Creating Respectful Healthcare Systems for Adolescents

The Covid-19 pandemic has been life altering. It significantly affected the lives of all the people around us, and young people faced a unique set of challenges. Being an adolescent myself, being well-connected with my peers, and also being associated with a country-wide youth network on adolescent health enabled me to develop a strong understanding of the situation. As a part of the STEPS youth network, we conducted a rapid needs assessment amongst young people across diverse backgrounds to gauge the effects on their overall health, education and basic needs during the national lockdown. I contributed to this process by adding things I personally faced as well as highlighting the issues faced by my peers. With similar contributions from almost 100 young people across 25 states and 6 Union Territories of the country, a report was created, and disseminated to the health ministry officials. After the lockdown, I was part of an engagement on psycho-social well-being of young people through which I developed a further understanding of issues. My reflections are based on these various experiences.

I felt that the disruption from the normality of a routine and a balanced and regular life led to lost thoughts and unhealthy coping strategies amongst most adolescents, like self-harm and drug abuse. I perceived that young people from all backgrounds, both urban and rural, were unable to get the right kind of help and guidance when it came to coping with the pandemic, and it led to numerous mental illnesses and ultimately, loss of lives due to suicide. In this article I would like to focus especially on the challenges in accessing SRH and mental health care services that young people faced.

A handful of my peers faced an increase in mental health issues due to the lockdown. There has been an increase in anxiety as there is uncertainty about the future, and stress related to academics. Some of my classmates have been unable to cope with the isolation of the lockdown. Adjusting to a new form of learning via online classes has also been an arduous task for most of us. I know of young people from rural areas who have been unable to access online classes due to irregular or no internet supply, and lack of access to devices. This has hindered their ability to understand their lessons, and in turn has added to their stress and pressure that they won’t be able to perform well in their exams.

While some of them resorted to self-harm, went into depression, had an increase in anxiety and panic attacks (due to lack of access of therapy), some even succumbed to suicide. We were just confined to our homes and detached from our friends whom we used to meet in schools and in our localities. Even though online classes were there, our regular routine was disrupted. All these often got replaced with an increase in social media time and its consequent lethargy played a major role in precipitating the mental health issues young people faced. Adequate awareness on the issues faced by adolescents was lacking even before the pandemic. During the pandemic and consequent lockdown too, it was assumed that adolescents are a ‘healthy population’ and do not require much attention. It was understandable that immediate focus was given to populations at higher risk of contracting COVID-19, which is important, but there was inadequate recognition that young people (including adolescents) are dealing with health issues, specifically mental health. This certainly aggravated the situation and there’s a pressing need to address it.

I have seen that adolescents like me were often unable to find the right kinds of safe spaces to communicate our distress and dilemmas. For most young people, neither their parents nor their teachers are well-informed about mental health and well-being and thus often fail to identify these and offer support. Furthermore, there is lack of proper mental health professionals. Due to the lockdown, most mental health professionals switched to online platforms to provide guidance and counseling. However only people who could afford online services or had good internet facilities could access them. For young people from rural areas, it was harder to access the right kind of mental health care services due to low awareness around mental health, the stigma around it, the lack of financial aid and challenges of internet access. Other challenges included the lack of privacy to discuss issues with a counselor/therapist while being at home, as well as a sense of disconnect in the absence of in-person sessions. A lot of adolescents who used to heavily rely on counselling sessions before the pandemic to get through difficulties and challenges they faced, couldn’t access them during the lockdown and it worsened their mental health issues.

There has also been disruption in access to SRH needs due to inadequate supply of quality services, as there was a complete lockdown for a very long time. A lot of adolescents were unable to get access to basic contraceptives and menstrual hygiene equipment as well as abortion pills and surgeries. This led to unwanted pregnancies and a lot of menstrual health issues. In rural areas, affordability of sanitary napkins is a huge problem, and most women use unhygienic substitutes which leads to numerous health problems, and sometimes even lead to death. The lockdown affected the timely supply of sanitary products to all parts of the country, especially remote areas.

While there are Adolescent Friendly Health Clinics (AFHC) [1] in the country, most adolescents are unaware of them because they are not promoted, or do not function well. Even before the pandemic, adolescents were uncomfortable to go to these clinics to share their problems and concerns as the professionals at these clinics are judgmental. There is a stigma around status, age and background that hinders the availability of quality and respectful health care services that young people should be able to access. I know of young people who have been shamed and judged for trying to get condoms and pregnancy kits.

There is a long way to go for adolescents to be provided with stigma-free, free or affordable healthcare services. Awareness about adolescent health issues, including SRH, should be made compulsory at the school-level, and should be incorporated in the syllabus. Most adolescents are unaware of their bodies and need to be educated about them, without stigma. Policies around AFHCs need to be strengthened and implemented in the right way. Training sessions for doctors in AFHCs, and teachers in schools need to be conducted in order to sensitise them about the issues adolescents face and ensure that they are non-judgemental when interacting with adolescents.

It is time for us to emphasize the diverse and nuanced needs of adolescents and youth in order to address the challenges effectively without being deprioritized. Young people need an enabling environment which ensures adequate conversations around our needs, acknowledges our unique concerns and offers non-judgmental optimal care. Though we are often referred to as the ‘future of the nation’, young people are also the leaders of today. Providing quality health care services and ensuring they are safe and healthy is the responsibility of the government, and it must be held accountable for it. In spite of promising initiatives, there has been glaring gaps in the focus given to adolescent health issues, including providing them with requisite information, commodities and services. The pandemic situation has accentuated these gaps and thus reiterated the need of these critical provisions to advance the health and well-being of young people.

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[1] A dedicated centres in a health facility where usually a counselor is available to
address adolescent health related issues