According to WHO guidelines age of Adolescents is 10-19yrs. This includes one fifth of population in India and they are the one who can change the social and economic growth of a country. Adolescent health has now become a major area of concern and has been included in RMNCH which was previously for maternal and child health has now included adolescent health and known as RMNCH+A. On 7 January 2014 Rashtriya Kishor Swasthya Karyakram was launched for adolescent health. The main six domain to focus on are nutrition, sexual and reproductive health, mental health, injuries and violence including gender based violence, substance misuse and noncommunicable disease.
The main intervention of the scheme weekly iron and folate acid supplement was provided, albendazole for de-worming , adolescent health friendly clinics and menstrual hygiene scheme promotion.
But the challenges continue as there is no data since 2014 to show effect of interventions. As the Government commits on to address the adolescent health needs by offering various programmes, there exist a gap between the service availability and the effective utilisation of such services by the target group.
In village level there is very less interaction of girls and married women with frontline workers and only limited utilization of Adolescent friendly health clinics.
Prevalence of anaemia is on rise and WIFS are being provided but is the effect seen is nowhere mentioned. Anaemia is seen more in girls 10-19 yrs and married girls 15-19 yr. While obesity is more in adolescent from urban than rural. The proportion of thin women decreases with age but was 42 percent for women age 15-19. Socio-cultural factors pose a major challenge in bringing the adolescents under the purview of health care.
Menstrual hygiene is one such major concern in rural areas. In adolescent girls use of sanitary napkins seen in urban than rural. The reason for this could be that only few napkins are available from their schools and due to the affordability they do not use napkins, shyness as it is not talked about as it is seen that in rural many girls do not know about the menstruation between age 10-14 yrs which is lack of awareness.
In conservative societies where reproductive and sexual health related issues are taboo for discussion, young people are hindered from actively seeking counsel for their needs .Early marriage of girls in practice is still a scourge in India. Married women with partner violence, less knowledge of sexual and reproductive health. Married adolescent girls have little decision making power in the family, are socially isolated and so less likely to access the services.
As we can see that teenage women age (15-19) in India is 8 percent who have begun childbearing from which 5 percent of women have had a live birth and 3 of women percent are pregnant with their first child. The level of teenage childbearing declined between 2005-06 (16%) and 2015-16 (8%). The decline is higher for women who have had a live birth (from 12% to 5%) than for women who were pregnant with their first child (from 4% to 3%) between 2005-06 and 2015-16. Patterns by Teenage pregnancy is relatively higher in rural areas. Nearly 1 in every 10 women in rural areas in the age group 15-19 have begun childbearing. Twenty percent of women age 15-19 with no schooling have already begun childbearing, compared with only 4 percent of women who had 12 or more years of schooling.
Childbearing among women age 15-19 decreases with the level of wealth. Only 3 percent of teenage women in the highest wealth quintile have begun childbearing, compared with 11 percent of teenage women in the lowest two wealth quintiles. Teenage childbearing is higher among scheduled tribe women age 15-19 years (11%) than the other three caste/tribe groups. More than half (52%) of currently married women age 15-19 have already begun childbearing. Tripura (19%); West Bengal (18%); Assam (14%); and Bihar, Jharkhand, and Andhra Pradesh (12% each) have higher levels of teenage pregnancy than other states and union territories. Information on fertility preferences can help family planning programme planners assess the desire for children, the extent of mistimed and unwanted pregnancies, and the demand for contraception to space or limit births.
It is seen that the level of teenage pregnancy decreases with an increasing level of schooling. The proportion of deaths in adolescent is also seen due to non-medical reasons (i.e., deaths due to accidents, violence, poisoning, homicides, or suicides) is higher among men (12%) than women (8%). The proportion of deaths due to non-medical reasons is particularly high for men age 15-19 is 42% and women age 15-19 is 29%. Likely tobacco use among school going boy and girls. It is also seen that there is increase in tobacco use by adolescent due to peer pressure and they think that those who smoke has more friends.
Though school based programmes have a better impact, many boys and girls of economically weaker sections of the society and those from rural areas are school dropouts. Knowledge and awareness regarding sexual and reproductive health among adolescents is still below average and most of them felt that their problems doesn’t require visit to a health facility or just took home remedies. In general these young people tend not to use existing reproductive health care services because of their belief that these services are not intended for them, concern that the staff will be hostile or judgemental, fear of medical procedures and contraceptives, lack of privacy, confidentiality, fear that their parents might learn of their visits.
The way to make them talk about their health related issues is by developing sustainable recruitment and training plan for peer educator to whom adolescents can talk to. But we need ensure that peer educator can facilitate information exchange. They could convey their problems and frontline workers can work on their problems.
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