Introduction:
Discussing sexuality is still considered a taboo in Indian Society. Sexual health education to school children and adolescents is a challenge for teachers and is seldom taught in a way to create medically appropriate, affirmative outlook towards sexuality. The problem is compounded by myths associated with sex information resulting in poor sexual information, high risk behavior, teenage pregnancy, sexually transmitted infections & sexual crimes. The problem is much higher in some part of country leading to sex discrimination. Age appropriate and adequate Adolescent Sexual & Reproductive Health (ASRH) will also have positive impact on decline in maternal and infant mortality. Researchers have also shown that ASRH intervention also encourage service usage by young people in Ghana (1). In India, socio-cultural barriers prevent young people talking about sexual health issues with parents and teachers. Moreover, the sexual and reproductive health needs of adolescents in India are currently overlooked or are not understood by the Indian healthcare system. These services are also not integrated well into Life skills module. The approaches adopted in schools, seminars are mostly consist of didactic lectures, or talks but seldom encourage active participation of the participants.
In the Rajasthan state of India, sex discrimination against the girl child, their late schooling, early marriage predispose girls to heavy disadvantages resulting into the poor health of the community. Adolescent children are highly receptive to innovations. Studies have shown that if the information is given earlier, it has positive impact on the future of teenagers (2). Poor knowledge also predispose women to adverse reproductive outcome (3). Researcher have also found that the family should be involved in sex education and modelling family sex education by gender has differentiated effects on the sexual debut of men and women (4). Comprehensive sexual health education has been emphasized globally(5). Despite our understanding of the situation, world over young population is passing through burden of poor sexual health education and reproductive rights (6,7). Schools have been suggested and many program by different health agencies have been introduced but are either impractical or requires lot of logistics and training (8,9). Our invention using mobile application circumvents many of these issues.

Description: Technical details and method of use
The invention implemented in urban area of Jodhpur, Rajasthan located in Western India. The project was an innovative method of imparting Sexual and Reproductive Health to adolescents' boys and girls. The Institutional Ethics Committee approved the invention for Human Research. Innovation
Active learning by Flipped Classrooms whereby basic information about sexuality and reproductive health is provided through a mobile application to be viewed at home by the students at his/her own pace along with their parents. The class time in school, is then, utilized for deeper learning, analysis, clarification with help of Audience Response System (ARS), or also known as Clickers, in presence of a facilitator who may be a class teacher or a competent and skilled health professionals, faculty or physician. Pre class material included small video or animation clips, presentations, short readings, quiz or stories. The presumed advantage of the method was that a pre-exposure sensitize all children about some basic concepts of ASRH. Here, the teachers and coordinators played a crucial role. During process they also got involved in the invention. They acted like bridge between health professionals, parents and students.
This bold and innovative idea, apart from creating medically appropriate awareness and education, will improve the health of society indirectly in long learn. The sexual and reproductive health education will follow a deep learning process, enhances life skills of communication, promote healthy sexual behavior. It will also change the perception of gender equality, empower teens to delay sexual activity, adopt abstinence and contraceptive methods, delay child birth to appropriate time, the spacing between children, care for their babies with higher responsibility. Using mobile phone app material, which will be culturally acceptable with parents, will also encourage and open pathways for active dialogue with parent teachers and siblings. In class activities, using Clickers (Audience Response System) will encourage shy student also to participate actively in the discussion. The technique will require little technical skill and amenable to adaptation as per the societal demands and scalable to a business model.

The design
Research has shown that Comprehensive Sexual Health education is very effective. It has been adopted by the developed nations. The situation in developing countries, however, is grim and challenges policy makers, educators, and health care professionals equally. Various researchers have discussed the current situation in India. Sexual and reproductive health education goes beyond just general health as it encompasses the whole of life and intergenerational health also. The seed that is sown now will reap rich dividends later. This needs empowering the young generation with knowledge and skills towards important area of reproductive health. Thirty schools were selected by random number generation. Fifteen schools were allocated to intervention arm and 15 were in the control arm. The intervention group were provided with mobile application. The application was 15 MB in size. It consists of small video clips, animations, short reading material, Frequently Asked Questions (FAQ) related to sexual and reproductive health. There were dashboard

Salient features:
1. Flip2Empower invention deliver basic information through a mobile application.
2. Participants have an opportunity to learn deeper with clarifications of the doubts.
3. Class interaction is augmented through use of Audience Response System (ARS) or Clickers.
4. The invention gives even the shy students an opportunity to participate.
5. Invention can be used in all situations requiring deeper learning or sensitive issues discussions like sexual health, relationship issues etc.

Discussion
Majority of problems related to maternal and infant morbidities and mortality revolves around reproductive health. Maternal nutrition, education, immunization, spacing and age of first baby are not only important contributors to the Infant Mortality Rate and Maternal Mortality Ratios but also important factors towards fertility and population explosion. Significant progress has been made in adolescent sexual and reproductive health and rights (ASRHR) in last 25 years. Trend analysis of key ASRHR indicators at global levels indicates improvements. Despite overall progress, however, unequal progress in many ASRHR outcomes is evident both within and between countries, and in some locations, the state of adolescents' lives has worsened (1). In India, adolescent sexual and reproductive health education faces many challenges and barriers. Poor sexual health exists across all socioeconomic groups and in both rural and urban settings. Girls have little understanding of pubertal changes, menstrual hygiene, reproductive tract infections (RTIs), contraception and sex itself (11). Multiple studies seeking awareness and perceptions about common adolescent issues have presented an alarming picture (12).
Studies have used technology for increasing participation (13). There are multiple health intervention using mobile phones (14). Most of these mHealth interventions are related to service delivery and awareness (15,16).
Our invention, on the other hand, is unique since apart from knowledge dissemination and encouraging service utilization, it encourages critical thinking stimulating better use of knowledge and skills in application. The invention is not a book or source of information but stimulate deeper learning empowering them with life skills.

1. Aninanya GA, Debpuur CY, Awine T, Williams JE, Hodgson A, Howard N. Effects of an adolescent sexual and reproductive health intervention on health service usage by young people in northern Ghana: a community-randomised trial. PLoS One. 2015 Apr 30;10(4):e0125267.
2. Monester J, Fisher J, Kirkman M, Rowe H, Holton S. 'If I had known the fertility health facts sooner...' Knowledge gaps as a barrier to effective fertility management: findings from the understanding fertility management in contemporary Australia survey. Eur J Contracept Reprod Health Care. 2019 Aug;24(4):274-279.
3. Tiwari S, Gray R, Jenkinson C, Carson C. Association between spousal emotional abuse and reproductive outcomes of women in India: findings from cross-sectional analysis of the 2005-2006 National Family Health Survey. Soc Psychiatry Psychiatr Epidemiol. 2018 May;53(5):509-519.
4. Faludi C, Rada C. Gender differences in sexual and reproductive health education in the family: a mixed methods study on Romanian young people. BMC Public Health. 2019 Aug 14;19(1):1103.
5. Comprehensive Sex Education: Research and Results. Advocates for Youth © September 2009 accessed on 2 August 2017 at http://www.advocatesforyouth.org/publications/1487
6. Ismail S et al. Adolescent sex education in India: Current perspectives. Indian J Psychiatry 2015;57:333
7. Khuchandani J et al.Beyond Controversies: Sexuality Education for Adolescents in India. J Family Med Prim Care. 2014 Jul-Sep; 3(3): 175-179.
8. Parwej S, Kumar R, Walia I, Aggarwal AK. Reproductive health education intervention trial. Indian J Pediatr. 2005;72:287-91.
9. United Nations Educational, Scientific and Cultural Organization (UNESCO). International technical guidance on sexuality education: An evidence-informed approach for schools, teachers, and health educators. Available from: http://unesdoc.unesco.org/images/0018/001832/183281e.pdf
10. Sreekumar S, Ramakrishnan J, Harisankar D, Mannethodi K. Felt needs and expectations of adolescents regarding sexual and reproductive health from schools and health systems: A descriptive study. Indian J Sex Transm Dis AIDS. 2019 Jan-Jun;40(l):30-34.
11. A. Thirunavukarasu, D. Simkiss, Developments in Reproductive Health Education in India, Journal of Tropical Pediatrics, 2013; 59(4): 255-257.
12. Nair MKC, Chacko DS, Ranjith Darwin M, et al. Menstrual disorders and menstrual hygiene practices in higher secondary school girls, Indian J Pediatr, 2012 ;79: 74-78.
13. Kuo CL, Chuang YH. [Kahoot: Applications and Effects in Education]. Hu Li Za Zhi. 2018 Dec;65(6): 13-19.

14. Nuwamanya E, Nuwasiima A, Babigumira JU, Asiimwe FT, Lubinga SJ, Babigumira JB. Study protocol: using a mobile phone-based application to increase awareness and uptake of sexual and reproductive health services among the youth in Uganda. A randomized controlled trial. Reprod Health. 2018 Dec 22;15(1):216.
15. Ippoliti NB, L'Engle K. Meet us on the phone: mobile phone programs for adolescent sexual and reproductive health in low-to-middle income countries. Reprod Health. 2017 Jan 17;14(1):11.
16. Feroz A, Abrejo F, Ali SA, Nuruddin R, Saleem S. Using mobile phones to improve young people's sexual and reproductive health in low- and middle-income countries: a systematic review protocol to identify barriers, facilitators and reported interventions. Syst Rev. 2019 May 18;8(1):117.

We claim
1. For empowering students learn sensitive topics and concepts related to Sexual and Reproductive Health (SRH).
2. The tool is effective in discussing complex life situations and in difficult decisions requiring shared knowledge and counseling.
3. This tool will be able to engage students in active learning in topics that require thorough knowledge and understanding of concepts like mathematical problems, physics and chemistry application.
4. It can also be used in any classroom activity for providing positive and constructive feedback.