1 A Case Study of Jharkhand, India August 2012 Are Young Women in India 2 Prepared to Deal with Sexual and Reproductive Health Issues? Ipas Development Foundation is a non-profit organization that works in India to increase women’s ability to exercise their sexual and reproductive rights, especially the right to safe abortion. We seek to eliminate unsafe abortion and the resulting deaths and injuries and to expand women’s access to comprehensive abortion care, including contraception and related reproductive health information and care. We strive to foster a legal, policy and social environment supportive of women’s rights to make their own sexual and reproductive health decisions freely and safely. Ipas Development Foundation (IDF) is a not-for-profit company registered under section 25 of The Indian Companies Act 1956. Ipas Development Foundation (IDF) E 63 Vasant Marg, Vasant Vihar New Delhi 110 057, India Phone: 91.11.4606.8888 Fax: 91.11.4166.1711 E-mail: [email protected] © 2013 Ipas Development Foundation Suggested Citation: Banerjee Sushanta K, Janardan Warvadekar, Kathryn L. Andersen, Paramita Aich, Bimla P. Upadhyay, Amit Rawat and Anisha Aggarwal (2013). Are Young Women in India Prepared to Deal with Sexual and Reproductive Health Issues?: A Case Study of Jharkhand, India. New Delhi, Ipas Development Foundation, India. Graphic Design: Write Media Produced in India 3 Are Young Women in India Prepared to Deal with Sexual and Reproductive Health Issues? A Case Study of Jharkhand, India August 2012 Sushanta K. Banerjee Janardan Warvadekar Kathryn L. Andersen Paramita Aich Bimla P. Upadhyay Amit Rawat Anisha Aggarwal Are Young Women in India 4 Prepared to Deal with Sexual and Reproductive Health Issues? Table of Contents A Case Study of Jharkhand, India August 2012 EXECUTIVE SUMMARY ......................................................................................................................................................5 INTRODUCTION ................................................................................................................................................................9 1.1 Background ......................................................................................................................................................9 1.2 Rationale for the study ...................................................................................................................................11 1.3 Key research questions ..................................................................................................................................11 1.4 Scope of the pilot intervention .....................................................................................................................11 1.5 Structure of the report ..................................................................................................................................12 STUDY DESIGN ................................................................................................................................................................13 2.1 Methods of data collection .............................................................................................................................13 2.1.1 Sample implementation ........................................................................................................................13 2.1.2 Survey instrument .................................................................................................................................13 2.2 Ethical considerations and training ................................................................................................................14 2.3 Analysis and measures ....................................................................................................................................14 PROFILE OF YOUNG WOMEN .........................................................................................................................................16 3.1 Socio-demographic and economic characteristics .........................................................................................16 3.2 Media exposure and access to SRH information ............................................................................................18 AGENCY AMONG MARRIED AND UNMARRIED YOUNG WOMEN .................................................................................20 4.1 Involvement in decision-making ....................................................................................................................20 4.2 Access to financial resources ..........................................................................................................................21 4.3 Freedom of movement ...................................................................................................................................21 4.4 Self-efficacy .....................................................................................................................................................23 4.5 Factors influencing agency .............................................................................................................................24 Awareness OF SexuaL AND REPRODUCTIVE HEALTH ISSUES ...................................................................................26 5.1 Awareness of sex and pregnancy-related issues .............................................................................................26 5.2 Awareness and knowledge of contraceptive methods ...................................................................................26 5.3 Awareness of abortion ....................................................................................................................................27 5.4 Factors influencing awareness of SRH issues: A multivariate analysis ...........................................................30 REPRODUCTIVE HISTORY AND UTILIZation OF REPRODUCTIVE HEALTH Services AMONG YOUNG MARRIED WOMEN .............................................................................................................................................32 6.1 Birth history and pregnancy outcome ...........................................................................................................32 6.2 Wantedness of pregnancies ............................................................................................................................32 6.3 Use of contraception ......................................................................................................................................34 6.4 Utilization of reproductive and adolescent health care services ...................................................................35 DISCUSSION AND Recommendations .......................................................................................................................37 REFERENCES ....................................................................................................................................................................41 APPENDIX ........................................................................................................................................................................43 Abbreviations ..............................................................................................................................................................54 5 Executive Summary There are 114 million young women aged 15 to the pregnancy, face postabortion complications and 24 years in India, comprising 20% of the female are more likely to delay seeking help for abortion- population. This magnitude does not only imply related complications than adults. According to the future strength of India in terms of social and WHO estimates, adolescent girls (10-19 years) in economic development; rather this young cohort developing countries undergo 2.2 to 4 million unsafe will lead demographic stabilization and quality of abortions every year and globally account for 70% life in future. Although, today’s youth are relatively of all hospitalizations from unsafe abortion. These better educated and exposed to modern technologies often lead to mortality and prolonged morbidity. of social communications, social vulnerabilities As estimated by WHO young women account for persist with marked influence of gender norms, early approximately 46% of unsafe abortion-related deaths interruption of school education, early marriage and every year. teenage pregnancy. Despite a strong policy on the minimum legal age at marriage, a sizeable proportion One way to address the gap between awareness of of Indian women get married before 18 years and sexual and reproductive health (SRH) issues and almost one-fifth of women in the age group of service availability and utilization is through youth- 15-19 years start child-bearing. For many youth, focused interventions. Several national policies and sexual and reproductive health-related experiences programs have committed to act on young women’s are uninformed and unsafe primarily because of lack SRH-related issues in India. However, available of awareness and skills in negotiating safe sex and evidence on implementation of such program is discussing reproductive health matters with their limited in India. Realizing these gaps, it is decided partners and parents. to pilot a youth-focused intervention to specifically address the information and service delivery needs