Hidden Pockets Collective took part in Public Consultation held by Prayasand Human Right Law Network in Bhopal in 2017. This year the theme was around Legal interventions in Sexual and Reproductive Health.
Are young people there in the National Health Policy 2017? In order to answer this question, it is important to understand the definition of young people. According to the National Youth Policy 2014, young people in India, which is people in the age group of 15-29 years of age, comprise 27.5% of the population. At present, about 34% of India’s Gross National Income (GNI) is contributed by the youth, aged 15-29 years. Government of India spends about Rs.55,000 crores on non-targeted schemes including health designed for various demographic segments of which youth are also beneficiaries.
Considering the youth contribution to the national population and Gross National Income, it becomes pertinent to understand the National Health Policy from the perspective of young people.
Areas where young people have been mentioned in the National Health Policy
It is essential to understand that though the National Youth Policy acknowledges that 15-29 years of age is the age group of the youth, the National Health Policy nowhere specifically addresses the need of this particular age group although it mentions and includes adolescents with respect to several aspects. However, taking into consideration the different aspects that pertain to the youth, following may be seen as the areas that address the needs of the youth:
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Objectives under Progressively achieve universal health coverage:
“Assuring availability of free, comprehensive primary health care services, for all aspects of reproductive, maternal, child and adolescent health and for the most prevalent communicable, non-communicable and occupational diseases in the population.”
Under Policy Thrust – Preventive and promotive health:
“an expansion of scope of interventions to include early detection and response to early childhood development delays and disability, adolescent and sexual health education, behavior change with respect to tobacco and alcohol use, screening, counseling for primary prevention and secondary prevention from common chronic illness –both communicable and non-communicable diseases.”
National Health programmes:
The policy gives special emphasis to the health challenges of adolescents and long term potential of investing in their health care.
“The scope of Reproductive and Sexual Healthshould be expanded to address issues like inadequate calorie intake, nutrition status and psychological problems interalia linked to misuse of technology, etc.”
However, this seems to only include youth between the age of 15-18 or 19.
In order to better understand the presence of youth in the National Health Policy, it becomes important to understand the policy in the light of the National Youth Policy, which was passed earlier in 2014.
Alignment between National Health Policy and National Youth Policy
Maternal health
National Health Policy 2017 and the National Youth Policy 2014, both address maternity health and the need to address the different aspects related to it for the mother and the newborn child. It is progressive that the government acknowledges the need for expansion of reproductive and sexual health for adolescents and the need to address social determinants for maternal health. However, how it intends to implement these measures has to be seen especially with respect to National Health Policy.
Education on nutrition
Both the policy frameworks have acknowledged the need to educate the youth about the need for the education among Youth about nutrition and calorie intake
Sex education
The National Youth Policy notes the need to create “awareness about family planning, birth control, STDs, HIV/AIDS and substance abuse, especially in rural areas and (c) addressing issues concerning emotional and mental health (e.g. risk of depression and potential suicide attempts), esp. in case of adolescent youth.”
Addressing high risk groups for sexually transmitted diseases
“Enhanced capacity for detection and treatment of communicable diseases must be developed, especially for pregnant mothers and other high-risk groups.” – National Youth Policy 2014
While there are alignments with respect to several policies, there are several gaps between the policies and even otherwise. These gaps may have a far-reaching effect on the sexual and reproductive health of the youth.
Gaps between both policies and otherwise
Addressing sex ratio
Along with maternal health, the National Youth Policy also addresses the need to bring down female feticide to improve child sex ratio
“There is a need to pay special attention to health issues concerning women youth. This would entail greater pre-natal and post-natal care for women in vulnerable age group of 14-18 years, need to bring down maternal and infant mortality rates, campaign against female feticide to improve child sex ratio, etc.”
Marginalized and disadvantaged youth
The National Youth Policy 2014 acknowledges the need to support “a few segments of the youth population require special attention. These include economically backward youth, women, youth with disabilities, youth living in conflict affected regions including left wing extremism, and youth at risk due to substance abuse, human trafficking or hazardous working conditions.”
This is not the case with the National Health Policy. Except women as a group, the intersectionality of young people with other groups of people has not been dealt with in detail in the National Health Policy 2017. There seems to be a gap in understanding the impact of an individual being subject to multiple challenges due to the intersectionality.
For example: A person may be disabled, transgender and HIV positive
Disability
- Equity: Reducing inequity would mean affirmative action to reach the poorest. It would mean minimizing disparity on account of gender, poverty, caste, disability, other forms of social exclusion and geographical barriers. It would imply greater investments and financial protection for the poor who suffer the largest burden of disease.
- Health Status and Programme Impact: Establish regular tracking of Disability Adjusted Life Years (DALY) Index as a measure of burden of disease and its trends by major categories by 2022.
- “Research on social determinants of health along with neglected health issues such as disability and transgender health will be promoted.”
Transgender violence:
- Unfortunately, both policies do not focus on the needs of sexual minorities going beyond the ambit of HIV/AIDS with focused interventions on the high risk communities like MSM (Men who have Sex with Men), Transgender, FSW (Female Sex workers), etc. and prioritized geographies for control of HIV/AIDS. It is worth noting though that the National Youth Policy was passed in January 2014 much before the NALSA judgment of 2014 that recognised transgenders as the third gender in the country.
- Gender violence also affects the transgender community, going beyond just women. However, the policy limits the scope to women.
Gender based violence:
- The section on Gender based violence notes that public hospitals need to be made women-friendly and the staff need orientation to gender sensitivity issues. It also states that healthcare to survivors and victims of gender based violence needs to be provided free and with dignity in the public and private sector.
- Gender violence also affects the transgender community, going beyond just women. However, the policy limits the scope to women.
- Even with respect to women, the policy does not qualify or define gender violence or gender sensitivity issues.
Universal Health Coverage and Right to Health
The 12th Plan seeks to extend the outreach of public health services for moving towards the goal of Universal Health Coverage (UHC) through National Health Mission. – National Youth Policy 2014
National Health Policy 2017 has reiterated the same. It advocates an “incremental assurance based approach”. The policy tries to understand Right to Health from two perspectives.
The policy mentions that the medical tribunal will also be responsible for resolution of disputes related healthcare and also the need for protection of patients including right to information, access to medical records, confidentiality, privacy, among others. Information related to health is of sensitive nature especially sexual and reproductive health. This could include details about HIV and AIDS patients, abortion data (both married and unmarried women), individuals affected by other STDs, among others. What happens if there is a data leak? The government recently admitted to Aadhaar data leak. Several state governments including Madhya Pradesh have mandated linking Aadhaar to HIV treatment. News reports note a drop in registration at ART centres since the announcement of this integration.
Right to privacywas recently declared as a fundamental right. However, there is no law protecting the privacy of Indians. It is worth noting that the verdict on mandating Aadhaar is expected in November 2017.
The consultation was an excellent initiative to bring people working in the public health sector under one umbrella and discuss issues affecting various different communities. We shared our concerns regarding young people and their role in the public health sector.
Note : Brindaalakshmi had attended and presented on behalf of Hidden Pockets Collective.
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