The 11 to 19 year old age is called adolescence. This is the period of rapid change and maturation when the child grows into the adult. This is one of the most enjoyable stages of one’s life and it has to be experienced with joy and friendship paving the way for building a healthy society with good social relationships. The National Population Policy 2000 identified adolescents as an under served group for which health needs and within this reproductive and sexual health interventions are to be designed. The National Youth Policy 2003 recognizes 13 to 19 years as a distinct age group which had to be covered by special programmes in all sectors including health. The National Curriculum Framework 2005 for school education highlights the need for integrating adolescent reproductive and sexual health messages into school curriculum .Based on this the National Adolescence Education Programme of NACO along with the Ministry of Human Resources Development is developed.
The govt has launched a Programme called the Adolescent Reproductive and Sexual Health Programme under National Rural Health Mission as a part of RCH. This focus on ARSH and special interventions for adolescents was in anticipation of the following expected outcomes: Delay age of marriage, Reduce incidence of teenage pregnancies, meet unmet contraceptive needs and reduce the number of maternal deaths, reduce the incidence of sexually transmitted diseases and reduce the proportion of HIV positive cases in the 10-19 years age group. One of the main problems during this phase of growth is the inadequate calorie intake. Studies have shown that girls in rural areas take a mean of 1355K.Cals/day in the 13-15 years and 1292 K.Cals/day in the 16-18 years which is much below the recommended age-groups. The commonly observed health problems are vaginal discharge, hair lice, headache, painful menstruation, irregular and excessive bleeding, dental problems and short sight. Silent urinary tract infection, poor menstrual hygiene is some other additional problems. Psychological problems also arise like emotional disturbances, depression, low self esteem, anxiety over inadequate or excessive secondary sexual development etc.Some of the specific strategies undertaken by various govts are Kishori Balika scheme under ICDS by Dept of Women and Child Development. Weekly once 100 mg iron Folic Acid supplementation of all adolescent girls through schools and anganwadi centers in AP.
Peer education and life skill development through education dept in Tamil Nadu, Maharashtra, Karnataka, AP etc.There is need for a service for providing counseling for adolescents within the district hospital and the CHC.In primary health centers and subcentres the skills to provide counseling both to adolescents and also to newly weds must be available. Peer educator network is also one of the key strategies to meet adolescents especially in marginalized groups like migrants ,rag pickers and certain occupational categories, street children and even larger socially under privileged groups like the urban slums or in tribal areas.Helplines and internet are some of the other way through which educated adolescent can access information. This is the period of life when there is maximal need for nutrition.
The major limiting factor in accessing this is poverty .The second factor is patriarchy when intra-family allocation reduced availability for the adolescent girl who needs this the most. There are various government efforts to address this problem. For example the ICDS programme provides for a package of nutritional services to be made available. In practice few adolescents have been able to access this. There have been special schemes to give 10kms of grain every month to the underweight adolescent. This too has been slow to implement. Preventing the marriage of girls below the legally permissible age of 18 should become a national concern .One needs to enforce the Child Marriage Restraint Act 1976 to reduce the incidence of teenage pregnancies. A more positive approach is to promote higher retention of girls at schools. This would also encourage their participation in the workforce. It is important to bring social pressure on errant families and specific communities by women’s groups and organizations. Promotion of healthy life styles through sports competition or a cultural programme for youth can also bring positive change. Some activities can provide opportunities for youth to take part together. A health component that has behavior change communication, counseling and service delivery aspects could be built into these.