South Asian ASRHR youth leaders: ‘Young people need spaces to have honest conversations’

Urja Humagain of Nepal and Vaibhav Gaur of India didn’t grow up thinking they’d be on the front lines of adolescent health reform. But once they recognized how deeply silence and stigma limit access to sexual and reproductive health information, even in the most privileged communities, they knew they couldn’t stay quiet.

The pair are now youth advisors to the Adolescent Sexual and Reproductive Health and Rights Exemplars project (ASHER), a collaboration between the African Institute for Development Policy (AFIDEP), Exemplars in Global Health (EGH), and many other country-based research organizations, including the Public Health Foundation of India and the Center for Research on Environment, Health and Population Activities in Nepal.

Launched at the Women Deliver 2023 Conference, ASHER studies six countries – Cameroon, Ghana, India, Malawi, Nepal, and Rwanda – that have achieved notable improvements in adolescent sexual and reproductive health and rights (ASRHR) outcomes. The project identifies positive outliers in the field – countries that made significant progress despite systemic challenges. Data collection is complete in all countries except India, where research is ongoing.

Youth engagement is at the heart of the project. Two youth advisors were selected from each country, including Humagain and Gaur, who bring both professional expertise and personal perspective to a field where cultural stigma still looms large. Despite growing up in capital cities and attending good schools, both describe discovering their sexual and reproductive health late – and the frustration of realizing how little space is offered to young people to talk openly about their bodies and health.

In this conversation, Humagain and Gaur reflect on what they've learned through ASHER, including regional differences in program delivery. They also explore what Nepal and India can learn from each other and why, in a shifting landscape of global health financing, youth voices matter more than ever.

Could you please introduce yourselves and share your roles, affiliated organizations, and your relationship with EGH?

Humagain: I'm Urja Humagain from Nepal. I'm 24 now, so I'm not really an adolescent anymore. I started working on ASRHR when I was around 18, becoming involved in youth-led organizations focused on sexual and reproductive health advocacy and research. I began with an organization called YUWA, where I served on the executive board for two years and helped lead the organization. I then joined Visible Impact as their monitoring and evaluation officer. Recently, I began working with Exemplars in Global Health as a youth advisor for the ASHER project from Nepal.

Gaur: I'm Vaibhav Gaur from India. I'm 23 and currently completing my post-grad in law. I started working on ASRHR in 2019 when I was 17, with an organization called the YP Foundation. My first work in ASRHR involved comprehensive sexuality education, training, and session facilitation in communities in Lucknow, the capital of Uttar Pradesh, my home state. Currently, I'm a youth advisor for the Exemplars in Global Health project from India, associated with the Ramalingaswami Center, based out of Bangalore.

What inspired you to become involved in advocating for ASRHR, and what motivates you to pursue this work?

Humagain: When I first joined YUWA, I wasn't very aware of my sexual and reproductive rights. But then I met a lot of young people through the organization who talked about ASRHR. That's when I began to understand all the things young people have been deprived of in terms of information and services. To be honest, I didn't realize these things were so important in young people's lives. What's interesting is that even though I lived my whole life in Kathmandu, the capital of Nepal, and I've been much more privileged regarding access to knowledge and services than many young people, I didn't know very much about myself, my body, and my sexual and reproductive rights. That was pretty surprising for me – how could other young people know about their health and rights if someone in my privileged position was so unaware?

I started doing a lot of peer-based work in ASRHR. I started talking to my friends and other young people and slowly got really comfortable talking about ASRHR. We hosted a lot of safe spaces. That was another point of realization – so many young people wanted to talk about it. They're curious, but amid their curiosity, I also saw much confusion and disappointment, motivating me to work more on ASRHR. Now when I give sessions to students aged 16 or 18, I see their faces light up when they learn something new about their bodies. That's really inspiring.

Gaur: My answer is very similar to Urja's – there's silence around ASRHR and sexual and reproductive rights as a whole. Initially, I was interested in development but didn't really know what specific area – I was exploring. But when I started to become involved in ASHER, I learned so much. Similar to Urja, I grew up in a state relatively close to Delhi and had the privilege of studying at one of the best law colleges in the country. Even with all these privileges, I realized I was learning so much about my body that I'd never been taught. I felt many young people needed spaces where we could have honest conversations. That's how I became involved in ASHER. I'm continuing because of support from peers, colleagues, and the organizations I've been associated with. They've always treated me like an equal, not some checkbox. Now, I'm starting to see multiple layers and intersectionalities in the SRHR and ASRHR spaces.

Given the shifting landscape of global health financing, what is youth leaders' role in navigating these challenges and continuing to drive ASRHR progress? What support can others in the field best provide you right now?

Humagain: To be honest, the global situation right now is disappointing and demotivating. Even though I've worked nearly six years on ASRHR, seeing all the pushback right now makes me really sad. Post-COVID, especially, there's a lot that happened globally. I feel like there are more challenges and issues now, making young people vulnerable. There should've been more support, but somehow, it's gone in reverse. It's surprising how much we've regressed in a very short time. It puts all the progress we've made so far in danger.

In this context, I feel responsible now that I know about ASRHR and am confident talking about it. I cannot just stay silent because so many people are still struggling. When I first started, I was lost. I wasn't confident enough to talk about it. I would've loved meeting someone who motivated me and said it's fine to talk about it – you have to talk about it. Right now, I feel young people like me should feel that sense of responsibility and continue raising their voices.

Projects like the ASHER project, highlighting success stories and exemplary work done in different countries, showing how far we've come, sharing this progress, should be emphasized more so we can keep motivating each other – even when everything feels discouraging. We can at least highlight these stories. It's the right time to discuss those successes and spotlight the efforts made over the years.

Others in the field should create more platforms – even platforms like this interview – which someone might read and get inspired. These platforms should continue inviting young people and show solidarity with the issue, reassuring us and other young people that we're not alone. Advocacy has become a lifelong journey for me, not just a task. Other young people should think this way as well because our health is at stake – that hasn't changed despite global aid shifts. The message remains clear.

Gaur: I concur with Urja that the global landscape has dramatically shifted in the past six years, impacting health at global, regional, and local levels. Coming from India, the country with the largest population, I feel more hopeful due to the extensive supportive policies and laws, especially favoring SRHR and youth.

Youth responsibility at national and global levels involves bringing out stories with a human touch – our lived experiences, realities, perceptions, and opinions. We must amplify our voices and local experiences. We need to show the solidarity we share – not just geographically, but as youth actively engaging in improving health outcomes and advocating for change. As Urja rightly said, we need more spaces so that voices can inspire others to speak confidently and openly about their rights without fear or compulsion. Creating and sharing these spaces is vital.

The best support that others in this field could provide us is to make space for young people. They can ensure that young people are at the table, their voices are heard, and their opinions are actually valued. They can ensure that young people are entrusted with responsibility and walk the path together with us. We all must strive to internalize that young people are not just the future – young people are the present and nothing should be done that affects us without us.

Could you talk about what you've learned through this research, particularly anything surprising or inspiring?

Humagain: Yes. Being part of the ASHER Youth Team has been a profound experience. I've met many people, especially other young advocates. It was surprising for me that Nepal was listed among exemplars – people from the ministry of health in Nepal were also surprised. They didn't expect that our progress was significant enough to be recognized as exemplary, given the perception that there's so much left to do.

It gave me perspective on how slow progress has been globally and has motivated me by emphasizing how much still needs to be achieved. Meeting stakeholders in Nepal – those who have actively worked on ASRHR – was striking. Their motivation and genuine desire to effect change were inspiring. Health typically isn't prioritized within the broader developmental agenda, yet seeing their commitment gave me hope. Meeting the pioneers directly responsible for positive developments in Nepal, such as policies around safe abortion, was particularly inspiring. Realizing this work started even before I was born gave me a deeper appreciation for the long-term nature of advocacy. However, there were also negative surprises. Areas where we'd made significant progress sometimes regressed – for example, comprehensive sexuality education transitioned from compulsory to optional. Understanding why these reversals happened remains a point of curiosity and concern for me.

Gaur: In India, the research covers Uttar Pradesh, Maharashtra, and Assam due to their diverse representation in health progress according to National Health Service data. I'm particularly interested to see how this diversity manifests clearly within these states. Every district differs significantly, especially in terms of literacy, digital and numeric skills, and general access to services. The diverse outcomes within states excite me because they showcase local variations despite similar statewide policies. For instance, districts in Uttar Pradesh bordering Nepal may exhibit vastly different outcomes compared to Lucknow, the state capital. Observing this detailed variation within the broader research is something I look forward to.

What stands out to you about the similarities and differences between Nepal and India's respective approaches to ASRHR? What do you think the two countries can learn from each other and from other exemplars?

Humagain: Vaibhav highlighted key similarities: notably, the collective silence around adolescent sexual and reproductive health in South Asia. We also share cultural, political, and sociocultural contexts marked by stigma and bias. These elements significantly influence adolescent SRHR services and education. The diversity within our countries, though culturally enriching, poses significant implementation challenges. For Nepal, geographical barriers add complexity, whereas India faces challenges related to implementing initiatives at scale for its massive population. Despite these common challenges, there's insufficient sharing and collaboration between our countries on effective ASRHR strategies. I'm genuinely eager to learn from India's research findings through ASHER. If India implements successful strategies, Nepal could significantly benefit by following similar paths.

Gaur: Completely agreeing with Urja, I find two main similarities stand out – collective silence and the challenge of diversity. India's challenges arise from the scale and diversity of the population, which create unique implementation complexities, including social stigmas and geographic barriers. An important shared aspect requiring more attention is the caste system – distinct from race and uniquely impactful on ASRHR in South Asia. Studying its effect further is necessary for a better understanding and effective policymaking.

India's diverse state-specific approaches offer valuable insights for Nepal, especially in geographically similar areas like Uttarakhand and Himachal Pradesh. These states' policies and practices could inform Nepal's approaches. Additionally, India's recent significant progress in digital infrastructure is a notable strength. Leveraging digital innovations to bridge conventional gaps could be a key learning area for Nepal. Strengthening South Asian Association for Regional Cooperation mechanisms and regional collaborations would also be beneficial. Given our geopolitical ties, more robust information exchange facilitated by platforms such as the UN’s regional offices could significantly improve the collective handling of common ASRHR challenges across South Asia.

Editor's Note: For more information about Adolescent Sexual and Reproductive Health and Rights, visit Exemplars in Global Health.

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