Adolescent :: Investment in Adolescent Health and Development

Today’s adolescents are tomorrow’s youth and adults to lead the community from the front. We have to invest on them so that we can get fruitful results of tomorrow. So, “Today’s expenditure on them is tomorrow’s investment”

The following points are compelling reasons for investing in adolescent health and development:
• Adolescents comprise a sizeable population – there are 225 million adolescents comprising nearly on-fifth of the total population (22%) Adolescents in the age group 10-14 years contribute more than half of the adolescent population (Census 2001).

• Composition varies by age and sex – Of the total population, 12.1prrecent belong to 10-14 age group and 9.7 percent are in the 15-19 age group. Female adolescents comprise 47 percent and male adolescents 53% to the total than the overall sex ratio of 933 (Census 2001). The present adverse sex ratio in 0-6 years (927 girls for 1000 boys), will affect the adolescent population in the coming years.

• Early marriage is common - Forty-three percent of the ever-married females are below 18 years of age even though the legal age of marriage of girls is 18 years. Nearly twenty percent of the 1.5 million girls under the age of 15 years are already mothers (Census 2001). Continuing of education pursuits delays age at marriage and has a direct bearing on fertility reduction supporting the need for education of girls.

• Female mortality rates are higher than males – Gender differentials in mortality rates exist during adolescence. Female mortality rates are higher as compared to males during 15-24 years and across initial stages of development (0-9 years). The pervasiveness of discrimination, lower nutritional status, early marriage and complications during pregnancy and childbirth among adolescents result in a high level of female mortality (CSO 2002, SRS 1999). Maternal morality of teenage mothers is a grave case for concern.

• Adolescents from rural areas and girls are disadvantaged in education – Twenty five percent of the 15-19 years age group in rural areas and ten percent in urban areas are illiterate. The male-female differences grow with each level of education (NSSO 55th Round, 2001). Enrolment figures in schools have improved, but gender disparities persist. Girls account for less than fifty percent enrolment at all stage so schooling. Rural girls are most disadvantaged. The challenge is to keep students in schools. The dropout rate fro class I to X is around seventy percent.

• Economic compulsions force many to work – Nearly one out of three adolescents in 15 -19 years is working – 21 percent as main workers and 12 percent as marginal workers (Census 2001). Economic compulsions force adolescents to participate in the workforce resulting in high dropout rate for education. Despite adult unemployment, employers like to engage children and adolescents because of cheap labour.

• Malnutrition and Anemia are rampant – Intake of nutrients is less than the recommended daily allowances for adolescents below the age of 18 years both for boys and girls in rural Indian (NNMB 2001). More than seventy percent girls in the age group of 10-19 years suffer from severe or moderate anemia (DLHS – RCH 2004). Adolescent mothers are at a higher risk of miscarriages, maternal mortality and giving birth to stillborn and underweight babies. Iodine Deficiency Disorders can lead to growth retardation and retard mental development. Only half of the households are using iodized salt for cooking in India (MICS 2000).

• Drug abuse is emerging as a problem – A major section of drug users are below 20 years. Forty percent of them started taking drugs when they were between 15 to 20 years of age (UNDOC, 2002). Social factors such as illiteracy, economic background, unemployment, rural residence and family disharmony increase vulnerability to drug abuse.

• Crimes against adolescents are prevalent – Limited empirical evidence indicated that in most of the cases, the abuser is a known person. Sexual abuse of both boys and girls cuts across economic and social classes. According to a survey, in 84 percent cases, the victims knew the offenders and 32 percent of the offenders were neighbours (NCRB, 2001). Crimes against girls range from eve teasing to abduction, rape, prostitution and violence to sexual harassment. Most rape victims are in the age group 14-18 years and a significant number are under 14 years of age (NCRB 2002). Unfortunately, social taboos prevent these crimes from being registered. Even when registered, prosecution rarely takes place. In case of sexual abuse of boys (12-17 years), they are mainly victims of homosexual abuse.

• Unmet need for contraceptives – While knowledge of family planning is being promoted, the availability and use of contraceptives is not publicized. Even amongst currently married women there is an unmet need of contraception, being the highest in the age group 15-19 years. Nearly 27 percent of adolescents have reported unmet need for contraception. 19% of TFR is contributed by adolescent mothers in the age group of 15-19 years (NFHS 2).

• Trafficking and Sex Work has increased – Extreme poverty, low status of women, lax border checks and complacency of law enforcement agencies has lead to increase in sex work. Expansion of trafficking and clandestine movement of young girls has also increased across national and international borders.

• Premarital sexual relations are increasing – Most sexually active adolescents are in their late adolescence. Incidences of unintended teenage pregnancies and abortions have shown a steady increase. Unsafe abortions are a major source of reproductive mortality and morbidity. Increase in age at marriage, increased mobility and negative peer pressure makes the young people vulnerable to indulge in unsafe sexual behaviour.

• Misconceptions about HIV/AIDS are widespread – There is a high level of awareness about HIV among young people especially among those who are more literate. However, misconceptions on certain modes of transmission are widespread. 73 percent of young people were unaware that healthy looking person could transmit infection. Many are unaware of the correct way of using a condom. Negative attitudes exist towards HIV positive individuals – only 40.7 percent of young people were willing to share food with infected persons (National Behavioural Surveillance Survey, 2001). A large percentage of HIV infected persons are between 20-40 years and had contacted the virus early in life indicating the importance of educating during adolescence. For awareness of AIDS, India ranks 123 among countries of the world.

• Injuries contribute to morbidity and mortality – Unintentional injuries (accidents, sports injuries etc.) and intentional injuries (suicide and homicide) are very common cause of adolescent morbidity and mortality.

Priority Health Problems of Adolescents are:
• Sexual ad reproductive health problems
• Nutritional problems
• Mental health problems
• Substance abuse
• Injuries and accidents
• Acute and chronic diseases (like asthma, TB, Diabetes etc.)

Adolescent Issues – Different Perspectives:
• Parents’ Perspective: examination marks, growth, career, happiness, good citizen.
• Teacher’s perspective: examination marks, all round development, career civic sense, safe behaviour.
• Health Sector’s Perspective: growth, health protection and promotion, safety, HIV/STI.
• Administrator’s / Policy makers’ Perspective: Healthy and productive population.
• Adolescents themselves: Body image, career, sexuality, general health.

It is noteworthy that priorities of adolescents themselves are at variance from adults’ perspectives.

The behaviours and lifestyles learned or adopted during adolescence will influence health both in the present and in the future. Tobacco use is a good example of how a behaviour, almost always adopted during adolescence, leads tp disease and death later in life. Further, the benefits of adolescent heath and development accrue not only to the adults that emerge from the process, but also to future generations.

Reasons for investing in adolescent health and development:
• To develop their capacity to cope up with the situation and deal with it positively.
• To increase relationship building capacity for happy and healthy married life.
• To reduce morbidity and mortality among adolescents. A healthy adolescent grows into a healthy adult, physically, emotionally and mentally.
• To build self-esteem in adolescents resulting in confident adults in a society.
• To inculcate healthy habits and positive thinking.
• As a human right adolescents have a right to achieve highest level of health.

Investing in adolescent health and development will reduce the morbidity and mortality in this age group. It will maximize their opportunity to develop to their full potential and to contribute the best they can to society.

Investing in adolescent health and development will also reduce the burden of morbidity and mortality in later life because healthy behaviours and practices adopted during adolescence tend to last a lifetime. Today’s adolescents are tomorrow’s parents, teachers and leaders. What they learn today, they will teach to their own children and to other children tomorrow. This positive and responsible behaviour of adolescents for self and their children later will help improve the maternal and child health profile of India. Therefore, investing in adolescents now will lead to a ‘demographic bonus’ later with less inputs of health sector in terms of cost and curative care. Main focus of health care will be preventive and promotive.

Investing in Adolescent Health and Development (AHD) makes economical sense: better-prepared and healthy adolescents will result in productivity gains when they enter the workforce. Return on investments made in early childhood health and development are being safeguarded by continuing attention to AHD. When adolescents develop suboptimally or die prematurely this means a waste of earlier investments. Investing in prevention and promotion during adolescence also averts future health costs: smoking prevention averts health costs much later in life.

Promoting and safeguarding adolescent health should not only be regarded as an investment, but also as a basic human right. Young people have the right to preventive health care and require specific protection for those living in exceptionally difficult condition or with disabilities. This means that governments have the responsibility to ensure that health and other basic services essential for good health are provided.