Available via license: CC BY 4.0
Content may be subject to copyright.
Citation: Sahadevan, S.; Dar Iang, M.;
Dureab, F. Effect of Adolescent
Health Policies on Health Outcomes
in India. Adolescents 2023,3, 613–624.
https://doi.org/10.3390/
adolescents3040043
Academic Editor: Dan Romer
Received: 8 July 2023
Revised: 15 September 2023
Accepted: 27 September 2023
Published: 7 October 2023
Copyright: © 2023 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license (https://
creativecommons.org/licenses/by/
4.0/).
Article
Effect of Adolescent Health Policies on Health Outcomes
in India
Sayooj Sahadevan, Maureen Dar Iang and Fekri Dureab *
Heidelberg Institute for Global Health, University Hospital, Heidelberg University, 69120 Heidelberg, Germany;
sayooj1091@gmail.com (S.S.); maureen.dar_iang@uni-heidelberg.de (M.D.I.)
*Correspondence: fekri.dureab@uni-heidelberg.de
Abstract:
Adolescence is a crucial phase marked by significant physical, psychological, emotional, and
social changes. India has the world’s largest adolescent population. Understanding and addressing
their health needs is vital for the nation’s social, political, and economic progress. The primary aim
of this study was to evaluate the main adolescent health policies and strategies implemented from
2006 to 2020 and analyze the outcomes for adolescent health in India. To achieve this objective, the
research adopted a mixed-method approach, combining qualitative and quantitative analyses of
health policies, strategies, and programs implemented since 2005. Additionally, data from the most
recent three Demographic Health Surveys (DHSs) were analyzed and compared to assess changes
in adolescent health indicators after implementing these policies/strategies. The findings focused
on India’s major adolescent health policies, namely the Adolescent Reproductive and Sexual Health
(ARSH) Strategy2005, Rashtriya Kishor Swasthya Karyakram (RKSK) 2014, and the School Health
Program 2020. All the strategies and programs aim to provide a comprehensive framework for sexual
and reproductive health services, expand the scope of adolescent health programming, and address
various health aspects. The analysis highlighted strengths in targeted interventions, monitoring,
and promotion but weaknesses in awareness, societal barriers, and healthcare worker participation.
Opportunities include female-friendly clinics and education about early pregnancy, while addressing
substance abuse and training volunteers remain challenges. Family planning has improved with
higher contraception usage and a decline in unmet needs. The incidence of violence decreased, and
positive health behaviors increased, such as condom use. However, challenges remain, including
limited access to health services, concerns about female providers, and low health insurance coverage.
Nutrition indicators showed a slight increase in overweight/obesity and anemia rates. In conclusion,
progress has been made, but certain adolescent health aspects still require attention. Further efforts are
needed to achieve universal health coverage and improve adolescent health outcomes. Conducting
targeted awareness campaigns, strengthening health worker and NGO engagement, and combating
the increasing prevalence of overweight and obesity among adolescents are recommended.
Keywords: India adolescent health; health policy and health strategy
1. Introduction
Adolescence is a critical phase of life marked by significant physical, psychological,
emotional, and social changes. The WHO defines any individual between the ages of
10 and
19 as an adolescent [
1
]. Although these definitions point chronologically to the
teenage years of an individual, the cultural and social experiences associated with this
phase may start earlier or later. Physical, emotional, social, and intellectual developments
can be used to classify adolescence into the following three categories: early adolescence
(ages 11–14), mid adolescence (ages 15–17), and late adolescence (ages 18–21) [2].
Historically, health policies prioritized maternal, child, and reproductive health, leav-
ing adolescents primarily overlooked. However, recent policy changes have addressed this
gap, including adolescents previously excluded from the country’s policies and strategies.
Adolescents 2023,3, 613–624. https://doi.org/10.3390/adolescents3040043 https://www.mdpi.com/journal/adolescents
Adolescents 2023,3614
Due to the distinct nature of crimes, health issues, and emotional and physical needs
affecting this age group, there has been a growing recognition of the necessity for their
representation as a separate demographic. Consequently, there has been an increasing
demand for the formulation of distinct policies tailored to address the specific needs of
adolescents [3].
The importance of addressing adolescent healthcare has garnered recognition from
the United Nations, leading to collaborations with several countries to address this concern.
A significant development in this occurred in 1987, when the International Association for
Adolescent Health (IAAH), a multifaceted non-governmental organization, was established
to meet the healthcare needs of adolescents worldwide. The IAAH has been actively
involved in various initiatives, including organizing health camps, offering scholarships
through sponsorships, and undertaking diverse endeavors to support the well-being of
adolescents [4].
India holds the world’s largest adolescent population of approximately 253 million,
and one in five citizens is between the ages of 10 and 19. India will benefit socially, politically,
and economically if this enormous population of teenagers is secure, healthy, educated, and
provided with knowledge and life skills to support the nation’s future development [
5
,
6
].
In recent years, the health and well-being of adolescents have emerged as priorities for
policymakers and public health professionals worldwide. India, with its large and diverse
population of adolescents, is no exception to this global concern. As a result, various
policies have been formulated and implemented to address the specific health needs of this
age group. Policymakers need to include the adolescent population in policy considerations.
Adolescents undergo periods of stress and heightened emotions, making them particularly
susceptible to various health-related issues [7].
Numerous policies have been developed and implemented to address the specific
health needs of this age group. However, many adolescents remain unaware of the diseases
and threats they are exposed to, leading them to overlook early signs of physical and
mental illnesses, often concealing their struggles from their peers and parents. During
adolescence, peer pressure and the desire to belong to social groups become pronounced,
making young individuals susceptible to developing habits such as addiction and engaging
in petty crimes [
8
]. To understand the challenges faced by adolescent girls, a noteworthy
study was conducted in Uttar Pradesh and Bihar. The research revealed that girls forced
into child marriages encountered depression and domestic violence and were compelled to
drop out of schools and colleges. Unplanned pregnancies were also prevalent, exacerbating
their already difficult situations. Moreover, the study highlighted an alarming increase in
suicide rates and suicide attempts among adolescents [8].
Additionally, there was another study carried out in India that specifically investigated
the prevalence of anemia among children and adolescents. The research revealed that while
iron deficiency anemia was the most common type, there were also widespread cases of
anemia caused by other factors, such as deficiencies in vitamin B12 and folic acid, among
adolescents, indicating inadequate dietary choices or insufficient access to nutritious food
within families across the country [9].
Countries have shown that policies and programs focusing on adolescents’ health can
have a profound impact on adolescents’ health and well-being. Both access to healthcare
centers and awareness about the necessity of specific health policies tailored to adolescents
pose significant challenges [
10
]. Therefore, the objective of this study is to assess the key
adolescent health policies and strategies that were implemented during the period from
2006 to 2020 and analyze the outcomes.
2. Methods
The mixed-method approach used in this study combined qualitative and quantitative data
analyses to gain a comprehensive understanding of the topic under
investigation—adolescent
health in India. By combining both qualitative and quantitative data analyses, the study
can provide a more comprehensive and robust understanding of adolescent health in India.
Adolescents 2023,3615
The qualitative analysis offered insights into the policy landscape and the state of research
in the field. The quantitative analysis enabled the assessment of tangible outcomes and
impacts of the government’s health policies on adolescent health indicators. The study
has the following two main components: a qualitative data analysis and a quantitative
data analysis.
2.1. Study Areas
The study area included the entire territory of India, located in the southwestern section
of the Asian continent. The nation has a total land area of 3,287,263 square kilometers [11].
2.2. Qualitative Data Analysis
The qualitative data analysis focused on examining official documents of the Indian
government, specifically strategies, policies, and program reports related to adolescent
health from 2005 to 2020. By analyzing these documents, the researchers aimed to gain
insights into the various initiatives and approaches taken by the government to address
adolescent health issues during this period. This qualitative analysis helped to understand
the policy context and the intent behind the programs implemented. In total, nine official
documents were reviewed, and this section analyzed three key policies chosen for their
nationwide coverage in India and their focus on the adolescent population. The purpose
was to assess the progress made and observe the changes that have taken place.
In addition to the official documents, the study also involved reviewing scientific
published papers on adolescent health in India using PubMed, Google Scholar, the Re-
search Gate website, and UN agency websites. The following keywords were used to
screen publications and journals and access government public access websites: “National
health policy”, “Adolescent health coverage”, “Health service delivery”, “Health security”,
“Health promotion”, “Adolescent Girls in India”, “National strategies”, “Ministry of Health,
India”, “India DHS”, and so on. This literature review contributes to the qualitative aspect
of the study, allowing researchers to gather existing knowledge, research findings, and
expert opinions on the topic using an SWOT analysis (strengths, weaknesses, opportunities,
and threats) [
12
]. Qualitative data from both official documents and scientific papers were
used to identify patterns related to adolescent health in India. A total of 24 documents
were reviewed. The following flow diagram (Figure 1) shows the identified, screened, and
reviewed documents for the SWOT analysis.
2.3. Quantitative Data Analysis
The quantitative data analysis in this study utilizes Demographic Health Survey (DHS)
data collected from 2005 to 2021. DHS is a large-scale survey that provides nationally repre-
sentative information on various health and demographic indicators. In this study, the DHS
data were used to measure the progress and impact of health policies on adolescent health
over the years. By employing quantitative data analysis techniques on the DHS data, re-
searchers can assess changes in key indicators of adolescent health, such as prevalence rates
of certain diseases, access to healthcare services, health behaviors, and socio-demographic
factors. Comparing data across different time points allows us to identify outcomes and
assess the effectiveness of health policies and interventions targeted at adolescents.
Adolescents 2023,3616
Adolescents 2023, 3, FOR PEER REVIEW 4
Figure 1. Literature review flow diagram for SWOT analyis.
2.3. Quantitative Data Analysis
The quantitative data analysis in this study utilizes Demographic Health Survey
(DHS) data collected from 2005 to 2021. DHS is a large-scale survey that provides nation-
ally representative information on various health and demographic indicators. In this
study, the DHS data were used to measure the progress and impact of health policies on
adolescent health over the years. By employing quantitative data analysis techniques on
the DHS data, researchers can assess changes in key indicators of adolescent health, such
as prevalence rates of certain diseases, access to healthcare services, health behaviors, and
socio-demographic factors. Comparing data across different time points allows us to iden-
tify outcomes and assess the effectiveness of health policies and interventions targeted at
adolescents.
3. Results
A total of nine policies/strategies/programs focusing on adolescent health between
2005 and 2020 were screened and reviewed (Table 1). The following section presents an
analysis of three prominent policies that were selected based on their nationwide scope,
Figure 1. Literature review flow diagram for SWOT analyis.
3. Results
A total of nine policies/strategies/programs focusing on adolescent health between
2005 and 2020 were screened and reviewed (Table 1). The following section presents
an analysis of three prominent policies that were selected based on their nationwide
scope, targeting the adolescent population, and their alignment with the period of the
Demographic Health Survey (DHS). The objective was to assess the changes in adolescents’
health indicators that have occurred from 2005 to 2020.
Table 1. Policies/strategies/programs focusing on adolescent health between 2005 and 2020.
Policy/Scheme Year Coverage Source
Adolescent Reproductive and Sexual Health
(ARSH) Strategy 2005
Introduced in New Delhi and later implemented
in all states MoHFW *
Kishori Shakti Yojana 2007 Odisha MWCD **
National Adolescent Health Strategy 2014 New Delhi UNFPA ***
Adolescents 2023,3617
Table 1. Cont.
Policy/Scheme Year Coverage Source
National Adolescent Health Program Rashtriya
Kishor Swasthya Karyakram (RKSK) 2014 All states of India MoHFW *
Beti Bachao Beti Padhao Yojana 2015 Uttar Pradesh, Haryana, Uttarakhand, Punjab,
Bihar and Delhi MWCD **
Rajiv Gandhi Scheme for Empowerment of
Adolescent Girls 2017 200 selected districts in India MWCD **
National Policy for Rare Diseases 2017 All states of India MoHFW *
Poshan Scheme for Holistic Nourishment 2018 Rajasthan MWCD **
School Health Program 2020 Government schools in all districts MoHFW *
* (MoHFW) Ministry of Health and Family Welfare, India; ** (MWCD) Ministry of women and child development;
*** (UNFPA) United Nations Population Fund.
1.
Adolescent Reproductive and Sexual Health Strategy (2005). This strategy aims to
provide a comprehensive framework for offering various sexual and reproductive
health services to adolescents. It encompasses a core package of services, including
preventive, promotive, curative, and counseling services to cater to the specific needs
of this age group.
2.
Rashtriya Kishor Swasthya Karyakram (RKSK) 2014. This strategy, called the National
Adolescent Health Program, has significantly expanded the scope of adolescent health
programming in India. It no longer confines itself solely to sexual and reproductive
health but includes nutrition, injuries and violence (including gender-based violence),
non-communicable diseases, mental health, and substance misuse. The strength of
this program lies in its health-promoting approach, shifting from clinic-based services
to prevention and promotion, reaching adolescents in their own environments, such
as schools, families, and communities.
3.
School Health Program 2020. The objectives of this program are focused on var-
ious aspects, including improving nutrition, enhancing vaccination status, sexual
and reproductive health, promoting mental health, preventing injuries and violence
(including GBV), and addressing substance misuse. Additionally, this program is
open to including other relevant topics as determined in consultation with other
national stakeholders.
This study reviewed several scientific papers that analyzed health policies imple-
mented between 2005 and 2020. Specifically, the following two prominent policies were
selected for analysis due to their national coverage and progressive nature of strategy:
the Adolescent Reproductive and Sexual Health Strategy (2005) and the Rashtriya Kishor
Swasthya Karyakram (2014). The analysis process applied an SWOT analysis to derive
meaningful results.
3.1. The Adolescent Reproductive and Sexual Health (ARSH) Strategy 2005
Strengths (S):
1.
Targeted interventions in schools. The strategy showed effective strategies for provid-
ing health interventions specifically tailored to the needs of adolescents within educa-
tional settings, which can be crucial in reaching a large number of
young individuals.
2.
Addressed sexual violence. The policies recognized and addressed the issue of sexual
violence among adolescents, indicating a proactive approach toward safeguarding
their well-being.
3.
Confidential and secure adolescent clinics. Establishing confidential and secure clinics
for adolescents indicated efforts to provide a safe and private space for seeking
healthcare services, encouraging adolescents to access healthcare without fear of
judgment or disclosure.
Adolescents 2023,3618
Weaknesses (W):
1.
Health service focus and limited focus on awareness. The analysis identified a lack of
awareness among adolescents about available health services and resources, which
hinders their ability to access necessary care.
2.
Not addressing societal barriers. The strategy may not have adequately addressed
societal barriers such as cultural norms, stigma, or discrimination that can impede
adolescents from seeking healthcare or engaging in preventive behaviors.
3.
Not addressing substance abuse. The policies may not have adequately tackled the
issue of substance abuse among adolescents, which could have negative implications
for their health and well-being.
Opportunities (O):
1.
Female-friendly clinics. There is potential for the development of clinics that are
specifically designed to cater to the needs and preferences of female adolescents,
ensuring inclusivity and accessibility of healthcare services for this group.
2. Free nutritional supplements. Providing free nutritional supplements to adolescents
can help address nutritional deficiencies, improving overall health and well-being in
this age group.
3.
Education about early pregnancy. Implementing educational programs focusing on
early pregnancy can raise awareness and empower adolescents to make informed
decisions about reproductive health.
Threats (T):
1.
Societal taboos are prevalent and difficult to configure. Deep-rooted societal taboos
and norms may pose challenges in designing and implementing effective policies that
address sensitive issues related to adolescent health.
2.
The scarcity of financial resources poses a significant threat to the successful imple-
mentation of strategies and related interventions on a national scale.
3.2. Rashtriya Kishor Swasthya Karyakram (RKSK) 2014
Strengths (S):
1.
Extensive monitoring and promotion. The policies demonstrate a strong commitment
to monitoring and promoting adolescent health, ensuring that the interventions are
effectively implemented and reaching the target population.
2.
Special training for health workers. The policies recognize the importance of ade-
quately trained healthcare workers who possess the necessary skills to address the
unique healthcare needs of adolescents.
3.
Additional focus on substance abuse. The policies have placed emphasis on tackling
the issue of substance abuse among adolescents, indicating a proactive approach to
addressing this significant health concern.
Weaknesses (W):
1.
Low utilization of clinics, both by adolescents and parents. There may be reluctance
among adolescents and their parents to utilize healthcare clinics for reasons such as
stigma, lack of awareness, or fear of judgment.
2.
Limited NGO involvement. The limited involvement of non-governmental organiza-
tions (NGOs) in implementing and supporting the policies could potentially impact
the reach and effectiveness of the interventions.
3.
Lack of privacy in clinics. Inadequate privacy measures in healthcare clinics may
discourage adolescents from seeking healthcare services, particularly for sensitive
issues, leading to reduced access to necessary care.
Adolescents 2023,3619
Opportunities (O):
1.
Weekly supplementation scheme. Implementing a weekly supplementation scheme
for essential nutrients, along with regular assessment, can improve the overall nutri-
tional status of adolescents, promoting their health and well-being.
2.
Counseling for substance abuse, tobacco use, etc. Integrating counseling services
as part of the policies can help address substance abuse and tobacco use, providing
support and resources for adolescents seeking to overcome these challenges.
3.
Special menstrual hygiene scheme. Introducing a dedicated scheme for menstrual
hygiene can improve access to menstrual products, education, and support for adoles-
cent girls, positively impacting their health and development.
Threats (T):
1.
Human resources. A shortage of trained healthcare personnel and other human
resources may limit the effective implementation and execution of the policies.
2.
Logistics supply. Challenges in logistics and supply chain management may hin-
der the timely delivery of healthcare services, medications, and resources to the
target population.
3.
Infrastructure. Inadequate healthcare infrastructure, including clinics and facilities,
could pose challenges to providing quality healthcare services to adolescents.
Table 2presents a comparison of various adolescent health indicators for adolescents
aged 14 to 19 years across three different DHSs for 2005/2006, 2015/2016, and 2019/2021.
Overall, there have been improvements in family planning—the percentage of married
women currently using any method of contraception increased from 13% in 2005/2006
to 14.9% in 2015/2016 and significantly rose to 28.1% in 2019/2021. Similarly, the use of
modern contraceptive methods among married adolescents increased. The increase in
demand for family planning to 40.9% in 2019/2021 and the decline in the unmet need for
family planning over the period indicate the success of the programs.
Generally, there was a reduction in violence and positive changes in certain health be-
haviors. Incidents of sexual violence committed by a husband/partner in the last
12 month
s
decreased from 11.6% in 2005/2006 to 6.1% in 2019/2021. Similarly, physical violence com-
mitted by a husband/partner in the last 12 months decreased. The percentage of women
married by age 15 declined significantly from 8.2% in 2005/2006 to 1.3% in 2019/2021.
The data showed improvement in knowledge and healthy behavioral practices among
adolescents; for instance, condom use at the last higher-risk sexual encounter (with a non-
marital, non-cohabiting partner) increased from 33.4% in 2005/2006 to 47.9% in 2015/2016
and further rose to 56.6% in 2019/2021 for male adolescents. Similarly, for girls, condom
use at higher-risk encounters increased from 20% in 2005/2006 to 62% in 2019/2021.
Table 2.
Comparison of health indicators among adolescents aged 14 to 19 years from three DHS
datasets in the years 2005/6, 2015/16, and 2019/21.
DHS Indicators 2005/2006
%
2015/2016
%
2019/2021
%
Family planning
Married adolescents currently using any method of contraception 13 14.9 28.1
Married adolescents currently using any modern method of contraception
6.9 10 18.8
Unmet need for family planning for adolescents 13.9 12.9 9.4
Demand for family planning satisfied by modern methods 7.3 26.9 40.9
Violence
Sexual violence committed by a husband/partner in the last 12 months 11.6 5.5 6.1
Physical violence committed by a husband/partner in the last 12 months 21.8 16.3 16.4
Women first married by the exact age of 15 8.2 1.9 1.3
Adolescents 2023,3620
Table 2. Cont.
DHS Indicators 2005/2006
%
2015/2016
%
2019/2021
%
Access to health
Adolescent girls’ access to health: Problems obtaining permission
to attend treatment 9.3 20.8 16.5
Adolescent girls’ access to health: Problems obtaining money for treatment
16.3 26.2 22.4
Adolescent girls’ access to health: Problems
with distance to health facilities 24.6 31.5 24.2
Adolescent girls’ access to health: Problems that there
may not be a female provider 21 41.6 34.3
No health insurance—Adolescent girls No data 83 74.5
No health insurance—Adolescent boys No data 81.5 73
Behaviors
Condom use at last higher-risk sex
(with a non-marital, non-cohabiting partner) [Adolescent boys] 33.4 47.9 56.6
Condom use at last higher-risk sex
(with a non-marital, non-cohabiting partner) [Adolescent girls] 20 35.3 62
Adolescent boys who smoke any type of tobacco 57.3 29.7 34.4
Adolescent girls who smoke any type of tobacco 3.1 1.1 0.8
Nutrition
Adolescent girls who are overweight or obese according to BMI (≥25.0) 2.4 4.2 5.4
Adolescent boys who are overweight or obese according to BMI (≥25.0) 1.7 4.8 6.6
Adolescent girls with any anemia 55.8 54.1 59.1
Adolescent boys with anemia 30.2 29.2 31.1
However, there are still challenges to accessing health services, especially those re-
lated to health insurance coverage. Women who reported fewer problems in obtaining
permission to attend treatment increased over time from 9.3% in 2005/2006 to 20.8% in
2015/2016 and slightly decreased again to 16.5% in 2019/2021. The percentage of women
aged
14–19 experiencing
difficulties obtaining money for treatment increased from 16.3% in
2005/2006 to 26.2% in 2015/2016 and slightly decreased to 22.4% in 2019/2021. Challenges
related to the distance of health facilities increased from 24.6% in 2005/2006 to 31.5% in
2015/2016 and slightly decreased again to 24.2% in 2019/2021. Concerns about the lack of
female providers at health facilities increased from 21% in 2005/2006 to 41.6% in 2015/2016
and improved to 34.3% in 2019/2021. Generally, the percentage of adolescents without
health insurance slightly decreased in 2019/2021 (see Table 2).
Nutrition indicators showed deterioration in the nutritional status of adolescents;
the percentage of females who are overweight or obese according to their body mass
index (BMI) increased from 2.4% in 2005/2006 to 4.2% in 2015/2016 and further rose to
5.4% in 2019/2021. Similarly, males who are overweight or obese according to their BMI
also increased from 1.7% in 2005/2006 to 4.8% in 2015/2016 and further rose to 6.6% in
2019/2021. In 2019/2021, approximately 59% of female adolescents and 31% of male
adolescents had some form of anemia.
4. Discussion
The Indian Ministry of Health and Family Welfare has established six strategic priori-
ties for adolescent health, each associated with outcome metrics. These priorities encompass
nutrition, sexual and reproductive health, non-communicable diseases, substance abuse,
injuries and violence (including gender-based violence), and mental health [
13
]. The
Adolescent Reproductive and Sexual Health Strategy implemented in India in 2005 is
the fundamental strategy to pave the road for better interventions targeting the young
population. Similar initiatives in southeast Asian countries were developed to address the
specific needs of adolescents, including their reproductive and sexual health; for instance,
in Bangladesh, Indonesia, and Thailand [14].
Adolescents 2023,3621
The ARSH Strategy initially emphasized the provision of reproductive and sexual
health services, offering a comprehensive package that included preventive, promotive,
curative, and counseling services through health facilities. This approach primarily re-
volved around the establishment of adolescent-friendly health clinics. However, in 2014, a
new program called RKSK was introduced, aiming to empower all adolescents in India
to make informed and responsible decisions regarding their health and well-being. The
RKSK program expanded the scope beyond sexual and reproductive health to encompass
a broader range of concerns, including non-communicable diseases, nutrition, mental
health, substance misuse, and injuries and violence. To effectively deliver these services,
the program utilizes both clinic-based and community-based service provision models,
complemented by activities to generate demand for these services [15].
Despite the expanded coverage and improved coordination between the central and
state governments in implementing RKSK compared to previous policies, certain challenges
persist that could potentially become problematic in the future. These challenges include
the insufficient participation of non-governmental organizations (NGOs) and inadequate
infrastructure [
15
]. Nevertheless, the primary unresolved issue persists in the population’s
mindset worldwide. Numerous parents feel uncomfortable with the idea of their children,
particularly young girls, attending adolescent clinics. They believe that exposing them to
information concerning reproductive and sexual health might corrupt their young minds.
Consequently, they withhold all such information from their children. This opposition
extends even to sex education at the school level, with many parents expressing their
disapproval. Moreover, societal pressure and the fear of bringing dishonor to their families
compel numerous women to suffer silently, enduring domestic violence without voicing
their plight. The attitudes, beliefs, and norms upheld by parents and the broader community
can significantly affect the choices and behaviors of adolescents when it comes to their
well-being. Often, adolescents encounter challenges when attempting to make informed
decisions about their health due to conflicting viewpoints from their families or societal
expectations. This resistance might manifest in discouragement from seeking sexual and
reproductive health information, stigmatization of mental health concerns, or even limited
access to necessary healthcare services. [
16
,
17
]. Hence, involving NGOs and the community
in adolescent programs can play a crucial role in fostering community acceptance of
sensitive issues concerning adolescent health [
14
]. For instance, in Pakistan, NGOs, such as
Aahung and Rutgers Pakistan, have achieved success by demonstrating their willingness to
comprehend the intricate contextual factors within communities. They actively collaborate
with various stakeholders, including parents, school officials, religious leaders, media
personnel, and adolescents themselves, to garner support and overcome resistance. These
organizations employ specific strategies, such as involving communities in content selection,
employing tactful approaches to address sensitive issues, engaging influential figures in
adolescents’ lives, strengthening media presence, showcasing successful school programs
to enhance understanding and transparency, and identifying opportune moments to deliver
key messages [
17
]. Moreover, India has made significant strides in promoting adolescent
health by integrating it into school programs since 2020, which encompass a wide range
of aspects and reach a large student population in the country. However, there is a need
for stronger monitoring, particularly in religious schools, as observed in the Indonesian
experience [18].
The health indicators for adolescents aged 14 to 19 across three year ranges (2005/2006,
2015/2016, and 2019/2021) can be read from the above table. The analysis reveals im-
provements in family planning indicators, including increased contraceptive use, decreased
unmet needs, and higher satisfaction with modern methods. Comparable trends were
observed in Bangladesh and Nepal [
19
]. Moreover, positive changes have been observed in
certain health behaviors and a reduction in violence. Incidents of sexual violence committed
by husbands/partners in the last 12 months have decreased recently. Physical violence
committed by husbands/partners in the last 12 months also decreased over time. These
findings closely align with the global average of 16% for adolescent girls aged 15–19 who
Adolescents 2023,3622
have ever been married or in a partnership and have experienced physical and/or sexual
intimate partner violence, which is close to the worldwide average within the past year [
20
].
Additionally, when comparing India to global trends, it is evident that there has been a
noteworthy reduction in the percentage of adolescent girls getting married at the precise
age of 15. In India, this figure decreased significantly from 8.2% in 2005/2006 to 1.3% in
2019/2021. Globally, there has also been a 15% decline in the proportion of young women
who were married as children. Previously, one in four young women were married before
reaching adulthood, but now it stands at approximately one in five [21].
According to the National Non-communicable Disease Monitoring Survey (NNMS)
2017–2018, the prevalence of tobacco use among male adolescents (15–17 years) was 11.9%,
while among female adolescents, it was 1.7%. On average, the prevalence of tobacco use
among all adolescents was 7% [
22
]. Comparatively, the Demographic and Health Surveys
(DHSs) showed a decrease in tobacco smoking among both male and female adolescents.
The prevalence of smoking among males decreased from 57.3% in 2005/2006 to 34.4% in
2019/2021, while among females, it declined from 3.1% in 2005/2006 to 0.8% in 2019/2021.
These findings indicate positive changes in the healthy behaviors of adolescents.
The collective global and national efforts toward achieving universal health cover-
age for adolescents are significantly supported by sustainable development goals and
the prevailing global political momentum. Adolescents, who constitute approximately
1.2 billion people,
or one in six of the global population, present a crucial demographic.
The majority of these adolescents, nearly nine out of ten, reside in low- and middle-income
countries (LMICs), where they face challenges accessing healthcare, social services, em-
ployment, and sustainable livelihoods. Asia houses over half of the world’s adolescent
population, with South Asia alone accommodating 344 million adolescents. In certain
countries, adolescents comprise as much as a quarter of the overall population, and their
numbers are projected to increase until 2050, particularly in low- and middle-income coun-
tries. For instance, in India, there is a significant adolescent population that is expected
to grow in the coming years [
23
]. Although there have been positive improvements in
various health indicators among adolescents, challenges persist in accessing health services
and ensuring adequate health insurance coverage. While the percentage of females fac-
ing permission-related obstacles for treatment has decreased over time, poverty remains
a concern. Challenges related to distance to health facilities fluctuated, while concerns
regarding the lack of female providers showed a slight improvement. Health insurance
coverage for both female and male adolescents has improved, yet a significant proportion
still lacks coverage. Health insurance coverage for adolescents is limited to less than 20%
in most countries, despite notable advancements regarding effective coverage of sexual
and reproductive health (SRH) services. However, there is a lack of progress specifically
targeting adolescents within these programs, as many national universal health coverage
initiatives exclude key SRH services that are vital for this age group [24].
Traditionally, under-nutrition is a major problem; however, the percentage classified as
overweight or obese based on their body mass index (BMI) has risen from 2.4% in 2005/2006
to 5.4% in 2019/2021 among females and from 1.7% in 2005/2006 to 6.6% in 2019/2021
among males. A study conducted in 2018 on the prevalence of childhood and adolescent
overweight and obesity in Asian countries found that the overall pooled prevalence of
obesity in adolescents aged 12–19 years was 8.6%, with 10.1% among boys and 6.2% among
girls. The study also reported that the prevalence of overweight in adolescents was 14.6%
overall, with 15.9% among boys and 13.7% among girls. The study indicated that a higher
percentage of boys were obese and overweight compared to girls among both children and
adolescents [25].
The limitations of this study include the absence of real-time information obtained
from conducting key informant interviews. This shortfall is due to financial constraints that
hindered the investigators from traveling to India for interview purposes. Furthermore, the
study faces a limitation in terms of data scarcity concerning adolescents under the age of
Adolescents 2023,3623
14. The prevailing focus of available DHS data primarily centers around adolescents aged
14 to 19 years.
5. Conclusions
In conclusion, efforts and progress have been made in India to implement initiatives
addressing the health needs of adolescents. However, we require a strategic focus on
nutrition, sexual and reproductive health, non-communicable diseases, substance abuse,
injuries and violence, and mental health. While progress has been made in certain areas,
challenges remain regarding inadequate infrastructure and health insurance coverage for
adolescents. Parental and societal resistance play a pivotal role in shaping adolescents’
capacity to address their health needs. Engaging NGOs and communities is crucial to fos-
tering acceptance, addressing sensitive issues, and changing societal norms. Undertaking
qualitative research to delve deeper into the dynamics of parental and societal resistance
that influence adolescents’ health-seeking behaviors is highly recommended. Additionally,
attention should be given to combating the increasing prevalence of overweight and obesity
among adolescents. Further efforts are needed to achieve universal health coverage and
improve adolescent health outcomes.
Author Contributions:
F.D., M.D.I. and S.S. worked on the study’s conceptualization and methodol-
ogy; S.S. wrote the original draft; F.D. and M.D.I. reviewed and edited the manuscript; F.D. and S.S.
analyzed and interpreted the data and results; F.D. supervised and approved the final version of the
manuscript. All authors have read and agreed to the published version of the manuscript.
Funding: This research received no external funding.
Institutional Review Board Statement: Not applicable.
Informed Consent Statement: As the data were anonymous, informed consent was waived.
Data Availability Statement: Data is available upon request from the authors.
Conflicts of Interest: The authors declare no conflict of interest.
References
1.
WHO. Adolescent Health. 2023. Available online: https://www.who.int/health-topics/adolescent-health#tab=tab_1 (accessed
on 30 May 2023).
2.
Sawyer, S.M.; Azzopardi, P.S.; Wickremarathne, D.; Patton, G.C. The age of adolescence. Lancet Child Adolesc Health
2018
,2,
223–228. [CrossRef] [PubMed]
3.
UNICEF. Adolescents: Health Risks and Solutions. 2021. Available online: https://www.unicef.org/media/60561/file/
adolescents-health-risks-solutions-2011.pdf (accessed on 4 January 2023).
4.
IAAH. International Association for Adolescent Health. 2023. Available online: https://iaah.org/about/ (accessed on
7 April 2023).
5.
UNICEF. Empowering Adolescent Girls and Boys in India. 2023. Available online: https://www.unicef.org/india/what-we-do/
adolescent-development-participation (accessed on 25 May 2023).
6.
Collin, P. Youth Civic Engagement: Building Bridges between Youth Practice and Policy. 2021. Available online: https:
//www.unicef.org/eap/media/11921/file (accessed on 7 April 2023).
7.
Nandita Babu, M.F. Adolescent Health and Well-Being: Issues, Challenges, and Current Status in India. In Handbook of Health and
Well-Being: Challenges, Strategies and Future Trends; Springer Nature: Singapore, 2022.
8.
Aggarwal, S.; Francis, K.L.; Dashti, S.G.; Patton, G. Child marriage and the mental health of adolescent girls: A longitudinal
cohort study from Uttar Pradesh and Bihar, India. Lancet Reg. Health-Southeast Asia 2023,8, 100102. [CrossRef] [PubMed]
9.
Sarna, A.; Porwal, A.; Ramesh, S.; Agrawal, P.K.; Acharya, R.; Johnston, R.; Khan, N.; Sachdev, H.P.S.; Nair, K.M.;
Ramakrishnan, L.; et al.
Characterisation of the types of anaemia prevalent among children and adolescents aged 1–19 years in
India: A population-based study. Lancet Child Adolesc. Health 2020,4, 515–525. [CrossRef]
10.
Sivagurunathan, C.; Umadevi, R.; Rama, R.; Gopalakrishnan, S. Adolescent health: Present status and its related programmes in
India. Are we in the right direction? J. Clin. Diagn. Res. JCDR 2015,9, LE01. [CrossRef]
11.
Chakraborty, A.; Joshi, P.; Ghosh, A.; Areendran, G. Assessing biome boundary shifts under climate change scenarios in India.
Ecol. Indic. 2013,34, 536–547. [CrossRef]
12.
Benzaghta, M.A.; Elwalda, A.; Mousa, M.M.; Erkan, I.; Rahman, M. SWOT analysis applications: An integrative literature review.
J. Glob. Bus. Insights 2021,6, 55–73. [CrossRef]
Adolescents 2023,3624
13.
Srivastava, N.M. Adolescent health in India: Need for more interventional research. Clin. Epidemiol. Glob. Health
2016
,4, 101–102.
[CrossRef]
14.
WHO. Strategic Directions for Improving Adolescent Health in South-East Asia Region. 2011. Available online: https://apps.
who.int/iris/bitstream/handle/10665/205917/B4771.pdf?sequence=1&isAllowed=y (accessed on 6 July 2023).
15.
Barua, A.; Watson, K.; Plesons, M.; Chandra-Mouli, V.; Sharma, K. Adolescent health programming in India: A rapid review.
Reprod. Health 2020,17, 87. [CrossRef] [PubMed]
16.
Roudsari, R.L.; Javadnoori, M.; Hasanpour, M.; Hazavehei, S.M.M.; Taghipour, A. Socio-cultural challenges to sexual health
education for female adolescents in Iran. Iran. J. Reprod. Med. 2013,11, 101–110.
17.
Munea, A.M.; Alene, G.D.; Debelew, G.T.; Sibhat, K.A. Socio-cultural context of adolescent sexuality and youth friendly service
intervention in West Gojjam Zone, Northwest Ethiopia: A qualitative study. BMC Public Health
2022
,22, 281. [CrossRef] [PubMed]
18.
Muthmainnah Nurmala, I.; Siswantara, P.; Rachmayanti, R.D.; Devi, Y.P. Implementation of Adolescent Health Programs at
Public Schools and Religion-Based Schools in Indonesia. J. Public Health Res. 2021,10, jphr.2021.1954. [CrossRef] [PubMed]
19.
USAIDS. The DHS Program STATcompiler. 2023. Available online: https://www.statcompiler.com/en/ (accessed on 6 July 2023).
20.
WHO. Violence against Women Prevalence Estimates, 2018: Global, Regional and National Prevalence Estimates for Intimate
Partner Violence against Women and Global and Regional Prevalence Estimates for Non-Partner Sexual Violence against Women.
2021. Available online: https://apps.who.int/iris/handle/10665/341337 (accessed on 7 July 2023).
21.
UNICEF. Child Marriage: Latest Trends and Future Prospects. 2018. Available online: https://data.unicef.org/resources/child-
marriage-latest-trends-and-future-prospects/ (accessed on 7 July 2023).
22.
MHFW. National Noncommunicable Disease Monitoring Survey (NNMS) 2017–18. 2018. Available online: https:
//cdn.who.int/media/docs/default-source/ncds/ncd-surveillance/data-reporting/india/india-nnms- 2017-18- factsheet.pdf?
sfvrsn=a3c7547b_1&download=true (accessed on 7 July 2023).
23.
WHO. Adolescent Health: The Missing Population in Universal Health Coverage. 2019. Available online: https://pmnch.who.
int/resources/publications/m/item/adolescent-health{-}{- }-the- missing-population- in-universal- health-coverage (accessed on
7 July 2023).
24.
UNFPA. Universal Health Coverage and Adolescent Sexual and Reproductive Health. My Body is My Body, My Life is My
Life: Sexual and Reproductive Health and Rights of Young People in Asia and the Pacific. 2021. Available online: https:
//asiapacific.unfpa.org/sites/default/files/pub-pdf/asrh_factsheet_7_uhc.pdf (accessed on 7 July 2023).
25.
Mazidi, M.; Banach, M.; Kengne, A.P.; Lipid and Blood Pressure Meta-analysis Collaboration Group. Prevalence of childhood
and adolescent overweight and obesity in Asian countries: A systematic review and meta-analysis. Arch. Med. Sci.
2018
,14,
1185–1203. [CrossRef] [PubMed]
Disclaimer/Publisher’s Note:
The statements, opinions and data contained in all publications are solely those of the individual
author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to
people or property resulting from any ideas, methods, instructions or products referred to in the content.
