 DEFINITIONS:

• Adolescents …… 10 -19 years

• Youth …………… 15 - 24 years

• Together, adolescents and youth are referred to as ‘Young

people’, encompassing the ages 10-24 years.
 Early Adolescence … 10-13 years
 Middle Adolescence … 14-16 years
 Late Adolescence … 17-19 years
Source: progress for children; A report card on adolescents. UNICEF
 Today, every fifth person in India is an adolescent (10-19 years) and
every third – a young person (10-24 years)

 Investing in this segment of population is the best way to leverage

the nation’s competitive advantage – its demographic dividend.
POPULATION OF ADOLESCENTS (10-19
YEARS)
Adolescent
Proportion of
Country Population (10-19 yrs)
(in million) Adolescents
Population (%)
(in million)

China 1358.8 191.2 14.1

India 1205.6 236.5 19.6
USA 312.2 43.0 13.8
Indonesia 240.6 43.4 16.8
Brazil 195.2 33.8 17.3
Pakistan 173.1 30.9 23.1

World Population Prospects –

The 2012 Revision, UN 2013
POPULATION OF YOUTH (15-24 YEARS)
Youth
Proportion
Country Population (15-24 yrs)
(in million) of Youths
Population (%)
(in million)

China 1358.8 242.2 17.8

India 1205.6 229.0 19.0
USA 312.2 43.9 14.1
Indonesia 240.6 40.5 16.8
Brazil 195.2 33.6 17.2
Pakistan 173.1 37.2 21.5

World Population Prospects –

The 2012 Revision, UN 2013
 Population Pyramid (By 10 Years Grouping)
India : 2001 & 2011 Censuses
Age-Sex Distribution, India, 2001 Age-Sex Distribution, India, 2011
80+ 80+
70-79 70-79
60-69 60-69
50-59 50-59
40-49 40-49
30-39 30-39
20-29 20-29
10-19 10-19
0-9 0-9

30.0 20.0 10.0 0.0 10.0 20.0 30.0 30.0 20.0 10.0 0.0 10.0 20.0 30.0
Females Males Females Males

The broad base is gradually shrinking and the bulge is

moving upwards indicating an increase in the median age
Source: SRS Report 2015, censusindia.gov.in
 Adolescents (10-19) : India
• Population (2011) 253 mn (225 mn)

• Decadal growth (2001-11) + 12.5%

• Sex Ratio (2011) 898 (882)

Youth (15-24) : India

• Population (2011) 231 mn (189 mn)

• Decadal growth (2001-11) + 22.1%

• Sex Ratio (2011) 908 (882)

Trends in Proportion of Population
– India
1961 to 2011 Census

• Since 1971 the proportion of adolescent population

has remained around 21 per cent
• Proportion of youth population increased steadily
from 16.5 per cent in 1971 to 19.2 per cent in 2011
Adolescent’s percentage in the top and bottom five States

Top Five State % Adolescent Bottom Five State % Adolescent

Uttar Pradesh 24.5 Kerala 16.3
Rajasthan 22.9 Tamil Nadu 17.2
Uttarakhand 22.5 Karnataka 18.9
Bihar 22.5 Maharashtra 19.0
Jharkhand 22.2 Andhra Pradesh 19.3
 Transitional stage of physical, psychological and social maturing from childhood to
adulthood
 A period of preparation for undertaking greater responsibilities like familial, social,
cultural and economic issues in adulthood.
 Parents of the next generation
 Future of the Nation – major economic & demographic force
 They have specific needs which vary with gender, life circumstances and socio
economic conditions.
 Health problems not given much prominence since they are less vulnerable to
diseases as compared to other age groups
 Morbidity and mortality occurring in this age group is mostly due to preventable
causes.
 Early menarche, late marriage, urbanization, migration and exposure to mass
media – have led to major changes in social & sexual behavior
 Adolescents are a group of apparently healthy individuals.
 Period of increased nutritional requirements demanding diet rich in protein, vitamins,
calcium, iodine, phosphorus and iron.
 Many adolescents die prematurely due to preventable or treatable causes
 Major health problems faced include:
o Mental health problems
o Early pregnancy and childbirth
o Human immunodeficiency virus/sexually transmitted infection (HIV/STI) and other
infectious diseases
o Violence, unintentional injuries, road traffic accidents
o Malnutrition
o Substance abuse
Source: Adolescent Health, WHO
 Adolescents have increased nutritional requirements demanding diet rich in protein, vitamins,
calcium, iodine, phosphorus and iron due to rapid growth spurt and increased physical activity.
 Diabetes, malnutrition, anemia – seen in Adolescents

 Eating disorders - anorexia nervosa or binge eating

 Mass media plays an important role in habit picking and decides their lifestyle pattern.

 Eat food or snacks while watching TV, buy food products based on advertisement, consume Junk food
products
 Consume low quality protein supplements and steroids without proper guidance - renal failure and
MI.
 Inadequate diet - stunted growth and delayed sexual maturation.
 Mental health problems in adolescents are often neglected leading to increased
mortality and morbidity.
 Suicidal behaviors reported in youths are more common in males, and are associated
with factors like absenteeism, independent decision making, premarital sex, sexual abuse,
physical abuse from parents and mental disorders.
 In India around 35.4% suicide victims were youths in the age group of 15-29 years
(NCRB 2011 data)
 Alcohol use disorder and psychiatric problems are the important cause of Years Lost
due to Disability (DALYs)
 Challenges in parenting: Due to cultural barriers parents neglect to talk about physical
changes during adolescence & hence growing children learn about sexuality &
secondary sex characteristics from their peer groups or other inappropriate sources
 Most of the children’s psychiatric disorders were unidentified because of parent’s
ignorance and negligence.
 31.3 per cent of the road traffic deaths were seen among 15 to 29 years individuals
(NCRB 2011, India)
 RISK FACTORS: Rash driving, breaking traffic rules, driving without license,
drunken driving and use of mobile phones while driving
 Sexual abuse is faced by adolescent girls and boys equally. These problems mostly
go unnoticed as the victim suffers in silence because of fear and social stigma.
 Adolescents are ignorant about the consequences of substance abuse
 NFHS–3 data shows, in the age group 15–19, about 11% of adolescent boys and 1% of
adolescent girls had consumed alcohol, in that 3% consume it daily.
 About 29% boys and 4% girls use some kind of tobacco. The average age at tobacco
use initiation was earliest at 12.3 y and alcohol usage at 13.6 y among adolescents
 About 11% of cannabis users were introduced to it before the age of 15.
 Initiating cannabis at this age is strongly associated with the development of
Schizophrenia spectrum disorders in adulthood
 Habits like smoking and alcoholism have lifelong impact and potential to cause health
problems like coronary heart disease and diabetes in adulthood. Even though there is
legal restriction, alcohol and tobacco products are available generously for under-18
age group.
 Primordial prevention from substance abuse with strict enforcement of law can
prevent occurrence of such diseases.
 At this age, curiosity about sexuality increases, they start showing sexual interest in
opposite sex.
 Media also plays a major role in exposing them to sexually explicit materials which make
them perpetrators of sexual violence.
 Early menarche, late marriage, less supervision – have increased opportunities for sexual
encounters
 Adolescent sex is a taboo in most societies which has lead to widespread ignorance
among the youth of the risks associated with unprotected sexual activity
 Sources of information and contraceptive advice is rarely accessible to adolescents
 Lack of sex education, lack of knowledge on transmission of STIs & HIV/AIDS
 Social stigma – undisclosed diseases left untreated leading to complications like infertility,
pelvic inflammatory disease and cancer
 In addition, impulsive sexual behavior and non-use of contraceptives are sometimes
exacerbated by alcohol and drug abuse
 High mortality & morbidity is associated with pregnancy & child bearing in
adolescent girls
 Rise in wanted and unwanted pregnancies leading to increased abortions & STDs
 Increased numbers of abandoned and abused children born to adolescent mothers
 There is an inverse relationship between fertility and education
 Early and more frequent childbearing consequently increases population size and
growth rate
anemia, fetal
 Pregnancy during adolescence is associated with increased risk of
growth retardation, prematurity, preterm delivery, complications during
labor and maternal mortality
 Reproductive and sexual health status of
Indian adolescents (NFHS-3 data)
S. No Factors Male (%) Female (%)

1 Sexual debut before the 2.7 8.0

age of 15+

2 Contraceptive awareness 96.0 94.0

(15-19)+
3 Ever used Contraceptives+
4 Condom used during first
time+
5 Births by age 18 (2008-
2012)*
6 Comprehensive knowledge
of HIV among adolescents+
2.7% boys and 8 % girls reported
sexual debut before the age of 15
29.4 40.4 and most of the sexual activity
happens in the context of marriage,
this leads to early pregnancy due to
19.0 3.0 social pressure.
Even though contraceptive
- 21.7 awareness is 94% among girls aged
15–19, only 23% of the married and
34.5 18.6 18% of the sexually active
unmarried girls in this group, used a
contraceptive once at least

7 STI/ symptoms of STI in 10.8 10.5

sexually active
adolescents+

8 Prevalence of HIV among 0.01

adolescents+
 RMNCH+A
 Adolescent Reproductive & Sexual Health Programme (ARSH)
 Adolescent Friendly Health Clinics (AFHCs)
 WIFS
 Rashtriya Kishor Swasthya Karyakram (RKSK)
 Kishori Shakti Yojana (KSY)
 Nutrition Programme for Adolescent Girls (NPAG)
 Rajiv Gandhi Scheme for Empowerment Of Adolescent Girls (SABLA)
 Balika Samridhi Yojana
 Sukanya Samriddhi Yojana
 National AIDS Control Programme
 Addresses the major causes of mortality among women and children
 Adolescent Health:
 Address teenage pregnancy and increase contraceptive prevalence in adolescents
 Introduce community based services through peer educators
 Strengthen ARSH Clinics
 Roll out National Iron Plus initiative including weekly IFA supplementation
 Promote menstrual hygiene

Priority interventions –
 Adolescent nutrition; Iron & Folic Acid supplementation

 Facility based adolescent reproductive & sexual health services (ARSH)

 Information & Counselling on Adolescent Sexual & Reproductive health and other health
issues
 Menstrual Hygiene

 Preventive Health Checkups

Priority interventions –
 Adolescent nutrition; Iron & Folic Acid supplementation
 Facility based adolescent reproductive & sexual health services (ARSH)
(Adolescent Health Clinics)
 Information & Counselling on Adolescent Sexual & Reproductive health and other
health issues
 Menstrual Hygiene
 Preventive Health Checkups
• Ensuring service availability to adolescents during routine clinics at sub centres &
on fixed days & timings at PHC, CHC and District Hospital Levels
• Facility based health services – Adolescent Friendly Health Clinics –
contraceptive provision, management of RTI/STI/Menstrual problems, antenatal
care, anemia
• Counselling – Dedicated ARSH & ICTC counselling – on issues like nutrition,
puberty, RTI/STI prevention, contraception, delayed marriage & childbearing,
substance misuse, sexual abuse, abortion services
• Community based interventions – Outreach activities – conducted in schools,
colleges, VHND, etc.
• Capacity building for service providers
 ‘Maitri’ in Maharashtra
 ‘Udaan’ in Uttrakhand
 ‘Sneha’ in Karnataka
 Counselling services – Nutrition, Puberty, RTI/STI prevention, contraception & delaying
marriage
 Curative Services- Treatment for:
 Severe malnutrition
 Common STI/RTI problems
 Menstrual disorders
 Sexual Concerns of Male & Female
 Mental Health Services/Management of depression
 Non-communicable diseases & other common ailments
 Injuries related to accidents & violence
 Substance Misuse
 Delay first pregnancy
 Decrease teenage pregnancies
 Reduction in maternal deaths among adolescent girls
 Management of Anemia
 Iron supplementation & Nutritional Counselling
 Appropriate health facility referrals
 Early & Safe abortion services are provided to adolescents

 Weekly Iron & Folic Acid Supplementation & Tab Albendazole

 Sanitary Napkins
 Contraceptives
 Medicines
 MOHFW launched WIFS to meet the challenge of high prevalence of ANEMIA amongst
adolescent girls & boys.
 Priority interventions –
 Administration of supervised weekly iron-folic supplements of 100mg elemental
iron & 500mcg folic acid using a fixed day approach
 Screening of target groups for moderate/severe anemia & referring these cases to
appropriate health facility
 Biannual deworming (Albendazole 400mg), six months apart, for control of
helminths infestation
 Information & Counselling for improving dietary intake & taking actions for
prevention of intestinal worm infestation
 WIFS covers over 11.2 Crore Beneficiaries – 8.4 Cr in school & 2.8 out-
of-school beneficiaries
 Minimum service
package for the
management of
anemia across life
stages
 Launched by MOHFW for promotion of menstrual hygiene among adolescent girls
in the age group 10-19 years in rural areas
 Priority interventions –
 Community based health education and outreach in the target population to
promote menstrual health
 Ensuring regular availability of high quality sanitary napkins to the adolescents
 Sourcing and procurement of sanitary napkins
 Storage and distribution of sanitary napkins to adolescent girls
 Training ASHA & Nodal teachers in Adolescent Health
 Safe disposal of sanitary napkins
 Launched on 7th January, 2014 by MOHFW to reach out to 253 million adolescents in the
country in their own spaces
 Introduces peer led interventions at the community level, supported by augmentation
of facility based services
 Broadens the focus of adolescent health programmes beyond reproductive & sexual
health & brings in focus on life skills, nutrition, injuries, gender based violence, etc.
 RKSK has been developed to strengthen the Adolescent Component of RMNCH+A
 Objectives:
 Improve nutrition
 Improve sexual and reproductive health
 Enhance mental health
 Prevent Injuries & Violence
 Prevent Substance Misuse
 Prevent Non-Communicable Disease
 WIFS covering government, government aided and municipal schools and
Anganwadi centres
 School Health Program under Ayushman Bharat
 Clinics & Counselling
 Peer Educators in the community
 Adolescent Health Day
 Menstrual Hygiene Scheme for Rural Adolescent Girls
 AFHCs at government health facilities with Medical Officers, ANMs and Counselors
trained in Adolescent Friendly Health Services
 To improve life skills, knowledge and attitude of adolescents
 Nutrition
 Sexual & Reproductive Health
 Conditions for NCDs
 Substance misuse, injuries and violence
 Mental Health
 Strategy to increase awareness among adolescents, parents, families and
stakeholders
 The AHD should be organized in every village
 Once every quarter on a convenient day (preferably a Sunday)
 Anganwadi Centres or Community Spaces may be venues for organizing the AHD
 Services should be offered to all adolescent target groups – M/F, 10-14 & 15-19 age,
school going, drop out & married adolesents
 Launched in the year 2000, KSY is a key component of ICDS
 Aim – Breaking the intergenerational life cycle of nutritional & gender
disadvantage & providing a supportive environment for self development
 OBJECTIVES:
 To improve nutritional & health status of girls aged 11-18 years
 To provide literacy & numeracy skills through non-formal education
 To stimulate a desire for more social exposure & knowledge & to help them improve
their decision making capabilities
 To train & equip adolescent girls to upgrade home based and vocational skills
 To promote awareness of health, hygiene, nutrition, family welfare, child care, home Mx
 To gain better understanding of environment related social issues & the impact on their
lives
 IFS supplementation along with deworming
 Education for school dropouts & functional literacy among illiterate adolescent girls
 Non-formal education to adolescent girls. Emphasis on life education aspects including
physical, developmental and sex education is given
 Beneficiaries – Adolescent girls who are unmarried & belong to BPL families,
School dropouts
 It was initiated as a pilot project, approved in the year 2009-10
 Centrally sponsored scheme
 Implemented in 51 identified districts across the country
 Aim – address the problem of undernutrition among adolescent girls
 Undernourished Adolescent Girls in the age group 11-19 years are covered under
the scheme:
 Body weight < 30kgs in age group 11-15 years
 Body weight < 35kgs in age group 15-19 years

 6kgs of free food grain is provided to each beneficiary per month

 The programme is being implemented through ICDS Scheme
 Implemented using ICDS through Anganwadi centres.
 It focuses on all out-of-school adolescent girls of age group 11-18 years.
 Services provided:
 Nutrition provision of 600 calories, 18–20 g of protein & micronutrients per day
for 300 days in a year
 Iron and folic acid supplementation,
 Health checkup and referral services: Kishori Diwas, Nutrition and Health
Education (NHE), ARSH, Counselling services on child care practices & home
management
 Life skill education & accessing public services
 Vocational training for girls aged 16 and above under NSDP (National Skill
Development Program).
 Launched by GOI in 1997
 Aim – to delay the age of marriage
 Objectives:
 To change negative family and community attitudes towards the girl child at
birth and towards her mother
 To improve enrollment and retention of girl children in schools to increase the
age of marriage of girls and to assist the girl to undertake income generation
activities
• The Sukanya Samriddhi Yojana is as girl child prosperity
scheme under Beti Bachao Beti padhao program of Prime
Minister Narendra Modi.
• SSY account is to ensure a bright future for girl children in
India. This yojana is to facilitate them proper education and
care free marriage expenses.
• The scheme has well been accepted by the masses in wake of
the financial security and independence it would provide to
the girl child as well as their parents and guardians.
 Under NACO, Adolescent Education Programme has been developed which focuses
primarily on prevention through awareness building
 This programme runs in secondary & senior secondary schools to built up the life skills of
adolescents to cope with the physical & psychological changes associated with growing up
 Co-Curricular Adolescent Education: 16 Hour Sessions are scheduled during the academic
terms of class IX and XI
 Life skills education in classes I-VIII
 Inclusion of HIV prevention education in teacher training & education programmes and to
out of school adolescents & young persons
 State AIDS Control Society have further adapted the modules after state level consultations
with NGOs, academicians, psychologists & parent teacher bodies
 Relevant messages on sexuality & relationships are developed and disseminated for youth
via posters, booklets, panels & printed material
 Incorporating measures to prevent stigma, discrimination against learners/students &
educators for HIV prevention
 censusindia.gov.in
 http://www.censusindia.gov.in/vital_statistics/SRS_Report_2015/6.Chap%202-
Population%20Composition-2015.pdf
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4413087/
 https://www.fitterfly.com/site/pdf/anemia-mukt-bharat.pdf
 http://apps.who.int/adolescent/second-decade/section2/page2/age-not-the-
whole-story.html
 http://apps.who.int/adolescent/second-decade/section/section_2/level2_2.php
 http://ncrb.gov.in/StatPublications/ADSI/ADSI2011/suicides-11.pdf
 https://nhm.gov.in/index1.php?lang=1&level=3&sublinkid=1024&lid=388
 Park’s Textbook Of Preventive & Social Medicine,25th Edition