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Strategic Information on Adolescent Health

Strategic Information on Adolescent Health. Ministry of Health and Family Welfare India. Existing MIS for National Reproductive and Child Health (RCH) Programme. Routine MIS: Monitoring of RCH programme Periodic National Surveys: Tracking improvement in health (RCH) status

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Strategic Information on Adolescent Health

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  1. Strategic Information on Adolescent Health Ministry of Health and Family Welfare India

  2. Existing MIS for National Reproductive and Child Health (RCH) Programme • Routine MIS: Monitoring of RCH programme • Periodic National Surveys: Tracking improvement in health (RCH) status • National Family Health Survey (NFHS): National and State level data • District Level Health Survey (DLHS): District level data • Special Surveys

  3. Limitations • There is a limited age and sex disaggregated RCH data available related to the adolescents and young people • Such strategic information is indispensable for advocacy, formulating policies, and developing rational programmes for adolescent health and development • Paucity of data comes in the way of developing specific strategies for special groups among this rather heterogeneous section of population

  4. NFHS Round 1 (1992-93), Round 2 (1998-99), Round 3 (2005-06) • Provides estimates of important family welfare and health indicators by background characteristics at the national and state levels • Measures trends in family welfare and health indicators over time at the national and state levels • Limitations • No men and unmarried men and women included in NFHS 1 and NFHS 2 • Youth Sample at sub-national may not permit detail analysis

  5. NFHS 3 • New areas included: Perinatal mortality, male involvement in family welfare, adolescent reproductive health, high-risk sexual behaviour, family life education, safe injections, tuberculosis, and malaria • 230,000 women age 15-49 and men age 15-54 throughout India • NFHS-3 tested more than 100,000 women and men for HIV • NFHS-3 also tested more than 200,000 adults and young children for anemia.

  6. DLHS The main focus of the DLHS-RCH has been on the following aspects: • Coverage of ANC & immunization services • Proportion of safe deliveries • Contraceptive prevalence rates • Unmet need for family planning • Awareness about RTI/ STI and • HIV/AIDS • Utilization of government health services and users’ satisfaction Limitations: • Unmarried men and women not included • Youth Sample at sub-national may be a problem but much larger then NFHS

  7. DLHS DLHS 1: 1998-99 DLHS-2: 2002-04: • 593 districts as per the 2001 Census • A total of 620 thousand households were covered • Interviewed 507 thousand currently married women (aged 15-44 years) • Interviewed 330 thousand husbands of eligible women were

  8. Secondary Analysis of existing data Objectives: • Secondary analysis of raw data collected under NFHS (1 and 2) and DLHS 2 rounds • To obtain age disaggregated data on sexual and reproductive health issues for the age group 15-24 years • To obtain an insight into the trends over these national surveys Steps: • Obtaining micro-data of the surveys • Data merging and preparation • Generation of tables and their validation

  9. Secondary Analysis • Age Blocks: 15-19, 20-24 and 25-49 years. • Domains: • Socio-demographic profile • Marriage • Morbidity • Fertility and Family planning • Maternal health • Child health and immunization • Anemia, level of nutrition • Health seeking behaviour • Knowledge awareness about RTI &STI • Knowledge awareness about HIV/AIDS

  10. Youth in India: Situation and Needs Study (2006-07) • Population based study • To provide information on: • Situation of youth • Life choices available to them on range of SRH issues • Behaviours and their antecedents • For evidence-informed programming

  11. Specific objectives • Identify key transitions facing youth, including education and livelihoods opportunities and experiences • Build evidence on the magnitude and patterns of sexual and reproductive practices in and outside of marriage • Identify the key factors underlying their sexual and reproductive health and choices • Advocate for evidence-based programming for young people

  12. Scope: Covers Six States of India

  13. Scope contd…

  14. Scope contd… • For each of Six state covered, the study would provide separate estimates for: • Rural & Urban areas • Male & Female populations • Married & Unmarried population

  15. Overall Sample Size Rural Urban • A: Unmarried • Females (15-24) 1750 1750 • Males (15-24) 1200-1500 1200-1500 • B: Married • Females (15-24) 1200-1500 1200-1500 • Males (15-29) 1000 1000 Total Sample Size: One State: 10000-12000 (approx.) Six States: 60000-72000 (approx.)

  16. Domains of reporting • Socio-demographic profile • YP control over their own life • SRH knowledge • Pre-marital relationships • Self reported health problems • Youth life style • Programme participation and voting experience • Married life

  17. % youth reporting premarital sex and % sexually experienced reporting consistent condom use, Maharashtra, Jharkhand, Tamil Nadu (Youth Study) Source: IIPS and Population Council 2007; forthcoming for Jharkhand and Tamil Nadu

  18. Marriage and regular exposure to sex initiated early Females • Almost half of all females marry before age 18 • About one third of young men marry before age 21 • % females aged 20-24 married by age 18 fell only from 50% to 47% between 1998-99 and 2006-7 (NFHS2 and NFHS3)

  19. % unmarried youth aware of selected SRH matters Maharashtra • Superficial awareness relatively high but in-depth awareness limited • Large gender differences in awareness Jharkhand Source: IIPS and Population Council 2007

  20. % youth reporting parents discussed various SRH matters • Parents rarely a source of information (except menstruation for girls) • Significant sources of information: • Peers reported by 19%-28% of females and 55%-76% of males • Media: 16%-67% females and 40%-63% of males • Perpetuating the cycle of misinformation? Maharashtra (unmarried) Jharkhand (unmarried) Cont… Source: Youth Study, Maharashtra and Jharkhand

  21. % approving of school based sex education, by topic % of women who say that topic should be taught in school • % approving any topic: • females: 40%-75% • males: 60% -80% • % approving HIV education • Females: 63% • Males: 81%-82% • % approving education on sex • Females: 43%-46% • Males: 62% % of men who say that topic should be taught in school • Source: IIPS and Macro International 2007 (NFHS3)

  22. % reporting pre-marital sex by whether or not school based sex education was received Maharashtra • Global review (>80 programmes): Sex education does not lead young people to engage in sex: no or + association with age at 1st sex; condom use, single partner relations (Kirby 2005) • No studies/assessments available from India – but preliminary Youth Study data suggest that compared to those not exposed to school based SE, those who were exposed were less or as likely to have experienced pre-marital sex Tamil Nadu Source: IIPS and Population Council 2007

  23. Youth assessment of school-based sex and family life education Maharashtra Jharkhand Tamil Nadu Exposure to SE varied by state: • Jharkhand: <10% • TN: 20% • Maharashtra: 12% (M) and 31% (F) • Youth assessments generally positive but large %s report embarrassment Source: IIPS and Population Council 2007 (Youth Study)

  24. Next Steps • Analysis of Adolescent Module of NFHS 3 • Completion of secondary analysis • DLHS 3: 2007-08 • Incorporation of selected YP coverage indicators: HIV test, - within past one year • Incorporation of certain adolescent SRH indicators: e.g. Use of sanitary napkins, Em. Contraceptive pills • Boys / young men to be included in the surveys • Routine MIS for RCH: Incorporation of selected ARSH indicators

  25. Thank You

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