The second Lancet Commission report on adolescent health has brought forth some alarming statistics regarding the state of adolescent well-being and health following the COVID-19 pandemic. The Commission estimates that by 2100, 1.8 billion adolescents will live in a world that is approximately 2.8 degrees Celsius warmer than it was in the past, all while facing increasing exposure to food insecurity, economic challenges, and armed conflicts. However, the consequences for female adolescents are even more concerning. In a world defined by increasing uncertainty and exposure to risks, adolescent girls face a disproportionate burden of early-life adversities, particularly deprivation and gender-based violence.
Moreover, they are more prone to child marriage, teen pregnancies and other discriminatory practices, leading to an increased exposure to non-communicable diseases (NCDs) – related mortality. These rising gender disparities in adolescent well-being is an indicator of lack of gender-specific measures and health policies to address the increased risks faced by girls and female adolescents.
Policies specifically targeting adolescents need to be examined from a gender-disaggregated lens – that is, they must be designed and implemented in ways that recognize the distinct lived experiences and challenges faced by young girls, in a manner that recognises and challenges the prevalent gender norms, roles and inequalities. A recent report by UNICEF also underscored that gender-based violence and discriminatory practices across the globe continue to worsen health risks for adolescent girls, highlighting the need for targeted interventions more than ever.
A sociological framework
A sociological lens is required to understand gender theory and social norms theory to dissect the mechanisms through which informal rules and societal expectations perpetuate inequalities in healthcare. Often, deeply rooted gender ideologies are decisive in women’s access to sexual and reproductive health (SRH) services. Young women are denied basic bodily rights at every stage of development – a ‘vicious’ cycle of denial. This cycle continues when adolescent girls become mothers. The statistics are indicative of this. 54% of adolescent girls are anemic, while a third of them are underweight and stunted.
Denial of information is a crucial part of this cycle. Prevalent norms around women prevent them from accessing crucial information. A teenage girl’s statement in Telangana is indicative of this:
‘I was extremely stressed, as I did not know the reason behind menstruation. Whenever I tried talking about it, my mother and sister hushed me up. I only knew that when my friend started her periods, she never came back to school.’
‘I was extremely stressed, as I did not know the reason behind menstruation. Whenever I tried talking about it, my mother and sister hushed me up. I only knew that when my friend started her periods, she never came back to school.’
Furthermore, the ease of access to such information is rooted in institutional factors, as highlighted by a 2023 UNESCO survey, which states that 23 million girls drop out of school annually due to the lack of proper menstrual hygiene management facilities. Further lack of awareness and workforce at the primary level, such as at primary healthcare institutions (PHCs), ensures the continued denial of crucial services and information. There are notable gaps in the training of service providers and peer educators, including insufficient training duration, lack of quality control, and uneven training content across states. Training of frontline workers, especially gender-sensitivity training, is virtually absent.
Girls from marginalised districts and communities are especially excluded from the provision of institutional services due to discrimination and additional infrastructural and geographical barriers. Thus, many marginalised communities are located far from health and educational facilities, making distance and the lack of transportation significant obstacles.
Adolescent girls and mental health challenges
The second Lancet Commission report also points out the deteriorating state of mental health among adolescents. According to the Commission’s report, an estimated 42 million years of healthy life will be lost to mental disorders or suicide.
Adolescent girls, in particular, have a substantially higher prevalence of depression, anxiety, eating disorders, suicidal ideation, and suicide attempts. Deteriorating mental health is often a response to systemic inequalities and cultural pressures. Feminist theory specifically highlights the role of societal expectations and norms in contributing to deteriorating mental health, especially, the pressures to cope with norms of femininity and deal with sexism and gender-based violence. Women are more likely to experience interpersonal violence, including domestic violence, sexual assault, and intimate partner violence.
In the age of increasing penetration of social media among teenagers, exacerbation of body-shaming-related mental health disorders has become especially concerning. Indeed, more than 60% of adolescent girls in 2023 reported dissatisfaction with their body image.
In the age of increasing penetration of social media among teenagers, exacerbation of body-shaming-related mental health disorders has become especially concerning. Indeed, more than 60% of adolescent girls in 2023 reported dissatisfaction with their body image.
Furthermore, experts have highlighted the lack of gender-specific research in the field of psychology to understand the differences in symptoms and disorders. Thus, approaching mental health from a feminist perspective requires the critical analysis of the ‘gender schemas’ – mental structures that organize information related to gender, which are central to the development of gender identity and influence behavior, preferences, and self-concept from an early age. This means that girls’ worldviews regarding gender roles shape how they view themselves. These pressures often heighten girls’ risk of depression, anxiety, and emotional distress, especially as gender expectations become more rigid during adolescence, and girls are more likely to internalise difficulties and experience lower subjective well-being compared to boys.
Obstacles in seeking information
Most girls are unaware of available services and lack basic information, especially about SRH topics. There is a notable absence of school- and community-based outreach activities to raise awareness about SRH. The stigma – related to menstruation, sexual health, or reproductive rights, which are often considered taboo – makes it difficult for teenagers to access reliable sources. This often pushes girls to rely on informal sources and misinformed agents. 72% of the girls in Bihar face healthcare barriers due to stigma and lack of information.
Lack of access extends into temporal dimensions, which, when combined with income inequalities, serve to exacerbate inequalities in access. Thus, adolescent girls in low-income communities often work 9 –11 hours daily in sectors like garment manufacturing, leaving them with no time to visit health facilities during operating hours. Financial constraints force reliance on free but overburdened public services, where providers are often unfamiliar with gender sensitivity and might not adequately understand or address the needs of these girls.
Multiple jeopardy: how intersectional identities exacerbate inequalities
Adolescent girls belonging to marginalised communities and regions are often at risk of multiple jeopardy, i.e., their multiple marginalisations may compound disadvantages for these girls rather than simply adding to their burdens. Adolescent girls from low-income families are more likely to suffer from undernutrition, anemia, and lack of access to quality health services. They also bear a disproportionate burden of unpaid domestic work, leaving them with less time for self-care and education.
Girls from such communities are often unable to access legal institutions and recourse, as they face an increased fear of criminalization, discrimination, and breaches of confidentiality. Furthermore, ambiguous laws, such as those on abortion, which require mandatory reporting to the police and the need for guardian consent, can deter girls from seeking safe, legal abortion services.
Addressing adolescent girls’ mental health, therefore, requires a holistic approach, which recognizes the multiple forms of discrimination faced by them and takes into account their positioning within a gender-unequal and gender-insensitive society. Integrating their concerns into mainstream healthcare systems and services, thus, requires not only extensive research into the subjective concerns of these girls but also gender-sensitivity training for healthcare providers at the primary level along with targeted and participatory approaches, especially for girls from marginalised communities.
About the author(s)
Sohalika Shrivastava is a 3rd year student at IIT Madras out and about to carve a niche for herself. In her free time she likes to read about and learn animal fact
