Adolescent healthcare: Concerns and strategies

The World Health Organization (WHO) defines adolescence both in terms of age - spanning the ages between 10 and 19 years - and in terms of a phase of life marked by special attributes such as rapid physical growth and development; physical, social and psychological maturity but not all at the same time; sexual maturity and sexual activity; experimentation; development of adult mental processes and adult identity and transition from total socio-economic dependence to relative independence. During the adolescent period, one attends puberty.

Puberty, which usually begins between the age of 10 and 16 years, is the gradual process of change from a child to an adult characterized by changes in the body, behaviour and lifestyle. Body parts like hands, arms, feet, legs, hip and chest become larger. The body produces hormones, which are special chemical messengers that tell the body how to grow and change. The sexual organs start developing and begin producing hormones. The skin may become oilier and hair appears in several parts.

In India, about 21 per cent of the total population is adolescents. Even though mortality is less in this age group, adolescents suffer from various health and nutritional problems that may lead to morbidity or deficiencies. Many health drawbacks like mental health problems, substance abuse, violence, unintentional injuries, nutritional problems, and sexual and reproductive health problems may arise during adolescence.

Many mental health problems such as conduct disorders, anxiety, depression, eating disorders and other risk behaviours, including those relating to sexual behaviour, substance abuse and violent behaviour may emerge in late childhood and early adolescence. Enhancing social skills, problem-solving skills and self-confidence can help prevent these mental health problems. Health workers need to have the competence to relate to young people, detect mental health problems early, and provide treatments that include counseling, cognitive-behavioural therapy and, wherever applicable, appropriate psychotropic medication. In addition to laws that limit the availability of illicit substances, tobacco and alcohol interventions to reduce demand for these substances improve healthy development. Increasing their awareness on the dangers of substance abuse, building their competence to resist peer pressure and to manage stress in a healthy manner are effective in reducing adolescents' motivation for substance abuse.

Life skills and social development programmes for children and adolescents are important for reducing violent behaviour. Supporting teachers and parents to build skills in problem-solving and non-violent disciplining is also effective in reducing violence. If violence occurs, actions to make health systems more responsive and build empathy and competence of health workers can ensure that adolescents get effective and sensitive care and treatment. Psychological and social support can help adolescents deal with the long-term psychological effects of violence, and reduce the likelihood of their becoming perpetuators of violence.

Approaches for reducing road accidents and occurrence of serious injuries are important for safeguarding adolescent health. Enforcing speed limits, combining education with laws to promote seat belt and helmet use, preventing driving under the influence of alcohol or other psycho-active substances, providing alternatives to driving by increasing the availability of safe and inexpensive public transport, taking actions to make the environment safer and educating children and adolescents on how to avoid drowning, burns and falls can help reduce the likelihood of their occurrence. When someone is injured, prompt access to effective trauma care can be life saving.

Malnutrition in early years is responsible for adverse health and social consequences throughout life. This is best prevented in childhood but actions to improve access to food could benefit adolescents as well. Anemia is a key nutritional problem in adolescent girls. Preventing too-early pregnancy and improving the nutritional status of girls before they enter pregnancy could reduce maternal and infant mortality, and contribute to breaking the cycle of inter-generational malnutrition. This will involve improving access to nutritious food, micronutrient supplementation (e.g. iron and folic acid supplementation) and in many places to prevent infections as well.

Adolescent girls need extra iron and folic acid for physiological and biological changes associated with age to prepare them for childbearing in due course of time and, in the longer term, to reduce nutritional anemia in older women of reproductive age. Adolescence is a period to shape healthy eating and exercise habits that can contribute to physical and psychological benefits during the adolescent period and reduces the likelihood of nutrition-related chronic diseases in adulthood. Promoting a healthy lifestyle is also crucial to halt the rapidly progressing obesity epidemic. Adequate nutrition and healthy eating and physical exercise habits at this age are foundations for good health in adulthood.

Programmes that aim to educate adolescents about sexual and reproductive health need to be combined with efforts to make it easier for adolescents to obtain any preventive or curative health services they might need from competent and empathetic health workers. Preventing adolescent pregnancy may require laws that specify a minimum age for marriage, as well as actions to mobilize families to give their daughters the additional time they need to develop from girlhood into womanhood before becoming wives and mothers.

An adolescent's risk of HIV infection is closely correlated with the age of sexual debut. Abstinence from sexual intercourse and delayed initiation of sexual behaviour are among the main aims of HIV prevention efforts for adolescents. Adolescents need HIV-testing services that are accessible and appropriate. Adolescents living with HIV need treatment, care, support and positive prevention services. Sexual coercion in adolescence needs to be fought at different levels. Adolescent girls should be protected from sexual harassment and coercion in educational institutions, work place and in other community settings. Laws on severe punishment for this crime should be passed and enforced, and public opinion should be mobilized to become fiercely intolerant towards it.

Dr Dharmakanta Kumbhakar

(drkdharmakanta1@gmail.com)