Closing the information gap amongst young people
By Pallavi Dhall, Associate Group Director and Priya Patil, Research Manager, Kantar Public, India
Every year, 6% of the adult population in India is diagnosed with sexually transmitted infections (STIs).1 This equates to more than 30 million infected people. Every year, a third of all pregnancies are terminated, which amounts to 15.6 million abortions, with at least 5% being unsafe abortions.2
Young people in India are enmeshed in an ecosystem that limits access to contraceptives and healthcare resources, and access to information about STIs and abortions. Social stigma around sex lies at the heart of the problem, alongside rampant misinformation, and a lack of both open discussion and school-based sexual and reproductive health (SRH) education.
Kantar Public was commissioned by The MTV Staying Alive Foundation to investigate the SRH challenges among young people and develop an impactful communications strategy for Season 2 of MTV Nishedh.
This popular ‘edutainment’ web series with a viewership of over 16.5 million, tackles various societal taboos and aims to inform young Indians aged 16-30 years about contraception methods, abortion, and verified SRH services available.
Misinformation about contraception increases the risks of STIs and unplanned pregnancies amongst the youth in India
Sexual and reproductive health and family planning are closely linked. Hence the study explored these two critical information areas in parallel, with the aim to uncover the whys and wherefores behind the unmet needs for support among women and girls of reproductive age.3
Fear of side effects and health concerns about contraception were found to be the primary barriers to family planning.4
This indicates a need to inform young people about the range and choice of contraceptives available, raise demand for these products, and ultimately empower young women to make informed choices about their sexual and reproductive health.
The study revealed that natural family planning is (dangerously) popular among the youth.5 Irrespective of marital status, young Indians rely heavily on this traditional method of contraception, as well as the consumption of food items (such as papaya or fenugreek) that are believed to reduce the risk of pregnancy.6
The prevalence of these beliefs and attitudes among young married people also explains the low uptake of modern contraceptives for family planning.7 This information deficit about the ineffectiveness of traditional methods of contraception, poses a high risk for unplanned pregnancy amongst the youth: teenage pregnancy in India stands at 6.8% among females aged 15-19 years.8
The research suggests that subjective factors, such as fear of stigmatisation around pre-marital sex or embarrassment, are the primary cause of the demand gap for modern contraception.9
These factors inhibit the accessibility of contraceptives, in particular, among unmarried young men and women. This demand gap is even more pronounced for contraception – such as contraceptive injections or intrauterine devices (IUDs) – that requires travel to healthcare facilities where the potential risk of encountering acquaintances or family members and being judged by them, further heightens anxiety.10
Embarrassment and fear of stigmatisation around pre-marital sex are the primary cause of the demand gap for modern contraception amongst young people in India.
Source: Kantar Public study for MTV Staying Alive Foundation, August 2021
At the same time, gender bias affects women’s access to contraceptives, due to a limited mobility irrespective of their marital status: only 29% of young women between the ages of 15-19 and 40% of young women in the age group of 20-24 are allowed to visit health facilities alone.11 Close networks with individuals in the vicinity intensify this fear of cultural taboo and stigmatisation, which contributes significantly to increasing the risk of STIs and unplanned pregnancies.
This gender bias is reflected in the stark contrast between the perceived ease of access for men to over-the-counter contraceptives, versus women – as highlighted in our study.
Gender bias affects women’s access to contraceptives, due to a limited mobility irrespective of their marital status.
Using information to empower SRH choices
The number of unsafe abortions in India suggests an information gap among young women and men. While there is awareness around medical abortion and the surgical termination of pregnancy, there is a significant lack of information about the gestational age limit for both procedures.12 Furthermore, young people are largely ignorant of abortion laws and legal requirements. At least 40% believe abortion to be illegal in India since they have never seen any publicised abortion-related information.13
This raises the risk of medical abortion pills being used by women without medical guidance. There is a clear need to inform young people about the common side-effects of medical abortion pills in order to reduce fears, and to clarify the factors that need to be considered to ensure safe usage (such as the mother's health, comorbidities, etc.).
Additionally, young people perceive family consent as a prerequisite for the legality of abortion.14 According to the youth – especially married women – this discretion does not lie with them. This illustrates women’s lack of information about their legal rights, which is causing them to endure the burden of unwanted pregnancies and their repercussions.
It is crucial to empower women by educating them about the Medical Termination of Pregnancy Amendment Act, 2021, and emphasizing the legal gestation age limit to ensure safety.
Informing women via the most frequently accessed information channels, such as digital and social media, would encourage them to take responsibility for their sexual health and trigger a dialogue to overcome the fear of social judgment.
Young people in India perceive family consent as a pre-requisite for the legality of abortion. According to young married women in particular, this discretion does not lie with them.
Identifying and leveraging the sources of information favoured by the youth
In India, parents fear that their children may indulge in promiscuous behaviour. Withholding information about sex and contraception is hence intended to protect young people from something harmful.15 However, this approach hinders youth's access to verified information sources.
Unverified channels such as social media and internet browsing, have become the primary information source for youth. In India, young people aged 16-30 years make up 51% of total internet users.16 Therefore, the misinformation from these channels poses the risk of poor sexual health and potentially traumatic experiences to many young people.
In order to reduce STIs, unplanned pregnancies and unsafe abortions, it is crucial for young people to be informed about contraceptive options via verified sources and guided effectively towards these.
Our research revealed that helpline numbers and chatbots are amongst the preferred verified information sources for practical help and advice around SRH.17 These sources are seen by young people as reliable and easy to access, as they assure the privacy of individuals.
Helpline numbers are favoured by both married and unmarried young people. By ensuring the anonymity of both callers and counsellors, they make it easier for the youth to discuss health issues and queries.
Social media platforms could also be leveraged through the engagement of young influencers to provide reliable SRH information and advocate the cause among their followers.
In contrast, promoting the availability of counselling facilities at government hospitals, is not favoured due to the fear of encountering family members.
The imperative for policymakers to develop a comprehensive digital communication strategy to reach every youth
There is a lack of effective information and communication around SRH related risks. This communication gap discourages women from prioritising their own health when it comes to pregnancy and abortion.
Policymakers and government communicators must consider a comprehensive approach to address interlinkages and target individuals at different stages – starting with sex education, population control, and encompassing reproductive, maternal, neonatal, child and adolescent health.
A digital communication plan should also consider the financial challenges that young couples face due to lack of family planning, poor maternal and child health, risk of STIs and Reproductive Tract Infections. The approach should therefore address both the demand of the youth, and at the same time the most suitable means of meeting these demands.
In a developing country with such a high internet penetration amongst the youth, an exclusively digital communication strategy can efficiently reach young people to inform them and tackle fears and preconceived notions in relation to sexual health.
Digital and social media platforms offer highly effective sources for communicating verified information to young people.
Engaging youth via credible information sources such as digital advertisements, web series such as MTV Nishedh, TV series, verified websites, or live feeds on social media platforms/ digital applications, can improve knowledge and practices.
To access further reliable information, young people can be directed on to chatbots/helpline numbers via these verified platforms.
Similarly, with regards to abortion information, policymakers should not limit themselves to conventional media sources but consider leveraging digital and social media platforms to inform the youth about their legal rights and government programmes, thereby empowering them to adopt safe SRH behaviours. Again, verified channels and programmes such as MTV Nishedh play a critical role in normalising the conversation about contraception and abortion, as they reach and influence millions of young people across India.
Our partners at The MTV Staying Alive Foundation commented:
With the research conducted by Kantar Public for MTV Nishedh, we have captured the existing attitudes, barriers, and misconceptions around sexual reproductive health and tuberculosis among the Indian youth. This enabled us to reflect their real lives, engage with them in all stages of the development of our series to ensure the stories are relatable, entertaining, and highly engaging.”
References and notes
1. National Health Portal, NIHFW.
2. Singh S, Shekhar C, Acharya R, et al. The incidence of abortion and unintended pregnancy in India, 2015 [published correction appears in Lancet Glob Health. 2017 Dec 12;:]. Lancet Glob Health. 2018;6(1):e111-e120. doi:10.1016/S2214-109X(17)30453-9
3. Kantar Public India. Study titled “Identifying key messaging strategy for MTV Nishedh”. Research conducted for MTV SAF, 2021. A formative study conducted across six states which includes qualitative focus groups and in-depth individual interviews with youth aged 16-30 years, TB Champions and domain experts. 50 young Indians and 17 experts were interviewed.
4. Most of the female participants asserted during the FGDs that they themselves and other females around them avoid frequent consumption of pills or other form of contraception due to fear of side effects and anxiety related to overall health including reproductive health.
5. Natural family planning (or "fertility awareness") is a method of contraception by which a woman monitors and records different fertility signals during her menstrual cycle to work out when she is likely to get pregnant.
6. The majority of male and female participants during the FGDs cited traditional methods such as eating papaya and fenugreek as a safe way to avoid pregnancy.
7. During the study most married participants asserted relying on traditional methods of contraception rather than modern contraceptives as they are perceived to be effective.
8. International Institute for Population Sciences. National Family Health Survey-5, 2021.
9. Kantar Public India. Study titled “Identifying key messaging strategy for MTV Nishedh” for MTV SAF,2021. A formative study conducted across six states which includes qualitative FGDs and IDIs with youth aged 16-30 years, TB Champions and domain experts.
10. Lack of information and difficulty in access due to social stigmas leads to poor demand of products that require visit to a healthcare facility/healthcare.
11. International Institute for Population Sciences. National Family Health Survey (NFHS-4)
12. Most participants during the FGDs were unable to report the correct gestational age limit for medical and surgical abortion procedures.
13. Medical Termination of Pregnancy Amendment Act 2021. Women are allowed to seek safe abortion services on grounds of contraceptive failure, increase in gestation limit to 24 weeks for special categories of women, and opinion of one provider required up to 20 weeks of gestation.
14. During the study most married participants asserted that for legal abortion consent of family members such as parents and in-laws is required.
15. Ismail S, Shajahan A, Sathyanarayana Rao TS, Wylie K. Adolescent sex education in India: Current perspectives. Indian J Psychiatry. 2015;57(4):333-337. doi:10.4103/0019-5545.171843
16. Distribution of internet users in India 2019, by age group - Statista.
17. All the participants preferred helpline numbers and chatbots as the most convenient way of seeking information regarding SRH and TB related queries. This was reported as the most efficient way to receive SRH and TB information without having to reveal the identity.
