Describe adolescent health and the services for adolescents.

Adolescent Health

• Why they matter despite low mortality — the habits formed in adolescence — tobacco, alcohol, diet, physical activity and sexual behaviour — determine adult non-communicable disease; the adolescent girl’S nutrition determines her future child’s birth weight; and most mental illness begins before the age of 24
• The group is therefore the point of greatest leverage in the whole life cycle, and intervening here is what breaks intergenerational cycles
• The health problems of Indian adolescents:
• Nutritional — anaemia, which is extremely common in adolescent girls; undernutrition and stunting; and, increasingly, overweight and obesity in urban areas
• Sexual and reproductive — early marriage and adolescent pregnancy, which carry higher risk of maternal death, obstructed labour, low birth weight and preterm delivery; unsafe abortion; sexually transmitted infection and HIV; and menstrual problems and poor menstrual hygiene
• Mental health — depression, anxiety, self-harm and suicide, which is a leading cause of death in this age group in India; examination stress; bullying; and internet and gaming addiction
• Substance use — tobacco, alcohol, and inhalants and other drugs, with initiation typically occurring in this period
• Injury and violence — road traffic injury, drowning, sexual violence and abuse
• Other — acne and skin problems, refractive error, dental caries, and chronic illness carried from childhood
• The barriers to adolescents using health services are specific and must be understood before services can be designed — lack of privacy and confidentiality; judgemental attitudes of staff; fear of parents being informed; inconvenient timings clashing with school; cost and lack of independent transport; services physically located among mothers and infants; and lack of awareness that services exist
• The concept of adolescent-friendly health services follows directly from those barriers, and is characterised as accessible, acceptable, equitable, appropriate and effective
• In practice this means — convenient timings, including after school; a separate, private space; assured confidentiality; non-judgemental, trained staff; free or affordable care; and services provided without requiring parental consent for counselling
• The INDIAN programme is rashtriya KISHOR swasthya karyakram (RKSK), which covers both boys and girls, 10 to 19, in both rural and urban areas
• Its six priority areas should be listed — nutrition; sexual and reproductive health; mental health; injuries and violence including gender-based violence; non-communicable diseases; and substance misuse
• Its delivery mechanisms — adolescent friendly health clinics; peer educators (Saathiya), two boys and two girls per village, which works because adolescents accept information from their peers more readily than from adults; adolescent health days; and community and school-based interventions
• Related schemes — the weekly iron and folic acid supplementation (WIFS) programme, giving weekly rather than daily tablets with biannual deworming, since weekly dosing is better tolerated and more easily supervised in schools; the menstrual hygiene scheme; and SABLA / Scheme for Adolescent Girls
• The legal framework — the prohibition of child marriage act, setting the minimum age at 18 for women and 21 for men; and the POCSO Act for protection from sexual offences
• A genuine tension should be acknowledged — POCSO makes all sexual activity below 18 an offence, which can deter adolescents from seeking contraception, testing or care for a pregnancy; the clinician must balance the legal duty with the young person’s health needs, and this is a real and unresolved difficulty rather than a settled matter
• The healthiest group and the most neglected, which is the paradox to open any adolescent health answer with
• This is the point of greatest leverage in the life cycle, since habits formed here decide adult disease
• Design services around the actual barriers — privacy, confidentiality, staff attitude and school timings
• Peer educators work where adults do not, since adolescents accept information more readily from their own age group
• Weekly iron is better tolerated than daily and is more easily supervised in a school setting
• Adolescent pregnancy carries higher risk of maternal death, obstructed labour and low birth weight
• Suicide is a leading cause of death here, which is rarely reflected in how services are organised
• Most mental illness begins before twenty-four, which makes adolescence the window for prevention
• RKSK covers six priority areas and includes boys as well as girls, which earlier schemes did not
• Substance use typically starts in this period, which is why tobacco and alcohol prevention targets adolescents
• Acknowledge the POCSO tension honestly; the law can deter adolescents from seeking contraception or antenatal care
• Menstrual hygiene affects school attendance, and is a health and education issue simultaneously
• Minimum marriage age is eighteen and twenty-one, and enforcement remains the difficulty rather than the law