FOCUS ON Demographic trends for adolescents: Ten key facts In 2009,there were 1.2 billion adolescents aged 10-19 in the world, Figure 2.1:Adolescent population(10-19 years)by region,2009 forming 18 per cent of world population.Adolescent numbers have Eastern and more than doubled since 1950. CEE/CIS Southern Africa Industrialized 58 million -91 million The vast majority of adolescents-88 per cent-live in developing countries 118 million West and countries.The least developed countries are home to roughly 1 in Central Africa -94 million every 6 adolescents Latin America and Caribbean Middle East and 108 million- North Africa More than half the world's adolescents live in either the South Asia -84 million or the East Asia and Pacific region,each of which contains roughly 330 million adolescents. .On current trends,however,the regional composition of adolescents is set to alter by mid-century.In 2050,sub-Saharan Africa is projected to have more adolescents than any other region,marginally surpassing East Asia and Pacific- South Asia 329 million 335 million the number in either of the Asian regions. Source:United Nations,Department of Economic and Social Affairs, India has the largest national population of adolescents(243 million). Population Division,World Population Prospects:The 2008 Revision, <www.esa.un.org/unpd/wpp2008/index.htm>,accessed October 2010 followed by China(207 million).United States(44 million),Indonesia and Pakistan (both 41 million). Adolescents account for only 12 per cent of people in the industrialized Figure 2.2:Trends in the adolescent population,1950-2050 world,reflecting the sharp ageing of Europe and Japan in particular.In 1400 contrast,adolescents account for more than 1 in every 5 inhabitants of sub-Saharan Africa,South Asia and the least developed countries. 1200 号1000 .Adolescent boys outnumber girls in all regions with data available. including the industrialized countries.Parity is closest in Africa,with 800 995 girls aged 10-19 for every 1,000 boys in Eastem and Southern Africa and 982 girls per 1,000 boys in West and Central Africa,while 600 the gender gap is greatest in both Asian regions. ndod 400 .At the global level,adolescents'share of the total population peaked in the 1980s at just over 20 per cent. 200 0 .Although adolescent numbers will continue to grow in absolute terms 19501960197019801990200020102020203020402050 until around 2030.adolescents'share of the total population is already -World -Least developed countries declining in all regions except West and Central Africa and will steadily -Developing countries -Industrialized countries diminish all over the world through 2050. Source:United Nations,Department of Economic and Social Affairs, One trend that will continue to intensify in the coming decades is Population Division,World Population Prospects:The 2008 Revision, <www.esa.un.org/unpd/wpp2008/index.htm>,accessed October 2010 that ever more adolescents will live in urban areas.In 2009,around 50 per cent of the world's adolescents lived in urban areas.By 2050. this share will rise to almost 70 per cent,with the strongest increases occurring in developing countries. See References,page 78. 20 THE STATE OF THE WORLD'S CHILDREN 2011
Demographic trends for adolescents: Ten key facts FOCUS ON • In 2009, there were 1.2 billion adolescents aged 10–19 in the world, forming 18 per cent of world population. Adolescent numbers have more than doubled since 1950. • The vast majority of adolescents – 88 per cent – live in developing countries. The least developed countries are home to roughly 1 in every 6 adolescents. • More than half the world’s adolescents live in either the South Asia or the East Asia and Pacific region, each of which contains roughly 330 million adolescents. • On current trends, however, the regional composition of adolescents is set to alter by mid-century. In 2050, sub-Saharan Africa is projected to have more adolescents than any other region, marginally surpassing the number in either of the Asian regions. • India has the largest national population of adolescents (243 million), followed by China (207 million), United States (44 million), Indonesia and Pakistan (both 41 million). • Adolescents account for only 12 per cent of people in the industrialized world, reflecting the sharp ageing of Europe and Japan in particular. In contrast, adolescents account for more than 1 in every 5 inhabitants of sub-Saharan Africa, South Asia and the least developed countries. • Adolescent boys outnumber girls in all regions with data available, including the industrialized countries. Parity is closest in Africa, with 995 girls aged 10–19 for every 1,000 boys in Eastern and Southern Africa and 982 girls per 1,000 boys in West and Central Africa, while the gender gap is greatest in both Asian regions. • At the global level, adolescents’ share of the total population peaked in the 1980s at just over 20 per cent. • Although adolescent numbers will continue to grow in absolute terms until around 2030, adolescents’ share of the total population is already declining in all regions except West and Central Africa and will steadily diminish all over the world through 2050. • One trend that will continue to intensify in the coming decades is that ever more adolescents will live in urban areas. In 2009, around 50 per cent of the world’s adolescents lived in urban areas. By 2050, this share will rise to almost 70 per cent, with the strongest increases occurring in developing countries. See References, page 78. Figure 2.1: Adolescent population (10–19 years) by region, 2009 Source: United Nations, Department of Economic and Social Affairs, Population Division, World Population Prospects: The 2008 Revision, <www.esa.un.org/unpd/wpp2008/index.htm>, accessed October 2010. East Asia and Pacific 329 million South Asia 335 million Middle East and North Africa 84 million West and Central Africa 94 million Eastern and Southern Africa 91 million CEE/CIS 58 million Industrialized countries 118 million Latin America and Caribbean 108 million Figure 2.2: Trends in the adolescent population, 1950–2050 Population in millions 0 200 400 600 800 1000 1200 1400 1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050 World Developing countries Least developed countries Industrialized countries Source: United Nations, Department of Economic and Social Affairs, Population Division, World Population Prospects: The 2008 Revision, <www.esa.un.org/unpd/wpp2008/index.htm>, accessed October 2010. 20 THE STATE OF THE WORLD’S CHILDREN 2011
are a regular threat in urban areas,and rising affluence- It is estimated that half the 150 million adolescents who con- with attendant increases in traffic volume-may account tinue smoking will in the end die from tobacco-related causes.s for the higher road fatalities recently seen in Asia and the Risky behaviours often overlap:A 2007 UNICEF report on eastern Mediterranean.Boys are more prone than girls child poverty in Organisation for Economic Co-operation and to injury and death from such accidents as well as from Development (OECD)countries indicated that adolescents violence stemming from chance encounters or organized who smoke are three times more likely to use alcohol regu- gang conflict.Because the rate of urbanization is most larly and eight times more likely to use cannabis.6 rapid in the poorest regions of sub-Saharan Africa and South Asia-which are also the areas with the greatest share of adolescents in the population-averting injuries Nutritional status in the second decade of life must become a major interna- Adolescent females are more prone to nutritional tional health objective. difficulties than adolescent males In early childhood(0-4 years),the available international Tobacco consumption and drug and alcohol use are evidence suggests that differences in nutritional status growing health risks for adolescents between girls and boys are statistically negligible in all In part,injuries arise from a propensity to take risks that regions except South Asia.?As the years pass,however, is a common feature of adolescence,connected with the girls run a greater risk than boys of nutritional difficulties, psychological need to explore boundaries as part of the notably anaemia.Data from 14 developing countries show development of individual identity.Such readiness to take a considerably higher incidence of anaemia among female risks leads many adolescents to experiment with tobacco, adolescents aged 15-19 as compared to their male counter- alcohol and other addictive drugs without sufficient under- parts in all but one country.s standing of the potential damage to health or of other long- term consequences of addiction,such as being drawn into In nine countries-all,aside from India,in West and Central crime to pay for a habit. Africa-more than half of girls aged 15-19 are anaemic. India also has the highest underweight prevalence among The most common addiction is cigarette smoking,a habit that adolescent girls among the countries with available data, almost all tobacco users form while in their adolescent years. at 47 per cent.The implications for adolescent girls in this Figure 2.3:Anaemia is a significant risk for adolescent Figure 2.4:Underweight is a major risk for adolescent girls(15-19)in sub-Saharan Africa and South Asia girls(15-19)in sub-Saharan Africa and South Asia Prevalence of anaemia among adolescent girls aged 15-19 in a Percentage of adolescent girls aged 15-19 who are underweight* subset of high-prevalence countries with available data in a subset of high-prevalence countries with available data 80 入 50 70 47 68 60 66 40 63 40 59 50 57 56 35 34 52 34 5 33 49 30 40 29 28 27 30 20 20 10 10 0 0 Mal Senegal Ghana Benin Congo India kina Guinea Sierra Republic Leone India Eritrea Bangladesh Niger Senegal Ethiopia Namibia Cambodia Chad Burkina Faso *The horizontal line at the 40 per cent mark represents the threshold at Defined as a body mass index of 18.5 or less. which anaemia is considered a severe national public health issue. Source:DHS and other national surveys,2002-2007. Source:DHS and national surveys,2003-2009. REALIZING THE RIGHTS OF ADOLESCENTS 21
realizing the rights of adolescents 21 are a regular threat in urban areas, and rising affluence – with attendant increases in traffic volume – may account for the higher road fatalities recently seen in Asia and the eastern Mediterranean. Boys are more prone than girls to injury and death from such accidents as well as from violence stemming from chance encounters or organized gang conflict. Because the rate of urbanization is most rapid in the poorest regions of sub-Saharan Africa and South Asia – which are also the areas with the greatest share of adolescents in the population – averting injuries in the second decade of life must become a major international health objective.4 Tobacco consumption and drug and alcohol use are growing health risks for adolescents In part, injuries arise from a propensity to take risks that is a common feature of adolescence, connected with the psychological need to explore boundaries as part of the development of individual identity. Such readiness to take risks leads many adolescents to experiment with tobacco, alcohol and other addictive drugs without sufficient understanding of the potential damage to health or of other longterm consequences of addiction, such as being drawn into crime to pay for a habit. The most common addiction is cigarette smoking, a habit that almost all tobacco users form while in their adolescent years. It is estimated that half the 150 million adolescents who continue smoking will in the end die from tobacco-related causes.5 Risky behaviours often overlap: A 2007 UNICEF report on child poverty in Organisation for Economic Co-operation and Development (OECD) countries indicated that adolescents who smoke are three times more likely to use alcohol regularly and eight times more likely to use cannabis.6 Nutritional status Adolescent females are more prone to nutritional difficulties than adolescent males In early childhood (0–4 years), the available international evidence suggests that differences in nutritional status between girls and boys are statistically negligible in all regions except South Asia.7 As the years pass, however, girls run a greater risk than boys of nutritional difficulties, notably anaemia. Data from 14 developing countries show a considerably higher incidence of anaemia among female adolescents aged 15–19 as compared to their male counterparts in all but one country.8 In nine countries – all, aside from India, in West and Central Africa – more than half of girls aged 15–19 are anaemic.9 India also has the highest underweight prevalence among adolescent girls among the countries with available data, at 47 per cent. The implications for adolescent girls in this Figure 2.3: Anaemia is a significant risk for adolescent girls (15–19) in sub-Saharan Africa and South Asia Prevalence of anaemia among adolescent girls aged 15–19 in a subset of high-prevalence countries with available data *The horizontal line at the 40 per cent mark represents the threshold at which anaemia is considered a severe national public health issue. Source: DHS and national surveys, 2003–2009. 0 10 20 30 40 50 60 70 80 68 66 63 59 57 56 52 51 51 49 Mali Senegal Ghana Benin Congo India Burkina Faso Guinea Sierra Leone United Republic of Tanzania Figure 2.4: Underweight is a major risk for adolescent girls (15–19) in sub-Saharan Africa and South Asia Percentage of adolescent girls aged 15–19 who are underweight* in a subset of high-prevalence countries with available data * Defined as a body mass index of 18.5 or less. Source: DHS and other national surveys, 2002–2007. 0 10 20 30 40 50 47 40 35 34 34 33 30 29 28 27 India Eritrea Bangladesh Niger Senegal Ethiopia Namibia Chad Cambodia Burkina Faso
country are particularly serious,given that in the period underscore the importance of making high-quality sexual 2000-2009,around 47 per cent of Indian women aged and reproductive health services and knowledge available 20-24 were married by age 18.10 Adolescent pregnancy is to adolescent girls and boys alike from an early age.15 a regular consequence of child marriage,and underweight mothers have a higher risk of maternal death or morbidity. Early pregnancy,often as a consequence of early marriage,increases maternity risks Obesity is a growing and serious concern in both indus- The third challenge is empowering adolescent girls in trialized countries and the developing world.Data from a particular with the knowledge of sexual and reproductive subset of 10 developing countries show that the percentage health,owing to the gender-related protection risks they of girls aged 15-19 who are overweight(i.e.,those with a face in many countries and communities.Child marriage, body mass index above 25.0)ranges between 21 and 36 often deemed by elders to protect girls-and,to a much per cent.11 Among the OECD countries,the highest lesser extent,boys-from sexual predation,promiscuity levels of obesity in 2007 were found in the four southern and social ostracism,in fact makes children more likely to European countries of Greece,Italy,Spain and Portugal, be ignorant about health and more vulnerable to school together with the mainly Anglophone nations of Canada, dropout.Many adolescent girls are required to marry early, the United Kingdom and the United States.12 and when they become pregnant,they face a much higher risk of maternal mortality,as their bodies are not mature enough to cope with the experience. Sexual and reproductive health matters Girls are more likely to have engaged in early sex in The younger a girl is when she becomes pregnant,whether adolescence but also less likely to use contraception she is married or not,the greater the risks to her health.In Investing in sexual and reproductive health knowledge and Latin America,for example,a study shows that girls who services for early adolescents is critical for several reasons.The give birth before the age of 16 are three to four times times first is that some adolescents are engaging in sexual relations more likely to suffer maternal death than women in their in early adolescence;international household survey data rep- twenties.Complications related to pregnancy and child- resentative of the developing world,excluding China,indicate birth are among the leading causes of death worldwide for that around 11 per cent of females and 6 per cent of males adolescent girls between the ages of 15 and 19.16 aged 15-19 claim to have had sex before the age of 15.13 For girls,child marriage is also associated with an increased Latin America and the Caribbean is the region with the risk of sexually transmitted infections and unwanted pregnan- highest proportion of adolescent females claiming to have cies.Research suggests that adolescent pregnancy is related had their sexual debut before age 15,at 22 per cent(there to factors beyond girls'control.One study undertaken in are no equivalent figures for young men for this region). Orellana,an Ecuadorian province in the Amazon basin, The lowest reported levels of sexual activity for both boys where nearly 40 per cent of girls aged 15-19 are or have been and girls under 15 occur in Asia.14 pregnant,found that the pregnancies had much less to do with choices made by the girls themselves than with structural The second reason concerns the alarming and consistent factors such as sexual abuse,parental absence and poverty.17 disparity in practice and knowledge of sexual and repro- ductive health between adolescent males and adolescent Unsafe abortions pose high risks for adolescent girls females.Adolescent males appear more likely to engage A further serious risk to health that arises as a consequence of is risky sexual behaviour than adolescent females.In 19 adolescent sexual activity is unsafe abortion,which directly selected developing countries with available data,males causes the deaths of many adolescent girls and injures many aged 15-19 were consistently more likely than females to more.A 2003 study by the World Health Organization have engaged in higher-risk sex with non-marital,non-estimates that 14 per cent of all unsafe abortions that take cohabiting partners in the preceding 12 months.The data place in the developing world-amounting to 2.5 million also suggest,however,that boys are more likely than girls that year-involve adolescents under age 20.18 Of the unsafe to use a condom when they engage in such higher-risk abortions that involve adolescents,most are conducted by sex-despite the fact that girls are at greater risk of sexu- untrained practitioners and often take place in hazardous ally transmitted infections,including HIV.These findings circumstances and unhygienic conditions.19 22 THE STATE OF THE WORLD'S CHILDREN 2011
22 THE STATE OF THE WORLD’S CHILDREN 2011 country are particularly serious, given that in the period 2000–2009, around 47 per cent of Indian women aged 20–24 were married by age 18.10 Adolescent pregnancy is a regular consequence of child marriage, and underweight mothers have a higher risk of maternal death or morbidity. Obesity is a growing and serious concern in both industrialized countries and the developing world. Data from a subset of 10 developing countries show that the percentage of girls aged 15–19 who are overweight (i.e., those with a body mass index above 25.0) ranges between 21 and 36 per cent.11 Among the OECD countries, the highest levels of obesity in 2007 were found in the four southern European countries of Greece, Italy, Spain and Portugal, together with the mainly Anglophone nations of Canada, the United Kingdom and the United States.12 Sexual and reproductive health matters Girls are more likely to have engaged in early sex in adolescence but also less likely to use contraception Investing in sexual and reproductive health knowledge and services for early adolescents is critical for several reasons. The first is that some adolescents are engaging in sexual relations in early adolescence; international household survey data representative of the developing world, excluding China, indicate that around 11 per cent of females and 6 per cent of males aged 15–19 claim to have had sex before the age of 15.13 Latin America and the Caribbean is the region with the highest proportion of adolescent females claiming to have had their sexual debut before age 15, at 22 per cent (there are no equivalent figures for young men for this region). The lowest reported levels of sexual activity for both boys and girls under 15 occur in Asia.14 The second reason concerns the alarming and consistent disparity in practice and knowledge of sexual and reproductive health between adolescent males and adolescent females. Adolescent males appear more likely to engage is risky sexual behaviour than adolescent females. In 19 selected developing countries with available data, males aged 15–19 were consistently more likely than females to have engaged in higher-risk sex with non-marital, noncohabiting partners in the preceding 12 months. The data also suggest, however, that boys are more likely than girls to use a condom when they engage in such higher-risk sex – despite the fact that girls are at greater risk of sexually transmitted infections, including HIV. These findings underscore the importance of making high-quality sexual and reproductive health services and knowledge available to adolescent girls and boys alike from an early age.15 Early pregnancy, often as a consequence of early marriage, increases maternity risks The third challenge is empowering adolescent girls in particular with the knowledge of sexual and reproductive health, owing to the gender-related protection risks they face in many countries and communities. Child marriage, often deemed by elders to protect girls – and, to a much lesser extent, boys – from sexual predation, promiscuity and social ostracism, in fact makes children more likely to be ignorant about health and more vulnerable to school dropout. Many adolescent girls are required to marry early, and when they become pregnant, they face a much higher risk of maternal mortality, as their bodies are not mature enough to cope with the experience. The younger a girl is when she becomes pregnant, whether she is married or not, the greater the risks to her health. In Latin America, for example, a study shows that girls who give birth before the age of 16 are three to four times times more likely to suffer maternal death than women in their twenties. Complications related to pregnancy and childbirth are among the leading causes of death worldwide for adolescent girls between the ages of 15 and 19.16 For girls, child marriage is also associated with an increased risk of sexually transmitted infections and unwanted pregnancies. Research suggests that adolescent pregnancy is related to factors beyond girls’ control. One study undertaken in Orellana, an Ecuadorian province in the Amazon basin, where nearly 40 per cent of girls aged 15–19 are or have been pregnant, found that the pregnancies had much less to do with choices made by the girls themselves than with structural factors such as sexual abuse, parental absence and poverty.17 Unsafe abortions pose high risks for adolescent girls A further serious risk to health that arises as a consequence of adolescent sexual activity is unsafe abortion, which directly causes the deaths of many adolescent girls and injures many more. A 2003 study by the World Health Organization estimates that 14 per cent of all unsafe abortions that take place in the developing world – amounting to 2.5 million that year – involve adolescents under age 20.18 Of the unsafe abortions that involve adolescents, most are conducted by untrained practitioners and often take place in hazardous circumstances and unhygienic conditions.19
COUNTRY:INDIA Risks and opportunities for the world's largest national population of adolescent girls India is home to more than 243 million adolescents. improve the survival and development of children and who account for almost 20 per cent of the country's adolescents.One such effort is the adolescent anae- population.Over the past two decades,rapid econom- mia control programme,a collaborative intervention ic growth-with real gross domestic product averag- supported by UNICEF that began in 2000in11 states. ing 4.8 per cent between 1990 and 2009-has lifted The main objective of the programme is to reduce the millions of Indians out of poverty:this,combined with prevalence and severity of anaemia in adolescent girls government programmes,has led to the improved through the provision of iron and folic acid supple- health and development of the country's adolescents. ments(weekly),deworming tablets(bi-annually)and However,many challenges remain for India's youthful information on improved nutrition practices.The pro- population,particularly for girls,who face gender gramme uses schools as the delivery channel for those disparities in education and nutrition,early marriage attending school and community Anganwadi Centres, Khamma Devi,an and discrimination,especially against those belonging through the Integrated Child Development Services to socially excluded castes and tribes. programme.for out-of-school girls.The programme advocate for women in currently reaches more than 15 million adolescent the community.explains India ranked 119 out of 169 country rankings in the girls and is expected to reach 20 million by the end of the ill effects of child United Nations Development Programme's gender 2010.Attention has also been given to child protection marriage to girls and inequality index(Gll)in 2010.While the country has issues.In 2007,the Government enacted the Prohibi- women in Himmatpura made significant progress towards gender parity in tion of Child Marriage Act,2006 to replace the earlier primary education enrolment,which stands at 0.96. Child Marriage Restraint Act,1929.The legislation Village,India. gender parity in secondary school enrolment remains aims to prohibit child marriage.protect its victims and low at 0.83.Adolescent girls also face a greater ensure punishment for those who abet,promote or risk of nutritional problems than adolescent boys. solemnize such marriages.However,implementation “Ensuring the including anaemia and underweight.Underweight and enforcement of the law remain a challenge. prevalence among adolescent girls aged 15-19 is nutritional,health 47 per cent in India,the world's highest.In addition. Non-governmental organizations such as the Centre and educational over half of girls aged 15-19(56 per cent)are anae- for Health Education,Training and Nutrition Aware- mic.This has serious implications,since many young ness(CHETNA)work closely with the Govemment needs of its women marry before age 20 and being anaemic or and civil society to improve the health and nutrition adolescent underweight increases their risks during pregnancy. of children,youth and women,including socially Anaemia is the main indirect cause of matemal excluded and disadvantaged groups.CHETNA also population, mortality.which stood at 230 matemal deaths per works to bring awareness of gender discrimination particularly girls, 100,000 live births in 2008.Such nutritional depriva- issues to communities,particularly to boys and men. tions continue throughout the life cycle and are often and provides support for comprehensive gender- remains a key passed on to the next generation. sensitive policies at state and national levels. challenge for Although the legal age for marriage is 18,the major- Ensuring the nutritional,health and educational India." ity of Indian women marry as adolescents.Recent needs of its adolescent population,particularly girls. data show that 30 per cent of girls aged 15-19 are remains a key challenge for India.Widening dis- currently married or in union,compared to only 5 parities,gender discrimination and the social divide per cent of boys of the same age.Also.3 in 5 women among castes and tribes are also among the barriers aged 20-49 were married as adolescents,compared to advancing the development and protection rights of to 1 in 5 men.There are considerable disparities young people.Increased investment in the country's depending on where girls live.For instance,while large adolescent population will help prepare them the prevalence of child marriage among urban girls to be healthy and productive citizens.As these young is around 29 per cent,it is 56 per cent for their rural people reach working age in the near future,the counterparts. country will reap the demographic dividend of having a more active,participatory and prosperous society. The Government of India,in partnership with other stakeholders,has made considerable efforts to See References,page 78. REALIZING THE RIGHTS OF ADOLESCENTS 23
realizing the rights of adolescents 23 India is home to more than 243 million adolescents, who account for almost 20 per cent of the country’s population. Over the past two decades, rapid economic growth – with real gross domestic product averaging 4.8 per cent between 1990 and 2009 – has lifted millions of Indians out of poverty; this, combined with government programmes, has led to the improved health and development of the country’s adolescents. However, many challenges remain for India’s youthful population, particularly for girls, who face gender disparities in education and nutrition, early marriage and discrimination, especially against those belonging to socially excluded castes and tribes. India ranked 119 out of 169 country rankings in the United Nations Development Programme’s gender inequality index (GII) in 2010. While the country has made significant progress towards gender parity in primary education enrolment, which stands at 0.96, gender parity in secondary school enrolment remains low at 0.83. Adolescent girls also face a greater risk of nutritional problems than adolescent boys, including anaemia and underweight. Underweight prevalence among adolescent girls aged 15–19 is 47 per cent in India, the world’s highest. In addition, over half of girls aged 15–19 (56 per cent) are anaemic. This has serious implications, since many young women marry before age 20 and being anaemic or underweight increases their risks during pregnancy. Anaemia is the main indirect cause of maternal mortality, which stood at 230 maternal deaths per 100,000 live births in 2008. Such nutritional deprivations continue throughout the life cycle and are often passed on to the next generation. Although the legal age for marriage is 18, the majority of Indian women marry as adolescents. Recent data show that 30 per cent of girls aged 15–19 are currently married or in union, compared to only 5 per cent of boys of the same age. Also, 3 in 5 women aged 20–49 were married as adolescents, compared to 1 in 5 men. There are considerable disparities depending on where girls live. For instance, while the prevalence of child marriage among urban girls is around 29 per cent, it is 56 per cent for their rural counterparts. The Government of India, in partnership with other stakeholders, has made considerable efforts to improve the survival and development of children and adolescents. One such effort is the adolescent anaemia control programme, a collaborative intervention supported by UNICEF that began in 2000 in 11 states. The main objective of the programme is to reduce the prevalence and severity of anaemia in adolescent girls through the provision of iron and folic acid supplements (weekly), deworming tablets (bi-annually) and information on improved nutrition practices. The programme uses schools as the delivery channel for those attending school and community Anganwadi Centres, through the Integrated Child Development Services programme, for out-of-school girls. The programme currently reaches more than 15 million adolescent girls and is expected to reach 20 million by the end of 2010. Attention has also been given to child protection issues. In 2007, the Government enacted the Prohibition of Child Marriage Act, 2006 to replace the earlier Child Marriage Restraint Act, 1929. The legislation aims to prohibit child marriage, protect its victims and ensure punishment for those who abet, promote or solemnize such marriages. However, implementation and enforcement of the law remain a challenge. Non-governmental organizations such as the Centre for Health Education, Training and Nutrition Awareness (CHETNA) work closely with the Government and civil society to improve the health and nutrition of children, youth and women, including socially excluded and disadvantaged groups. CHETNA also works to bring awareness of gender discrimination issues to communities, particularly to boys and men, and provides support for comprehensive gendersensitive policies at state and national levels. Ensuring the nutritional, health and educational needs of its adolescent population, particularly girls, remains a key challenge for India. Widening disparities, gender discrimination and the social divide among castes and tribes are also among the barriers to advancing the development and protection rights of young people. Increased investment in the country’s large adolescent population will help prepare them to be healthy and productive citizens. As these young people reach working age in the near future, the country will reap the demographic dividend of having a more active, participatory and prosperous society. See References, page 78. COUNTRY: INDIA Risks and opportunities for the world’s largest national population of adolescent girls Khamma Devi, an advocate for women in the community, explains the ill effects of child marriage to girls and women in Himmatpura Village, India. “Ensuring the nutritional, health and educational needs of its adolescent population, particularly girls, remains a key challenge for India
Gathering accurate data on adolescent abortions is almost makes this disease a prominent cause of death for women impossible given the level of secrecy and shame surround- aged 15-29 worldwide,as well as one of the leading causes ing the procedure,but the number has been estimated at of death for men in this age group.2 1 million-4 million per year.20 Many of the girls and women who seek abortions do so because they have had insuf- Many new HIV cases worldwide involve young people aged ficient control over their own fertility,whether because of 15-24.In four of the world's seven regions,young females poverty,ignorance,problems with male partners or lack of are more likely to be living with HIV than young males access to contraception. -around twice as likely.In Eastern and Southern African countries with adult HIV prevalence of 10 per cent or higher, HIV and AIDS prevalence among girls and women aged 15-24 is two to three times higher than it is for their male peers.23 HIV and AIDS are life-threatening challenges for adolescents in high-prevalence countries The risk of HIV infection is considerably higher Preventing the transmission of HIV is one of the most impor- among adolescent girls than adolescent boys tant challenges for adolescent survival and health.Although Adolescent girls are at far greater risk of contracting AIDS is estimated to be only the eighth leading cause of HIV than boys,as data from six countries in Eastern and death among adolescents aged 15-19,and the sixth leading Southern Africa show.In Lesotho,for example,population cause among 10-14-year-olds,it takes a disproportionately based survey data show that HIV prevalence among males high toll in high-prevalence countries.21 It is the sheer scale aged 15-19 was around 2 per cent in 2004,compared with of the AlDS epidemic in Eastern and Southern Africa that 8 per cent for girls of the same age.The risks of HIV preva- Figure 2.5:Young males in late adolescence(15-19)are more likely to engage in higher risk sex than females of the same age group Percentage of young people aged 15-19 who had higher-risk sex with a non-marital,non-cohabitating partner in the last 12 months in selected countries South Africa 95 99 Namibia 84 98 Swaziland 82 98 Haiti 711 99 Ukraine 70 96 Guyana 59 96 Kenya 56 98 Moldova 54 94 Lesotho 54 97 United Republic 49 of Tanzania 95 Zambia 48 94 Uganda 44 94 Dominican Republic 43 96 Malawi 29 92 Central African Republic 28 83 Zimbabwe 24■ 97 Viet Nam 52 Cambodia ■Female 70 ■Male India 63 0% 20 40 60 80 100 Source:DHS,MICS and national surveys,2003-2009. 24 THE STATE OF THE WORLD'S CHILDREN 2011
24 THE STATE OF THE WORLD’S CHILDREN 2011 Gathering accurate data on adolescent abortions is almost impossible given the level of secrecy and shame surrounding the procedure, but the number has been estimated at 1 million–4 million per year.20 Many of the girls and women who seek abortions do so because they have had insufficient control over their own fertility, whether because of poverty, ignorance, problems with male partners or lack of access to contraception. HIV and AIDS HIV and AIDS are life-threatening challenges for adolescents in high-prevalence countries Preventing the transmission of HIV is one of the most important challenges for adolescent survival and health. Although AIDS is estimated to be only the eighth leading cause of death among adolescents aged 15–19, and the sixth leading cause among 10–14-year-olds, it takes a disproportionately high toll in high-prevalence countries.21 It is the sheer scale of the AIDS epidemic in Eastern and Southern Africa that makes this disease a prominent cause of death for women aged 15–29 worldwide, as well as one of the leading causes of death for men in this age group.22 Many new HIV cases worldwide involve young people aged 15–24. In four of the world’s seven regions, young females are more likely to be living with HIV than young males – around twice as likely. In Eastern and Southern African countries with adult HIV prevalence of 10 per cent or higher, prevalence among girls and women aged 15–24 is two to three times higher than it is for their male peers.23 The risk of HIV infection is considerably higher among adolescent girls than adolescent boys Adolescent girls are at far greater risk of contracting HIV than boys, as data from six countries in Eastern and Southern Africa show. In Lesotho, for example, population based survey data show that HIV prevalence among males aged 15–19 was around 2 per cent in 2004, compared with 8 per cent for girls of the same age. The risks of HIV prevaFigure 2.5: Young males in late adolescence (15–19) are more likely to engage in higher risk sex than females of the same age group Source: DHS, MICS and national surveys, 2003–2009. Percentage of young people aged 15–19 who had higher-risk sex with a non-marital, non-cohabitating partner in the last 12 months in selected countries Female Male South Africa Namibia Swaziland Haiti Ukraine Guyana Kenya Moldova Lesotho Zambia Uganda Dominican Republic Malawi Central African Republic Zimbabwe Viet Nam Cambodia India 0% 20 40 60 80 100 United Republic of Tanzania 84 98 1 1 63 70 52 4 97 82 98 71 99 70 96 59 96 56 98 54 94 54 97 49 95 94 94 48 44 43 29 28 24 96 92 83 95 99