Why India Needs To Invest In Health, Education Of Adolescent Girls

Ahead of the interim budget to be presented by the Union government on February 1, we explain why it is important to invest in the health and education of India’s adolescent girls. By addressing the gaps in financing, focusing on foundational skills and digital literacy, and considering state-specific needs, the budget can lay a strong foundation for the holistic development of India's adolescents, preparing them for a productive and digitally competent future.

Adolescence, defined by the World Health Organization as the age range of 10 to 19 years, is a transformative period marked by significant mental, emotional, and psychological development.

In India, policies regarding adolescent development encompass a broad spectrum of values, principles, and objectives aimed at enhancing the socio-economic well-being of this demographic. These policies are developed by various ministries, such as the Ministry of Education, Women and Child Development, Youth and Sports Affairs, and Health and Family Welfare.

Key policies concerning the adolescent group include the National Adolescent Health strategy (Rashtriya Kishor Swasthya Karyakram or RKSK), the National Health Policy of 2017, the National Youth Policy of 2003 and 2014, and the National Mental Health Policy of 2014. Each of these has specific and interconnected goals. Additionally, policies such as the National Population Policy of 2000 and the more recent National Education Policy of 2020, though not exclusively focused on adolescents, include aspects relevant to this age group.

Health and adolescent girls

Nearly three in every five adolescent Indian girls in the age-group of 10-19 have anaemia, compared to 28% boys, according to the fifth National Family Health Survey (NFHS-5), conducted during 2019-2021. This underscores the unique health challenges faced by girls, which can lead to severe long-term health complications and impede cognitive and physical development.

Iron-deficiency anaemia “reduces the work capacity of individuals and entire populations, bringing serious economic consequences and obstacles to national development’’, according to the WHO, as IndiaSpend reported in October 2016. Anaemia has led to 17% loss in productivity among workers engaged in heavy physical labour and a 5% dip in the output of moderately active workers, according to this 2002 study published in the Journal of Nutrition.

Issues related to sexual and reproductive health also remain significant points of discussion, with early pregnancies and lack of awareness about reproductive health being major concerns. While the age-specific fertility rate per 1,000 women aged 15-19 has declined from 51 during NFHS-4 (2015-16) to 43 in NFHS-5, India still accounts for one in every seven unintended pregnancies globally, as reported by UNFPA in 2022. Further, 6.8% of adolescent girls aged 15-19 years have begun childbearing, NFHS-5 shows.

Nutritional deficiencies are prevalent, with the persistence of stunting and underweight problems among this age group. Over 41.9% of school-going girls are reported as underweight as per NFHS-4. These issues are more pronounced in certain states such as Bihar, Jharkhand and Gujarat indicating regional disparities in nutritional health.

Nutritional support to adolescent girls through supplementary nutrition has been revamped under the new Mission POSHAN 2.0. The earlier Scheme for Adolescent Girls was covering out-of-school adolescent girls aged 11-14 years. Under the POSHAN 2.0, the targeted beneficiaries include all 14-18 year old girls from the aspirational districts.

The NFHS survey also sheds light on menstrual health, noting a positive increase in the use of menstrual hygiene products, with 78% of girls aged 15-19 years now using them, up from 58% in 2015-16. However, this underscores the need for continued efforts to ensure universal access to menstrual health products and education.

A growing concern in adolescent health is the rise in mental health issues. Half of all mental health conditions begin by the age of 14, with self-harm being a leading cause of death among 15- to 19-year-olds. The National Mental Health Survey of India 2015-16 found that the prevalence of mental disorders in adolescents aged 13-17 years was about 7.3%, with a higher incidence of stress-related disorders reported among girls compared to boys. UNICEF's 2019 report on adolescent well-being in India highlights the increasing burden of mental health issues (cases of depression and anxiety among teenagers), emphasising the need for targeted interventions.

The effectiveness and reach of the programmes such as RKSK and POSHAN 2.0 are fundamentally linked to their financial resources, as funding greatly affects their coverage and overall impact. RKSK, implemented by the Ministry of Health & Family Welfare, is crucial for adolescent health but confronts implementation hurdles due to the underutilisation of funds.

Education and adolescent girls

Adolescence is a time of transition from elementary to secondary education and from education to work. Limited educational opportunities impact girls’ future potential. According to an October 2020 research study across eight countries including India, an investment of $1.53 per day per girl to achieve universal secondary school completion can help developing economies expand their gross domestic product (GDP) by an average of 10% by the year 2030.

At present, the female labour force participation rate (FLPR) in India is 37%, one of the lowest among G20 countries. While more girls pursuing higher education is one of the reasons for low FLPR, lack of adequate knowledge, skills and education on the other hand, is also deterring women to be part of the skilled workforce.

Secondary education catering to girls in the 14-18 years age group plays a critical role in transitioning from education to work. While there is substantial improvement in girls’ net enrolment rate at secondary level, rising from 43.9 in 2012-13 to 48 in 2021-22, a large number of adolescent girls are still out of school. As per the Unified District Information System for Education, in 2021-22, while the drop-out rate for girls in the country is 1.35% at the primary level of education, it increases to 12.25% at the secondary level, compared to 12.96% for adolescent boys. The Covid-19 pandemic has had a profound effect on the learning outcomes of India’s adolescent girls. ASER 2023 ‘Beyond Basics’ survey shows that 24% female students of age 14-18 years could not read a grade II level text during the survey.

During the pandemic, the transition of schools to virtual mode impacted the learning of those students most who had no or limited access to digital devices. The ASER survey also revealed a clear gender disparity among adolescent youth. Of those who can use smartphones, among them, 43% male students had their own devices, while only 19% female students possessed the same.

One of the critical factors determining quality education is the presence of teachers in government schools. According to the Parliamentary Standing Committee report of the Department of School Education and Literacy, in 2022-23, of the total sanctioned posts of teachers, 15% vacancy is at secondary level and 19% at higher secondary level.

As education at secondary level is not free, parents are more willing to pay for their sons' education than their daughters. Therefore, it is the low fee charging government schools that indirectly cater more to girl children at the secondary level. Hence, government financing for secondary education is even more crucial for adolescent girls.

“Every extra year spent in school increases the income earned by a girl by no less than 10%-20%,” IndiaSpend reported in October 2018, based on the Teen Age Girls report released by Nanhi Kali, a project by the Naandi Foundation, which works with adolescent girls. “The returns are higher, up to 15%-25%, on secondary education.”

Only 18.6% girls surveyed in rural areas said boys in their community can do as much household work as they did, while 23.8% girls in urban areas said so. A higher burden of unpaid domestic and care-giving work mean these girls have little time for themselves.

However, total public expenditure--by the Union and state governments together--on secondary education is stagnant at around 1% of GDP for the last five years and the Union government share is declining over time. A CBGA-CRY study estimates an additional 0.2%- 0.3% of GDP is required to ensure universal quality secondary education for all eligible girls of age 15-19 years.

In 2022, a special campaign under Beti Bachao Beti Padhao, named Kanya Shiksha Pravesh Utsav, was launched by Ministry of Women and Child Development in convergence with Department of School Education and Literacy to re-enroll out of school adolescent girls in the age group of 11-14 years. In 2022-23, Rs 90 crore was released by the Union Government under BBBP while the figures were Rs 53 crore and Rs 57 crore in 2020-21 and 2021-22 respectively, the government told Lok Sabha in July 2023. According to the PRABANDH portal, as of 2022, 144,000 adolescent girls were identified across 22 states and of them, 100,000 have been re-enrolled. However, the number of out-of-school girls would be higher than the reported number as the meeting minutes of the Project Approval Board for Samagra Shiksha Abhiyan shows that many states have not yet started uploading the data on the PRABANDH portal.

*The authors are with Centre for Budget and Governance Accountability (CBGA), New Delhi

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