In this slide, the terms that are commonly used in the literature: adolescents, youth and young people, are listed alongside age bands. WHO defines adolescents as individuals who are going through a very special phase in their lives – adolescence. A phase during which enormous physical and psychological changes occur, as do changes in social perceptions and expectations. A phase when an individual is no longer a child, but not yet an adult. Although according to WHO&apos;s definition, adolescents are aged between 10-19, WHO is conscious that adolescence is a phase in an individual&apos;s life, rather than a fixed time period.
Adolescents are a very diverse group. A boy of 12 is very different from a young man of 19. A boy of 12 is also very different - physically but also psychologically from a girl of the same age. A boy of 12 who is part of a caring and financially secure family is growing up in very different circumstances from another of the same age who has run away from home to escape physical violence. Two boys of 12 who are growing up in very similar conditions may develop in very different ways. All these categories of adolescents have different needs; different but also changing needs.
Adolescence is a time of rapid physical and psychological growth and development, and one in which individuals develop new capacities. It is also a time of changing social relationships, expectations, roles and responsibilities.
Good health certainly means the absence of disease or infirmity. But it goes beyond that to include well being – physical, mental and social well being.
In all countries and communities, many adolescents move from childhood through adolescence into adulthood in good health.
Unfortunately, many other adolescents do not do so. The main health problems affecting adolescents are listed on this slide. These problems vary both between and within countries.
The Common Agenda for Adolescent Health and Development endorsed by UNFPA, UNICEF and WHO in 1995 lists what adolescents need to grow and develop in good health, and why they need these things. A useful analogy is that of an 8 year old girl who needs to cross the road every day to get to school. She needs information & skills: where to look, what to look for, when to walk across, when not to do so. She needs a safe & supportive environment: a zebra crossing, traffic lights that work or a traffic warden in position, drivers who respect traffic rules or are punished if they do not do so. She may also need health & counselling services, if she stumbles and falls, or is struck down by a vehicle. One problem with this analogy is that it presents health services in a curative context alone. Health workers and health services have important roles to play in promotive and preventive health as well.
Who needs to contribute to the health and development of adolescents ? To answer this question, it is useful to think of these players in concentric circles of contact & influence. At the centre is the adolescent himself or herself. Parents, siblings and some other family members are in immediate contact with the adolescent & constitute the first circle. The second circle includes people in regular contact with them such as their own friends, family friends, teachers, sports coaches, health workers and religious leaders. The third circle includes musicians, film stars & sports figures who have a tremendous influence on them from afar. Finally in the fourth circle, politicians, journalists and bureaucrats (within the government & private sectors) affect their lives in small & big ways, through their words and deeds.
There are sound demographic, public health, economic and human rights reasons for addressing the health of adolescents.
Adolescents represent one fifth of the world&apos;s population.
The global population of adolescents is estimated to continue to increase and to peak just over thirty years from now.
There are an estimated 2.6 million deaths in the 10-24 year age group every year. 97% of them occur in low and middle income countries. The causes of these deaths are indicated on this slide. There are substantial regional differences in mortality rates and causes of mortality, but that is beyond the scope of this presentation.
Our case for investing in the health of adolescents becomes stronger when we include those who face illnesses (including nutritional problems) and injuries which hinder their ability to grow and develop to their full potential, and also to function optimally. UNAIDS and WHO estimate that by the beginning of 2004 over 40 million people were infected with HIV. More than 10 million of these were young people. The regional distribution as well as the sex distribution in each region are shown on this slide. All the young people, and those who join their ranks, need care and support. There are other important causes of morbidity including anaemia, depression and vesico-vaginal fistula.
Our case for attention to adolescent health becomes even stronger as one moves from mortality and morbidity to behaviours. This is a phase of life when important behaviours – habits if you like – that will determine health and disease in adulthood are formed. Smoking, diet and exercise behaviours are cases in point.
One final point is that some health problems (illnesses and infections) and health-related behaviours acquired during adolescence have their impact during adolescence; others have their impact in adulthood; and still others have their impact in the next generation.
Given even reasonably good governance, a healthy and productive work force can help move a country from low to middle income. Economists talk about the importance of using the current bulge in the adolescent population to make this leap. Investing in the health and development of adolescents can enable countries to make full use of this demographic dividend. Vietnam has an adolescent bulge today. The bulge has already started reducing in size and will soon be gone.
Socio-economic deprivation appears to be both a cause and a consequence of adolescent pregnancy. Girls from poor communities get pregnant in their early or middle adolescence. This in turn leads to loss of educational and employment opportunities keeping them in poverty.
We have an important responsibility in helping to fulfil adolescents&apos; rights as outlined in the Convention on the rights of the child.
A framework is a structure. Conceptual and operational frameworks provide a structure to think about and to do things. The World Bank, WHO and UNFPA have all developed frameworks on adolescent health and development. The World Bank&apos;s framework is the broadest one. It addresses health and development in a broad sense. WHO&apos;s framework is one that addresses the role of the health sector in improving the health and development of adolescents. UNFPA&apos;s framework addresses sexual and reproductive health.
Concept of Adolescent Sexual & Reproductive Health (ASRH), Problems, Control & Prevention
Concept of Adolescent Sexual &
Reproductive Health (ASRH),
Problems, Control & Prevention
Training Course in Sexual and Reproductive Health Research
[Dr] Amzad Ali
Cell: +8801713 004696
• What is ARSH and meaning of adolescence?
• What are the physical and emotional changes that take place
• The health problems that adolescents face
• What adolescents need to grow & develop in good health
• who needs to meet the needs & fulfil the rights of
• Why we should invest in the health & development of
• Frameworks for addressing the health & development of
What is Adolescence?
• A phase which involves -
Transition period between childhood and
adulthood where physical and cognitive
changes prepare us for adult responsibilities
Progression from appearance of secondary sexual
characteristics (puberty) to sexual and
Development of adult mental process and identity
Transition from total social-economic dependence
to relative independence
What is early, middle and late
• Early (10 – 14)
– Growth Spurt, Beginning of Sexual Maturity and Start to
• Middle (14 – 15)
– Main Physical Change Completed, Develop stronger sense
of Identity, relates strongly to peer group, Thinking
• Late (16 – 19)
– Body takes adult form, has distinct identity and more
settled ideas and opinions.
The second decade:
No longer children, not yet adults !
Adolescents 10 - 19 years
Youth 15-24 years
Young people 10-24 years
Source: A picture of health? A review and annotated bibliography of the
health of young people in developing countries (WHO, UNICEF, 1995).
Adolescents are a diverse
Adolescents are a diverse
সম্পেকর্ মধুরতা বজায় রাখেত দুজেনর মােঝই থাকেত হেব েয গুণগুেলা
Factors Shaping Adolescence
What is special about adolescence ?
(What makes it different from childhood & adulthood ?)
Adolescence is a unique time in life requiring
– Physical, emotional, psychological and
– Emerging sexuality
– Awareness of gender identification and
What is special…..cont’d
• A time of rapid physical and psychological
(cognitive and emotional) growth and
• Distinct from both childhood and adulthood
• A time in which new capacities are developed.
• A time to test independence from the family
• A time of changing new relationships-peers,
partners, parents, social relationships,
expectations, roles and responsibilities.
2. What do we mean by the
'health' and Adolescent
“Health is a state of complete
physical, mental and social well-being
and not merely the absence of disease
Source: Constitution of the World Health Organization, 1948.
3. What are the main health
problems of adolescents ?
Many adolescents move from childhood
through adolescence into adulthood in
Key Health Problems
Sexual & Reproductive health
- Too early pregnancy
risks to mother
risks to baby
- Health problems during
pregnancy & child birth
(including unsafe abortion)
- Sexually Transmitted
Infections including HIV
- Harmful traditional practices
e.g. marriage, Sexual
Source: United Nations. World Youth Report 2005. Young people today, and in 2015. United Nations. 2005. ISBN 92-1-
- Injuries from accidents
& intentional violence
- Mental health problems
- Substance use
- Endemic diseases:
Other Adolescent Health Problems?
•Menstrual Problems for girl
•Men’s reproductive issues-
•Mental Health Problems
•Early and Unprotected Sex
•Accidents and violence
•Depression and Suicide
•Nutrition issues and eating habits
This lack of proper education induces gender based violence in
the community, which mainly affects the adolescent girls.
Eve-teasing, sexual abuse of female adolescent girls, dowry
related violence, sexual harassment at the workplace or in
the educational institutions become headache of the
government time to time.
– No prior knowledge
– Fail to understand normal and to recognize
– School Health Checkups are usually not performed
to identify these
– Parental support & reassurance is a must need.
– Lack of proper information and management
Mental Health Problems
– May first become apparent in Adolescence
– Shock appears from friends and lovers
– More often not considered as a problem
– Thus fail to
• Recognize and
• Seek medical treatment
Early and Unprotected Sex
Sexual activity is more common than available
Evidenced by increased no. of-
Steep Rise in HIV
Early and unprotected sexual experience is not
planned, and with no knowledge of consequences
lead to social problem.
Predisposing Factors for Early and
Adolescents live in Increasingly sexualized
Impact of Media – Electronic and Print
Rapid Growth of cities and breakdown of
traditional family structure – Erode protective
Conflict and forced migration – put them at risk
Pressured in to desperate situations – forced into
sex for survival sp. during economic hardships etc.
Trend – earlier sexual maturation while late
4. What do adolescents need
to grow & develop in good
need & why?
• Information & skills
(they are still developing)
• Safe & supportive
(they live in an adult world)
• Health & counselling
(they need a safety net)
Access to economy and
decision making options
Involve young people as key decision-makers in
program design, implementation, and evaluation
accurate information in a
manner appropriate to their
age group and sex
Address barriers to accessing
health and information services
Empower adolescents to make life choices that are
best for them
Use information/Services thru Media
Adolescent sexual and reproductive
health education for adolescents must:
Sexual and reproductive health information promotes
promiscuity and early sexual activity.
Sexuality education contributes to:
higher levels of abstinence
later initiation of sexual
Sexuality education can help protect young people from some
of the potential risks of sexual activity.*
*Conclusion from a multi-country study carried out by UNAIDS
greater use of contraception
fewer sexual partners
Providing adolescents with sexual and
reproductive health education
adolescent sexual and reproductive health
( 7 )
5. Who needs to contribute
to meeting these needs &
fulfilling these rights ?
6. Why should we invest in
the health and
• Demographic rationale
• Public health rationale
• Economic rationale
• Human rights rationale
• One in five individuals
in the world today is
an adolescent (around
• The largest number of
adolescents in the
history of mankind.
of total pop in
Demographic rationale – 1/2
• There are around
2.6 million deaths
among the 10-24
year age group
• 97% occur in low
and middle income
Public health rationale: mortality – 1/5
Source: UNAIDS/UNICEF, 2002
Public health rationale: morbidity – 3/5
East Asia & Pacific
Latin America & Caribbean
There are over 10 million young people (15-24) living with HIV/AIDS
Public health rationale:
behaviours – 4/5
• Nearly two thirds of
premature deaths and
one third of the total
disease burden in
adults are associated
with conditions or
began in youth.
0 10 20 30 40 50 60 70
Age of smoking initiation
Age when this has its major impact
Adolescence Adulthood Childhood
++ + ++
Tobacco use + +++ +
Public health rationale – 5/5
sound reasons for investment for this
rationale – 2/4
The need to make full use
of the demographic
dividend when one can.
Economic rationale - 4/4
Socio-economic deprivation: a cause & consequence of
" We young women are not prepared to become
mothers. I would like to continue my studies. But since
I have had my daughter, my options have changed
because I have many more obligations now."
Source: World Development Report 2006 (World Bank, 2006.)
Convention on the rights
of the child
• Article 24: The right to the highest
level of health possible & to
access the required health
• Article 17: The right to access
appropriate information from the
media & to be protected from
• Article 13: The right to seek,
receive and impart information
and ideas of all kinds
Choices: A guide for young people
Gill Gordon, 1999.
Human rights rationale -1/2
6. Frameworks for
addressing the health and
First lens: Broadening opportunities for young
people to develop skills and use them
Second lens: Helping them acquire the
capabilities to make good decisions in pursuing
Third lens: Offering them second chances to
recover from bad decisions, either by them or
World Bank framework: Youth
transitions seen through three lenses