Adolescent Health-An Overview

1. Adolescent Health-An Overview DR.HARIVANSH CHOPRA MD.,D.C.H. ASSOCIATE PROFESSOR LLRMMC MEERUT

2. THREE STORIES WITH SIMILAR ENDING NINA URBAN ADOLESCENT CHETAN ADOLESCENT BOY RESHMA RURAL ADOLESCENT APPARENTLY HEALTHY SON OF A DOCTOR EXPERIMENTING SEXUALLY DEVELOPING RAPIDLY TEENAGE PREGNANCY NEVER SCREENED EARLYMARRIAGE ABORTION R.M.P. +HISTROY OF CHD TEENAGE PREGNANCY DEATH

3. Adolescent Health-An Overview ALL THESE EVENTS ARE THE EXAMPLES OF SYSTEM FAILURE SYSTEM WHICH IS INSENSITIVE TO THE NEEDS OF ADOLESCENT

4. DISADVANTAGE • DOUBLE DISADVANTAGE • CARRY THE BURDEN OF PRE EXISTING DISEASES OF CHILD HOOD • DEVELOPING RAPIDLY AND HAVING EXTREME DEGREE OF PRESSURE • FROM PEERS, PARENTS, SOCIETY AND SELF LACK KNOWLEDGE AND SKILL TO COPE UP WITH PRESSURE Adolescent Health-An Overview

5. Adolescent Health-An Overview No longer Children, Not Yet Adults Young people 10-24 Years Adolescence 10-19 years Youth 15-24 Years

6. Adolescent Health-An Overview Population Profile: Ages 10-24 Years in India Population Reference Bureau. Inc.

7. Adolescent Health-An Overview India: Country of Diversity • 5,000 year old civilization • 325 languages spoken – 1,652 dialects • 18 official languages • 29 states, 5 union territories • 3.28 million sq. kilometers - Area • 7,516 kilometers - Coastline • 1,000,000,000 people in 2000 • 207 Million Adolescents

8. Adolescent Health-An Overview Adolescents: A Very diverse population segment • Different stages of development • Different circumstances • Different needs and • Diverse problems

9. Adolescent Health-An Overview Adolescents have important subgroups with markedly different needs: Urban Rural Slum Street Children Those in specially difficult circumstances

10. Adolescent Health-An Overview Why Focus on Adolescents? • Large number >22% of the population (Approximately 207 Million of our population); • Adolescence is a period of rapid physical growth, sexual and psycho-social changes; • Habits and behavior picked up during adolescence (Risk taking behavior, substance abuse, eating habits, conflict resolution) have life long impact.

11. Adolescent Health-An Overview Why Focus on Adolescents? • Adolescence is the last chance to correct growth lag and malnutrition; • Many adolescent boys and girls are sexually active but lack information and skills for self protection (Low level of information on FP, low contraception use); • Have simple, but wide pervading and crucial RH needs – menstrual hygiene, contraception; (including Emergency Contraception), safety from STI/HIV; • Communication gap exists with parents and other adults (Lack of family “Connectedness”);

12. Public Health Implications • 70% of mortality in adulthood is linked to habits picked up during adolescence. (Risk taking behavior, substance abuse, eating habits, conflict resolution); • Prevailing malnutrition, anemia, stunting and lack of immunization has adverse impact on MMR, IMR, morbidity and have inter- generational effects; • Adolescent sexuality: leads to adolescent pregnancy, unsafe abortions, RTI, STI/HIV and social problems; • Adolescent pregnancy : Risk of ADVERSE outcome (IMR, MMR, LBW babies) is higher; • Lack of “connectedness” with parents and other adults prevents transmission of health messages and crucial skills, leading to adoption of risky behavior- substance abuse, early sexual debut, STI/HIV etc.

13. Adolescent Health-An Overview Characteristics • A – Aggressive Anaemic Abortion • D – Dynamic,Developing,Depressed • O – Overconfident,Overindulging,Obese • L – Loud but lonely,& Lack information • E – Enthusiastic,Explorative,& Experimenting • S – Social,Sexual, & Spiritual • C – Courageous,cheerful, &concern • E – Emotional,Eager,& Emulating • N - Nervous,Never say no to peers • T – Temperamental,Teenage pregnancy

14. Ill Health Recipe: “Ye Dil Mange More” Lifestyle of Adolescents Tobacco/Alcohol Excess dietary FAT Lack of vegetables & fruits Sedentary habits Sexual behavior/ poor genital hygiene Adolescent Health-An Overview

15. Adolescent Health-An Overview A Common Scenario • 14 Year old school girls in a big City X: • Out of 100 girls: • 60 have never had sex; • 15 have had sex, but are not currently sexually active; • 25 are sexually active more or less regularly • 8 have had health problems; • 2 have been coerced into having sex; All these girls have different needs for health information, services and social support

16. Adolescent Health-An Overview Evidence of Common Roots* Risk & Protective factors foradolescents Early Sex Substance Use Depression A positive relationship with parents Conflict in the family A positive school environment Friends who are negative role models A positive relationship with adults in the community Having spiritual beliefs Engaging in other risky behaviours *”Broadening the Horizon” Evidence from 52 countries

17. Adolescent Health-An Overview Priority Health Problems • Sexual and reproductive health problems • Nutritional problems • Mental health problems • Substance abuse • Accidental and intentional violence Clustering of problems

18. PREVALENCE OF ANAEMIA IN ADOLESCENT-MEERUT 42 36 34 Adolescent Health-An Overview

19. Adolescent Health-An Overview Health problems • Large number are malnourished, and anaemic – (56% Baroda study, 95% SWACH study), or stunted (59% boys, 37% girls- NNMB 2000); • Obesity is increasing,8-10% in public schools of Meerut and Delhi. • Adolescent pregnancy – common (50%of women in india had a child before reaching the age of 20- IP-JAN 2004) • Large number of adolescents are – still un-immunized. (TT,RUBELLA );

20. Adolescent Health-An Overview HEALTH PROBLEMS • One out of 10 children in India is sexually abused at any given point of time (WHO) • Sexual problems;25%of patients attending Government STI clinics are Younger than 18 • Year old (Ramasubban-1995) • Increasing vulnerability to HIV/AIDS,Over 50%of all new HIV cases in india are among 10- • 24years (UNAIDS-2002) • Substance abuse is quite common

21. PROGRAMMES FOR ADOLESCENTS KISHORI SHAKTI YOJANA –To improve the health and nutritional status of girls BALIKA SAMRIDHI YOJANA –To Delay the age of marriage NEHRU YUVA KENDRA – ACT AS HEALTH AWARENESS UNIT-Through active participation of youth MAHILA SAMAKHYA PROGRAMME- Equal access to education facilities for adolescent girls and young women Adolescent Health-An Overview

22. Adolescent Health-An Overview PROGRAMMES FOR ADOLESCENTS SCHOOL AIDS EDUCATION, UNIVERSITY TALKS AIDS TRAINING OF RURAL YOUTH FOR SELF EMPLOYMENT REPRODUCTIVE AND CHILD HEALTH PROGRAMME ? WHERE ARE THE BOYS NO COMPREHENSIVE PROGRAMME ADDRESSING ALL NEEDS OF ADOLESCENT

23. To promote healthy development to meet needs and build competencies To prevent and respond to health problem from: Early, unprotected, unwanted sex Use of tobacco and misuse of alcohol and other substances Accidents Violence Poor nutrition Endemic disease Adolescent Health-An Overview Programming

24. STRATEGIES FOR PROMOTION OF ADOLESCENT HEALTH A =ADOPTION OF HEALTHY LIFE STYLE D=DEVELOP APPROPRIATE I.E.C. STRATEGY DISCOURAGE EARLY MARRIAGE AND TEENAGE PREGNANCY O=ORGANIZE ADOLECENT/ YOUTH FRIENDLY CLINIC L=LIFE SKILL EDUCATION , LEGAL SUPPORT, LIASIAN WITH PEERS , PARENTS E=EDUCATE ABOUT SEXUALITY,SAFE SEX,SPIRITUALITY,RESPONSIBLE PARENTHOOD S=SAFE, SECURE AND SUPPORTIVE ENVIRONMENT TO BE PROVIDED C=COUNSELLING / CURRICULM IN SCHOOL INCUSIVE OF FAMILY LIFE EDUCATION E=ENABLE &EMPOWER FOR RESPONSIBLE CITIZENSHIP N=NETWORKING FOR EXPERIENCE SHARING T=TRAINING FOR INCOME GENERATION,TEEN CLUBS

25. Adolescent Health-An Overview IAP HAS MADE AN ADOLESCENT CHAPTER EXISTING HEALTH FACILITIES MUST BE MADE ADOLESCENT FRIENDLY IAPSM HAS GOT THE INSIGHT LET US JOIN TOGETHER AND TAKE APPROPRIATE ACTION LET US WORK WITH YOUTH NOT MERELY FOR YOUTH AND MAKE THEM CHANGE AGENTS

26. Adolescent Health-An Overview THE CHALLENGES ARE THERE BUT POTENTIAL IS FAR GREATER Thank You!