A holistic approach to adolescent health and well-being: Leveraging India’s demographic dividend

While some adolescents have access to necessary information and services, many are not adequately supported to make a successful transition from childhood to adulthood

Poonam Muttreja and Sanghamitra Singh November 16, 2021 16:12:40 IST
A holistic approach to adolescent health and well-being: Leveraging India’s demographic dividend

Representational image. Image courtesy: Ben Blennerhassett/Unsplash

 At 253 million, India has the world’s largest adolescent population (aged between 10 and 19 years). This group constitutes about one-fifth of the country’s total population, according to data from Census 2011.  During their formative years, adolescents are confronted with several challenges that could impede their overall growth and development.

While some adolescents have access to necessary information and services, many are not adequately supported to make a successful transition from childhood to adulthood.

India is home to the largest number of child brides in the world and accounts for about a third of the global incidence of child marriage. Early marriages are a culmination of several factors such as gender inequality, poverty, weak enactment of laws protecting girls, low levels of education among girls and their families.

The practice has societal sanction in many communities across India. The lack of agency for girls jeopardizes their education and economic growth.

Familial pressure to have children at a young age, coupled with inadequate access to information and services on nutrition and sexual and reproductive health (SRH) makes them vulnerable to teenage pregnancies, unsafe abortions, anaemia and compromised health outcomes.

According to a study by the Guttmacher Institute, about 2 million adolescent girls wanting to avoid pregnancy do not use a modern contraceptive method and are therefore categorised as having an “unmet need” for modern contraception.  About 9,30,000 abortions occur annually among adolescent girls with 78 percent of them performed under unsafe conditions.

As per the fourth National Family Health Survey (NFHS 4 2015-16), more than half (54 percent) of all adolescent girls in India are anaemic. They are also more likely to experience violence and abuse resulting in mental trauma and depression. Low-income levels and the need to financially support families at a young age push several adolescents, especially those from marginalised sections of society, to a perpetual state of poverty, affecting their mental and physical health and self-esteem.

Despite global evidence on the interconnectedness of nutrition, education, health and well-being, government programmes are often designed and implemented in siloes by different ministries, resulting in a lack of convergent action.

The Rashtriya Kishor Swasthya Karyakram (RKSK) addresses several issues pertaining to adolescents such as SRH, nutrition, mental health, substance abuse, gender-based violence and non-communicable diseases. It, however, does not focus on adolescent issues from the perspective of social determinants of health, which can influence health equity in positive or negative ways.

Societal stigma associated with SRH discourages open conversations on the subject and deter adolescents from approaching adolescent-friendly health clinics.

The COVID-19 pandemic has exacerbated pre-existing challenges for adolescents in India and globally. School closures, loss of social networks, restrictions in mobility, parental morbidity, increasing responsibilities of domestic chores and caregiving, and experiences of violence have resulted in helplessness, anxiety, and fear that can have a lifelong impact on adolescents.

The gender gap in education has almost doubled from 8.7 percent during pre-COVID times to 15 percent during the pandemic with several adolescent girls dropping out of school and being pushed into child marriages. This threatens to reverse decades of progress.

UNICEF projects that up to 10 million more girls are at risk of child marriage in the decade of 2021–2030.

 

School closures also resulted in an increased unmet need for sanitary pads and iron and folic-acid tablets among adolescents. Evidence also suggests that there are long-term implications for adolescents as a result of the economic stress caused by the pandemic. These include children from marginalised communities being pushed into child labour and families facing difficulties in bearing the costs of digital resources.

Several global studies have underscored the need for adequate investments in adolescents’ well-being, which in turn can bring significant returns for not just adolescents but also for the entire nation. The Lancet Commission’s report on Adolescent Health and Wellbeing, published in 2017, has estimated that investments of $5.20 (Rs 387) per capita each year in improving adolescent health and well-being could save 12.5 million lives and prevent 30 million unplanned pregnancies.

Going forward, there is a need for a holistic and convergent approach to improving health outcomes for adolescents. Reproductive, maternal and child health and nutrition outcomes are closely linked to the health status of girls and young women across various stages of their life.

Integration of family planning and SRH services in nutrition programming is, therefore, an important intervention that should be scaled up.

Second, there is a need to empower girls with education, information, skills and support structures, which enhance their agency, autonomy and decision-making. Third, information and services pertaining to adolescents’ sexual and reproductive well-being, mental health and nutrition must reach everyone, including those from vulnerable socioeconomic populations.

Fourth, strengthening data-management systems will help in understanding and addressing gaps between adolescent-specific policies and programme implementation. Fifth, the pandemic has underscored the need for health literacy and initiating the concept of self-care among adolescents.

WHO defines self-care as “the ability of individuals, families and communities to promote health, prevent disease, maintain health, and to cope with illness and disability with or without the support of a healthcare provider”.

Self-care interventions can play a critical role in promoting confidentiality, empowerment and self-confidence while ensuring that quality, accessible and equitable services reach adolescents. Finally, in order to make policies and programmes more inclusive of adolescents’ needs, it is imperative that their voices are recognised and included in all aspects of decision-making.

Given that adolescents and future generations will shoulder much of the long-term economic, social and health-related consequences of the pandemic, timely investments in their health and well-being must be made through clearly defined and targetted policy and programmatic interventions. Investing in adolescents is also imperative in order to leverage the nation’s competitive advantage—its demographic dividend.

As we envision a greater role for adolescents in the nation-building process, it is essential to understand the linkages between their overall well-being, economic growth and sustainable development.

Poonam Muttreja is executive director at Population Foundation of India. Sanghamitra Singh is senior manager, Knowledge Management and Partnerships at Population Foundation of India

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