Adolescent age group is defined as 10 -19 years as per United
Nations[1], which is sometimes further sub-divided into early adolescent
(10-13 years), mid adolescent (13-16 years) and late adolescent (17-19
years). This age group, which is neither children nor adults, has
totally different health needs. There were an estimated 1.2 billion
adolescent globally, making nearly 18% of world population in 2009 [2].
Amongst all adolescents, 350 million are in South East Asia, which makes
22% of the population in this region. India has the largest population
of adolescents in the world being home to approximately 243 million
individuals aged 10-19 years[2].This is an important age group, which if
provided with proper healthcare and education, will be an invaluable
asset for the nation building.
Pediatricians, amongst many parents, are still
perceived as doctors who provide care to sick children, resulting in
only a few adolescents being brought or attending a consultation.
Moreover, the adolescent health is different from child health in at
least 2 ways: One, the adolescents can make decision for themselves for
seeking healthcare and that their major needs are preventive, and
promotive rather than predominant curative-healthcare.
The global and national discourse on adolescent
health is often marred by multiplicity of challenges and
multi-disciplinary nature of the interventions. The discourse often gets
confused where to start with: is it child labor? Is it preventing
tobacco and alcohol use? Is it behavioral issues? Is it sexuality and
reproductive health issues? Is it school education for adolescent? Is it
to prevent early marriage? The overwhelming challenges and the linked
cacophony are often seen as major hurdles in identifying a real start
point. A pediatrician can play an important role in all of these efforts
to prepare adolescent for adulthood. Pediatricians can shape the role of
adolescents in active societal participation. They can be good counselor
for stressed school going adolescent and exam-facing young adolescent,
can play a crucial role in improving mental health and suicide
preventions. There are increasing and now sufficient evidence that a
healthy adolescent girl grows up to become a healthy mother; and when
married and becomes pregnant in adulthood, bears and delivers a healthy
baby. Investment in adolescent is an investment not only in adults but
also in future generations [3].
While India is yet to catch up with the situation
where adolescents regularly attend health facilities and practitioners
for preventive check-ups, it is time that opportunities for recent
initiatives for adolescent friendly health services (AFHS) should be
used as the right platform for increasing attendance at the clinics and
providing quality care. At this point, I would like to commend the
Government of India for the inclusion of adolescent health services on
forefront as part of RMNCH+A strategy adopted in 2013 [4]. We also need
to remember that the adolescent health services have always been part of
various National programs including erstwhile Reproductive and Child
program and the recently initiated Weekly Iron Folic acid
Supplementation (WIFS) for prevention of anemia [5]. Integrated Child
Development Services scheme’s inclusion of adolescent girls in its ambit
of service recipients is another step likely to make a difference[6].
Similarly, the expansion of mid-day meal program up to middle schools
will benefit additional number of adolescent girls and boys to keep them
healthy[7]. However, it is important from policy need to be translated
into actual implementation at the ground to bring changes. IAP is
willing to support the national and state governments in these efforts,
as and when requested.
A large proportion of Indian population lives in
rural area and the nearest specialist or pediatrician is posted at the
Community Health Centres, which caters to population of 80,000-120,000.
Thus, it may not be possible to provide preventive and promotive
healthcare to adolescent, who are one fifth of total population on
regular basis. No wonder, so many adolescents in India are either anemic
or underweight. The Government of India, therefore, needs to collaborate
with professional bodies such as IAP to support them in reaching the
unreached segment of adolescent population in the country. I am sure all
my fellow pediatricians would come up to challenge to support both
national and state governments in these efforts.
I strongly believe that all the IAP members should
care for 0-18 years of age group in their practice. We need to have
sustained advocacy and efforts to increase awareness that pediatricians
provide adolescent friendly health services, with provision for
counseling and in the environment of confidentiality. The ‘menu’ of
services for adolescent need to be definitely increased over a period of
time; and also adolescent vaccination (i.e. dTaP, HPV vaccines and
varicella vaccine), which is still under-serviced area, can possibly be
used for ‘piggybacking’ of the preventive health advice and counseling.
Adolescent vaccination itself needs additional attention in India is as
it provides the provide opportunity to those children who did not
complete immunization in childhood and also compensate for waning
immunity.I also foresee that IAP will bring a separate position paper on
adolescent vaccination in India, to guide the pediatricians.
Mission Kishore Uday
IAP has already started ‘Mission Kishore Uday’
this year, to address the health needs of the adolescents in India. Some
of the approaches proposed and adopted in ‘Mission Kishore Uday’
are: to intervene by counseling on normal body developments, on avoiding
or minimizing the risk-taking behavior, on sexuality issues, on positive
parenting and on effective communication etc.
I, as part of ‘Mission Kishore Uday’, have
continuously promoted that the parents have a major role in prevention
as they have the sacred and honorable duty of rearing children with love
and righteousness and by becoming role model and countering the negative
messages from the media. Through Mission Kishore Uday, we have
continuously encouraged ‘3L’ of positive parenting: (L)ove for teenager,
Set (L)imits, and Provide (L)attitude. From my experience with this
approach, I can vouch that these ‘3L’ always makes a lot of difference.
I call upon my fellow IAPians to adopt this approach in their office
practice.
Adolescents are the future of this nation and we as
pediatricians have a responsibility of shaping their future, by
providing them the right kind of health and behavioral guidance. I call
upon my fellow IAPians that while in our office practice we need to make
more active efforts for comprehensive services for adolescents, we at
various forums including at monthly IAP meetings, should bring attention
on various government schemes/programs for improving health of the
adolescents. We need to identify the possible support to government in
these areas and as and where possible should be involved in these
efforts. My vision, with your support, is that once a parent comes with
a newborn to us, we should develop personal affinity and bonding with
that child to see him/her through healthy childhood and then adolescence
to become a productive citizen of this country and assist in building of
this great nation.
References
1. UN on adolescent age group. United Nations,
Department of Economic and Social Affairs, Population Division, World
Population Prospects: The 2008 revision,
<www.esa.un.org/unpd/wpp2008/index.htm>. Accessed October 2010; and
UNICEF global databases, Accessed October 2010.
2. UNICEF. State of the World Children 2011.
Adolescence: An Age of Opportunity. NewYork: United Nations Children’s
Fund; 2011.
3. Nair MKC. Adolescent sexual and reproductive
health. Indian Pediatr. 2004; 41:7-13.
4. Government of India. A strategic approach to
Reproductive, maternal, new-born, child and adolescent health (RMNCHA+A)
in India. Ministry of Health and Family Welfare. New Delhi: Government
of India; February 2013.
5. Government of India. National Rural Health Mission
(NRHM). MoHFW, New Delhi: Government of India. Available at:
www.nrhm.nic.in. Accessed on 17 August 2013.
6. Government of India. Integrated Child Development
Services (ICDS) Scheme. Ministry of Women and Child Development, New
Delhi: Government of India. Available at: www.mowcd.nic.in. Accessed on
17 August 2013.
7. Government of India. Mid-day meal scheme. Ministry
of Human Resources Development. New Delhi: Government of India.
Available at: www.mdm.nic.in. Accessed on 17 August 2013.