although there are no national estimates of the burden of stis in indian children , several regional studies have indicated the potential burden of stis and the causal factors . studies estimate that the prevalence of stis in indian children could range from less than 1% to more than 15% , with existing estimates for common bacterial and viral infections . what is most disconcerting is the substantial burden of hiv infections in children and young adults . of all the cases of hiv in india , a major proportion ( more than one in four ) is seen in younger individuals due to risky sexual behaviors such as unprotected sex and multiple sexual partners . unfortunately , indian adolescents seem to be inadequately informed about signs , symptoms , and prevention of stis . in one particular study from delhi , more than one third of students did not understand the signs and symptoms of stis . the majority ( 71% ) had not heard about genital herpes , and almost half had not heard about gonorrhea ( 44% ) or syphilis ( 43% ) , which are the leading causes of stis . with regard to hiv , there has been some amount of social marketing and public discourse among youth in india , but in - depth knowledge seems to be lacking . a study of more than 1000 students from delhi reported that all the students ( 100% ) had heard about hiv , but majority of the students could neither write the full forms of hiv and aids , nor were they able to identify modes of prevention and transmission of hiv . in another study of adolescent females from maharashtra , the majority ( 54% ) of study participants were not aware about the transmission mode of hiv / aids from one person to another . this is especially disconcerting , given that maharashtra is one of the states with the highest burden of hiv . interestingly , the state of maharashtra does not have a provision for sexuality education in schools . according to the national family health survey of india , only 36% of male and 20% of female adolescents have comprehensive knowledge of hiv / aids . adolescents knowledge and awareness about human sexuality could possibly prevent and alleviate the burden of stis . a national study of unmarried women in india reported that majority of the recipients of sex and family life education had awareness of reducing and preventing stis and hiv , whereas majority of those who did not get such education were not aware of stis and hiv prevention . pregnancy - related deaths and complications are a leading cause of mortality and morbidity in adolescent indian females . a lot of pregnancies , especially in rural india happen to young females resulting in adverse maternal and child health outcomes . according to national estimates , almost one in six pregnancies in india several regional studies in india have also estimated the rates of teenage or early pregnancy to be in the range of 5% to more than 30% . there are pregnancies in adolescent females that are aborted or not reported , and there are adolescent females at perennial risk of early or unwanted pregnancy . although there are substantial public debates and controversies on sexuality education , the grave public health issue of teenage pregnancy remains neglected . estimating the medical , social , and economic consequences of teenage pregnancy in india , a report sponsored by the world bank indicated that delaying of teen pregnancies to early 20s would increase the nation 's productivity by more than us$7 billion . the two major implicating factors for adolescent pregnancies in india are early marriage and lack of birth control or unprotected sex . in either case given that more than one fourth of indian girls get married before the age of 18 years , the efficacy of child marriage ban in india remains questionable with regard to preventing early pregnancies . however , greater awareness about human sexuality has the potential to delay unwanted and unintended early pregnancies . in a national study , it was reported that unmarried young women in india who have received sex and family life education are more likely to know about birth control and contraception . compared to india , youth in many developing countries have greater knowledge of contraception , birth control , and lesser prevalence of teen pregnancy . one putative cause could be the emphasis on sexuality education and implementation of standardized curriculums in schools of many western countries . menstrual health of adolescent females is a fairly well - researched and reasonably explored area of child sexuality in the indian context . several studies from various parts of india have assessed menstrual morbidity , knowledge , perceptions , sources of information , and educational needs of adolescent females with regard to menstrual health and hygiene . the common prominent observations from these studies are : a widespread lack of knowledge about menstruation ( including information on anatomy and physiology ) ; clouding of perceptions by religious , cultural , and social taboos / myths ; need for education on menstrual hygiene practices ; and a need for resources ( e.g. water and sanitary pads ) to promote menstrual health and hygiene . the problems are more profound in adolescent females from rural and socio - economically disadvantaged backgrounds . several professional organizations ( e.g. unicef and who ) have advocated for greater emphasis on menstrual health and hygiene in adolescent females of developing countries . interestingly , adolescent indian females seem to be fairly inquisitive and keen on receiving menstrual health education and promotion . greater knowledge about sexuality is one possible solution for this unmet reproductive health need of adolescent females in india . in this regard , it is recommended that an evidence - based , standardized , and culturally relevant sexuality education / family life curriculum should be implemented across schools nationwide . in addition to the key issues discussed above , there are several emerging issues that need specific mention in the context of child sexuality and sexuality education . many of the emerging issues could be a result of the changing values / norms of the indian society ( e.g. westernization ) . first , there are issues that interface with child sexuality and other disciplines in humanities . prominent examples are child pornography , prostitution , child sexual abuse and poor parenting , adolescent dating violence or intimate partner violence , body image disorders , rape and abortion , female feticide and psychosexual disorders , homosexuality , masturbation and pornography consumption by adolescents . second , in recent times , there has been a fair amount of research on sexual behavior and attitudes of adolescents in india . studies have examined views about puberty and infertility ; age at first sexual intercourse and engagement in premarital sex ; number of sexual partners and emergency contraception , substance use and attitudes about sexual behaviors and virginity , and a cohort of other factors . for example , a recent study from pune reported that adolescents who reported sexual abuse , poor relationship with parents , sti symptoms , and substance use were more likely to have engaged in early sexual activities . knowledge about sexuality could serve as a vehicle for primary prevention and possibly counter the emergence of some of these issues that are new to the indian society , but widely prevalent in some western countries . it is fairly evident that the aforementioned child sexuality issues impose a substantial health - related , physical , and psychological burden on indian adolescents . given all the scientific evidence shared above , it is also important to understand public views on adolescent sexuality education in the indian scenario . ( b )  sexuality education should focus solely on abstinence and avoidance of premarital sex , sexuality education should be comprehensive and address a broader variety of topics that can also count as life skills .  therefore , the two key questions to be considered are : should sexuality education be a part of growing up for indian children ? if yes , what should sexuality education comprise ? successful health education and promotion programs have a major focus on the needs of target population ( in this case , indian adolescents ) . tailored interventions for health problems have to be based on the information provided by individuals in the target population . available scientific evidence suggests that indian children have frequently expressed the need of and desire for formal sexuality education . in addition , the disclosure of unmet reproductive health needs , menstrual problems , symptoms of stis , and the questions asked by cross sections of children nationwide , should also be considered as a proxy measure of childrens need for sexuality education . interestingly , not only have the indian children expressed a need for sexuality education , but in many studies , they have also expressed the preferred channels for delivery of sexuality education . family physicians , parents , and schools remain popular choices as sources of information and agents for delivering sexuality education . considering the proven need for sexuality education , the other key factor is the content of sexuality education . there are two major and broadly known practices in the context of sexuality education for children : abstinence - based and comprehensive sexuality education . abstinence - based sexuality education focuses primarily on promoting abstinence outside of marriage . on the contrary , comprehensive sexuality education supports adolescents ability to decide whether and when to have sex and also prepares young people for skills and knowledge on healthy sexual behavior . banning sexuality education or abstinence the commonly publicized reason is that promoting sexuality education leads to promiscuous behaviors and early sexual activity . however , scientific evidence suggests the contrary . in a recent meta - analysis from low- and middle - income countries , it was reported that compared with abstinence only group , the group of students who received school - based sexuality education had significantly greater hiv knowledge , self - efficacy related to refusing sex or condom use , fewer sexual partners , and lesser prevalence of early sexual activity . according to a major report commissioned by unesco that included a review of interventions from developed and developing countries , comprehensive sexuality education was found to reduce misinformation and increase awareness , enable youth to make healthy decisions , and have a positive impact on behavior . the report also found concrete evidence for the ability of comprehensive sexuality education to reduce risk behaviors , delay first sexual activity , reduce the frequency of sex and number of sexual partners , and increase contraceptive use . in another recent study of more than 900 adolescents of a vernacular school in maharashtra , students who were not exposed to scientific literature on reproductive and sexual health were more likely to have initiated sex early . an intervention with adolescents in chandigarh used a comprehensive reproductive health education program for the trial covering a broad array of topics including stis , pregnancy , menstrual health , birth control , and medical termination of pregnancy . the vast majority ( > 80% ) of parents , teachers , and students favored the educational program . in addition , the intervention group reported substantial gains in knowledge scores on a plethora of sexuality education topics . several other high - profile systematic reviews and meta - analyses have shown that comprehensive sexuality education has greater efficacy and cost - effectiveness ( even in the developing countries ) with regard to improving sexual health outcomes in adolescents . there is little evidence of success or inconsistent evidence for the efficacy of abstinence only or no sexuality education for adolescents with regard to sexual health outcomes . although there are many philosophies about content of sexuality education , stakeholders in india must understand that sexuality education should aim beyond just the prevention of negative consequences of risky behaviors . sexuality education should include teaching youth about the important role their sexuality plays in their personality , the many positive things one 's sexuality brings to life , and the role our sexuality plays in connecting an individual to others . according to sexuality information and education council of the united states , what children may be exposed to through a sexuality education curriculum is a lifelong process of acquiring information and forming attitudes , beliefs , and values . the curriculum encompasses sexual development , sexual and reproductive health , interpersonal relationships , affection , intimacy , body image , and gender roles . until the public demands that health education be designed to prevent morbidity and unwanted pregnancy , social agendas will drive much of the policy being made . there is profound scientific evidence on cost - effectiveness , outcomes , and cultural relevance of various types of sexuality education in the context of both developed and developing countries . policymakers and stakeholders should keep scientific evidence at the core of policymaking and health program planning on sexuality education for adolescents in india . informed and evidence - based decision - making for appropriate policies and scientific sexuality education programs india takes pride in its modernization , and the future generation will thrive in a far more modern and westernized climate than political and religious leaders of today . yes , we are bound by our culture , but is nt  science  the  culture  of modernity ?
sexuality education for adolescents is one of the most controversial topics in the field of child health . in the past decade , 
 policymakers in india have also struggled with the issue and there has been greater public discourse . 
 however , policymaking and public discussions on adolescent sexuality education are frequently fueled by religious , social , and cultural values , while receiving scant scientific attention . to meet the needs of an expanding young population in india , scientific evidence for best practices must be kept at the core of policymaking in the context of sexuality education for adolescents .