10/ Shiv Chandra Adolescents and Reproductive Health Shiv Chandra Mathur Professor of Preventive and Social Medicine. Director, State Institute of Health and Family Welfare,Rajasthan, Jaipur , India

10/ Shiv Chandra What is Adolescence It is the transitional period separating childhood and adulthood. It is the phase of life when certain specific anatomical, physiological and psychological changes occur in the body.

10/ Shiv Chandra Defining the Young Adolescents years Early adolescence years Late adolescence years Youth15-24 years Young People10-24 years Youth Policy of India includes people unto the age of 35 years.

10/ Shiv Chandra Changing World of Adolescents Globalization of trade/economic relationships Mass Communication and the development of a youth culture Modes of Governance and exclusion of certain social group Decentralization of decision making Changing nature of work,requiring new skills and capacities Urbanization and Migration Emerging and resurgent diseases particularly HIV/AIDS Changing Family structures and dispersal of family members Trafficking in illicit drugs and human trafficking Conflict and social disruption

10/ Shiv Chandra Psychological changes in Adolescence Internalized sense of Identity. Drawing apart from old members of family. Intense relationship with Peers. Strong Emotions.Gradual move from involvement with same sex to mixed group. Greater creativity. Energy, new ideas and skills.

10/ Shiv Chandra Reproductive Health Problem of Adolescents Too Early Pregnancy* Unwanted Pregnancy STD/RTI/HIV/AIDS Failure to negotiate for contraceptive use

10/ Shiv Chandra Figure 3: Percentage of Women Giving Birth by Age 20, by Level of Education AfricaLatin America and the Caribbean Asia No education Primary Grade Secondary Grade

10/ Shiv Chandra Rights (CRC) denied by Early Marriage The right to education (Article 28) The right to be protected from physical/mental violence(Article 19) The right from all forms of sexual protection (Article 34) The right to highest attainable standards of Health (Article24) The right to education/vocational guidance (Article 28) The right to rest/participate freely in cultural life (Article31)

10/ Shiv Chandra Consequences of Limited Investments in ARH Early Pregnancy and Childbearing Contributing Factors Early Marriage Poverty Gender Discrimination Lack of IEC Inability to negotiate contraceptive use Social Consequences High IMR/MMR Higher Health Costs Higher Social Welfare Costs Reduced Prospects for eradicating Poverty Reduced Demographic Bonus

10/ Shiv Chandra Consequences of Limited Investments in ARH Unwanted Pregnancy Contributing Factors Lack of Reproductive Rights Low access to IEC/Contraceptives Gender Bias Sexual Violence Poverty Social Consequences Reduced Investments in Children’s needs and development Reinforcement of Gender Inequality Increased Population Momentum

10/ Shiv Chandra Basic Errors in Sex Education To talk at wrong level To place things in too favorable a light To be too problem oriented To be too abstract

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10/ Shiv Chandra ABC approach - UNGASS, 2001 Abstain from sexual relations (Delay!) Be faithful to one uninfected partner Condom - consistent and correct use Drugs and Alcohol - avoid

10/ Shiv Chandra Improving Voluntary Counseling and Testing for Youth Training of service providers on counseling Availability of privacy Free or reduced price of tests for youth Outreach to schools/youth groups Multimedia campaigns to inform youth Referral system for young clients

10/ Shiv Chandra What makes Health Services Youth-Friendly Service Providers Specially trained staff Respect for Young People Privacy/confidentiality honored Adequate time for client- provider interaction Peer-counselors available Health Facilities Convenient hours/location Adequate space and sufficient privacy Comfortable surroundings

10/ Shiv Chandra What makes Health Services Youth-Friendly - ll Program Design Involvement of youth No overcrowding Wide range of services Necessary referrals Affordable Fee Other measures IEC material for taking away Group Discussions available

10/ Shiv Chandra Service Providers to Youth Teachers. Peer Educators. Nurses. Community Workers. Doctors.

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10/ Shiv Chandra Millenium Development Goals Eradicate extreme poverty and hunger Achieve universal primary education Promote Gender Equality and Empower women Reduce Child Mortality Improve Maternal Health Combat Malaria,HIV/AIDS and other diseases Ensure Environmental Sustainability Develop a global partnership for development

10/ Shiv Chandra Lessons for the Future Involvement of Policy-Makers, Government Leaders and Civil Society Leaders Community Participation for Youth- friendly Policy Gender Awareness and Equity Social Mobilization for Higher Age at Marriage Safer Sex practices to be promoted