The 2030 Agenda for Sustainable Development and its Global Strategy for Women’s, Children’s and Adolescents’ Health provides a unique opportunity for accelerated action for the health of adolescents. Investment in adolescent health is also essential to achieve the 17 SDGs and their 169 targets, each of which relates to adolescent development, health or well-being directly or indirectly. India has the largest adolescent population in the World. The health status of an adolescent determines the health status in his/her adulthood. Many serious diseases in adulthood have their roots in adolescence. The main health issues faced by the adolescents include: Mental health problems, early pregnancy and childbirth, (HIV/STI) and other infectious diseases, violence, injuries, malnutrition and substance abuse. To achieve wholesome adolescent health, we need to have a multidimensional approach covering all the adolescent health problems with special emphasis on mental health, behaviour change communication towards healthy lifestyle and positive social environment to acquire life skills. Adolescence is one of life’s fascinating and perhaps most complex stages, a time when young people take on new responsibilities and experiment with independence. They search for identity, learn to apply values acquired in early childhood, and develop skills that will help them become caring and responsible adults.
Government of India launched its first comprehensive program for adolescents, “Rashtriya Kishor Swasthya Karyakram,” during January 2014, which has a sharp focus on adolescents’ sexual health. The program envisages that all adolescents in India are able to realize their full potential by making informed and responsible decisions related to their health and well being.
The health status of an adolescent determines the health status in his/her adulthood. Many serious diseases in adulthood have their roots in adolescence. The main health issues faced by the adolescents include mental health problems, early pregnancy and childbirth, HIV/sexually transmitted infection (STI) and other infectious diseases, violence, unintentional injuries, malnutrition, and substance abuse.
Adolescents have increased nutritional requirements demanding diet rich in protein, vitamins, calcium, iodine, phosphorus, and iron due to rapid growth spurt and increased physical activity. NFHS 3 data show, in the age group 15–19 years, 47% girls and 58% boys were thin, 56% girls and 30% boys were anemic, 2.4% girls and 31.7% boys were overweight, and 2/1000 adolescent girls and 1/1000 adolescent boys suffer from diabetes. They are also highly prone for eating disorders such as anorexia nervosa or binge eating due to body dissatisfaction and depression. Use of mass media is higher among adolescents (male 88.2% and female 71.5%). It plays an important role in habit picking and decides their lifestyle pattern.
Mental health problems are one of the most neglected issues among adolescent. Mortality and morbidity due to mental disorders in adolescents increased and topped in recent years. This suicidal behavior is independently associated with factors such as absenteeism, independent decision making, premarital sex, sexual abuse, physical abuse from parents, and mental disorders. In India, suicide among adolescents is higher than any other age groups, that is, 40% of suicide deaths in men and 56% of suicide deaths in women occurred in 15–29 years of age.
Accidents and Violence:
Sexual abuse is one of the major problems faced by adolescent girls and boys equally. These problems mostly go unnoticed as the victim suffers in silence because of fear and social stigma. This indirectly affects the physical health, mental health, and academic performance. Sexual abuse is one of the major problems faced by adolescent girls and boys equally. These problems mostly go unnoticed as the victim suffers in silence because of fear and social stigma. This indirectly affects the physical health, mental health, and academic performance.
Reproductive and Sexual Health::
Adolescents have diverse sexual and reproductive health problems. Even though contraceptive awareness is 94% among girls aged 15–19 years, only 23% of the married and 18% of the sexually active unmarried girls in this group used a contraceptive once at least. Adolescent fertility rates contribute 17% to the total fertility rate in India, and about 14% of births in women aged below 20 were unplanned. Early and unplanned adolescent pregnancies are highly prone for adverse pregnancy outcomes such as eclampsia, low birth weight, early neonatal death, and congenital malformation. In addition, 34% of ever married adolescent girls (15–19 years) reported that they suffered physical, emotional, or sexual violence inflicted by their partner. There is a remarkable decline in these rates as age of marriage raises. Hence, early marriage also carries the risk of subjecting girls to all forms of violence. . The awareness regarding transmission of STIs is low among adolescents, in addition to social stigma, the diseases were often undisclosed, left untreated leading to complications such as infertility, pelvic inflammatory disease, and cancer.
Substance abuse is yet another serious issue as adolescents are ignorant about its consequences. About 29% boys and 4% girls use some kind of tobacco. The average age at tobacco use initiation was earliest at 12.3 years and alcohol usage at 13.6 years among adolescents. About 11% of cannabis users were introduced to it before the age of 15. Initiating cannabis at this age is strongly associated with the development of schizophrenia spectrum disorders in adulthood.
There are many healthcare programs under various ministries to address the problems of adolescents, namely, Kishori Shakti Yojana, Balika Samridhi Yojana, Rajiv Gandhi Scheme for Empowerment of Adolescent Girls, “SABLA”, Rashtriya Kishor Swasthya Karyakram, and Adolescent Reproductive Sexual Health Programme (ARSH).
Kishori Shakti Yojana:
A special intervention for adolescent girls using the Integrated Child Development Scheme (ICDS) was put into operation from November 1991. It aims to break the cycle of nutritional and gender disadvantage to provide a supportive atmosphere for self development. All unmarried adolescent girls(11–18 years) whose family’s income is below Rs. 6400 per annum in the rural areas are the beneficiaries of the program. Services provided are educational activities through nonformal and functioned literacy pattern, immunization, general health checkup every 6 months, treatment for minor ailments, deworming, prophylaxis measures against anemia, goiter, vitamin deficiencies, etc., referral to public health center (PHC)/district hospital in the case of acute need, and convergence with Reproductive Child Health Scheme.
Balika Samridhi Yojana:
It was launched by Government of India in 1997. The objectives are to change negative family and community attitudes toward the girl child at birth and toward her mother, to improve enrollment and retention of girl children in schools, to increase the age of marriage of girls, and to assist the girl to undertake income generation activities, implemented in both rural and urban areas. The target groupis girl child of below poverty line families, who is born on or after August 15, 1997. The benefits are restricted to two girl children in a household irrespective of number of children in the household.
Rajiv Gandhi Scheme for Empowerment of Adolescent Girls, “SABLA”:
The scheme is implemented using the platform of ICDS through Anganwadi centers. It focuses on all out of school adolescent girls. The objectives are to enable the adolescent girls for self development and empowerment, to improve their nutrition and health status, promote awareness about health, hygiene, nutrition, reproductive/sexual health, family/child care, upgrade home based skills, life skills, and tie up with National Skill Development Program (NSDP) for vocational skills, mainstreaming out of school adolescent girls into formal/nonformal education and to provide information about existing public services (PHC/community health center/Post Office/Bank/Police Station). Services provided are nutrition provision of 600 calories, 18–20 g of protein and micronutrients per day for 300 days in a year, iron and folic acid supplementation, health checkup and referral services: Kishori Diwas, Nutrition and Health Education (NHE), counseling/guidance on family welfare, ARSH, child care practices and home management, life skill education and accessing public services and vocational training for girls aged 16 and above under NSDP.
Rashtriya Kishor Swasthya Karyakram:
The Ministry of Health and Family Welfare launched Rashtriya Kishor Swasthya Karyakram on January 7, 2014 for adolescents (10–19 years) with an objective to focus more on continuum of care for adolescent health and developmental needs. The main strategies are community based interventions, facility based interventions, and social and behavior change communication with focus on interpersonal communication.
The package of services provided to all adolescent married/unmarried girls and boys under reproductive and child health II are promotive services, preventive services, curative services, referral services, and outreach services. The package of health services through adolescent friendly health services clinic are monitoring of growth and development, monitoring of behavior problems, offer information and counseling on developmental changes, personal care and ways of seeking help, reproductive health including contraceptives, STI treatment, pregnancy care and postabortion management, voluntary counseling and testing for HIV, management of sexual violence and mental health services including management of substance abuse.
Today, the contribution of the group to improving the lives of young girls in the community is acknowledged by everyone. They disseminate health messages through wall writings, impart health education to pregnant and postnatal mothers, supervise the growth monitoring of under five children. They are also involved in decision making at the village level. Their voices are heard in village matters, especially in health and sanitation related matters.
A monthly group meeting led by the ASHA serves as a forum for discussion on diverse topics that range from dealing with menstruation to the importance of Antenatal care and postnatal care PNC, management of diarrhea, healthy eating practices, good hygiene, and safe water. They are also taught about the importance of delaying marriage and motherhood. Vocational training and recreational activities are a part of the agenda. The group meetings provide a safe space in which the girls share their feelings and problems. Confidentiality is assured, and the ASHA plays a vital role in holding the group together. Many express huge enthusiasm about the improvements in their lives since they joined Adarsha Kishori Panchayat.
To achieve wholesome adolescent health, we need to have a multidimensional approach covering all the adolescent health problems with special emphasis on mental health, behavior change communication toward healthy lifestyle, and positive social environment to acquire life skills. Adolescent friendly clinics need to be widely established throughout India and should achieve universal coverage. Screening of adolescent on regular basis could be an effective tool to control the existing disease and to update occurrence of any new diseases. Empower and involve adolescents in decisions that affect them and facilitate them with every opportunity for developing into a successful adult. Offering such opportunities to the growing children gives them a chance to build a safe, happy, healthy, and productive nation in the future.
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