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INTRODUCTION
"A world fit for children is one in which ...
all children, including adolescents, have
ample opportunity to develop their individual
capacities in a safe and supportive
environment".

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t Friendly School Initiative
NO LONGER CHILDREN, NOT YET ADULTS

Young people
Adolescence
10-24 Years
10-19 years

Youth
07/03/24 15-24 Years 3
 WHAT IS ADOLESCENCE?

A phase which involves -

 Progression from appearance of
secondary sexual characteristics
(puberty) to sexual and reproductive
maturity
 Development of adult mental process
and identity
 Transition from total social-economic
dependence to relative independence
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What is early, middle and late Adolescence?

Early (10 – 14))

 Growth Spurt, Beginning of Sexual Maturity and
Start to think abstractly.
Middle (14 – 15)
 Main Physical Change Completed, Develop
stronger sense of Identity, relates strongly to
peer group, Thinking becomes reflective.
Late (16 – 19)
 Body takes adult form, has distinct identity and
more settled ideas and opinions

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 THREE STORIES WITH SIMILAR ENDING
RESHMA NINA CHETAN
RURAL ADOLESCENT URBAN ADOLESCENT ADOLESCENT BOY

EXPERIMENTING APPARENTLY HEALTHY

DEVELOPING RAPIDLY SEXUALLY SON OF A DOCTOR

EARLY MARRIAGE TEENAGE PREGNANCY NEVER SCREENED

TEENAGE PREGNANCY ABORTION R.M.P. +HISTROY OF CHD

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DEATH 6
 CHARACTERISTICS

A – Aggressive Anaemic Abortion

D – Dynamic,Developing,Depressed
O – Overconfident,Overindulging,Obese
L – Loud but lonely,& Lack information
E – Enthusiastic,Explorative,& Experimenting
S – Social,Sexual, & Spiritual
C – Courageous,cheerful, &concern
E – Emotional,Eager,& Emulating
N - Nervous,Never say no to peers
T – Temperamental,Teenage pregnancy

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WHY ADOLESCENTS ARE IMPORTANT?

• They are a demographic force.

• They are an economic force.
• They are the future health.
• They have a right to participate.

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PUBLIC HEALTH IMPLICATIONS

• 70% of mortality in adulthood is linked to

habits picked up during adolescence. (Risk
taking behavior, substance abuse, eating
habits, conflict resolution);
• Prevailing malnutrition, anemia, stunting and
lack of immunization has adverse impact on
MMR, IMR, morbidity and have inter-
generational effects;
• Adolescent sexuality: leads to adolescent
pregnancy, unsafe abortions, RTI, STI/HIV
and social problems;
• Adolescent pregnancy : Risk of ADVERSE
outcome (IMR, MMR, LBW babies) is higher;
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Population Profile: Ages 10-24 Years in India

Population age-10-24 (Millions) 284.2

10-24 years as % of total population 30
% Male enrolled in secondary school 59

% Female enrolled in secondary school

38

Average age at first marriage 20

Total fertility rate 3.4
% TFR contributed by 15-19 years 9
% 07/03/24
using contraceptives 7 10
 Why Focus on Adolescents?

• Large number >22% of the population

(Approximately 207 Million of our
population);

• Adolescence is a period of rapid physical

growth, sexual and psycho-social
changes;

• Habits and behavior picked up during

adolescence (Risk taking behavior,
substance abuse, eating habits, conflict
resolution) have life long impact.
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• Adolescence is the last chance to correct growth
lag and malnutrition;
• Many adolescent boys and girls are sexually
active but lack information and skills for self
protection (Low level of information on FP, low
contraception use);
• Have simple, but wide pervading and crucial RH
needs – menstrual hygiene, contraception;
(including Emergency Contraception), safety
from STI/HIV;
• Communication gap exists with parents and
other adults (Lack of family “Connectedness”);

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Health Recipe: “Ye Dil Mange More”
Lifestyle of Adolescents
Tobacco/
Alcohol

Excess
dietary FAT
Lack of vegetables
& fruits

Sedentary Sexual behavior/

habits poor genital hygiene
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Why pay attention to Adolescent Health?

• To reduce death and disease in

adolescents
• To reduce the burden of disease in later
life
• To invest in health — today and
tomorrow
• To deliver on human rights
• To protect human capital

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What are Adolescent Health Problems?

Young Adolescents
 Can not bear the responsibility of their
own health
 Lack knowledge about the physical
changes happening in body
 Such concerns – low self esteem and
depression
 Need reassurance and Support

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 70%
60%
50%
40%
30%
20%
10%
0%
BOYS GIRLS-R GIRLS(U)

NORMAL ANAEMIC

Malnutrition
 Shortage of food – priority for babies – inadequate
adolescent diet – delayed/impaired development.
 Girls – fed last and fed least – pubertal delay – small
pelvis.
 Baby mothers – less equipped to withstand
complications (physically immature body)
 MMR higher in anemic adolescent mothers
 Undernourished Adolescent Mother – LBW Babies

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General Health Problems
 Same illnesses but
 Less likely to recognize symptoms
 More likely to underestimate their importance
 Least likely section to go for early treatment
 afraid about outcome,
 worried about stigma, and
 do not have confidence on treatment.
 Parents actively take care of health of young
children
 Parents feel adolescents responsible for their heath
needs – as they become more independent
 Conditions like Asthma and Epilepsy become
uncontrolled – as considered responsible for self
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Menstrual Problems
 Without proper knowledge – fail to understand normal
and to recognize menstrual problems
 School Health Checkups usually fail to identify these
Mental Health Problems
 May first become apparent in Adolescence
 No frame of reference available with them
 Thus fail to
 Recognize and
 Seek medical treatment
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 Early and Unprotected Sex
 Sexual activity is more common than
available official data – evidenced by
increased no. of-
 Unwanted Pregnancies
 Unsafe Abortions
 Steep Rise in HIV
 Early and unprotected sexual experience
is not planned, and with no knowledge of
consequences

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 Predisposing Factors for Early and Unprotected
Sex
 Adolescents live in Increasingly sexualized societies
 Impact of Media – Electronic and Print
 Rapid Growth of cities and breakdown of traditional
family structure – Erode protective cultural layer
 Conflict and forced migration – put them at risk
 Pressured in to desperate situations – forced into sex
for survival sp. during economic hardships etc.
 Trend – earlier sexual maturation while late marriage

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  Early and Unprotected Sex – Results In
 STI 1 in 20 young people every year
 7000 young people every day are infected with
HIV

 Early and Unprotected Sex – Remedy

 Abstaining from Sex
 Delaying the onset of first sexual experience
 Increasing the level of protection through
condoms

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  Addictive Behavior (Risk Taking)
 Do not assess the long term consequences
 Alcohol and drugs – further reduce caution
and judgment
 May appear to be a way out for one who
sees no positive solution – but actually is
a way to more serious problems
 Expensive and illegal habits – draws them
to crime

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  Accident and Violence
 Deaths and Injuries are more common in
them
 Unintentional Injuries is the leading cause
of Death in many countries
 Vulnerable both as victims and
perpetrators
 Violence with in home is usually not
treated seriously.
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  Sexual Abuse
 For millions – sex is linked with – cruelty, violence and
abuse – family members or adults with privileged access.
 Women are conditioned to be submissive to men – thus
early marriage, birth spacing, unprotected sex or unfaithful
partner.
 Much sexual abuse takes place in home and is never
reported
 Homeless –street adolescents are more vulnerable
 Young women may trade sex
 Increase in world trade sexual exploitation of young people
– “sex Tourism”
 UNICEF estimates – 1 million adolescents are recruited in
commercial sex trade

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  Depression and suicide
 Common with Low self esteem
 They feel they have no future and are useless
 Reduces the quality of life
 Likely to take risk with own health
 Depression can lead to suicide
 90,000 young people commit suicide every year.

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  Eating Disorder
 Obesity and eating disorders exist along with
malnutrition
 From early age adolescents are under pressure
to be ultra thin – impact of media
 Bulimia and anorexia can permanently damage
physical and mental health.
 Obesity – if failed to deal in time may lead to
serious health problems.

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 Why Invest in Adolescent Health?

 Health Benefits
 Current & Future Health
 Intergenerational Effects
 Economic Benefits
 Improved Productivity
 Return On Investments
 Alleviate Future Health Cost
 As a Human Right

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Guiding Principals for
Adolescent Health Programming

• Adolescence is a time for opportunity and risk

• Not all adolescents are equally vulnerable
• Adolescent Development underlies prevention
of Health Problems
• Problems have common roots and are
interrelated
• Social environment influences adolescent
behavior
• Gender considerations are fundamental
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 Adolescents: A Very diverse
population segment

• Different stages of development

• Different circumstances
• Different needs and
• Diverse problems

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 Adolescent Health-An Overview

Evidence of Common Roots*

Risk & Protective factors for Early Sex Substance Depression
adolescents Use
A positive relationship with
parents

Conflict in the family

A positive school
environment
Friends who are negative role
models
A positive relationship with
adults in the community
Having spiritual beliefs

Engaging in other risky

behaviours
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 Programming
To promote healthy To prevent and respond to
development to meet health problem from:
needs and build  Early, unprotected,
competencies unwanted sex
Safety,
 Use of tobacco and
Belonging, misuse of alcohol and
Self Physical other substances
Esteem, eg eating habits  Accidents
Caring  Violence
relationship
 Poor nutrition
Psychological  Endemic disease
eg communication

Moral
eg personal responsibility

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Vocational 31
eg entrepreneurial skills
STRATEGIES FOR PROMOTION OF ADOLESCENT HEALTH
A =ADOPTION OF HEALTHY LIFE STYLE

D=DEVELOP APPROPRIATE I.E.C. STRATEGY

DISCOURAGE EARLY MARRIAGE AND TEENAGE PREGNANCY

O=ORGANIZE ADOLECENT/ YOUTH FRIENDLY CLINIC

L=LIFE SKILL EDUCATION , LEGAL SUPPORT, LIASIAN WITH PEERS , PARENTS

E=EDUCATE ABOUT SEXUALITY,SAFE SEX,SPIRITUALITY,RESPONSIBLE

PARENTHOOD

S=SAFE, SECURE AND SUPPORTIVE ENVIRONMENT TO BE PROVIDED

C=COUNSELLING / CURRICULM IN SCHOOL INCUSIVE OF FAMILY

LIFE EDUCATION

E=ENABLE &EMPOWER FOR RESPONSIBLE CITIZENSHIP

N=NETWORKING FOR EXPERIENCE SHARING

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T= TRAINING FOR INCOME GENERATION,TEEN CLUBS
 PROGRAMMES FOR ADOLESCENTS

KISHORI SHAKTI YOJANA –To improve the health and

nutritional status of girls

BALIKA SAMRIDHI YOJANA –To Delay the age of marriage

NEHRU YUVA KENDRA – ACT AS HEALTH AWARENESS

UNIT-Through active participation of youth

MAHILA SAMAKHYA PROGRAMME- Equal access to

educational facilities for adolescent girls and young women

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 PROGRAMMES FOR ADOLESCENTS

SCHOOL AIDS EDUCATION, UNIVERSITY TALKS AIDS

TRAINING OF RURAL YOUTH FOR SELF EMPLOYMENT

REPRODUCTIVE AND CHILD HEALTH PROGRAMME

? WHERE ARE THE BOYS

NO COMPREHENSIVE PROGRAMME
ADDRESSING
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ALL NEEDS OF ADOLESCENT 34
 BIBLIOGRAPHY
 K.K Gulani, “ community health
nursing,” first edition (2005), kumar
publishing home, Delhi, page no:
453-465
 Stanhope, “ community health
nursing,” first edition, 2002, mosby
publications philadelphia, page no:
391-420.

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 THE CHALLENGES ARE THERE BUT
POTENTIAL IS FAR GREATER

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Thank You! 36