For young people across the globe and Sri Lanka, today’s world is a very traumatic and trying time.
Tossed about like a ship without a rudder, amid unsettling and hostile environments, many are unable to cope with the overwhelming challenges that life has thrust on them. Lacking the empathy and compassion of adults to steer them on life’s journey, a large number seek the easy way out by taking their own lives prematurely.
“These desperate measures can be avoided if their teachers, parents, guardians can offer them tools that will empower them and give them back their confidence in themselves. Providing them correct information, knowledge on reproductive health in a youth friendly environment are key tools in filling the gaps and overcoming restraints in achieving quality adolescent well being”, was the consensus of opinion by a panel of experts in the field addressing the media at a seminar conducted by the Health Education Bureau( HEB) . The discussion held on International Youth Day, August 15, also coincided with the formal launch of the Adolescent Friendly website ‘ Yowun Piyasa’.
Participants at the discussion opened by Director Maternal Health Services Ministry of Health, Dr Priyani Senadeera, Director Mental Health Unit Ministry of Health Dr Chitramalee De Silva, Rajarata University lecturer Dr Manoj Fernando and lead speaker Director General Health Services, Dr Jayasundara Bandara.
Following hot on the heels of a discussion on Maternal suicides, now an emerging and disturbing trend in Sri Lanka, the facts unveiled at the latter seminar on the well being of adolescents were no less distressing.
The speakers focused on both, the negative and positive aspects of the subject, while noting that the prevalence of suicides among young people had fallen significantly compared to what they were in the mid 1990s when they spiked to a percentage comparable to those of most western countries .
Those most vulnerable to both attempting or successfully completing their desperate bid to end their lives were those poised on the threshold of adulthood – adolescents between 15-24 years, their untimely deaths robbing the nation of persons in the prime of their lives and impacting the socio economic status and well being of the nation as a whole. According to the speakers, of 21 million people living in Sri Lanka, 3.3 million ( 16.4%) are youth.
In other words, one in every six people are between 15-24 years of age. “Youth is the second formative stage of life after childhood. It is a period with growth, opportunities and challenges, both, physically and mentally”, Dr Chiranthika Vitharna said. “ It is an age when they tend to do exploration and experimentation with the external world, especially, substance use, abuse and sexuality, away from the watchful eyes of parents and guardians. We need to be extra watchful of them and monitor their movements without imposing on them”.
Health and well being the FHB speaker said, were closely linked , “ They are without doubt a very significant aspect of young people and their lives”.
Causes leading to self harm
Citing proven factors, the panel of speakers agreed that among the many causes leading to self harm or attempted self harm in both, school going and out of school adolescents, the following reasons were among the commonest and main root causes of existing emotional and psychological distress among young persons: High levels of stress due to the competitive nature of education , deteriorating quality of relationships with the family, lack of knowledge and peer pressure. They pointed out that culturally appropriate and locally available psycho-social services focusing on the needs of young people, was a major drawback to the mental health of Lankan youth. Other causes included lack of exercise with about half of males and three fourths of females leading sedentary lifestyles stuck to their desks in the classroom or computers and television sets at home. “ Exercise is a must . At least ten minutes or more should be set aside in the school curriculum for children to play outdoors”, Dr Jyasundara Bandara emphasized, adding that a proposal to this effect had already been made and a plan was being worked out accordingly with the National Institute of Education and the Health Ministry. Poor diets ingested by youth containing high salt, sugar, unsaturated fats were another leading concern to which attention was drawn. “ They can lead to early diabetes, hypertension, heart attacks and other non communicable diseases which comprise nearly 90% of all diseases in the country” Dr Senadeera noted.
“All of them are preventable. “ It is a multi factoral issue and every single cause is important”, she stressed.
Citing statistics from a school based study, the speakers said, nearly half of the boys in school going population consumed carbonated cola drinks compared to 35-36% of females, while one fifth of the sample population had consumed pre-cooked food like sausage and other instant processed foods.
Substance use
Other facts that emerged were, that currently around 9% of youth were using tobacco and 10% alcohol, their first smoke and first sip of alcohol being taken with their friends. Peer pressure and submitting to peers is a major issue as many still do not know they could be heading to drastic health impacts” , doctors warned. They also noted that the internet was now being used to replace personal communication by youth . Ten percent of youth use the internet daily with more males from the urban sector. While learning from the internet is a good thing, being hooked on it for most of their free time and having access to un monitored channels as well as violence and pornography, could expose these vulnerable youth to much danger, mentally and psychologically” warned Dr Manoj Fernando.
Giving both, the negative and positive aspects of the radio, television and smart phones which had now invaded our country, he said, on the positive side they provided pleasure, education, information, skills development and could act as a change agent . On the negative side, it could lead to exposure to violence, idealisation of suicide and to tobacco and alcohol use. “ Misleading advertisements claiming to make persons fair and lovely instantly has affected both male and female adolescents mentally and psychologically.
Adolescence is a period of physical change and the period when young people can become too absorbed about their body and the way they see it. The media must be accountable and responsible in the way they advertise these products to vulnerable teenagers.”, he said.
A survey initiated by UNICEF in 2004 to fill a gap in information identified as a major drawback to formulating policies and programs on adolescent well being is worth looking at in the backdrop to the above facts. The principal investigator was Neil Thalagala and Project Consultant Lalini Rajapakse while the UNICEF coordinator was Harischandra Yakandawela. Following are some of the interesting facts that emerged from the abstract downloaded from the internet.
The survey incidentally consisted of two main components- the first carried out among 29,911 school going adolescents representing 25 administrative districts in the country, and the other among 10,079 out of school adolescents representing five sectors – Colombo Metro, other urban, rural, estate and the North East.
The findings among school going adolescents showed that 28% were uncertain of their future goals. A further 36% become traditionally popular professionals, such as, doctors, lawyers, accountants, bankers, and engineers. Boys had displayed wider choices than the girls. Less than 24% chose a more realistic approach of selecting alternative options.
So what do these findings suggest?
The researchers stated, it revealed that most ambitions of schoolchildren are governed by traditional societal norms rather than those promoted by critical and creative analysis displaying self awareness. In the parallel survey of out of school adolescents the key problem was finding employment ( 72%). However, 32% felt they lacked skills useful to others.
Life skills and self esteem
Around 14% school adolescents and 21% out of school adolescents did not like any attribute they had, while nearly 60% rated themselves as ‘average”.
The survey found 40-60% reacting positively to academic pressure by teachers and parents,while fear of failing exams was one of the biggest negative factors among schoolchildren. Financial constraints, parental disharmony, absence of mother at home were other issues that worried the school adolescent.
On the whole it was found that the majority of school youth ( 60%) had close ties with their families and 52% said the family was a refuge for problems. Only 4% of school adolescents reported serious problems with their family.
Family ties among out of school adolescents
However, these bonds were looser among the older group with only 32% saying their family was warm and caring, and 4% feeling ‘left out’ by the family.
Knowledge about Reproductive health
Here, the difference was marginal, researchers found among the two groups.
In the age group 10-13 the extent of knowledge was dismally low with regard to their physiological changes and processes in their bodies during this particular period. Girls seemed to be more aware of them than boys, they found.
Knowledge of Reproductive Health matters such as production of sperms, ova, conception, sex hormones , secondary sexual characteristics, nocturnal emissions, fertility, was very limited among both sexes with less than 50% able to give correct answers to the questions distributed. It further revealed that less than 25% of girls in the same age group were able to correctly answer questions on risks of conception, signs of pregnancy, while contraceptive methods were known to a very small proportion in both groups, although it was more among the older groups and those whose socio economic status and knowledge was higher.
Contraceptives used
With regard to contraceptive use, condoms were the most frequent method (29%) followed by the Pill ( 24%). Less than 10% knew about the other methods such as, Depo Provero, IUD, Norplant, Vasectomy , LRT.
Among the out of school adolescents, it was further found that knowledge of sexually transmitted diseases in general was still poor ( 57%) .While 59% were aware of HIV/AIDS, diseases like gonorrhea, herpes, genital warts were known to less than 40 percent of the risk population.
Knowledge of symptoms and signs of STDs were also very poor- less than 20% . However, knowledge on transmission and prevention was now much higher than before although it did not exceed 50%.
“Sexually active adolescents run several risks that impact their health,” the speakers warned. “ They include acquiring STDs, pregnancy, abortion, social and mental problems and suicide.
Education on these risks with life skills , empowering parents, teachers, and student leaders to identify the high risk groups and introduce interventions is the only way to reduce the vulnerability of our young people to such unhealthy risks,” the speakers agreed.
Describing the well being of adolescence as a “ right’, they called on the media to play a more positive role in guiding them on the correct path.
Most young people frequently face situations bigger than they can handle, Often it is temporary despair. But, sometimes it is more than that, like a pre-existing condition aggravated by frustrations. Hence, we need to talk about depression openly and compassionately.
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Health Ministry intervention
Care for Adolescents and Youth Adolescent and Youth Health component was incorporated into the NFHP in 2014 which includes the health needs of the 10-24 year age group. For provision of services to adolescents and young, Adolescent Youth Friendly Health Service (AYFHS) Centers under the name of “Yowun Piyasa” were being established in government hospitals. There were only nine AYFHS centers functioning in the country by 2014. In 2015, a national review of AYFHS was conducted with the participation of all relevant stakeholders to identify the gaps and barriers that had affected the program.
Nine existing AYFHS centers were visited and a revamping process initiated. The first provincial level review was conducted in the Western Province. A circular on adolescent sexual and reproductive health service provision was issued after obtaining legal clarification from the Attorney General to address issues encountered by the public health staff in provision of adolescent sexual health services in the field. Guideline for public health staff on adolescent sexual and reproductive health service provision has been drafted, targeting the reduction of teenage pregnancies which was 5.3 % in 2014.
An advocacy program for members of the judiciary was conducted on the importance of the provision of adolescent sexual and reproductive health services for needy groups with the participation of the Director General of Health Services. A revision of standards for AYFHS was initiated with the participation of the international expert on the field, with the support of the World Health Organization. Quality assessment tools for AYFHS were developed with technical support from the same expert. Sexual and reproductive health package for public health midwives, as an aid on provision of adolescent sexual and reproductive health education for young persons in the field was developed. Development of a youth health website for the 15-24 year age group was initiated which includes youth friendly content in all three languages.
Training of trainers were conducted to improve capacity building of primary health care workers and other officers dealing with young persons at AYFHS Centers. Capacity building of the staff of newly established AYFHS centers was conducted parallel to it. National Youth Health Survey 2012-2013 was completed and activities planned for the dissemination of its findings. Future interventions would be developed based on the findings of the priority areas identified in the Youth Health Survey. ANNUAL HEALTH BULLETIN - 2015 Public Health Services