Tiffany Nassiri-Ansari
In Conversation With, the Lancet Commission on Gender and Global Health’s seminar series, returned with a sixth episode hosted by Commissioner Renu Khanna on October 6th. Perspectives and initiatives of young people in all their diversity featured two panel discussions which centered the voices of young people in identifying the challenges faced by their cohort and their visions for the future. Commissioner Khanna, founder of the Society for Health Alternatives (SAHAJ), was joined by two moderators and six speakers.
Panel 1:
Panel 2:
This webinar was co-convened with the Asian-Pacific Resource and Research Centre for Women (ARROW) and Society for Health Alternatives (SAHAJ). Commissioner Khanna and speakers were joined by fellow Commissioners and livestream audiences on Zoom and YouTube. A recording of the ninety-minute webinar is publicly available on the Commission’s YouTube channel.
Commissioner Khanna introduced the webinar as a discussion devoted to the concerns and issues of adolescents and young people, with a focus on identifying promising practices and potential solutions to guide future action.
This panel is just two years shy of the thirtieth anniversary of 1994’s International Conference on Population and Development in Cairo, which placed adolescent sexual and reproductive health and rights (ASRHR) on the global agenda. In the twenty-eight years since, several advancements have been made at the policy and programme levels for specific groups and issues. Countries have developed policies and programmes for adolescents and young people such as adolescent-friendly health services, and the diversity of this group is increasingly recognised as youth-led organisations continue to emerge and demand a seat at the table. However, many gaps remain. Khanna identified taboos around menstruation, fear-mongering about adolescent sexuality, and persistent gender norms as just some of the many challenges impeding continued progress on ASRHR. In addition to these social barriers, legal barriers such as the continued requirement for parental or spousal consent, debates around the ages of consent and marriage, and criminalisation of consensual sexual activity among underage individuals prevent adolescents and young people from accessing ASRHR.
Health systems barriers exacerbate matters as well. Where ASRHR services exist, they are not always adolescent-friendly; provider attitudes and biases continue to contribute to disempowering environments. Many contexts and communities also continue to grapple with a lack of key ASRHR services, such as comprehensive sexuality education (CSE). As we move towards the 2030 goalpost set by the SDGs, Khanna questioned how we might build on lessons learned to confront these challenges. She expressed hope that today’s discussion would address a number of questions on designing policies and programmes that respond to the needs of young people in all their diversity, enhancing political commitment to generate more investment in ASRHR, and creating space for the meaningful participation of different groups of young people as well as the transformation of gender norms.
Having set the scene, Khanna swiftly introduced the two panels before handing over to the moderators. She billed the first panel as a platform for young people to share their challenges and concerns, and the second as a sharing session on promising practices and potential solutions which can be scaled up and lead to improvements in ASRHR.
Moderator Fara Rom introduced the first panel with an acknowledgement of the diversity of young people’s needs, concerns, and challenges, and the frequent marginalisation and exclusion of crucial voices from decision-making. She dedicated this panel to the voices of young people working on the ground to address their issues and challenges, and invited the three panellists to enlighten audience members on the challenges faced by young people in their communities and countries.
Jivitesh Gupta spoke first, sharing the challenges he has faced as a very young adolescent (VYA) in accessing civic spaces and healthcare services. VYAs are commonly defined as adolescents between the ages of ten and fourteen, and Gupta identified this cohort as a very underrepresented group globally in terms of meaningful participation in policy planning, implementation, monitoring, and evaluation. This lack of VYA representation can be attributed to lack of affordable and quality education, cultural barriers, prevalence of harmful practices such as child marriage and illegal adoption, lack of youth-friendly ASRHR information, barriers to services in academic institutions and healthcare facilities, and lack of access to legal aid. He stressed that myths, stereotypes, and ignorance of mentors, parents, guardians, and government at all levels cannot be used as an excuse for the underrepresentation of VYAs, who must be considered equal among all stakeholders for policies, programmes, and activities meant for them at the very least.
Gupta reflected on his personal experiences of participation in stakeholder consultations to further urge improvements to engagement with VYAs, warning against tokenistic inclusion. He shared a recent experience in which he and his sister were invited to participate as younger and older adolescents, respectively, in multistakeholder consultations on a draft National Youth Policy, yet their suggestions were conspicuously absent from the final compilation of suggestions forwarded to the ministry. Nevertheless, he expressed optimism that his active representation of VYAs in fora such as this webinar will encourage more VYAs to step forward and volunteer for civic action.
Sharing his hopes for the future of VYAs, Gupta reiterated that young people must be empowered to represent themselves. With proper resources and supportive guardians, “we can do justice to our role as responsible global citizens”. In particular, he called upon all stakeholders involved to provide CSE to VYAs as an early intervention to prevent self-harm and sexual abuse, improve health-seeking behaviour, and ease the transition into adulthood. He outlined ways in which government bodies, private actors, and civil society can create a supportive and empowering environment for VYAs to represent themselves in inter-generational dialogues and interactions with lawmakers, acting as agents of positive change for a better future.
Pooja Katwa brought the lens of disability to this discussion on youth perspectives, speaking about the challenges she has experienced as a person living with vision impairment. She shared that discrimination began at birth, with society treating her differently and schools going so far as to reject her application at the mere age of six. Principals suggested that her parents enrol her in ‘special’ schools, but her parents persisted and were eventually successful in enrolling her in a ‘mainstream’ school; unfortunately, she continued to face discrimination and marginalisation from teachers and students alike throughout her schooling. Despite graduating with a master’s degree, Katwa faced similar challenges in seeking employment due to ableist stigmatisation of her disability.
Katwa has experienced marginalisation in every corner of society, including the health system. While many Indian communities rely on anganwadis for basic healthcare, she shared that she has never been contacted or assisted by these community health workers. Her only exposure to ASRHR has been through SAHAJ, which provided her with information on menstruation, contraception, abortion, and more. She stressed that this important information must be made available to all, regardless of (dis)ability.
Advocating for the rights of people with disabilities to live a normal life, Katwa called on the Indian government to reconsider its eligibility criteria for pension schemes, increase the budget allocation for education and employment for the disabled, and improve infrastructure to be more disabled-friendly. She recommended strict implementation of legal provisions to protect disabled people from abuse, improvement of health and counselling centres to accommodate people with disabilities, and sensitisation of healthcare providers as well as members of society at large to prevent further discrimination.
Pema Wangmo Lama added her voice to the discussion as a Mugum representative of Nepal’s Indigenous youth, sharing the challenges faced by her peers in accessing ASRHR. Indigenous women and girls in particular struggle to access SRHR services due to the stigmatisation of their identities, and Indigenous youth wield a limited amount of power over their own SRHR due to multiple forms of social and political discrimination. This leaves an entire group of young people vulnerable to SRHR violations, with the rate of sexual violence experienced by Indigenous women and girls nearly threefold that of their non-Indigenous counterparts.
Challenges to the collective rights of Indigenous people are numerous: derogatory views, forced evictions, internal displacement, and militarisation contribute to the overall poor educational and economic status of Indigenous people, with significant knock-on effects for their SRHR. Indigenous and rural youth face additional barriers due to inadequate provision of sexual and reproductive education, stigmatisation of sexual education as “too mature” for young people, and lack of country-level disaggregated data on the status of Indigenous youth’s access to ASRHR. With Indigenous identity still not officially recognised in most of the country, Lama noted that Indigenous youth are left behind in national research, studies, and statistics, causing further discrimination and biased policies which exacerbate the situation.
Lama invoked the theme of this year’s International Youth Day, “Intergenerational solidarity: creating a world for all ages”, to call for action that focuses on leveraging the potential of all generations. She also called on the state to recognise the historical discrimination, exclusion, cultural assimilation, and deprivation of rights which have led to the marginalisation of Indigenous people, and to provide accessible, adequate, and quality health care for Indigenous people with due acknowledgement of their collective rights and traditional health systems. Lama emphasised the need for CSE to “promote a safe and enabling environment for knowledge transfer,” and urged stakeholders to include Indigenous youth in the design and implementation of culturally appropriate community-based interventions and services. In closing, she noted that progressive change is a constant effort, and youth in all their diversity must be at the forefront of this movement to fight for due recognition of their experiences and narratives as well as meaningful participation in determining their future.
Moderator Fara Rom thanked the speakers for sharing their experiences, challenges, and suggestions for a better future, and echoed all three panellists in calling for the meaningful engagement of young people in policy- and decision-making. Noting that inclusive solutions can only be developed when we listen to young people, she then handed over to fellow moderator Souvik Pyne for the second panel on promising practices.
Pyne began by thanking the first set of speakers for articulating the myriad challenges they face due to their unique identities, and noted that solutions often fail to acknowledge the diversity and heterogeneity of young people. He urged stakeholders to think of solutions and practices which are not one-size-fits-all, and invited the second set of speakers to share some promising initiatives taken by young people themselves as well as the multilateral agencies which support young people in their endeavours.
Born and raised in Afghanistan, Ahmad Nisar has years of experience operating in a fragile and conflict-ridden setting. He highlighted that what some take for granted as basic rights can be a privilege or even distant dream for young people living in conflict zones. Nisar shared that his experiences of community engagement certainly align with statistics which suggest that mental health, alcohol and drug use, and child pregnancy are some of the main health problems faced by adolescents, recalling the challenges of a seventeen-year-old boy who became the sole breadwinner of his family when his father was killed in a missile attack and continues to experience PTSD as a result of this. This young man is just one of an estimated 54% of adolescents around the world with an unmet need for mental health services, a service gap exacerbated in conflict zones where the country allocates most of its budget for military use and external funding rarely reaches those who need it most.
Identifying a need for community members to provide psychological support, Nisar established Changemaker, an initiative that pushes the narrative around mental health and merges its interconnected links with other SDGs. The initiative provides young people with the support they need through WhatsApp or phone calls, operating as an anonymous, accessible, and free service. While it is currently limited in capacity, Nisar shared his hopes that expansion or duplication of such efforts might help decrease the overall prevalence of mental illness among young people. He also shared ideas for a decentralised and computerised system that would encourage and enable displaced healthcare workers to return and provide care in post-conflict situations. Another challenge Nisar has noted is the prevalence of underage alcohol and drug abuse due to a variety of enabling factors, and he suggested that schools and communities utilise motivational interventions which position the young person as a partner in their own recovery process. Changemaker adopts a similar approach, centering young people in health interventions and encouraging them to question their own health behaviours and choices.
In closing, Nisar reiterated the key message of this webinar by calling for young people to be given a seat at the table. He noted that panels like this have a proven impact on improving health outcomes for adolescents by showing faith in the power of young people, the first and foundational step towards ending the widespread challenges faced by today’s youth.
Best Chitsanupong Nithiwana joined the conversation to share some of the successes and solutions she has found as a young woman advocating for queer rights in Thailand, often praised for its inclusivity and diversity. However, she learned first-hand that this reputation does not necessarily match up to reality in 2018, when she was not allowed to wear clothes matching her gender identity to her graduation ceremony. Nithiwana successfully pushed her university to change its regulations after creating an online petition which garnered 2000 signatures and the support of multiple human rights and LGBTQ rights organisations, citing the Gender Equality Act as grounds for her request.
This experience, among other challenges, inspired Nithiwana to establish Young Pride Club, which empowers LGBTQ youth to advocate for gender equality in Thailand. Through youth leadership workshops which bring together queer youth leaders from four region, Young Pride Club has empowered fifty youth leaders since 2020 to become community leaders, scholarship recipients, and changemakers at the local and international levels. The organisation also generates impact through collaboration, working with partners and LGBTQ youth to organise the first Youth Pride in Bangkok in 2020.
Drawing from her experiences and successes, Best highlighted the need to monitor and hold governments and organisations accountable by collecting information on and evaluating their work. She called for reform of existing laws to protect and fulfil rights, supportive and effective implementation of laws related to gender and student rights, and meaningful participation and representation of LGBTQ youth.
Finally, Dr. Venkatraman Chandra-Mouli joined the panel as a long-time WHO public health professional to highlight how multilateral organisations can support the leadership of local youth in innovating and implementing their own solutions. He drew on a case study from Jamaica to illustrate one example that WHO has been involved in, which is a long-running project to help girls who drop out of school due to unintended pregnancy return to formal education.
Forty years ago, a local NGO in Kingston identified the challenges facing teenage mothers such as the lack of re-entry opportunities into secondary schools, lack of continuous education opportunities, and high second birth rate. This Jamaican-designed, Jamaican-led initiative created an intervention package which has enabled adolescent mothers to return to schools and move on with their lives, receiving external support but maintaining local leadership throughout the past four decades. Today, this program has been scaled up throughout the Caribbean and is being introduced to South Africa, proof of the change that is possible when young people are involved in the identification of their challenges and solutions.
On that note, moderator Souvik Pyne thanked the panellists for their interventions and highlighted the importance of multistakeholder, multisectoral approaches that centre the lived experiences of young people to identify not only their needs but potential solutions as well. In closing, he called for continued learning and growth among all stakeholders before handing back to Commissioner Renu Khanna for the Q&A session.
Khanna thanked both sets of speakers for an uplifting discussion, and posed two audience questions to the panel.
Are there any learnings on best practices to make teachers and school administrative staff more gender-sensitive and gender-responsive?
Dr. Chandra-Mouli shared an example of a program in South Africa, where a women – typically a qualified teacher with teaching responsibilities – is appointed the Guardian Teacher. Having a go-to person for any students experiencing bullying or student harassment is immensely helpful for young people in terms of identifying someone with a mandate to help them.
From a more preventive aspect, he highlighted an initiative from Rutgers International which takes a whole-of-school approach to make schools a safe space by working not just with children but also teachers, principals, and staff to model healthy gender norms to prevent violence in schools.
Many times, bullying, failure, jealousy, love affairs, and sexual harassment lead youth to self-harm, suicidal ideas, and suicide. Are there any learnings from this? How can these be prevented and dealt with?
Gupta noted the need for a mindset change in addressing these challenges, as young people are discouraged from seeking help due to stereotypes which brand those who require psychological support as “mentally disturbed”.
Dr. Chandra-Mouli echoed this need to support young people in seeking help, suggesting that youth are given clear steps to seek support be it through the provision of a safe space, a hotline, or a person who is qualified to give advice on the situation. All of these interventions require constant communication with young people to ensure they know how to reach out for help.
Finally, Lama emphasised the importance of constant communication between young people themselves as well as with their families to identify challenges and promote mindfulness. The latter practice especially was highlighted as a way to discourage young people from promoting bullying and to instead create safe spaces for sharing within peer groups and families. She also suggested offering counselling sessions for support and integrating morals and ethics into school syllabi to prevent harmful behaviours.
Lamenting that the discussion was heating up just as time had run out, Khanna once again thanked the speakers for an informative conversation. Her key takeaway was the need to create an enabling environment for young people “wherein they can find in themselves the ability and the potential to contribute their ideas and thoughts”.
Co-chair Pascale Allotey expressed her appreciation to all panellists as well, sharing that the webinar had left her feeling hopeful for the future. In closing, Allotey noted that those in positions of privilege and leadership have a lot of work to do, and must start by explicitly and regularly stepping aside to create spaces for and amplify the voices of youth, “recognising that nothing we do matters if it doesn’t work for them – it’s not our future, it’s theirs”.
Tiffany Nassiri-Ansari sits on the Secretariat of the Commission and serves as a Research Assistant at UNU-IIGH.
