Desai Sapna, Pandey Neelanjana, Singh Roopal J, Bhasin Shikha
Population Council, New Delhi, India.
SSM Popul Health. 2021 Apr 2;14:100777. doi: 10.1016/j.ssmph.2021.100777. eCollection 2021 Jun.
India's adolescent health policy aims to improve sexual and reproductive health, especially amongst the most vulnerable. There is limited evidence on how gender influences treatment-seeking patterns amongst unmarried adolescents.
We analyzed data from 11,651 unmarried adolescent boys and girls aged 15-19 from a cross-sectional survey conducted in two large states of India. We conducted sex-disaggregated analyses to estimate the prevalence of symptoms of genital infections and compare treatment-seeking patterns. We identified correlates through multivariable regression and used a conceptual framework to explore structural, household, social and individual factors that influence gender inequities in adolescent sexual and reproductive health.
One in five unmarried adolescents reported symptoms of genital infections, such as burning or discharge, in the past three months. Factors associated with reporting symptoms varied between boys and girls, except for a common correlation with symptoms of depression. At least two-thirds of boys sought treatment, compared to approximately one in four girls (rural: 66.2% boys, 23.1% girls; urban: 69.4% boys, 30.7% girls). Boys primarily sought care from medical shops or private facilities, while girls used both private and government services. Amongst boys, having friends and being in school was associated with seeking treatment (aOR: 11.47; 95% CI: 2.75, 47.87; aOR: 1.95; 95% CI: 1.24, 3.07, respectively). Odds of seeking treatment were higher amongst girls with exposure to any mass media (aOR: 1.93; 95% CI: 1.25, 2.99) and who had discussed puberty with a parent (aOR: 1.98; 95% CI: 1.32, 2.98).
Stark sex differentials in factors associated with symptoms and in treatment-seeking illustrate how structural gender inequities, such as access to economic resources and education, influence sexual and reproductive health amongst adolescents. Along with health system interventions, addressing gender inequities calls for strategies to strengthen parental engagement, social support and girls' access to resources.
印度的青少年健康政策旨在改善性健康和生殖健康，尤其是在最脆弱群体中。关于性别如何影响未婚青少年的求医模式，证据有限。
我们分析了来自印度两个大邦的一项横断面调查中11651名年龄在15至19岁的未婚青少年男孩和女孩的数据。我们进行了按性别分类的分析，以估计生殖器感染症状的患病率并比较求医模式。我们通过多变量回归确定了相关因素，并使用一个概念框架来探讨影响青少年性健康和生殖健康中性别不平等的结构、家庭、社会和个人因素。
五分之一的未婚青少年报告在过去三个月中有生殖器感染症状，如灼痛或分泌物。除了与抑郁症状有共同关联外，报告症状的相关因素在男孩和女孩之间有所不同。至少三分之二的男孩寻求治疗，而女孩中约四分之一寻求治疗（农村：男孩66.2%，女孩23.1%；城市：男孩69.4%，女孩30.7%）。男孩主要从药店或私人机构寻求护理，而女孩则使用私人和政府服务。在男孩中，有朋友和上学与寻求治疗有关（调整后比值比分别为：11.47；95%置信区间：2.75，47.87；1.95；95%置信区间：1.24，3.07）。接触过任何大众媒体的女孩（调整后比值比：1.93；95%置信区间：1.25，2.99）以及与父母讨论过青春期的女孩（调整后比值比：1.98；95%置信区间：1.32，2.98）寻求治疗的几率更高。
与症状和求医相关因素中明显的性别差异说明了结构性性别不平等，如获得经济资源和教育的机会，如何影响青少年的性健康和生殖健康。除了卫生系统干预措施外，解决性别不平等问题还需要采取战略来加强父母参与、社会支持以及女孩获得资源的机会。
