Adolescents aged between 10 and 19 years account for 22.8 per cent of India's total population. Yet, this sizeable segment remains largely ignored in government programs. It is not for want of trying, though. Several policy documents have been formulated to address the diverse needs of adolescents but strangely, none appear to have taken off.
The most recent of these is the National Population Policy, which recognizes adolescents as an under-served category and aims to provide for their nutritional, contraceptive and information needs. Other policies targeting this group include the National Nutrition Policy of 1983, which identifies adolescent girls as a vulnerable group; the National Education Policy of 1986, which reaffirms the government's commitment to eradicate illiteracy in the 13 to 55 years age group; and the National Plan of Action for Children, which has a separate section devoted to the needs of adolescent girls.
So where has the slip-up occurred?
According to community health activist Geeta Sodhi, there exists a large gap between adolescents and the health system. "To bridge this gap we need to understand adolescents, their needs and the context that shapes their growing up processes. We also need to acknowledge the fact that the health system does not hang loose and actually operates within the same context," she says.
Social workers like Sodhi face innumerable challenges especially when it comes to issues which have to do with sex because of existing rigid mindsets which continue to regard sex as dirty, immoral and a taboo subject. This attitude is reflected in the way childbirth is de-linked from sexual intimacy in the formative years of children.
Unfortunately, these normative patterns of thought and behavior are visible also in the health system's response to adolescents. It is this normative response that creates barriers to adolescents seeking information, counseling and healthcare.
Social activists and policymakers are also concerned that the knowledge level about contraceptive methods is unsatisfactory in the adolescent age group. Sodhi points out that one of the key concerns expressed by adolescents across cultural and class barriers is that their sexuality is not acknowledged, not respected and is also not placed within the present day context of the changing socio-cultural environment. This age group needs emotional and psychological support because it is grappling with identity concerns and peer pressures, adds Sodhi.
These, and many other concerns, came up during a recent conference on adolescent health held in New Delhi. Dr Karuna Singh of the Municipal Corporation of Delhi's India Population Project VIII, which organized the meet, spoke of the amazingly high levels of ignorance of adolescent needs within the medical fraternity.
Defining adolescence as a stage of transience fraught with anxiety, myth and mistaken beliefs, Singh says it is up to medical professionals and educationists to come forward to allay such fears.
According to estimates of the Technical Group on Population Projections constituted by the Planning Commission, almost 230 million Indians fell in the adolescent age group as on March 1, 2000. According to Singh, 16 per cent of pregnancies and 20 per cent of abortions occur among this age group.
So to meet the needs of this group, the Corporation has plans to set up adolescent clinics in the periphery of cities, in slum clusters and in Municipal Corporation of Delhi (MCD)-run hospitals.
Union Health Minister C P Thakur has also expressed concern at the neglect accorded to this group which he describes as a major potential human resource. Addressing the needs of this segment will contribute not only to the social and economic development of the country but also to other concerns like social harmony, ensuring gender parity and population stabilization efforts, he adds.
But programs for adolescents must recognize the vast diversity existing in this segment of the population. Adolescents include a wide spectrum of categories like those in school and out of school, those who are working, those who are sexually exploited, married and unmarried, in tribal/rural/urban areas, in institutions and those disabled in conflict.
Hence, the programs need to focus not only on issues like counseling services, contraception, nutrition and rehabilitation but also provide for other enabling factors like skill development, protection from abuse and vocational guidance, according to the Minister.
A recent study by the United Nations Population Fund (UNFPA), titled 'Adolescents in India - A Profile', concludes that adolescent mortality rates are lower than for other age groups. This, however, is not because adolescents as a group are healthy but mainly because they are assumed to be healthy and are therefore overlooked in most health programs.
There is another aspect of this grim reality. The all-pervasive gender discrimination, lower nutritional status of females, early marriages, high fertility and early child bearing (leading to maternal mortality) too contribute to a wide difference in mortality rates in adolescent females and males.
It is only when adolescents are given due importance in policy formulation, can this state of affairs change. As Sodhi says, "They need to be spoken to more and with respect by parents, teachers and healthcare providers. Most of all they need to be accepted, respected and included in decision-making processes."