"Since the 'youth uprising' of 1976 and the subsequent
mobilization of young women and men against apartheid policies and racial oppression, the term 'youth' hasrepresented a potent and important element of the political struggle.Ithas also been used to characterize a segment of the population seen as violent, unruly, undisciplined and underdeveloped" (National Youth Commission, 1997).
The term 'youth' as used in the quotation given above refers to people between 14 to 35 years of age. In an attempt to move away from this negative concept of young people, the South African government commissioned the National Youth Policy.
Diversity and uniqueness amongst the young people of South Africa was being recognized. This document brought to the fore the present status of South African youth and their vulnerability as a population within the general South African context.
According to Dickson-Tetteh and Ladha (2000), there is an estimated 18 million people in South Africa below the age of20. This accounts for 44% of the total South African population. Within the youth cohort there is inequity, with African youth facing the biggest problems in terms of housing, employment, access to health, access to education and exposure to crime and violence, when compared to the White, Coloured and Indian youth populations (National Youth Commission, 1997).
Whilst the adolescent population is at risk for many health related problems, it would appear that the area of sexual and reproductive health behaviours is responsible for the largest proportion of death and disability among young South Africans. An estimated 4 million cases of sexually transmitted infections take place yearly. Of this incidence, a little over half take place in the adolescent population. This is not
surprising since the average age for commencement of sexual activityhasbeen found to be 15 years for females and 14 years for males. The 1998 national antenatal sera- prevalence survey demonstrated that 21 % of clients attending antenatal clinic in the under 20 year old category were found tobeHIV positive (Dickson-Tetteh& Ladha, 2000). This is not surprising in the light of the HIV / AIDS pandemic in South Africa at present, the worst affected province being KwaZulu-Natal (Heunis et al, 2000).
Despite declining fertility rates in the adult population, the adolescent pregnancy rate remains high, especially with regards to the Coloured andruralAfrican female
population groups (South African Demographic and Health Survey, 1998). Byage 19, an estimated 35% of the adolescent population within South Africa has either been pregnant or has had a child; a concern for the government and researchers in the area
of adolescent health alike (South African Demographic and Health Survey, 1998).
Adolescent pregnancy poses many health risks for both the mother and child. "One in eight teenage deliveries are by caeSMean section, which indicates complicated births, and highlights the risk that adolescents place themselves at (sic) by becoming
pregnant at such an early age" (Dickson-Tetteh& Ladha, 2000). Disruption of
schooling adds to the picture of vulnerability. Incomplete school results in low paying jobs and poor socio-economic status(National Youth Commission, 1997).
Governmental amendment to legislation surrounding the issue of termination of pregnancy now makes it possible for women to legally procure abortions. This has translated into less women dying from complications related to illegal abortions. In 1999, an estimated 11%of abortions were done on females under the age of eighteen.
This is despite an encouragingly high percentage of contraceptive use amongst sexually active adolescents in the 15 to 19 year age group. Injectable contraception appearsto be more popular with adolescent clients, while condom usage is relatively low (South African Demographic and Health Survey, 1998). This is disturbing given the high HIV prevalence amongst adolescents and their susceptibility to the disease as a result of immature body physiology. Commencement of sexual activity earlier will also possibly mean more sexual partnersthanfor those who commence first
intercourse later in life.
Within the South African context, violence against women has been seen to have a significant effect on early childbearing. Some adolescents view sexual coercion as a norm and accept being forced into sexual relationships (Chetty, 2000). Dickson- Tetteh and Ladha (2000) make reference to a study conducted in the Western Cape
where a staggering 32% of pregnant adolescents indicated having been forced into having sexual intercourse, which resulted in their pregnancy.Anestimated 15% of youth in South Africa are thought to suffer from mental illness that may need diagnosis and hospitalization. Alcohol and tobacco usage amongst young South Africans is high. A reported 80% of adolescents in the 10 to 21 year age category admitted to having used alcohol at least once, with 10% of all adolescents smoking.
Adolescent morbidity from injuries (including accidents, homicides and suicides) appears to be high, with a reported 78% of deaths amongst adolescent males and 41 % amongst adolescent females. The HIV pandemic has also contributed significantly to the mortality and morbidity rates amongst adolescents in South Africa (South African Demographic and Health Survey, 1998; Dickson-Tetteh& Ladha, 2000).
As can be seen from the information just presented, adolescent health needs attention as the plight of adolescents within South Africa appears dire. Prior to the 1990's youth in South Africa were viewed as part of the population at large and were catered for in the same light. With democratization, a new view of young people also emerged (National YouthCommissio~1997). They were now being perceived as a separate population group with specific needs that had to be specifically catered for. Health care for young South Africans was one of the areas that came under focus. Previously, adolescent health was provided with the general health structure and the individual received paediatric or adult services, based on age.
In1993, Yach highlighted the need for adolescent health services in South Africa,in the editorial section of the South African Medical Journal. Mention was made of the fact that adolescents as a population are at risk for problems such as substance abuse,
sexually transmitted infections and violence (Yach, 1993). The same facts were corroborated by Richter (2000), and Dickson-Tetteh et al (2001). Yach (1993) emphasized the need for health promoting programmes thataimsat lifestyle change, with a view to combating risk factors. The World Health Organisation (WHO) had this to say about adolescents in making a case for strengthening adolescent health in nursing and midwifery curriculum:
"One in five people in the world today are adolescents aged between 10 and 19 years and 85% of this group live in developing countries. Adolescents have specific health problems and needs, which generally are not adequately met in most countries. Although the perspective on adolescents has tended to be problem-oriented, perpetuating a rather narrow view of adolescent health, this life stage has enormous potential for health promotion and illness prevention."
(WHO, Annex I, 2001, pI) The need for adolescent specific health policies and services was also brought into focus by Health Minister for South Africa, Dr. Manto Tshabalala-Msimang, in her address given at the launch of the "Contraceptive Policy Guidelines" and, "Youth and Adolescent Health Policy Guidelines", held on the 26thMarch 2002. "The Youth and Adolescent Health Policy Guidelines aim at preventing and responding to the needs of young people such as unsafe sexual behaviour, and promoting healthy lifestyles of all youth and adolescents" (Tshabalala-Msimang, 2002). As can be seen by the
information presented, the last decade has seen an increase in the awareness amongst health care providers for the need for adolescent specific health care.