Professor Susan Sawyer holds the chair of adolescent health at The University of Melbourne and is the director of the RCH Centre for Adolescent Health. Trained as a respiratory paediatrician, she has been a consultant to WHO, UNICEF, UNFPA and the World Bank. In the city as part of a global event — The World Congress on Adolescent Health — Prof. Sawyer speaks to Bindu Shajan Perappadan on the dynamic adolescent population in India and about the various challenges they face in terms of migration, exploding social media, sexual security and increasing physical attacks involving adolescents.
What are the major challenges that adolescents face today in terms of their endeavour to become productive adults?
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What are the India-specific problems that you see?
The heavy burden of marriage that happens too early. India is investing in reducing the extent of child marriage. But still, half of the world’s child marriages come from this part of the world. Continued efforts are needed...and a considerable challenge for India is around the sensitivity in this community, as in all communities, about recognising that young people are sexual beings, and that sexuality does not simply start on the night of your wedding.
Therefore, for this particular country, we need to figure out how we can do a better job of developing comprehensive sexuality programmes in our schools to support young girls and boys to grow up with an understanding of their bodies, menstrual management for girls. For boys, the need would be to understand the appropriate and inappropriate forms of engagement with other boys and girls.
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The other challenge for India, therefore, is around gender norms and what is deemed as acceptable and unacceptable behaviour for both boys and girls.
With a dynamic social media, what are the new challenges that experts face when dealing with adolescents?
Social media brings with it tremendous opportunities to gain access to information. Some of the challenges that come with it are access to some of the worst aspects of sexual violence and inappropriate information such as pornography. Helping young people understand what is quality information is important.
However, if we recognise that some of the worst accesses to the dangers of sexual and reproductive health are available online, how do we then move beyond this and recognise that sexuality is an intrinsic part of what it is to be human.
We should be able to engage youth on such subjects within our schools and families in ways that provide them with the language to talk about sexuality. This should equip them to be confident to say ‘no’ when they mean ‘no’, and ‘yes’ in ways that are healthy and safe.
What are the major mental health issues among adolescents?
Some of the most common mental health issues among young people include depression and anxiety. In many parts of the world, there have been epidemics of self harm. Other forms of mental disorder include more complex forms of depression like psychosis, eating disorders, ADHD.
Do conflicts/migrations have a positive/negative effect on the overall well being of the adolescent?
Economic migration is thought to have a remarkably positive effect on the health of young people in the long run. When we compare the overall burden of disease of young people growing up in higher income countries to which they typically migrate, their pattern becomes much more typical of the burden of disease in that country rather than the low-income country they migrate from.
How does early intervention help with adolescents in terms of parents/school/doctors?
Young people need access to health services and the role of families, schools, and health services is mostly around prevention. They have to equip young people with the skills to negotiate their world without having to wait till they are so unwell that they need healthcare.
An example would be to intervene in sexual and reproductive health to help delay the onset of sexual activity until a time that young people feel is right. Tobacco is another case where we need legislative framework and legal requirements that make it impossible for the tobacco industry to advertise to young people... and make it illegal for young people to access it.
How big a problem is drug abuse among adolescents?
Drug abuse is a problem in all countries. It is the young people who have greatest issues with substances like tobacco, marijuana, alcohol, or other injectable forms of drugs.
What are the strengths of today’s adolescents?
At the World Congress of Adolescent Health in the Capital, we heard from youth leaders and advocates. We should equip the youth with education and recognise them as part of the solution and not the problem. We are in a rich space culturally by listening to young people and engaging with them. India seems to have a wealth of young people who are ready to contribute to policies and programmes that can benefit the next generation.
Troubled childhood
Contraception
Current use of contraception among married female adolescents (15-19 years): 13% (NFHS-3)
Tobacco Use
Tobacco use among minors (age 15-17 years): 9.6% (Global Adult Tobacco Survey, 2009-10)
Nutrition
Anaemia: 56% girls and 30% boys (15-19 years) (NFHS-3)
Obesity: 5.3 % (8-18 years) (Misra et al. 2011)
Injuries & Violence
Adolescent (15–19 years) girls who have experienced physical or sexual violence: 22% (NFHS-3)
Mental Health
Prevalence of mental disorder among 13-17 years- 7.3% (National Mental Health Survey, 2015-16)
More than 22,000 adolescents die annually due to road accidents (Ministry of Road Transport and Highways, 2014)
SOURCE: Adolescent Health Programming in India: past, present and lesson learned from MAMTA-Health Institute for Mother & Child, Delhi