Adolescent Health : Reassessing the Passage to Adulthood Book

Young people between the ages of 10 and 19, sometimes called adolescents, are generally healthy. Yet because these ages encompass the transition to adulthood, including both the biological events of puberty and the psychosocial adjustments of maturation, they are associated with risk-taking behavior and, for young women, increased health risks from pregnancy and childbirth. Gender discrimination, in food allocation, use of health care, and access to education, further compromises young women ' s current and future well-being. In developing countries, because of the burden of infectious disease, programs for adolescents ' health needs have been slow to develop, particularly the essential preventive services. Cultural expectations and sensitivities have also slowed attention to these needs. But now that girls remain in school longer and their contributions to their families ' and countries ' development are better understood, governments are becoming supportive of education and health service programs, and especially those to help young women prevent too-early pregnancy. Not only are such programs desired by the young women themselves, they also result in dramatic financial benefits for countries. Studies show that investments in family planning preclude the need for much higher expenditures on medical and other care following an adolescent birth. This paper reviews current data on adolescent health, with an emphasis on sexual and reproductive activity. It assesses, by region, trends in sexual knowledge, contraceptive use, marriage, fertility, and sexually transmitted diseases, including HIV. It also looks at related issues of sexual abuse and genital mutilation as well as nutritionalneeds and health problems stemming primarily from risk-taking behavior. The paper summarizes program approaches that have been implemented and, where possible, presents evaluation data. Promising programs have been identified in health education (including the newer, more experimental curricula such as " life planning " ), health and family planning services, multiservice centers for youth, outreach programs (particularly important for reaching " street kids " and other marginalized young people), and communications. To reach adolescents, it is important to use appropriate spokespersons and messages, which require testing, and to identify the target population ' s preferred media formats. For all programs, effectiveness can be increased by including young people in the program ' s needs assessment and design and, when appropriate, in the implementation. The paper recommends changes in law and policy and programmatic revisions and additions designed to increase adolescent ' s access to services and to enhance the quality and relevance of services for young women.