Nisha, a RURAL WOMEN’S SOCIAL EDUCATION CENTRE (RUWSEC), youth volunteer from Kanchipuram district, Narapakam panchayat, has a clear vision of how through her leadership, the health system stakeholders in her village panchayat, will deliver comprehensive sexual and reproductive health information and services for women and adolescent girls in all their diversity. Nisha is one of the many passionate youth leaders who gathered at the training organized by RUWSEC, 6-7 June 2026 in Chennai.
It was a fulfilling experience to witness the leadership of young people in the training in Chennai, as part of the Kaleidoscope: Reclaiming Sexual and Reproductive , Health, Rights , and Justice (Kaleidoscope) Collective. Kaleidoscope initiative in Tamil Nadu is being implemented in 6 districts – Chengalpattu, Dharmapuri, Kanchipuram, Perambalur, Theni and Thoothukkudi, directly contributing to the broader kaleidoscope initiative vision of women and adolescent girls transforming their local health systems, which have failed and excluded them, into systems that are shaped by and for them, and are accountable to them.
In the larger universe, the Kaleidoscope initiative is a collective of 17 transnational feminist organizations in the Global South working towards health systems strengthening for sexual and reproductive health and rights and justice (SRHRJ) particularly safe abortion rooted in Asia and Africa, specifically in India, Nepal, Benin and Kenya.
Coming back to the Tamil Nadu, India, where the initiative is being implemented, the state has a fairly good socio- economic, and health including reproductive health profile. Accordingly, to the recent report published by RUWSEC, Tamil Nadu projects a per capita income is `2.78 lakh in 2022-23 fiscal year, which is 1.6 times the overall India average. Tamil Nadu has also seen a significant decline in poverty rates in the recent years, including the multidimensionally poor reduced from 36.5% in 2005-06 to 1.4% in 2022-23.[i]
The state’s Maternal Mortality Ratio (MMR), as reported by the Sample Registration System (SRS), has declined from 97 per 100,000 live births in 2007-09 to 35 per 100,000 births in 2021-23. The total fertility rate in the state is at 1.6 (Urban) and 1.8 (Rural) children per woman,[ii] The contraceptive prevalence rate (CPR) (modern methods) in Tamil Nadu has increased from 53% during 2015-16 (NFHS-4) to 65% during 2023-24 (NFHS-6).[iii] All these socio- economic, and health including reproductive health profile indicators point to the pattern,
Despite this progress, the state of Tamil Nadu, can do more. According to NFHS-6 (2023-24), women aged 20-24 years married before attaining the legal minimum age of 18 years is at 9.2% (Urban) and 11.5% (Rural), and women ( technically adolescents) aged 15-19 years who were already mothers or pregnant at the time of survey (%) remained high at 2.4% (urban) and 4.6% (rural). This data patterns point to the fact that adolescent pregnancy averages despite improvements, remain high posing a major public health crisis, in Tamil Nadu. The various consequences of adolescent pregnancies including the highest probability of their dying or enduring lifetime complications are well documented.
In absolute numbers, across India, adolescent pregnancies remain high. The year 2019 saw 8.6 million pregnant adolescent girls in India, with rural and socioeconomically disadvantaged adolescent girls bearing the brunt.[iv] These numbers are not small, and point to a major public health crisis, a gender and reproductive justice crises, across India, with some deep questions that we need to ask?
A recent research on trends in teenage pregnancy in Tamil Nadu (2019-2024), emphasizes that there is a need for greater emphasis on school-based sex education, behavioural change communication, and community participation.[v] What is also needed is universal access to quality, safe, adolescent friendly sexual and reproductive health information and services within public health systems.
The training of youth champions and leaders, by RUWSEC, is the step forward, in terms of making health systems accountable to women and adolescent girls in all their diversity. The youth champions, are training themselves to work with and also be part of local government-mandated committees (Health committees at the public health facilities, and School Management committees in the government schools).
As ways forward, government initiatives such as the Rashtriya Kishor Swasthya Karyakram (RKSK), and Adolescent Friendly Health Services (AFHS) and clinics, Adolescent Reproductive and Sexual Health (ARSH) Strategy, all need to actively engage adolescents, young people within the programmes as active leaders and system stakeholders. This will ensure long-term alignment of all system stakeholders including adolescents to a common reproductive justice centered health systems agenda that addresses the root causes of reproductive health and rights inequities at scale contributing to overall reproductive health and well-being of women and adolescent girls in all their diversity.
[i] Data accessed from Government of Tamil Nadu, State Planning Commission. (2025). Economic Survey of Tamil Nadu 2024–25. https://www.thehindu.com/ news/resources/69325492-Full-Document-ofTamil-Nadu-first-Economic-Survey-2025.pdf dated 14/06/2026
[ii] Data accessed from https://www.mohfw- dohfw.gov.in/static/uploads/2026/05/111ff4a13ca36b5cabb7f94aec5bb0ce.pdf dated 12.06.2026
[iii] Data accessed from the National Family Health Survey (NFHS-6) , dated 13.06.2026
[iv] Data accessed from https://iiphs.ac.in/teenage-pregnancy-can-a-child-raise-a-child/ dated 10.06.2026
[v] Vijaykumar R, Nirmalson J. Trends of teenage pregnancy in Tamil Nadu (2019-2024). Tamil Nadu Journal of Public Health and Medical Research, Vol4,Issue4,October-December 2024
