|Year : 2011 | Volume
| Issue : 4 | Page : 245-246
Promoting adolescent health and development in South-East Asia
Regional Director, WHO South-East Asia Region,
|Date of Web Publication||3-Jan-2012|
Regional Director, WHO South-East Asia Region
|How to cite this article:|
Plianbangchang S. Promoting adolescent health and development in South-East Asia. Indian J Community Med 2011;36:245-6
Adolescence (10-19 years of age) is a period of rapid transition in life from "childhood" to "adulthood." This phase of life is full of opportunities and healthy adolescents are a great asset for contributing to national development. However, adolescents are also exposed to risks and vulnerabilities at the same time. In the WHO South-East Asia (SEA) Region, there are about 350 million adolescents, which is 22% of the total population.  Adolescence is generally perceived to be a healthy period of life because mortality is relatively low in this age group. This is, however, deceptive, since adolescents face many challenges in their life and several of these challenges relate to their health. These health challenges are, of course, different from what they faced when they were younger.
Globally, every year 2.6 million young people die and most of these deaths are preventable, with 97% of these deaths occurring in low- and middle-income countries and mostly in Asia and Africa. In the WHO SEA Region, important causes of maternal mortality are hemorrhage, sepsis, and complications from abortion. These causes account for a higher proportion of deaths among young women, including adolescent girls, whereas among young men injury-related deaths are the significant causes of deaths in the SEA Region.  These include traffic accidents, violence, fire-related incidents, and drowning. Moreover, it is estimated that nearly two thirds of premature deaths and one third of the total disease burden in adults are associated with conditions or behaviors initiated during adolescence.
The "health" and "nutrition" status of adolescents is likely to have an intergenerational effect on their offsprings. Early marriage and early childbearing among girls of 18 years of age are common in a number of countries in the Region. More than 68% of girls in Bangladesh, 51.4% in Nepal, 47.4% in India, and 24% in Indonesia are married by 18 years of age.  Early pregnancy has higher chances of adverse reproductive health outcomes such as high maternal mortality and high infant mortality. Compared with women in their twenties, adolescent girls are 2-5 times more likely to die from causes related to pregnancy and childbirth. Hence, the adolescent age group significantly contributes to population momentum and to population dynamics, and this age group also contributes to a high Maternal mortality ratio (MMR) and a high infant mortality rate (IMR) in this Region. This situation leaves the chances of Member States to achieve MDGs 4 and 5 by 2015 at risk.
Information on sexual initiation among adolescents and young people is difficult to obtain. However, the age of sexual debut is reported to be decreasing over the years in countries of the Region. Early sexual activity associated with a low rate of condom use exposes adolescents to the risks of Sexually transmitted disease (STIs), HIV infection, unintended pregnancy, as well as unsafe abortion and its consequence. Unmet needs for contraceptive services are high among adolescents in Bangladesh, India, and Nepal. Use of contraceptive supplies is still low in several countries; 87% of women aged 15-19 years in India and 58% in Bangladesh are not using any methods of contraception. 
Furthermore, undernutrition and anemia are important public health concerns in the adolescent age group. In many countries of the Region, instances of overweight and obesity are also common in children and adolescents. Drug and substance abuse is another important public health problem. The Global Youth Tobacco Survey shows a high prevalence of tobacco use in young people. 
For all these and for other reasons, adolescents deserve a sound public health response that should come primarily from national policies and programes that fully involve multidisciplinary and multisectoral actions in their development and implementation.
Although health services are available, it is a common observation that adolescents and other young people are reluctant to come forward to use them; the main reason being lack of privacy and confidentiality. This is in addition to many other sociocultural barriers and financial constraints. We must recognize also that our health-care providers still have limitations in their capacity to deal sensitively and without being judgmental with the social dimensions of adolescent health issues. In this regard, there is an urgent need for strengthening the capacity of health-careproviders.
The World Health Assembly adopted a resolution on "Youth and Health Risks" in 2011. The resolution is to further facilitate our work in this important area since it is intended to promote the linkages between the national adolescent health programes and the UN Secretary-General's Strategy on Women's and Children's Health. The resolution is also to ensure linkages with the programes on prevention and control of noncommunicable diseases.
Significant progress has been made in the Region toward meeting the numerous challenges faced by adolescents. Almost all countries in the Region are systematically implementing adolescent health programes with support from many stakeholders and partners both within and outside the UN system. To improve access by adolescent clients to quality health services in a comprehensive manner, country-specific national standards and operating guidelines have already been developed and used in several Member States.
To strengthen the capacity of programe managers and other service providers, training modules and other necessary tools have been adapted for use to suit specific social and cultural conditions in countries. A large number of health workers, including medical doctors, have been trained to manage adolescent-friendly clinics. Despite these initiatives and developments, Member States still face challenges in scaling up the implementation of their adolescent health programes. However, the efforts to overcome these challenges are underway through interagency coordination and cooperation.
As far as health services are concerned, at present the main focus of adolescent health programes is on sexual and reproductive health, including prevention of HIV infection. However, efforts have been intensified to address other important areas such as nutrition, healthy lifestyles, mental health and mental well-being, as well as prevention of violence and injuries. It is necessary, in this development process, to build strong partnerships with different stakeholders and with different groups of people who are influential in advocating for sound physical and mental and the social well-being of adolescents.
At the same time, adolescents must be appropriately equipped with relevant knowledge and skills and must be provided with an enabling environment in order to encourage them to come forward with their demand for health services without any hesitation or fear.
Strategic information for advocacy, planning, and programming in the Member States is being reviewed and strengthened. Lack of age- and sex-specific data at the national level remains an important constraint. Information on several aspects of health and the social dimensions of health for the adolescent age group is not easily available from the usual sources such as the National Health Information Systems.
WHO has advocated including measurable adolescent health indicators in the national adolescent health programes for effective monitoring and objective assessment of programe implementation. Data generated from adolescent health programes should also be analyzed with respect to age and sex. Attempts should be made to disaggregate the existing data from any sources according to age and sex. This is to better understand the trends of sexual and reproductive health parameters relating to adolescents.
To move the agenda of adolescent health and development forward, WHO has been engaged in developing and sustaining partnerships with other UN agencies and partners in striding forward multisectorally and through multidisciplinary involvement in the most coordinated manner to support Member States. To a certain extent, this movement in adolescent health and development would tangibly help countries in their efforts to achieve the MDGs and contribute to overall national development.
| References|| |
|1.||World Population Prospects: The 2010 Revision. Available from: http://esa.un.org/unpd/wpp/index.htm |
|2.||Patton GC, Coffey C, Sawyer SM, Viner RM, Haller DM, Bose K, et al. Global patterns of mortality in young people: a systematic analysis of population health data. Lancet 2009;374:881-92. |
|3.||Bangladesh DHS 2007, India NFHS-3 2005-06, Indonesia DHS 2007, Nepal DHS 2006. |
|4.||Bangladesh DHS 2007, India NFHS-3 2005-2006. |
|5.||Global Youth Tobacco Survey (GYTS) 2009. |