Although the human body is in transition at all ages, adolescence stands out due to the speed and extent of changes that occur during these formative years. India has the world’s largest adolescent population at approximately 243 million and these foundational years matter, especially for girls.  Investing in the health and wellbeing of girls is a unique window of opportunity to bring about inter-generational change, as a healthy and well-nourished girl is empowered to take steps for self-progress.  

India’s socio-cultural beliefs have resulted in the female gender being denied the 3As – awareness, availability and accessibility.  Lack of awareness on health & hygiene practices, a balanced diet, perils of anemia, and consequences of early marriage & early pregnancy; insufficient availability to medical advice, education, skill training, toilets, hygiene supplies; and poor accessibility to services available, be it medical, educational or sanitation facilities.  

Nutrition is essential for better health, yet under-nutrition deficiencies exist in the form of Protein Energy Malnutrition (PEM), anemia, deficiency in iron, iodine, vit A & zinc; this leads to weak immune systems, stunted growth, unsafe pregnancy, high child mortality rates, anemic babies, cognitive disabilities and the prevalence of non-communicable diseases. In India more than half of the women are anemic and 18.7% of women & girls have low Body Mass Index (BMI).

Hygienic behaviour such as the use of toilets, handwashing, and practicing personal hygiene also requires attention if we are to improve health parameters.  Although menstruation is a natural occurrence, it is associated with several myths in many parts of the country due to the absence of adequate information and awareness.  In rural areas, prevailing taboos that shroud menstruation and menstrual practices result in ignorance of scientific facts and sanitary know-how. This leads to infections associated with reproductive health which is often passed down to the offspring of an expectant mother. Given the dearth of sanitary facilities including girls’ toilets, availability of sanitary napkins, and social stigma associated with menstruation, many girls drop out of school. This makes them more vulnerable. 

Health & hygiene issues of adolescent girls require integrated action from the Department of Education, Health, Women & Child Development, and Water Sanitation Hygiene (WASH) along with multiple stakeholders like NGOs, community-based organisations, and the corporate sector. Needless to say, the beneficiary must also take ownership of these development projects.

To address the multi-dimensional issues of adolescent girls, the Government has initiated much noteworthy healthcare, nutrition, and WASH programs.  Balika Samridhi Yojana, Adolescent Reproductive Sexual Health Programme (ARSH), National Nutrition Mission i.e. POSHAN Abhiyaan, Balwadi Nutrition Programme, Swachh Bharat Mission, and Menstrual Hygiene Scheme are amongst these initiatives.  

The corporate sector is a significant stakeholder which must play the role of a facilitator and knowledge partner to augment government development initiatives and reach out to a larger beneficiary base. To enhance good hygiene and health practices, the private sector should also have a role in providing social support, facilities, services and resources in addition to advocating policy.

The way forward is to ensure that all projects are holistic in outlook ensuring equal importance to the software aspect of development issues through a collaborative approach.  To create a congenial atmosphere for adolescent girls we should focus on “CAP” i.e., convergence, awareness, and partnerships.  

Appropriate hygiene behavior, nutritional intake, and sanitation facilities are all a precursor to good health.  Capacity building in these segments must be interlinked as achieving one without the other will not have a sustainable impact on maternal and child health.  Thus, the convergence of programs is imperative to improve the condition of adolescent girls.  

Simply building toilets or hospitals will not bring about behavioral change or a health-seeking attitude; it requires focused awareness programs which educate communities as to why they should adopt a nutritional attitude and hygienic practices, including using lavatories and sanitary supplies. Similarly, suggestions on preventive health and institutional deliveries will have wider acceptability if the rationale is explained leading to less resistance which arises out of socio-cultural beliefs.

Finally, partnerships between multiple stakeholders to share knowledge and use technological/operational expertise are essential for scalability. Every player in the development ecosystem brings a certain attribute to the table - international agencies bring knowledge, best practices, and policy; govt involvement leads to greater outreach and public welfare schemes; while local NGO/CBO lend ground connect and private sector participation results in access to R&D, technology, operational expertise, etc.  Thus, strategic partnerships assist in leveraging resources to plug the socio-financial gap in order to achieve a result-oriented outcome.

The goal is common and the only way to achieve it is through a collective approach.  Everyone benefits when adolescent girls are healthy, productive, and add to national growth. As our PM Narendra Modi has said “Individual efforts can bring excellence, but only collective efforts can deliver effectively”.