“ ADOLESCENT HEALTH”

: A CHALLENGE

Presented By:-

Dr.P.P.Singh

Medical Superintendent cum Pathologist

SDN HOSPITAL SHAHADARA DELHI

BACKGROUND

POPULATION GROWTH IS A MAJOR PROBLEM

1952 FAMILY PLANING.

1977 FAMILY WELFARE.

1980 CSSM.

1994 INTERNATIONALCONFERANCE ON POPULATION & DEVELOPMENT AT CAIRO.

1997 FROM TARGET APPROCH TO TARGET FREE ( CNA)

2001. NATIONAL POPULATION POLICY

1. CSSM 3. CARE OF WOMEN

FOR RTI/STI(AIDS)

2. FAMILY PLANING

4. ADOLESCENT HEALTH

RCH

WHOLESTIC LIFECYCLE APPROACH TO

WOMEN HEALTH

CHILD ADULT HOOD

Cross road

“ADOLESCENT PERIOD”

ADOLESCENCE IS THE PERIOD BETWEEN THE AGES OF 10-19 YEARS OF AGE.

Biological maturity.

Psychological Upheavals

Problems of Social adjustment.

Age : 10-19 yrs.

Breast budding:8yrs

Contraception:-to avoid STD/pregnancy

Drug Abuse. Emotional issue Femininity

Gynecological problems

Hormonal & metabolic changes.

Insecurity feelings

Juvenile diabetes

Knowledge

Legal issues

Menarche

Nutrition

Oncology

Psychosocial Quiescent period before puberty.

Reassurance

STDS&AID

Teenage pregnancy

Unwanted pregnancy

Vaccination

Worldwide awareness

X linked diseases

Youth population: 275 million in INDIA.

Zebra line of cross road

MAGNITUDE OF THE PROBLEM

•1.5 Million young peoples.

•South East Asian Countries. 28 – 34 % of Populations.

•Youth Population in India 21.8% 207 Million

•Married Adolescent 20 per 1000 couples

•Married Before 15 years – 6 % Urban

-- 21 % Rural.

GLOBAL DATA

1 IN 10 adolescent are Mothers.

1 in 4 married adolescent are Mothers.

3 times more likely to die from complication of pregnancy.

1 in 20 adolescent contract STD.

½ of regular smoker who start in adolescent.

5-8 out of 10 is unemployed.

73 million 10-14 yr.old are working world wide.

WHO,TRS-1999

INDIA

DISTRIBUTION OF PROJECTED POPULATION BY AGE (%)

YEAR

AGE-

1996 2001 2011 2016

0-9 21.9 22.2 29.5 19.0

10-24 32.2 31.8 29.0 19.0

25-49 31.8 32.0 35.2 37.1

SOURCE 9TH PLAN

STATEWISE DISTERBUTION OF PERCENTAGE OF WOMEN

AGED 20-24 yrs MARRIED BEFORE 18 YRS.

INDIA 54.7%

BIHAR 69.1

ORISSA 45.5

ASSAM 44.4

KERALA 19.3

MIZORAM 13.3

UTTAR PRADESH 63.9

MADHYA PRADESH 73.0

RAJESTHAN 69.5

DELHI 28.7

PUNJAB 14.9

HIMACHAL 24.2

HARYANA 57.2

PERCENTAGE DISTRIBUTION OF LIVE BIRTHS BY ORDER OF BIRTHS AND AGE AT MARRIGE

YEAR 96-97 FW

AGE 1 2 3 4 5+

<18yrs 23.0 20.3 18.0 14.0 24.7

18-20 31.2 23.9 17.8 11.2 15.9

21-23 34.9 26.8 16.3 9.7 12.3

24+ 38.4 26.2 14.9 9.2 11.4

Order of live birth

USA INDIA

•Population(Mill.)

•Age 10-24

•Marriage Age yrs.

•Fertility Rate

•Low Birth Weight %

•Contraceptive Prevalence

•Teen Age (15-19 yrs.)Mill.

•Illiterate %

•Married %

54.2

25.2

2.0

7.0

46.0

17.5

0.0

5.0

274.8

19.2

3.9

33.0

19.0

89.6

34.0

44.0

Countries Adolescent Population

Married before 15 yrs

Teen aged Mothers

Remarks

Ban gala Desh 34% 61% 27% 1st Child 6%

India 21% 20/1000

Urban 22%

Rural 46%

17% 6% Urban

21%Rural

Indonesia 22% Experienced Sex

28.2% Male

46.4% Female

Maldives 19%

Myanmar 23% STD 32%

I/V Drug User

Nepal 50% 47% 5.3% Pregnancy ends in Abortions.

Sri lanka 19%

 

Thailand

27% 11%

South East Asia

Recent studies about sexual behavior in Adolescents in India shows;

        Earlier practice of sex than decade ago.

        High incidence of teenage pregnancies.

        Abuse of drugs & alcohol are at high levels.

        Rising trends in STI & AIDS amongst young.

        Sex related crimes such as Rape, molestation & sex abuse has increased. 

 

The present situation amongst Indian Adolescent female is shocking .

        In spite of law about right age of marriage, 40% of females get married before 18 year of age.

        25% of Rape victims are under 16 years.

        20% of sex workers are adolescent.

        16% of pregnancies are in teen age group.

        20% of abortions do occur in teen age group.

        Only 8.6% use contraception and so are more likely to undergo risking second trimester abortions.

        Anemia, Iodine deficiencies is approximately 50% amongst teen age group.

        A rough estimate of around 5% is prevalent in India for substance abuse or drug dependence.

 

Adolescent has to cope up with number of Compulsions

A.     A. Conflicting set of values between parental and that espoused by mass media.

B.     B. Various sexual concerns

      Sexual inadequacy.

      How to deal with powerful sexual feelings & fantasies.

      Whether to participate in various types of sexual behavior like masturbation and participate in sexual intercourse.

      Recognise love.

C. Prevent unwanted pregnancies and STD.

Health Problems in Adolescent

Use of Tobacco, Alcohol / Drugs

Behavior – Like Dangerous Driving, Unprotected Sex,

Accidental, Violence / Injuries

Pregnancy – Within /Outside Marriage

STD /AIDS

Abortions 70000 Globally / Year

Sexual Abuse.

Stress.

Nutritional issue --

Anemia's -- 27% in developing countries

6% in developed countries.

Goiters --30-50%.

Growth stunting -- 32% In India.

INFORMATION, EDUCATION & COUNSELING are the standard rules for tackling the issue of Adolescent. It is important to provide certain services for adolescents.

 

1.      Safe, accessible, high quality, gender sensitive schooling and training.

2.      Preparation /Participation in earnings on their account.

3.      Family support for productive girlhood and delay in marriage.

4.      Life skill to avoid un fortunate, unwanted sex and substance abuse.

5.      Broader reproductive health and nutrition information services.

 

CHALLENGES

I. BUILDING POLITICAL COMMITMENT.

II. IDENTIFYING PRIORITIES FOR ACTION

III. MONITORING AND EVALUATION.

IV. MAINTAINING IMPLEMENTATION

INFORMATION, EDUCATION & COUNSELING is the standard rules for tackling the issue of Adolescent. IT is necessary to provide certain services for adolescents.

1. Safe, accessible, high quality, gender sensitive schooling and training.

2.   Preparation /Participation in earnings on their account.

3.   Family support for productive girlhood and delay in marriage.

4.   Life skill to avoid unfortunate, unwanted sex and substance abuse.

5.   Broader reproductive health and nutrition information services.

 

AWARENESS

Sexually Transmitted Diseases

Non planned pregnancy-abortion

Low Education

Poor Counseling

Diet+Develop.Poor

Overall increase of Morbidity+Mortality

Low SE status

Exposure to Media+ Western Culture

Social support. value decreased Sexual activity early

Teen Age Pregnancy

SUMMARY

•Adolescence is a gateway to the promotion of health.

•Many of the behavioural factors acquired during adolescence will last a lifetime.( gender relations, sexual conduct, use of tobacco,alcohol/drugs, eating habits and dealing with conflicts and risk)

•They will affect the health and well being of future generations.

•The magnitude of problem is a real challenge.

•IEC is the standard rules for tackling the issue of Adolescent

•Major interventions is to create a safe and supportive environment at all levels.

Current Married Adolescent 1961 70

1981 44

1992 39-46%Rural 22 % Urban

Average Age 19.5.

Fertility Rural 20.3 Urban 9.8

Family Welfare Awareness 1993 &1995

Sterilization 89%

Condom 69%

OC 49%

IUCD 39%

7% are practicing.

Sexually active

1996 15-19 14.8 16.1 state of addiction

2001 16.0 18.8 smoking 13.4

Working tobacco 15.0

Male female drugs 14.2

Urban rural urban rural

64.4 77.0 14.5 31.2

source nsso.

Mortality rate

Age total male female

10-14 1.3 1.2 1.3

15-19 1.9 1.4 2.4

source sfs 1997