Contraceptives & Minors: Why Karnataka Should Invest in ‘Sexuality Education’

Karnataka plans to 'counsel' adolescent students who approach pharmacies for contraceptives.

Is adolescent sexuality addressed properly in Karnataka where the state government is mulling a decision to 'counsel' students who approach pharmacies for contraceptives.

(Image: Namita Chauhan/The Quint)

Many research studies have shown that "adolescent sexuality is a normal and expected aspect of adolescent development." The resurgence of developmental hormones and the growth of reproductive parts of adolescent bodies induce feelings of sexual attraction.

In a prevailing environment of shame and secrecy surrounding the act of sex or any sexual feeling, socially and legally, there is a prevailing denial of adolescent sexuality. The Protection of Children from Sexual Offences (POCSO) Act, 2012 and the Indian Penal Code, 1860, do not recognise the possibility of consensual sexual acts among adolescents. The truth, however, is that children below the age of 18 are having sex.

Why has the debate around adolescent sexuality resurfaced?

Contraceptives Allegedly Found on Adolescents in Karnataka

In the third week of January 2023, several media outlets reported that the Drug Control Department (DCD) of Karnataka issued a circular to all pharmacists, prohibiting them from selling oral contraceptives, condoms, and antidepressants to persons under 18 years of age, resulting in an outcry from several civil society organisations and individuals.

Subsequently, Bhagoji T Khanapure, drug controller of Karnataka, denied that the department issued such a circular and clarified that they only want to “create awareness by telling pharmacists to counsel minors who want to purchase condoms and oral contraceptives.''

According media reports, the statements made by the Drug Controller of Karnataka were in response to an incident in November 2022, where several items including condoms, cigarettes, and contraceptive pills were allegedly found in the bags of some students of certain Karnataka schools. This resulted in the Associated Management of Schools in Karnataka (KAMS) instructing schools to conduct regular searches of school bags of students.

While the DCD has denied issuing the circular, advice to search bags of students and the purported decision to allow pharmacists to counsel minors raise concerns of moral policing and a denial of adolescent sexual and reproductive health needs.

The purported decision to inhibit access to basic sexual health services, seems to stem from a need to control the sexual desires of adolescents, rather than any concern for their health.

But Adolescents Are Sexually Active

Ground-level reports, as well as data, and experience show that a vast number of adolescents are sexually active. As per the National Family Health Survey -5 (2019-21), for instance, among persons who were between the ages of 20 and 49, 35 percent of women and 5.9 percent of men had sex for the first time before they attained 18 years.

Data from NFHS-5 also shows that some form of contraception is used by 28.1 percent of married women between the ages of 15 and 19 years, and 42.2 percent of married men within the same age group.

Amongst sexually active unmarried women between the ages of 15 and 19 years, 45 percent use some form of contraception.

Amongst women, who use modern contraceptive methods, between the ages of 15 and 49 years, pharmacies or drug stores were a source of condoms for 26.7 percent women, source of oral contraceptives pills for 3l.6 percent women and source of emergency contraceptives for 40.8 percent of women.

Several programmes of the Ministry of Health and Family Welfare appear to acknowledge that adolescents are sexually active.

The Rashtriya Kishor Swasthya Karyakram, the Adolescent Reproductive and Sexual Health (ARSH) project by the CBSE, the School Health Program (SHP), and the Adolescence Education Program (AEP) include aspects of sexual and reproductive health including education and equipping the child with accurate information, knowledge and life skills.

Where India’s Sex Education Is Found Lacking

In 2014, the United Nations Committee of the Rights of the Child observed that “it is seriously concerned at the lack of access to sexual and reproductive information and services, including modern contraception methods, by adolescent girls and the consequent high rate of teenage pregnancies, widespread use of female sterilisation and unsafe abortions in the country.”

The Committee recommended that India “take measures to ensure that adolescent girls and boys have effective access to confidential sexual and reproductive health information and services such as modern contraception as well as girls’ access to legal abortions in practice.”

Restricting access to condoms and contraceptives will place adolescents at greater health risks and would not be in line with the United Nations International Conference on Population and Development (ICPD), 1994 at which India also affirmed the Sexual and Reproductive Rights (SRRs) of adolescents and young people.

The Sustainable Development Goals of 2015, places a positive duty on signatories to “ensure universal access to sexual and reproductive health care services,” and this obligation would extend to adolescents as well.

The recent incident of supervisors allegedly finding condoms in students’ bags, presents an opportunity to consider constructive interventions that can enhance the sexual and reproductive health of adolescents without stigmatising them.

A Case for Sexuality Education

In its policy brief on Implication of the POCSO Act in India on Adolescent Sexuality, Enfold Proactive Health Trust stated:

“Concerns that adolescents are predisposed to making impulsive and poor decisions can be effectively mitigated through the provision of age-appropriate, evidence-informed, comprehensive, and rights-based sexuality education.”

A comprehensive rights-based sexuality and life skills education curriculum is needed to create a healthy attitude towards sexuality and to sensitise children about consent, gender equality, gender identity, rights of LGBTQIA+, and understanding of one’s own body, while also addressing interpersonal relationships and decision-making skills.

Such education can also become a vehicle to address myths, misinformation, and ambiguity surrounding issues such as contracting HIV, STDs and STIs, and can create awareness on how to prevent early pregnancies and safe and healthy sexual habits.

The impact of comprehensive sexuality education can be seen from its early inclusion at the age of four in schools in the Netherlands, which has resulted in the country having, according to The Atlantic, one of the lowest rates of sexually transmitted diseases and infections as well as teenage pregnancies.

The example of the Netherlands reveals that access to comprehensive sexuality education without the fear of surveillance, criminalisation, and reprimand is what is needed to provide a safe and healthy environment for adolescents to make informed and safe choices.

It is often believed that such education will trigger sexual behaviour among minors. However, evidence supports that it actually delays sexual activity and promotes responsible sexual behaviour. This is evidenced from a 56 percent decline in teenage pregnancies in the UK between 1998-2013, a success attributed to the National Teenage Pregnancy Strategy (NTPS), aimed at promoting widespread contraceptive use.

Possible Risks of Negative Intervention

If adolescents are denied contraceptives and condoms, which could ensure safe sex practices, the results could be catastrophic. It could exacerbate the risk of death from complications related to abortion which is already the highest in India for the ages of 15 to 19 years.

Restrictive measures not only infringe on the sexual and reproductive rights of the adolescents but also mean worse health outcomes for adolescents in terms of early pregnancy, sexually transmitted diseases, HIV/AIDs or transmission of HPV which can cause cervical cancer.

Adolescents and the youth can only make informed decisions regarding their bodies and sexuality when safe spaces for discussion are fostered and practice of safe sex is enabled through access to contraceptives and condoms.

Towards this end, Departments of Health, Education, and Women and Child Development need to work together with the assistance of domain experts and civil society organisations, to respond to adolescent sexuality in a scientific and empathetic manner that advances their health and well-being.

(Disclaimer: This article was edited on 11 February to make a correction in the NFHS (2019-21) data.)

(Gopika Nangia, Shivangi Puri, and Vibha Angre are researchers at Enfold Proactive Health Trust, a non-profit organisation that been working in the area of prevention of and response to child sexual abuse in India, since 2001. This is an opinion piece and the views expressed above are the authors' own. The Quint neither endorses nor is responsible for the same.)