE

SL. NO. MEDIA ENT (IN %)

1 Rarely 10 35.72

2 OFTEN 6 21.42

VERY
3 FREQUENTLY 12 42.86

TOTAL 28 100.00

This table shows that 42.86 percent of the youths are using the media very frequently for getting knowledge
about youth reproductive health as against 35.72 percent youths who rarely use media for any awareness on
Reproductive Health.

AWARENESS REGARDING REPRODUCTIVE HEALTH BEHAVIOUR

Reproductive health is a state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity, in all matters relating to the reproductive system and to its functions
and processes. Reproductive health therefore implies that people are able to have a satisfying and
 41

safe sex life and that they have the capability to reproduce and the freedom to decide if, when and
how often to do so. Implicit in this last condition are the right of men and women to be informed
and to have access to safe, effective, affordable and acceptable methods of family planning of their
choice, as well as other methods of their choice for the regulation of fertility which are not against
the law, and the right of access to appropriate health care services that will enable women to go
safely through pregnancy and childbirth and provide couples with the best chance of having a
healthy infant.

Awareness regarding reproductive health ensures better health condition among women. This
chapter deals with the awareness of the sample women regarding reproductive health care which is
discussed in the following tables

Table No- 5.8

Distribution of Respondents on the basis of idea about Reproductive Health

N-30

IDEA ABOUT
REPRODUCTI RESPOND
SL. NO. VE HEALTH ENT PERCENTAGE

1 YES 20 66.67

2 NO 10 33.33

TOTAL 30 100.00

From the above table it is clear that 66.67 percent of the respondents have awareness about Reproductive
Health whereas still there are 10percent of the respondents who do not have any idea about reproductive
Health

Table no-5.9

Distribution of respondents on the basis of knowledge about reproductive health and other
aspects of Reproductive Health Behaviour

N-30

Sl. Awareness on the No. of Total Percentage Total

No following Respondents
 42

Yes No Yes No

1 Puberty 25 05 30 83.33 16.67 100

Knowledge about family

2 planning method 28 02 30 93.33 6.67 100
knowledge about the use
3 of contraceptive 27 03 30 90 10 100
aware about the
development of secondary
4 sexual characteristics 21 09 30 70 30 100

5 RTI and STI 21 09 30 70 30 100

awareness about
reproductive health
6 outcomes 12 18 30 40 60 100
7 Awareness about youth 09 21 30 30 70 100
lead programmes

From the above table it is pertinent that the youth in the slum have got a good awareness level regarding
Reproductive health and the issues related to Reproductive health such as puberty, family planning method.
But awareness regarding the youth related and lead programmes about Reproductive Health are average
where only 40 percent of the respondents have got awareness regarding the programmes.

OPINIONS:

Opinion of the respondents is of utmost importance with regard to the subject where the respondents were
asked about the necessity of sex education, person by whom sex education to be imparted, importance of TV
and Media in imparting education regarding Reproductive Health issues which is being depicted in the
following tables

Table No-5.10

Distribution of Respondents on the basis of influence of Television

N-30

RESPOND PERCENTAGE
SL. NO. AWARENESS THROUGH TV/FUNS ENT (IN %)

1 YES 29 96.67

2 NO 1 3.33
 43

TOTAL 30 100.00

96.67 percent of the respondents have opined that television has influenced the awareness level on
reproductive health.

Table no 5.11

Distribution of Respondents on the basis of receipt of sex education by family

N-30

SEX EDUCATION BY
SL. NO. FAMILY RESPONDENT PERCENTAGE

1 YES 4 13.33

2 NO 26 86.67

TOTAL 30 100.00

Table no- 5.11

Distribution of Respondents on the basis of necessity of sex education

N-30

RESPOND PERCENTAGE
SL. NO. NECESSARY OF SEX EDUCATION ENT (IN %)

1 YES 30 100.00

2 NO 0 0.00

TOTAL 30 100.00

This table has shown that all the youths feel the necessity of imparting sex education and awareness about
reproductive health by family, friends, TV or any other means.

Table No- 5.12

Distribution of respondents on the basis of imparting sex education

N-30
 44

BEST PERSON PROVIDE SEX RESPOND

SL. NO. EDUCATION ENT PERCENTAGE

1 PARENTS 3 10.00

2 TEACHERS 10 33.33

3 HEALTH CARE PROVIDER 11 36.67

4 ALL 6 20.00

TOTAL 30 100.00

Above table give the idea about the opinion of the youth where 36.67 percent of the youth feel that the best
person to impart awareness on Reproductive Health is the health acre provider whereas 33.33 percent of the
respondents that sex education can be imparted through in the best manner by the teachers.

SUMMARY AND CONCLUSION

Reproductive health is a state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity, in all matters relating to the reproductive system and to its functions
and processes. Reproductive health therefore implies that people are able to have a satisfying and
 45

safe sex life and that they have the capability to reproduce and the freedom to decide if, when and
how often to do so. Implicit in this last condition are the right of men and women to be informed
and to have access to safe, effective, affordable and acceptable methods of family planning of their
choice, as well as other methods of their choice for the regulation of fertility which are not against
the law, and the right of access to appropriate health care services that will enable women to go
safely through pregnancy and childbirth and provide couples with the best chance of having a
healthy infant. In line with the above definition of reproductive health, reproductive health care is
defined as the constellation of methods, techniques and services that contribute to reproductive
health and well-being by preventing and solving reproductive health problems. It also includes
sexual health, the purpose of which is the enhancement of life and personal relations, and not
merely counseling and care related to reproduction and sexually transmitted diseases.

This piece of work entitled “Awareness about Reproductive Health Behaviour among youth
with special reference to an Urban Slum” deals with various aspects of Reproductive Health,
Reproductive health outcomes, reproductive rights, men’s involvement in the reproductive health
pregrammes and developmental policy and programmes, awarenss about reproductive health
behavior and participation, opinion and suggestions.

The first chapter deals with the introduction of the dissertation which carries certain theoretical
concepts about Reproductive Health which are such as: Reproductive Rights, Knowledge about the
sexual and Reproductive Health Behaviour and health of men in developing countries,
Reproductive health outcomes, Underlying risk and protective factors, Changing policy and
programme environment.

The second chapter deals with the Review of Literature. The various studies undertaken by
different researchers and the source materials have been included in the review of literature.
The third chapter concerns with the Research Methodology. Methodology is the way to
systematically solve the research problem. The research methodology of this dissertation consists of
the following research such as objectives of the study, scope of the study, formulation of hypothesis,
universe and sampling procedure, research design, tools and techniques of data collection, building
rapport with the respondents, dimension of analysis and the last step is limitations of the study.
The fourth chapter deals with the Demographic profile of the area which gives an idea about
the geographical location and features of Orissa, Bhubaneswar and then about Buddha Nagaar Slum
The next chapter deals with the interpretation and analysis data collected from the youths
on various aspects.
 46

CONCLUSION:
Most fundamentally from the above analysis it can be concluded that women’s education and
social status is one of the important determinant of Reproductive Health Scenario.

The awareness level on Reproductive Health is quite good among the slum youths which are
directly related to their social surrounding. Participation in different Reproductive activities is
vividly depicted in some cases but when observed carefully,

As far as the government programmes are concerned it is found that many youths are still
unaware about the Reproductive Health Programmes.

Thus the initial hypothesis formulated at the outset is justifiably asserted by the prevalence of
such factors so as to reinforce the dominant undercurrents that accompany the awareness level
associated with the reproductive health scenario of the slum youths.

SUGGESSTIONS:

Out of many problems that affect our society, problems related to health with special reference to
Reproductive Health is one of them. Long term plans and programmes need to be implemented both
by the State Governments and the NGOs. The suggestions regarding the impact of Awareness on
Reproductive Health of the Youths in slum are as follows:

 Youth education and economic empowerment needs to be focused

 Youths need to be aware about the Reproductive Health Behaviour and its replication for
their health

 Not only awareness but also meaningful participation on the part of the youths has to be
taken care of.

 Sensitizing Governments, NGOs, UN agencies and donors on Reproductive Health issues.

 Alleviating poverty and ill health of youths and addressing their problems.

 Community based work need to be revamped for the improvement of the health scenario of
the youths

 Proper implementation and monitoring of the Reproductive Health Programmes.

Health sector reform can have either positive or negative impacts on reproductive
health, whether deliberately or not. Provisions will, therefore, be needed in health sector reform to
 47

protect reproductive health goals and reproductive health proponents will need to become effective
advocates for these goals. In order to do so, reproductive health people need to understand and learn
the language of health sector reform and how to use these tools to effectively to achieve
reproductive health goals.

BIBLIOGRAPHY
 48

1. Kanbargi Dr. Ramesh - “ Health and Development in India: Trends and Prospects”,

Concept Publishing Company, (1997) New Delhi.

2. Mahapatra Mihir Kumar & Raj S.N. Rajesh - “ Health Scenario in India:

Progress and Challenges”, (2007) New Delhi

3. Murugesan P. - “Health System in India: Present situation and future perspectives”,

(2007) New Delhi.

4. Reddy P.R. & Chandrashekhar K. - “Health & Nutritional Status and Quality of

Life”, (1998) New Delhi.

Sonfield Adam – “Looking at Men's Sexual and Reproductive Health Needs” (2002), New
York
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