Tuesday, 28 January 2014

World Population Day – Focus on Adolescent Pregnancy Adolescent Reproductive and Sexual Health (ARSH) Scheme to Reduce Vulnerability

World Population Day
In order to focus attention on the urgency and importance of population issues in the context of overall development strategy, 11th July is observed as World Population Day, every year since 1989. Theme for this year is, ‘Adolescent Pregnancy’, in the hope of creating a world where every pregnancy is wanted, every childbirth is safe, and every young person’s potential is fulfilled.
            Adolescence is a decisive age for girls around the world. What transpires during a girl’s teenage years shapes the direction of her life and that of her family. For many girls in developing countries, the mere onset of puberty that occurs during adolescence marks a time of heightened vulnerability: leaving school, child marriage, early pregnancy etc.  Adolescent girls are less likely than older women to access sexual and reproductive health care, including modern contraception and skilled assistance during pregnancy and childbirth. Many are poor, have little control over household income, have limited knowledge about sexual and reproductive health issues, and lack the ability to make independent decisions about their health.
Adolescent pregnancy brings detrimental social and economic consequences for a girl, her family, her community and her nation. Many girls who become pregnant drop out of school, drastically limiting their future opportunities. A woman’s education is strongly correlated to her earning potential, her health and the health of her children. Thus, adolescent pregnancy fuels the intergenerational cycle of poverty and poor health. The younger a girl is when she becomes pregnant, whether she is married or not, the greater the risk to her health. Married adolescents may feel social pressure to bear a child and thus not seek family planning services. Unmarried adolescent girls face a different type of social pressure of fearing judgment or dealing with a socially-unacceptable pregnancy.

About 16 million girls under age 18 give birth each year. Another 3.2 million undergo unsafe abortions. Almost 90 per cent of the pregnant adolescents in the developing world are married. But for many of these girls, pregnancy has little to do with informed choice and is often a consequence of discrimination, rights violations (including child marriage) or inadequate education.
Adolescent pregnancy is an important health issue with the youngest mothers facing higher risk of maternal complications, death and disability along with their children. It is also an issue of human rights with the adolescent pregnancy often resulting in an abrupt end of childhood, a curtailed education and lost opportunities. So, we must provide all adolescents with age-appropriate, comprehensive education on sexuality. This is especially important to empowering young women to decide when and if they wish to become mothers. In addition, we must provide comprehensive sexual and reproductive health services that cover family planning and the prevention and treatment of sexually transmitted infections, including HIV. Maternal health services that women need must be guaranteed.
Adolescent pregnancies put newborns at risk. The risk of death during the first month of life is fifty percent higher among babies born to adolescent mothers. The younger the mother is the higher risk for the baby. Fifteen per cent of all unsafe abortions in low- and middle-income countries are among adolescent girls aged 15-19 years. In 2008, there were an estimated 3.2 million unsafe abortions in developing countries among girls aged 15-19 and adolescents are more seriously affected by complications than are older women. Unsafe abortion is responsible for about 13 per cent of all maternal deaths, with adolescents disproportionately affected.

Young people aged 15 to 24 accounts for 41 per cent of new HIV infections worldwide. Adolescent girls are at far greater risk of contracting HIV than adolescent boys. Young women make up 64 per cent of all new infections among young people worldwide.

According to 2001 census data, there are 225 million adolescents, which comprise nearly one-fifth (22%) of India’s total population. Of the total adolescent population, 12% belong to the 10-14 years age group and nearly 10% are in the 15-19 years age group. This age group comprises of individuals in a transient phase of life requiring nutrition, education, counseling and guidance to ensure their development into healthy adults. Following data on adolescents from various national surveys call for focused attention with respect to health for this age group;
·          More than half of the girls in the 15-19 age group are anaemic - 56% (NFHS-3)
·         Over half (58%) of Indian women are married before they attain 18 years of age (NFHS-3)
·         16% of girls aged 15-19 have already begun child bearing and 12% have had a live birth
·         Only 14% of women in the 15-19 age group have received complete ANC
·         62% of currently married adolescents have had complications during pregnancy 52% of women in the 15-19 age group have delivered at home
·         8.3% of all pregnancies in this age group result in spontaneous abortions
·        45% of all maternal deaths take place among the15-24 age group and Neo-natal Mortality Rate(NMR) is as high as 54/1000 among those in the age group of 15-19 years.
·         Neo-natal Mortality Rate among rural adolescents is as high as 60/1000.
·        50% higher risk of infant deaths among mothers aged below 20 years (NFHS-3)
·        Only 66.2% of pregnant girls below 20 years of age have been given or purchased iron and folate tablets as part of antenatal care (NFHS -3)
·         6000 adolescent mothers die every year due to anemia (NFHS -3)
·        47 per cent girls in this age group are underweight (NFHS -3)

Accordingly Government of India has accorded priority to Adolescent Health in the RCH-II programme.  The Programme Implementation Plan (PIP) of Adolescent Reproductive and Sexual Health (ARSH) focuses on reorganizing the existing public health system in order to the service needs of adolescents. Steps are being taken to ensure improved service delivery for adolescents during routine sub-centre clinics and ensure service availability on fixed days and timings at the PHC and CHC levels. Outreach activities in tune with this have also been initiated in some states. A core package of services includes preventive, promotive, curative and counselling services. Adolescent-friendly services are to be made available for all adolescents – married and unmarried, girls and boys – during the clinic sessions, but not denied services routine hours. 

All States have incorporated this into their State PIPs. There are close to 3000 adolescent friendly health clinics across District Hospitals, CHCs and PHCs. Efforts are underway to ensure availability of trained staff at these clinics as well as in routine OPDs. Medical Officers and ANM/LHV/Counsellors have been trained on offering adolescent friendly health services across the country. This network needs to be expanded and strengthened to increase access to quality services for adolescents.

The Ministry of Health & Family Welfare has also rolled out a new scheme for thePromotion of Menstrual Hygiene among Adolescent Girls in the age group of 10-19 years in Rural areas. This programme is aimed at ensuring that adolescent girls (10- 19 years) in rural areas have adequate knowledge and information about hygiene and the use of sanitary napkins. This scheme has been launched in 25% of Districts in the country i.e. 152 districts across 20 States in the first phase.

Further, the School Health Programme has been launched to address the health needs of school going children and adolescents in the 6-18 year age groups in the government and aided schools. This is the only public sector programme specifically focused on school age children. Its main focus is to address the health needs of children, both physical and mental, and in addition, it provides for nutrition interventions, promotes physical activities and counseling. This preventative and curative service provisions have long fetched dividend in the future MCH and RCH profile. Components of School Health Programme include screening and early management of disease, disability and common deficiency, supplementation, health education and health promoting schools. 

Health service provision through screening, health care and referral specifically for general health, assessment and follow up of Anaemia /Nutritional status, visual acuity, dental check up, common skin conditions, heart defects, physical disabilities, learning disorders, behavior problems. Basic medicines are being made available for common ailments prevalent among this age bracket. Bi-annually supervised schedule for de-worming, as per national guidelines is being followed. Fixed day immunisation coupled with education about the issue, as per national schedule has been included in the package of service. Referral service connectivity from primary, till super specialist health facilities has been initiated.

To conclude, the actions to meet adolescents’ sexual and reproductive health needs would protect their rights and help prevent girls from having too many children too early in life, which threatens the health of mothers and children and strains young families’ limited resources. Preventing unintended adolescent pregnancies and investing in girls’ education, health and rights have powerful ripple effects in other areas of their lives. Educated young women offer a powerful boost to their families’ well-being, contributing to increased household income and savings, better family health and improved opportunities for future generations.

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