How Covid-19 has impacted India's young
Access to essential health services has suffered a major setback, as the focus of India’s public health system shifted to managing and containing the Covid-19 pandemic.
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The onset of Covid-19, followed by the countrywide lockdown severely impacted the availability of essential healthcare services, particularly for vulnerable population groups. Although the elderly have been the primary focus of concern, and rightly so, the young people have also been considerably impacted due to the pandemic. With the objective to assess the knowledge, attitudes and perceptions of young people regarding Covid-19, as well as the challenges faced by them, Population Foundation of India (PFI) conducted two rapid telephonic assessment studies with young people and frontline healthcare workers (FLWs) in five states — Uttar Pradesh, Bihar and Rajasthan, Jharkhand and Odisha — in April-May, 2020.
Findings from the studies revealed that access to essential health services has suffered a major setback, as the focus of India’s public health system shifted to managing and containing the pandemic. The increased demand on health infrastructure and healthcare providers, coupled with constrained supply chains, not only left the health systems overstretched, but also led to limited provision and access to non-Covid-19 related health services, drugs and products, such as contraceptives, sanitary pads and personal protective equipment.
58 per cent of the girls under 18 years of age reported an unmet need for sanitary pads and only 31 per cent of adolescents confirmed receiving Iron & Folic Acid tablets during the lockdown. (Photo: Reuters)
In the absence of Village Health and Nutrition Days (VHND) and service provision at the village-level by auxiliary nurse midwives (ANMs), beneficiaries were not able to access ante-natal care and immunisation services. The fear of being infected kept many away from accessing services at health facilities. FLWs expressed concern over the stigma and discriminatory behaviour against them, leading to mental stress. While 58 per cent of the respondents were aware that FLWs were providing family-planning counselling services, 70 per cent were not aware that they were also providing contraceptives. 58 per cent of women under 18 years of age reported an unmet need for sanitary pads. Only 31 per cent of adolescents confirmed receiving Iron & Folic Acid tablets.
The FLWs also expressed concern regarding the inequitable distribution of food, which could lead to increased levels of malnutrition among women and children. The lockdown has severely impacted the education of young people, as the schools remain closed for an extended period. There is a fear that many adolescent girls may not return to school post the lockdown and several may be pushed into forced marriages.
The decreased access to health services and the disruption of social and protective networks added to the vulnerabilities of young people. Young people, especially women, saw an increase in their domestic workload, experienced violence at home, and mental anxieties. 51 per cent female adolescents said that they experienced an increase in workload during the lockdown, as compared to 23 per cent male adolescents. In Uttar Pradesh, 96 per cent of the female respondents experienced an increase in workload, with 67 per cent being below 18 years of age. One in four young people in UP reported feeling depressed while 89 per cent of young women reported seeking information on mental anxiety due to the lockdown.
These findings reiterate the need to ensure safe spaces, both online and offline, for young people to seek support. The continued relevance of on-ground health workforce like FLWs, as reliable sources of information and as points of contact to the public health system, reiterate their importance in handling a public health emergency. Going forward, it is critical to invest in our 3.3 million-strong female frontline workforce to empower, equip and strengthen them.
The studies also recommend the need to promote health education and public health messaging which reaches the last mile, especially during emergencies like Covid-19. It is imperative to ensure uninterrupted supply and access to essential health services, including reproductive health and mental health services. And finally, we need innovative social and behavioural change in communication strategies, which promote healthy behaviour and help fight the stigma that hinders people’s, particularly women’s, access to health services.
We have to rebuild our health systems to ensure they meet the needs and realities of all in times of crisis. This includes prioritising and funding primary healthcare and Universal Health Coverage (UHC) grounded in gender equality and human rights. It is important for us to not view Covid-19 as a standalone disaster, and that we need to equip ourselves with adequate knowledge, gender-disaggregated data. And finally, the government should leverage partnerships with NGOs to support information and service delivery to ensure we reach the last mile in this time of crisis.