Demographic Profile of Adolescents – India

Young people between 10-24 years constitute approximately one third and adolescents aged between 10-19 years constitute 22.8 percent of India’s population. The data indicates that within the adolescent age group itself, the proportion of 10-14 years olds is greater than that of the 15-19 years age group. The gender wise breakdown of the 10-24 year population does not show any significant difference between the sexes. However various studies reveal distinctive differences between opportunities and experiences available to boys and girls across almost all regions in the country among both married and unmarried groups.

 To understand the specific needs of young people in India, it is important to take a closer look into the lives and conditions that they usually face. Through studies undertaken in the past one decade, a clear picture emerges. Research conducted in different part of the country from time to time reveal distinctive trends and mindsets of this young cohort and provide an outline of the challenges they face.

ISSUES OF YOUNG PEOPLE : SOCIAL FACTORS REPONSIBLE FOR YOUNG PEOPLE’S STATUS, OPPORTUNITIES AND DEVELOPMENT

Demographic and social influences on the health of young people (aged 10 to 24 years) describe their social context  that include relations with family, peers and school; physical health and satisfaction with life; health behaviours including patterns of eating, hygiene  and physical activity; and risk behaviours like use of tobacco, drugs; sexual behaviour including gender biases and myths. Various studies based on statistical analysis identify meaningful differences in the prevalence of health and social indicators by gender, age group and attitudes and  influences of society. Findings along with their sources are mentioned under each topic that explain how social determinants impinge on the health, status, opportunities and development of young people.

Several cross-regional patterns reveal the magnitude and direction of differences between subgroups, thus contributing to a better understanding of the social determinants of health, development and well-being among young people, and provide the means to help protect and promote their interests.

Gender Imbalance

In a traditional male-dominated society like India, gender discrimination against women and girls further made acute by poverty, denies them their rights and entitlements even before birth i.e medical termination of female foetus. Since 1991, 80% of Indian districts have seen a decline in female sex ratio with the highest numbers in Punjab and Haryana. Since a girl is considered as ‘paraya dhan’ or property of the family into which she will marry, her education and development is seen as a burden. Therefore in a family of limited resources, priority in every sphere is given to boys. Following birth, as compared to boys, girls are denied all resources, care and opportunities needed for growth and development. Economists call this phenomenon as ‘feminization of poverty’ where a majority of women are among the most vulnerable in the world*.

Since patriarchal values are embedded in social life, they are reflected in every sphere of a woman’s life. Households and society use notions of family honour to influence and control over mobility, self expression, career choices, clothing, relationships, opportunities and other life choices. Despite having the world’s largest democracy, Indian women are denied effective participation by urban and rural governance structures. Such contexts add serious challenges in promoting women’s access to information, knowledge, leadership skills, assets, resources and services, decent and productive work, thereby denying them autonomy and independence.

*Lopez-Carlos, Zahidi

×

Nutrition

Due to increased physical activity in this growing age, caloric and protein requirements are maximal. However, due to lack of awareness, gender discrimination and other factors like menstruation and pregnancy, most adolescents have poor eating habits. This accentuates the potential risk for nutritional anaemia, especially among adolescent girls.Conversely, the problem of being over-weight and obesity is increasing in developing countries among urban adolescents due to poor eating habits*.

  • Eating disorders – Negative influence of media, peer pressure and unhealthy eating habits like regular intake of processed and junk food, result in obesity among urban adolescents. In addition to these, lifestyle choices like increased usage of television/computer, a sedentary lifestyle that discourage adequate physical activity indicate the prevalence of becoming overweight and obesity in several Indian states like Punjab, Maharashtra, Meghalaya, Delhi and Chennai**. On the other hand, many adolescents may have poor body image and becoming anorexic by not eating enough, in an attempt to lose weight. Thus, eating disorders result in lower intake of naturally produced healthy foods that contain nutritious elements.
  • Lack of nutrition – India has the highest number of underweight adolescents in the world, almost 47% of girls in the 11-19 age group, especially among the marginalised***. Under nutrition is more acute in the 15-19 years age group where 56% girls and 30% boys are anaemic****.The combination of poor nutrition and early child-bearing among girls resulting in iron and folic acid deficiencies, poses serious health risks during pregnancy and childbirth.
  • Nutrition and maternal mortality – In comparison with adult mothers, teenage mothers are more prone to having low birth weight babies (38.9%) and stillbirths (5.1%). This is a key indicator of maternal malnutrition*****. If the newborn happens to be a girl, it translates into a vicious cycle of female malnutrition throughout adolescence and adulthood.

* M. A. Mendez, C. A. Monteiro, and B. M. Popkin, American Journal of Clinical Nutrition, 2005.
** S. Kaur, U. Kapil, and P. Singh, Current Science, vol. 88, 2005
*** UNICEF : “State of the World’s Children”
**** NFHS-3
***** http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2963772/#B12

×

Education

Low levels of education and awareness in the society hampers the overall understanding and ability of an adolescent in making responsible life choices. Literacy rates of adolescents have seen an improvement in recent times at 88.4% for males and 77.4% for females within the 15-24 year old age group*. However, the school life expectancy (SLE) which means the number of years that a child spends in school is low at 11 years for males and 10 years for females. Consequently uneducated adolescents tend to have lower opportunities for employment or economic independence. Various studies link greater number of years of education with the ability to have better lives. For example, compared to India, SLE for young people in developing countries like Mexico and Brazil is 14.

Lack of education – Since a large majority of India’s adolescent girls do not attend secondary school, much less higher education, the school and University programmes have an inherently limited outreach. Globally it is found that early marriage and early child-bearing is not so common in educated and wealthier societies**.

Low awareness – Recent studies show that young people are prone to suffer from negative consequences of unprotected sex and harmful sexual behaviour because they are likely to be poorly informed or misinformed about responsible sexual behaviour. In the absence of reliable sources of information, they tend to rely on films and peers of the same sex for information. For example, more than 60% of females between 15-19 years in Gujarat, Bihar, Jharkhand, Uttar Pradesh and Madhya Pradesh were unaware of HIV infection***. Despite evidence that correct and relevant information delays sexual initiation, prevents unplanned pregnancies and provides protection from transmission of sexually transmitted diseases (STIs), due to rigid social norms, sex education remains inadequate and sexual and reproductive health (SRH) services remain inaccessible or of low quality.

Lack of life skill education in schools – India’s Adolescence Education Programme was not accepted as part of school curriculum in many states. In contrast, in Japan, sex education is mandatory from age 10 or 11 covering biological topics on menstruation and ejaculation. Other Asian countries like Indonesia, Mongolia, South Korea and Thailand have systematic policy framework for teaching sex education within the school framework. However, Pakistan, Bangladesh, Nepal and Myanmar do not have coordinated sex education programmes****.

Incomplete education – According to UNICEF, motherhood among teenagers is nine times more among girls with no schooling than among women with 12 or more years of education. Level of awareness regarding infections and HIV/AIDS and protective factors showed significant variation with the variation in education levels and marital status. Better educated young people were considerably aware as were the unmarried. This makes married women with incomplete education as the most vulnerable and poorly informed group.

Misconceptions about sex related topics – Correct awareness about spread of STDs and HIV infection is low among adolescents in India but shows state-wide variation with northern and eastern states being particularly limited. Lack of in-depth awareness of protective behaviours has often been cited as a significant impediment to the adoption of safe sex practices. This is because taboos regarding providing proper information on sex related issues, understanding and appreciation of one’s own body, its needs and health requirements are still rampant. E.g. The belief that ‘condoms should not be used because it encourages sex outside marriage’***** and that ‘it diminishes pleasure for men’ hinders contraceptive usage that can effectively curb spread of STDs/RTIs and AIDS. Similarly several other dangerous misconceptions like those cited below, push young people towards death and disability****** :

  • Women cannot get pregnant the first time they have sex
  • STD symptoms go away on their own
  • A HIV- infected person can be identified by his/her appearance
  • Condom use encourages promiscuity and must not be shared with wives
  • Sex with a virgin cures STDs

* United Nations Statistics Division
** UNICEF : Innocenti Digest : Child Marriages, 2001
*** GOI, MOHFW, Department of AIDS Control, 2010
**** http://en.wikipedia.org/wiki/Sex_education
***** Population Council : Early marriage and sexual and reproductive health risks, 2008
****** Brown et al. 2001

×

Sexual And Reproductive Health

Reproductive diseases like sexually transmitted diseases STD/reproductive tract infections (RTIs) and HIV/AIDS –In most cases, symptoms and consequences of these infections are unreported and unaddressed. Treatment seeking behaviour, especially among women is low. For example, only half of the women surveyed in a district in Andhra Pradesh sought treatment for symptoms of genital infections, the proportion of which was much lower at one fifth of women in a district in Madhya Pradesh.

  • Within marriage – In a study conducted among 16-22 year olds in Tamil Nadu, 49% were found to suffer from RTIs and 18% from STDs. Findings reveal that in many cases, husbands transmit these infections to their wives, who are unlikely to seek treatment even when symptoms occur*. India is the country after South Africa and Nigeria to have the third highest prevalence of HIV/AIDS in the world**. With 31% AIDS cases in the country, more information is needed to design culturally acceptable gender-sensitive interventions for young people.
  • Outside marriage – Under-reporting of symptoms is evident, a fact that was observed during a study where only 3 % of unmarried females and 5% of unmarried males reported symptoms of infection like ulcers and sores***.
  • Homosexuality – Another factor that is hardly recognized by HIV research and policymaking is the country’s male homosexual population estimated at 50 million****. Most men who have sex with men (MSMs) seek under cover partners and are forced by mainstream family culture to marry. Their problems are neither recognized nor addressed and pose high risks to young people’s sexual health, especially AIDS. This further facilitates the rapid spread of HIV among their wives and unborn children.

* Joseph, Prasad and Abraham, 2003
** CIA World Factbook
*** NACO and UNICEF, 2002
**** Hamsafar Trust, Mumbai

×

Communication

Evidences from around the world suggest that supportive communication between parents and children not only enables young people to make a safe and confident transition to adulthood but also equips them to make informed choices in every area of their lives.

Parent-child communication – A study on parental perspectives found that parents are indeed concerned about their children’s transition into sexual life. However, traditional norms on parenting compounded by lack of correct information on such sensitive topics results in limited skills in communicating with their adolescent sons and daughters. This absence of a supportive environment has more adverse consequences for girls, especially where they are denied information that could lead to protective choices. Regional differences in parent-child communication regarding sensitive issues do exist, with the northern states a more authoritarian communication that is less open and direct.

Inadequacy of School Curriculum – In spite of continuing efforts to promote the inclusion of life skill and sexuality education within the prescribed school curricula, most Indian states do not have a comprehensive health education system. The unpreparedness of teachers and the education system to deal with RSH issues further discourages communication on sensitive but critical concerns among school-going adolescents.

Restrictions on mobility – As girls approach puberty, strict societal norms impinge upon their mobility and freedom of expression. Young girls are increasingly and closely identified by their sexuality which is reflected in parental and community fears about girls having pre-marital sexual activity and maintaining sexual chastity of girls This restricts their mobility and communication with the outside world making her less informed and aware than her male counterparts, especially in rural settings.

Role of media – Gender stereotyping of women generation after generation in the media as submissive wives and girlfriends, dutiful daughters, conniving mothers-in law or sex sirens have relegated women to an inferior status in the eyes of the society. Although women-centric films are gradually becoming popular, much of the present day media still portrays an ideal woman as shy and weak and someone who needs to be protected by a man. Viewed through patriarchal mindsets, blatant portrayal of women as sex objects makes young women vulnerable to all forms of violence, especially rape, molestation and teasing. Widespread exposure to media like television, magazines and internet wrongly makes a young mind vulnerable to negative influences like aggressive male behaviour and pornography.

×

Exercising Rights

The Indian constitutions grants equal rights to all citizens of India including young people. But in practice, women and girls are denied. This discrimination continues throughout their life cycle with the denial of the right to nutrition, education, health, equal rights to property, right to live in a safe environment and heinous practices like dowry, sati and domestic violence.

  • Denial of economic and property rights – As compared to men, far fewer women are part of a paid workforce and their unpaid work like house work and childcare is regarded as invisible. Most Indian girls do not get a share of ancestral property. In case of divorce, with lower access to legal and family support, their economic security can be endangered. Due to denial of equal property rights, Indian women are less likely to receive inheritance than men, have fewer and generally lower paying employment opportunities and are often prevented from working due to family or social expectations or in order to take on childbirth and childcare roles.However, recent legislation aims to ensure that daughters have equal inheritance rights and that divorced women will have 50% share of marital property*. In spite of this, due to unawareness and lack of bargaining power, in practice, far fewer girls actually exercise these rights.

* Centre for Social Research, 2013

×

Outreach of Sexual and Reproductive Health (SRH) Services

Access to information and services – The extent to which young people are regularly exposed to mass media is a huge indicator for assessing their awareness levels regarding SRH. Findings indicate huge regional differences where almost half of the young people in the southern Indian states were exposed to some form media and were more exposed to messages on sexual and reproductive matters since they read newspapers, used internet and watched television and films, as compared to their northern counterparts*.

Interaction with healthcare provider – A healthcare provider is a critical point of contact for reaching out to young people and a favourable interaction where privacy in discussing sensitive matters is ensured, almost always results in increase of access to SRH services. However, one-third of married young people surveyed, reported having any interaction at all with a healthcare provider with the most likely topic to be discussed is family planning and HIV prevention as less talked about. Antenatal care is the topic most likely to have been discussed in most parts of India with very low priority given to post partum care.

Inadequacy/Apathy of service provider – Lack of sensitivity among service providers, especially for sexual and reproductive health services is common. Besides, most government health centres are severely under-staffed due to low availability of skilled workers, in certain areas. Absence of female health workers, deters adolescent girls from openly addressing their concerns. Owing to the poor quality of government health services and expensive private health services, young people are discouraged from seeking healthcare.

* Shireen J Jejeebhoy , Sexual and Reproductive Health Needs of Married Adolescent Girls,2007

×

Employment

Globally 73 million young people aged 15-24 years are expected to be unemployed. However, informal work among them remains pervasive. UNICEF estimates that approximately five million children work as domestic servants in South Asia including one in every five in India.

Lack of vocational skills – Vocational skills offer opportunities to adolescents, especially those who have dropped out of school and have the potential to lift them out of poverty. However a lack of vocational training severely limits their options for employment and financial stability.

Lack of employment opportunities – Most opportunities for employment are available in and around big cities and industrial areas. By and large they are inaccessible to young people living in remote or tribal areas.

Unpaid domestic work – Social constructs around gender roles inevitably place a high burden of care work on women. Older women are unable to cope with the triple burden of domestic and reproductive responsibilities and paid employment. To help sustain family income, the burden of extra household works and care falls on the young shoulders of adolescent girls often at the cost of her education and employment opportunities.

Exploitation at work– Although labour laws in India prohibit employing children below 14 years of age social protection and law enforcement is weak. Informal and irregular employment is widespread making them vulnerable to exploitation.

Social stigma at work – Young people belonging to certain vulnerable groups like men who have sex with men (MSMs), scheduled castes and scheduled tribes, children of sex workers, HIV/AIDS infected people and transgenders, face ridicule and unacceptability in the workplace and denied employment in private or public sectors. Further due to lack of education and skills, they are often unable to escape from this vicious circle and end up destitute or trapped in doing sex work.

×

Violence

Madhya Pradesh, Maharashtra and Tamil Nadu are reported to have the highest crime rates in the country with Kerala registering the highest number of cases. This could be a attributed to higher level of literacy in the state. In India, violence against women is shockingly common. Alarmingly, the proportion of IPC crimes committed against women under total IPC crimes has increased during last five years from 8.9 per cent in 2008 to 9.4 per cent in 2012*.

Violence against women – Recent reports indicate that a woman is raped every 14 hours in Delhi. A recent study concluded that India is the 4th worst country for women to live in after Afghanistan, Congo and Pakistan**. As statistics indicate, due to ‘culture of silence’ stemming from fear of social stigma, most cases are unreported. Deeply-entrenched gender biases in our laws, our police force, our judiciary and other state institutions continue to act as deterrents for aggrieved women from seeking justice.

  • Sexual abuse – Human trafficking for bonded labour and commercial sexual exploitation affect young girls adversely because they form a large majority of the 200,000 persons trafficked every year. Another factor is a skewed sex ratio against females due to which bride trafficking where girls are kidnapped and abused in the name of marriage, is on the rise. Research in two populous states of India indicates that forced sex within marriage is widespread, although the percentage is higher in the northern states of Bihar, Rajasthan, Uttar Pradesh and Madhya Pradesh as compared to the south.
  • Violence and neglect – Researchers estimate that 25,000 to 100,000 women are killed every year in India due to dowry related reasons and 1,25,000 through kidnappings, acid attacks and other forms of assault***, etc. Beyond violence, many girls are subjected to subtle neglect all throughout their lives in terms of nutrition, healthcare, amenities and opportunities as compared to boys in the family.
  • Forced abortions – Although abortion is legal in India, more than 90% are carried out in unrecognized institutions that do not use safe standardized methods. Out of 6.5 million abortions recorded in 2008, 66% were deemed unsafe****. Although studies reveal that failure of contraceptive followed by injury to physical and mental health as major reasons for abortions, societal pressures also influence this decision. Reasons vary from preference for male children, disapproval of single or early motherhood, stigmatization of people with disabilities to low economic support. In remote rural settings, the incidence of abortions carried out by uncertified medical practitioners is high.
  • Abuse within Marriage –In a patriarchal society, control over wealth and decision-making is in the hands of the men within the family and marital conflicts are strong predetermining factors resulting in abuse of women. The common perception of domestic violence is that it occurs most commonly amongst poor communities, lower castes, and in slums. Recent studies, however reveal that educated and working women are more likely to experience domestic violence, and this form of violence is not unique to any specific region, caste, socio-economic group, or religion. This implies that it is not lack of education that makes women more susceptible to violence, but rather the widespread acceptance of violence towards women. The “culture of silence” and accepting attitude towards violence are the most problematic parts of tackling this issue. A shocking study revealed attitude of adolescents towards marital violence where it found that 57% of boys and 53% of girls in the 15-19 years age group think that a husband is justified in hitting or beating his wife*****. When a girl is brought up believing she is inferior, it retards her self-esteem and does not allow her to exercise the human right of equality. Socialised with this concept, she is too submissive to protest effectively and take recourse to legal protection. An in depth study on young people revealed that violence and controlling behaviour by husbands is rampant all over India but shows some state-wide variation. 90% of young women in north and central India reported such behaviour as against 58% in the south.

* National Crime Records Bureau, 2012
** Trust Law : Danger Poll
*** New York Time, January 13, 2013I:International Society Against Dowry and Bride Burning in India
**** Ministry of Health and Family Welfare, India
***** UNICEF : Global Report Card on Adolescents, 2012

×

Contraception

Unmet need of contraception – Several researches in different parts of the country, reveal an increasing level of sexual activity among 10-24 year olds. For example, compared to females, males are more likely to indulge in heterosexual premarital sex (32% vs.6%)*. On the other hand, although ninety five percent of young people are aware of contraceptives, usage is abominably low, only about 7% among 15-19 year olds**.

  • Within marriage – In case of married young people, female sterilization (tubectomy) is by far the commonest method even though it carries the highest risk among all forms of contraception. It is alarming to note that 95.6% of all sterilizations are undergone by women while among men; the far simpler vasectomy is a mere 4.4%. Indicative of women bearing burden of contraception, they cannot avail of safer choices due to lack of awareness and bargaining power***.
  • Outside marriage – Condom use in extra marital relationships is low although gender differences are marked. Only 9% of young women as compared to 23% – 27% of young men could negotiate use of condoms in such relationships which is a strong indicator of the need for women to learn to negotiate safer sexual practices to protect themselves.

* Guttmacher Institute :International Perspectives on Sexual and Reproductive health, Jeejebhoy and India –Early Marriage SRH
** NFHS-3
*** Shireen J Jejeebhoy , Sexual and Reproductive Health Needs of Married Adolescent Girls,2007

×

Early Marriage

Early marriage for boys and girls is a termination of their childhood. It is a violation of the human right to free and full consent to a marriage1, something that is not possible when either or both partners are immature. Although this practice shows a decline, it is still widely prevalent in India.

Early Marriage in India – More than one third of all child brides in the world live in India. Early marriage affects girls more adversely in its magnitude and intensity and is highly prevalent in the states of Andhra Pradesh, Rajasthan, Madhya Pradesh, Uttar Pradesh and Bihar. Since most are unregistered, they are not part of any standard data collecting system. Available data indicates that 43% of girls are married before the legal age of 18 years. However, early marriage is less prevalent among men all over India where about 80% marry only after they are 212. But inter-state variations exist. For example, 64% of rural men aged 25-29 and 66.5% of women aged 20-24 years were married by 21 and 18 years respectively, in Madhya Pradesh3. On a macro level, in a country where one in every five adolescent girl between 15-17 years of age is married4, makes early fertility one of the main contributors to an increasing population in India.

A majority of married young people live in non-nuclear households suggesting that social norms related to early marriage more often influence this decision in joint families. More than four-fifths of all married adolescent girls between 15-19 years of age, currently live in joint households where their education and opportunities are controlled5.

Global scenario of Early Marriage – One out of nine girls in developing countries will be married by age 15, according to the United Nations. This is in sharp contrast to a developed country like USA where average age for marriage for women is 276.

Consequences of Early Marriage – Girls forced to marry early, face pregnancy related life-threatening health risks along with termination of education, awareness and other opportunities for self-development.

  • Early onset of sexual activity – Initiation of sexual activity is different for both boys and girls. Research indicates that at an age when they are physically and emotionally immature, girls are often subjected to coercive sex within the confines of marriage7. This leads to health complications like early pregnancy, anaemia, chronic back pain, low immunity, mental stress and other sexual and reproductive diseases8. They also face unplanned pregnancies (35% in Madhya Pradesh, 16.7% in Andhra Pradesh) the consequences of which are often fatal.
  • Early and repeated pregnancies – Because they are married early, adolescent girls have to deal with early and unplanned pregnancies. Over 70% of these child mothers are from Scheduled castes (dalits) and tribal regions9. Due to preference for sons, a married woman undergoes repeated and unwanted pregnancies where gender power
  • Maternal morbidity and mortality – Due to gender discrimination in nutrition and lack of access to maternal health services, poor and pregnant adolescents undergo ill-health and morbidity. Teenage pregnancies account for 16% of all pregnancies in India and 9% of maternal deaths10. Since the first birth is more likely to pose health risks for the woman, maternal health seeking behaviour during this period is important. There is great variation among states in pregnancy related care of adolescents. While 63% had received some antenatal care in Andhra Pradesh, only 45% in Madhya Pradesh reported having the same. Only 57% of all deliveries in India are institutional11 followed by abysmally low levels of post natal care (31.9% in Madhya Pradesh and 5.8% in Andhra Pradesh). Inadequacy of maternal healthcare facilities, especially in interior regions of the country is a major reason for maternal deaths in the country.

1 1948 Universal Declaration of Human Rights (UDHR); India: Prohibition of Child Marriage Act (2006)
2 India Development Gateway, 2011 : ‘Facts and Figures about Child Marriage’
3 IIPS and Macro International, 2007a
4District Level Household and Facility Survey (DLHS-3), M.P.
5NFHS-3
6 The National marriage Project : Knot Yet, 2013
7 National Geographic: Millions of Young Girls forced into Marriage
8 OneWorldSouthASia : http://southasia.oneworld.net/news/india-bengal-records-highest-teen-pregnancy-cases#.UdZdUDs_tak
9 IIPS, 2013
10 NFHS-3
11 Ministry of Health and Family Welfare, 2009

×

Health

Inter-linked with poverty and unawareness, health, hygiene and sexual and reproductive choices among adolescents are poor, leaving them by and large unable to cope with challenges. 

Hygiene– Lack of health awareness like washing hands with soap and water; and availability of clean water for drinking and sanitation, are reasons why a large number of young people suffer from water borne diseases, diarrhoea and other infections. Successful interventions indicate that an increase in school sanitation improves academic performance of both boys and girls and increases school attendance of girls significantly, especially where there are separate bathrooms.

  • Menstrual Hygiene– Widespread ignorance about menstrual hygiene among adolescent girls is a very important risk factor for reproductive tract infections. In a study conducted among this group, it was found that although almost half of them were aware of the use of sanitary pads during menstruation, only 11.25% in West Bengal used them regularly* as against 54% girls in Andhra Pradesh. However, use of old cloth was the usual practice for protection (35% in Andhra Pradesh)** .Moreover since menstruation is considered to be dirty and unclean, girls are barred from doing housework and attending school, while a majority are not allowed to participate in religious occasions.

Substance abuse – Substance abuse is harmful for survival, protection, growth and development of healthy adolescents and does not allow them to achieve quality of life. It may include smoking, injecting harmful drugs, chewing tobacco, intake of white ink and cough syrup. Findings suggest that substance abuse is rampant and consists of 40% of users who are below the age of 18 years. As observed, a notable proportion of teens in West Bengal, Andhra Pradesh, Uttar Pradesh and Haryana are regular users. Usually influenced by families and older peers, every year, about 55,000 marginalized children take up smoking. This risky behavior is often initiated during childhood and adolescence, as more than 70% of adult smokers report that they started smoking on a daily basis since childhood*** . This problem is especially acute in the North-east Indian states of Mizoram, Manipur, Meghalaya, Nagaland and parts of Assam where every third adolescent above the age of 10 years is reported to be a victim of substance abuse. The situation has reached terrifying dimensions because of strong links between drug addiction and HIV transmission. The other major cause of HIV apart from unsafe sex is the high incidence of IDU (Intravenous Drug Use), especially rampant in the North East**** .

* All India Institute of Hygiene and Public Health, 2007
** Water Supply and Sanitation Collaborative Council, 2011
*** Gautam Ghosh : Substance Abuse among Young People in India
**** Youth Ki Awaz

×