|Year : 2017 | Volume
| Issue : 2 | Page : 78-82
Adolescent health and adolescent health programs in India
Chetna Maliye, BS Garg
Department of Community Medicine, MGIMS, Wardha, Maharashtra, India
|Date of Web Publication||15-Sep-2017|
B S Garg
Department of Community Medicine, MGIMS, Sevagram, Wardha, Maharashtra
Source of Support: None, Conflict of Interest: None
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.
Keywords: Adolescent health, health programs, India
|How to cite this article:|
Maliye C, Garg B S. Adolescent health and adolescent health programs in India. J Mahatma Gandhi Inst Med Sci 2017;22:78-82
| Introduction|| |
The World Health Organization defines adolescents as those people between 10 and 19 years of age. Adolescence is one of the most rapid and formative phases of human development, and the distinctive physical, cognitive, social, emotional and sexual development that takes place during adolescence demands special attention in national development policies, programs and plans.
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. When adolescents are supported and encouraged by caring adults, they thrive in unimaginable ways, becoming resourceful and contributing members of families and communities.
The global interest in adolescent health grew after the International Conference on Population and Development (ICPD) conference. The ICPD in Cairo, Egypt, in 1994, strongly recommend actions to be taken by the countries and to work on advanced gender equality and equity and the empowerment of women and the elimination of all kinds of violence against women. The program of action developed during the ICPD put human rights at the center of development and called for a comprehensive approach to sexual and reproductive health and reproductive rights, recognizing that sexual and reproductive health services and programs must be guided by the needs of, and must protect the human rights of individuals, especially women and girls. The ICPD conference set the platform for the countries to set up programs for the development of adolescents worldwide.
The 2030 Agenda for Sustainable Development and its Global Strategy for Women's, Children's, and Adolescents' Health provide a unique opportunity for accelerated action for the health of adolescents. Investment in adolescent health is also essential to achieve the 17 Sustainable Development Goals and their 169 targets, each of which relates to adolescent development, health, or well-being directly or indirectly.
In India, data on adolescents from national surveys including National Family Health Survey III (NFHS-3), District Level Household and Facility Survey III, and Sample Registration System call for focused attention with respect to health and social development for this age group. It has therefore been realized that investing in adolescent health will yield demographic and economic dividends for India. In view of this, 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.
India has the largest adolescent population in the world. In India, the proportion of adolescents is 24.5% in Uttar Pradesh, 16.3% in Kerala, 19% in Maharashtra, and 21% for India.
| Adolescent Health Problems|| |
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.
| Nutritional Health|| |
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. Its influence is clearly shown in a study from Chennai done in the age group 11–17 years reporting that 90% eat either food or snacks while watching TV, 82% buy food products and snacks based on advertisement, 59% skipped outdoor activities for TV, 42% follows diet, and 42% exercise to get the body like their favorite media personality. Television viewing in childhood and adolescence is associated with overweight, poor fitness, smoking, and raised cholesterol in adulthood.
| Mental Health|| |
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. A study from Goa, among 16–24 years old, shows 3.9% of youths reported suicidal behaviors with females four times more prone than males. 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.
The prevalence rate of child and adolescent psychiatric disorders in the community has been found to be 6.46%, and in schools, it was 23.33%, and the reporting systems of psychiatric disorders in children are found to be inadequate. From the above studies, it is evident that a considerable proportion of adolescent have mental health problems.
| Accidents and Violence|| |
In India, in 2001–2003, deaths due to injuries constituted nearly 20% of the total deaths in 5–29 age groups. About 77.5% of adolescents are at risky behaviors, ignore traffic rules leading to road traffic accidents and deaths, as reported in a study from Delhi. 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. All the three NFHS show almost equal prevalence (59.1%, 59.8%, and 58.2%) of pregnant and mothered adolescent and there is a steady increase in the percentage of first pregnancy among adolescents (11.7%, 12.4%, and 14.4%). Early marriage and low contraceptive usage are the reasons behind this trend.
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.
In India, 19% girls and 35% boys had comprehensive knowledge about HIV/AIDS. Only 15% young men and women (15–24 years) reported that they received family life or sex education. Eventually, due to inadequate knowledge, they are at greater risk of exposure to unprotected sex, unethical sexual practice, and STIs. In the age group of 15–19 years, among those who had sexual intercourse, 10.5% of girls and 10.8% of boys reported having STI or symptoms of STI and 0.07% of girls and 0.01% of boys were found to be HIV positive. 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|| |
Substance abuse is yet another serious issue as adolescents are ignorant about its consequences. NFHS-3 data show, in the age group 15–19, about 11% of adolescent boys and 1% of adolescent girls had consumed alcohol, in that 3% consume it daily. 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.
| Adolescent Health Care Programs in India|| |
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 group is 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.
| Adolescent Reproductive Sexual Health Program|| |
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.
| Success Story on Working with Adolescents at MGIMS, Sewagram-Kishori Panchayat: A Platform for Empowering Adolescent Girls|| |
Excited voices and smiles greet a visitor who walks into the roomful of adolescent girls. They lean against each other affectionately, bonded both by their adolescence and their belonging to the group - Kishori Panchayat - in the village of Padegaon in Wardha district of Maharashtra. This group of girls between the ages of 12–16 years was formed in the year 2004, when Community led Initiatives for Child Survival (CLICS) Doot Accredited Social Health Activist (now ASHA) Ms. Alka Sathaone started spreading the word about its advantages. Her daughter Ashwini and that of another community health worker Baby Dyaneshwar Mendule's daughter Arti and their friend Tina Bakane were the first three members in the Kishori Panchayat. Slowly and steadily the group grew, despite resistance from the girls' families and some people in the community. “Families were afraid we would ruin their daughters,” remembers Alka. Several trips were made to the girls' homes to convince their families of the advantages of the group. Some of the girls also needed convincing. Pragati, who was the leader of this Kishori Panchayat, says she was approached twice before she consented to join. “I told my friends that I would rather watch Television than waste my time in such meeting!” she laughs, describing her initial reaction to the idea. An initiative of the CLICS program of Department of Community Medicine, MGIMS, Sewagram, the Kishori Panchayat is intended to provide a platform for adolescent girls to discuss the problems of growing up, learn life skills, and develop capacity for decision-making for their own health. Adarsh Kishori Panchayat, which is what this particular group of girls has named, has 15 members today. While this is the “nodal” collective, most of the girls have taken the initiative of starting their own groups in different areas of this village. These subgroup Kishori Panchayats, in which the girls act as peer educators, have up to 20 members each!
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. Eighty-nine such groups exist in the four PHC area of Wardha district today, and the girls are regarded as role models for others in the area. The members of each Kishori Panchayat belong to one of the four committees: education, health, cultural, and sanitation. 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, and the girls participate in plays with these themes, staged regularly in their own village and others. Breaking into songs about diarrhea and clean water is part of the group practice: in fact, one of the rules of the group is to begin each session with a song.
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. Most perceive her as a mother figure, with the added advantage of being able to ask questions, they are afraid to broach to their own mothers.
Many express huge enthusiasm about the improvements in their lives since they joined Adarsha Kishori Panchayat. Pooja says her performance in school has improved since she became a member. “I did not have a voice earlier,” she explains. “Being a member of this group taught me to speak up and now I can ask questions in class without feeling embarrassed.” For Suvarna, the body changes brought about by adolescence were frightening to deal with alone. Being a part of this group of girls has helped ease her fears and shown her “the light in the midst of darkness.” Ashwini and Dipali, too, say that being in this group has helped them deal with the changes in their own bodies. “Our own mothers told us we should hide these events,” they say. “It is a relief to learn that there is nothing to be ashamed of.”
Increased confidence and better health have also resulted in better friendships and relationships for all the girls. Being able to speak out in front of an audience, being heard the way they have never been before, being seen and recognized for their talents… these are just some of the factors that have contributed to an increase in the self-esteem of the girls.
Their role play on “Save the girl child” received first prize in a competition held at regional level at Nagpur. They are excited about the future of the group and feel that they can achieve lots more. The present Kishori Panchayat is the fourth generation of adolescent girls. The three founder members of Kishori Panchayat, namely, Ashwini, Arti, and Tina have become idols for the newer generation. At present, Ashwini Sathaone is pursuing her Masters in Social Work, Arti is doing Bachelor in Science, and Tina is working as a Nurse in a corporate hospital in Pune.
CLICS Doot Alka is working as ASHA. Alka has become a family member of every household in the village. Her leadership skills, communication skills, and her dedication for creating health awareness are lauded by the community as well as by the health system and ICDS. She is invited in various forums to share her experiences. Alka says she is very lucky to have a family which supports her work enthusiastically. Her son has become an engineer and daughter is pursuing Masters in Social work. She is very happy about academic achievements of her children.
Alka has guided the Kishori girls and showed them a right path to walk on without fear. Kishori girls are pursuing higher education and stand different from their peers as they are more confident as Kishori Panchayat has brought a revolutionary change in their personality. Kishori girls wish that every Kishori girl of India should get an opportunity to be a part of the adolescent girl's platform as it will help in rearing a new generation of active and responsible citizens. She was recognized by conferring her with first Late Dr. Anand Karkhanis Best Health Worker Award in 2006.
The Zilla Parishad, Wardha and the district health system of Wardha has been so impressed with its impact on teenage girls in the district that they decided to constitute one group in each village of Wardha district.
| Conclusion|| |
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.
Exclusive data pertaining to the adolescent health issues in Indian scenario are not available when compared to the developed countries. Nation- and State-wise detailed investigation and reports on adolescent's health issues is the need of the hour. This will help to create better awareness among the stakeholders about the importance of strengthening adolescent health services under a single agency to meet their felt needs.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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