Adolescence

sexes, there is still a considerable gap between knowingabout HIV and actually changing practices; this stemspartly from the difficulty of addressing social and culturalmores.Disability in adolescenceNobody knows how many adolescents are affected byphysical or mental disability. Adolescents with disabilitiesare likely to suffer forms of discrimination, exclusion andstigmatization similar to those endured by younger children.Disabled adolescents are often segregated from societyand regarded as passive victims or objects of charity.They are also vulnerable to physical violence and abuse ofall kinds. They are substantially less likely to be in school,and even if they are, they may suffer below-average transitionrates. This lack of educational opportunities maycontribute to long-term poverty.An equity-based approach to disability – together with theassertive campaigning of disability-rights organizations –has led to a sharp change in perceptions. This approach,founded on human rights, emphasizes the barriers andbottlenecks that exclude children and adolescents livingwith disabilities. Such barriers include retrograde attitudes,government policies, the structure of public institutions andlack of access to transport, buildings and other resourcesthat should be available to all.Adolescents face health challenges that paediatric andadult physicians alike are often ill-equipped to handle.Rapid physical and emotional growth, as well as the frequentlyconflicting and influential cultural messages theyreceive from the outside world, account for the uniquenature of their health concerns. Without proper educationand support, adolescents lack the knowledge and confidenceto make informed decisions about their health andsafety – decisions that may have life-long consequences.In order to protect young people from health threatssuch as disease, sexually transmitted infections, earlyand unwanted pregnancy, HIV transmission and drugand alcohol abuse, communities must address their particularneeds, and governments must invest in establishingadolescent-friendly health care services in hospitals, clinicsand youth centres.Studies show that adolescents avoid health care services– effectively nullifying preventive care – and distruststaff. They can be put off by the long waits, distanceto health facilities or unwelcoming services, or theymay feel too ashamed to ask for the money to coverthe cost of their visit. Creating a welcoming, privatespace, where adolescents feel comfortable and are ableto obtain prescriptions and counselling, is crucial torealizing their right to adequate health care services.Adolescent-friendly health facilities should be physicallyaccessible, open at convenient times, require no appointments,offer services for free and provide referrals toother relevant services. In addition, cultural, generationaland gender-specific barriers must be broken downto make way for an open dialogue between adolescentsand trained staff who can provide effective treatmentand counselling.This evolution of attitudes is having an increasing effecton policy and practice in almost every country of theworld. A seal was set on it by the Convention on theRights of Persons with Disabilities, which was adoptedby the United Nations General Assembly in December2006. 26Nevertheless, adolescents with disabilities still all too oftensuffer discrimination and exclusion. Disability issues cannotbe considered in isolation but must factor into all areasof provision for adolescents.Adolescent-friendly health servicesEducation in adolescenceIn most countries with universal or near-universal primaryeducation and well-developed education systems,many children make the transition to secondary educationin early adolescence. At the global level, however, universalprimary education has not yet been achieved, despitesignificant progress towards it over the last decade.Achieving higher rates of primary education is fundamentalto strengthening the numbers of early adolescents whoare ready to make the jump to secondary school at theappropriate age.Net primary enrolment in developing countries stood at90 per cent for boys and 87 per cent for girls in the period2005–2009, with much lower levels of 81 per cent and77 per cent respectively in sub-Saharan Africa, the mostdisadvantaged region. 27 Many millions of adolescents acrossthe world have not completed a full course of qualityprimary education that would prepare them to participatein secondary education.26THE STATE OF THE WORLD’S CHILDREN 2011