Do most of us really know the meaning of the term adolescence? If yes, do they realise the significance of this phase in a person’s life? Even if people know about this age group, most don’t understand its transformative potential. Which explains why we have made so little investment in adolescents.
The World Health Organization defines adolescents as people in the age group 10 to 19 years. India has 253 million of them. In most countries, adolescence is the phase of lowest mortality. But this dominant view seems to be the reason why till very recently national health programmes paid very little attention to this large subset of the population, which is virtually invisible in the system.
This is the stage of life when there are rapid physical and psychological changes that significantly define their high-risk or healthy behaviour. Moreover, social norms and cultural values in India greatly affect different aspects of adolescent health and well-being.
One-quarter to a third of them get married before they turn 18. They are often thrown into the vicious cycle of violence, malnutrition, poverty, etc. Added to this is the problem of little or no formal education and poor access to information or services, leading to high morbidity and mortality. Though we have strong legislation for their welfare. the implementation is cavalier. If we could prevent child marriage and invest in their well-being, the lives of millions of adolescents can be changed.
The Lancet Commission’s report on adolescent health and well-being, released recently, showed that in India almost 39,000 young adults die every year because of violence and other kinds of harm they do to themselves, whereas another 24,000 are killed in road accidents. Deaths among adolescents, aged 15-19 years, are attributed primarily to social and behavioral factors (48.6%). Enacting laws, with supportive education and healthcare systems, is critical in preventing these deaths.
Although significant strides have been made in primary school enrolment, a large number of adolescent girls and boys drop out by the time they enter secondary school (46.7% among girls and 48.1% among boys). Guaranteeing and supporting access to free, quality secondary education presents the ‘single-best investment for health and wellbeing’. Hence, it is critical to increase the age limit for the Right to Education (RTE) to 18 years, even if it requires additional resources.
The recently launched Rashtriya Kishore Swasthya Karyakram (RKSK) is a very comprehensive programme with all the right choices. Being one of the multi-burden countries, India really has to gear up to meet the health needs of its adolescents. The heterogeneity of this age group — school/out of school, married/unmarried, at workplace/on streets, on drugs/selling sex — makes the interventions in this subgroup a multi-sectoral and multidisciplinary task.
During adolescence one acquires physical, cognitive, emotional, social and economic resources. Investment in adolescent health and well-being today will pay dividends well into the next generation.
Sunil Mehra is director, Centre for Adolescent Health and Development, MAMTA Health Institute for Mother and Child, Delhi
The views expressed are personal.