Abstract
BackgroundYoung, rural Indian women lack sexual and reproductive health (SRH) information and agency and are at risk of negative sexual and reproductive health outcomes. Youth-focused interventions have been shown to improve agency and self-efficacy of young women to make decisions regarding their sexual and reproductive health. The objectives of this study were to assess young women’s sexual and reproductive health knowledge; describe their health-seeking behaviors; describe young women’s experiences with sexual and reproductive health issues, including unwanted pregnancy and abortion; and identify sources of information, including media sources.MethodA cross-sectional survey with a representative sample of 1381 married and unmarried women young women (15–24 years) from three rural community development blocks in Jharkhand, India was conducted in 2012. Participants were asked a series of questions related to their SRH knowledge and behavior, as well as questions related to their agency in several domains related to self-efficacy and decision-making. Linear regression was used to assess factors associated with greater or less individual agency and to determine differences in SRH knowledge and behavior between married and unmarried women.ResultsDespite national policies, participants married young (mean 15.7 years) and bore children early (53 % with first birth by 17 years). Women achieved low composite scores on knowledge around sex and pregnancy, contraception, and abortion knowledge. Around 3 % of married young women reported experiencing induced abortion; 92 % of these women used private or illegal providers. Married and unmarried women also had limited agency in decision-making, freedom of mobility, self-efficacy, and financial resources. Most of the women in the sample received SRH information by word of mouth.ConclusionsLack of knowledge about sexual and reproductive health in this context indicates that young rural Indian women would benefit from a youth-friendly SRH intervention to improve the women’s self-efficacy and decision-making capacity regarding their own health. A communication intervention using outreach workers may be a successful method for delivering this intervention.
Highlights
Young, rural Indian women lack sexual and reproductive health (SRH) information and agency and are at risk of negative sexual and reproductive health outcomes
Lack of knowledge about sexual and reproductive health in this context indicates that young rural Indian women would benefit from a youth-friendly SRH intervention to improve the women’s self-efficacy and decision-making capacity regarding their own health
In India, young women, those living in rural areas, are at high risk for negative sexual and reproductive health (SRH) outcomes, with those ages 15–24 years accounting for 41 % of total maternal deaths in India [1]
Summary
Rural Indian women lack sexual and reproductive health (SRH) information and agency and are at risk of negative sexual and reproductive health outcomes. In India, young women, those living in rural areas, are at high risk for negative sexual and reproductive health (SRH) outcomes, with those ages 15–24 years accounting for 41 % of total maternal deaths in India [1]. Marriage, combined with lack of SRH knowledge and information, and limited agency to negotiate sexual encounters contribute to early and unprotected sex for youth [2, 3]. Unsafe abortion accounts for 8-9 % of all maternal deaths in India [1], and given young women’s tendency to approach unskilled and illegal abortion providers, to seek abortion care later in pregnancy, and to delay seeking care for abortion-related complications, the proportion of maternal death due to unsafe abortion is likely higher in young women [10,11,12,13]
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