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TRANSITIONS TO ADULTHOOD Some Implications for Advocacy and Action
HEALTH Anemia and parasites: The interrelated problems of anemia and parasitic infections are the most prevalent health conditions among adolescents. While the greatest impact can be seen among poorer adolescents and those in rural areas with poor infrastructure, these conditions cut across all geographic regions and are surprisingly common even among well-off adolescents. Nutrition and hygiene education campaigns for adolescents, parents, and health care providers would be important first steps in eradicating these problems. Given the high exposure to the mass media reported by all adolescents, the media could be an effective tool for this campaign, in addition to the schools. Campaigns in other countries have used sports figures and other celebrities to promote healthy behaviors; Egypt might use members of its national football (soccer) team to convey these messages. This education campaign could be supported by a national effort to provide subsidized iron tablets. Policy-makers should also be planning for the longer-term goal of providing water and sanitation infrastructure to underserved communities. School Health Insurance System: More research is needed to investigate the reasons for low utilization of the School Health Insurance System. One reason cited for not using the SHIS was the unavailability of the school doctor, frequently because doctors are in charge of more than one school. Where possible, policy should ensure that one doctor or other provider is dedicated to each school and available during the whole school day. Physical activity: The survey findings show that girls get very little physical activity and rarely frequent sports facilities. The clear positive effects of physical activity on self-esteem, confidence levels, stress reduction, and overall health and well-being make it critical to develop programs to encourage physical activity among girls, under conditions that would be acceptable to girls and their parents. Schools in particular should be active in promoting physical activity among all adolescents, but especially among girls. Because of mobility restrictions, girls have fewer venues for physical activity available to them. Official agencies and NGOs should invest more in appropriate sports facilities for girls. EDUCATION Enrollment and retention: More effort is needed to increase awareness in some communities of the importance of education for both sexes, but especially for girls in rural areas and Upper Egypt. Because of the sensitivity of girls' (and boys') enrollment and retention to economic factors, scholarships should be provided to low-income families to help them with school fees, focusing on primary and middle school ages. School curriculum: With economic conditions changing rapidly in Egypt, the school curriculum should be more directly linked to the job market and future economic roles. A number of our findings support this: currently both parents and adolescents say that the benefit of education is largely social rather than economic; and second, drop-out rates are higher for boys in urban areas where more work opportunities exist. Vocational training should be better integrated into the schooling system. Courses on technical and administrative employment could also be offered to older adolescents in schools to link their education with work opportunities. Literacy classes: Literacy classes have been unsuccessful in reaching this age?group. More research is needed to determine the reasons behind this failure, perhaps because of program contents, inappropriate scheduling, or social perceptions. EMPLOYMENT Because adolescents are earning well through their work, there have to be incentives to influence decisions in favor of education. A stronger link between the school curriculum and the job market would help to weight these decisions in favor of increased education. Moreover, vocational training and/or other job training should also be closely integrated into the education system. Even though working adolescents are earning well, they are working long hours and in work environments that are hazardous to their health and safety. The minimum legal age for work and length of the working day should be enforced, and the safety of the workplace should be regularly inspected. The large numbers of unmarried young women who are not in school and not working suggests a serious under-utilization of their time. Work opportunities should thus be expanded to give this group more productive opportunities and access to resources, and perhaps help them to resist pressures for early marriage. Effective vocational training programs could target unmarried adolescent girls who have left school. Other livelihoods programs should aid less-educated girls in finding appropriate work or setting up their own small businesses. REPRODUCTIVE HEALTH Adolescents do not have enough of the necessary information about their bodies, maturation, or other aspects of reproductive health to prepare them for future reproductive roles. They would like this information to come from parents, but there is little dialogue between parents and their children on these issues, probably due to lack of parental knowledge and embarrassment. NGO and public programs should target both girls and boys with information about this life-stage, while also equipping parents with knowledge and communication skills and encouraging them to discuss these issues at home. Schools could also play a role in helping adolescents through this tumultuous period of their lives, by providing education on these topics and counseling services, as well as teaching good communication skills. Schools can also assist girls in the management of their menstruation by upgrading toilet facilities. ADOLESCENT MARRIAGE Although adolescent marriage is becoming less frequent in Egypt, it is still common enough in pockets of the country to be of serious concern, especially because pregnancy usually occurs almost immediately after marriage. With the pregnancy and birth outcomes so poor among this group of young women, public officials and communities should not simply wait for the problem to disappear on its own. Many of the women who have married during adolescence have never attended school or dropped out at an early age. Consequently, emphasis should continue on enrolling girls in school and retaining them for as long as possible. Expanding work opportunities for unmarried out-of-school girls could help to delay marriage, as well as provide them with more resources and productive opportunities. Communities and public officials should place more emphasis on enforcing the legal minimum marriage age restriction already in place. Egypt may consider raising the legal marriage age for girls, as have a number of other developing countries. For those young women who are married before age 20, the high likelihood of an immediate pregnancy puts them and their children at increased risk of illness and death. More effort should be placed on raising awareness of the negative health implications of early childbearing, particularly among parents, future husbands, and community opinion leaders. Moreover, the widespread practice of discouraging young couples from using contraceptives should be addressed, through education on the benefits of delaying a first birth and of birth spacing. Failing that, emphasis should be placed on the importance of monitoring pregnancy at local Maternal and Child Health units. Close supervision could at least help to reduce some of the risks of childbearing during adolescence. | |||||||||||
