Young people and suicide

Further word on Zika. After the world sat up and noticed the rapid spread of the mosquito-borne Zika, which has the deadliest effects on the fetuses carried by women infected by the virus, the World Health Organization (WHO) made a budget call for $58 million to fund the global response to the disease. But so far, says Dr. Anthony Costello, director for Maternal, Newborn, Child and Adolescent Health for WHO, the world health body has been able to raise only “under $4 million.” Crucial funding allotted by the Obama administration in the United States, he added, has been held up by Congress, with Republican legislators insisting that enough funds remain from other programs that could be directed toward fighting Zika.

I don’t know if members of the political opposition, who are especially virulent during the election period, would change their minds once the virus makes “landfall” in the United States, given that it is now spreading rapidly through “America’s backyard.”

Also, recent findings have shown that Zika is not only transmitted by mosquitoes but also through sex. There have been cases of women infected by the virus after having sex with their infected male partners. The Zika virus, say experts, can remain in the semen of infected men for up to 62 days, although they are still determining the “average duration” of Zika infection in men.

A major problem, says Costello, is “vector control”—that is, limiting the number and spread of the mosquitoes that carry the disease. The problem, says the doctor, is that the spread of mosquito-borne diseases was once stringently controlled by the use of insecticides and insect repellents. But after studies determined the bad effects of these chemicals, such as DDT, on human beings and the environment, these were banned from common use. Which is why, says Costello, diseases like dengue have made a comeback in places where they once had been eradicated. While mutations, of which the deadly strain of Zika is believed to be part, are presenting challenges to present-day researchers and caregivers.

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One of the advantages to be gained from taking part in international conferences, such as the biannual Women Deliver held last week in Copenhagen, is that one can “pick and choose” from a wide range of topics discussed by experts from all over the world who otherwise would not be available as news sources.

“Women Deliver” started out as a gathering to build more political will and raise the funding from governments around the world on the issue of maternal health. But it has since expanded its scope to a broad range of health issues—such as Zika—while building a very strong youth component.

Even with the growing focus on the particular problems of young people, especially around such “taboo” topics like sexuality and early pregnancy, certain sectors of the young are overlooked, if not ignored.

One of these are married adolescents, and in countries like India where child marriages are still common enough to raise concern, “child brides are not treated as children.”

Dr. Venkatraman Chandra-Mouli, of the WHO Department of Reproductive Health and Research, says that in most of the world “adolescence is viewed as a time of changes.” This developmental stage has been recognized as a time when a child undergoes changes in various aspects—physically, socially, mentally, intellectually—in preparation for adulthood. But with early marriages, he said, this crucial period of transition disappears and there is an abrupt, jolting jump from childhood to adulthood.

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Such abrupt life changes, says Chandra-Mouli, may account for the startling fact that in many societies, “suicide has become one of the top causes of death for teenagers.” Unable to cope with the jarring demands of marital sex (often accompanied by violence) and motherhood, young women may elect to simply take their own lives.

Globally, say studies, suicide is the top cause of death among adolescent girls, while maternal mortality accounts for the second highest number of deaths among girls age 15 to 19 years old.

Much of the stress on young women, it has been found, is due to the clash between their concept of themselves and what they want from life, and the expectations of their parents and of society. “Harmful, rigid social norms,” say researchers, are a strong factor in youngsters’ mental health.

As for boys, they may be subject to “different vulnerabilities,” such as resorting to violence or embracing gang culture, if not drug use, indulging in alcohol and other dangerous activities.

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This is why, say researchers in the field of adolescent health, authorities must closely study “effective strategies to provide health and reproductive services to youth.”

Young people are a health market unto themselves, and health services and approaches must be targeted to especially appeal to young people, and more important, keep them coming back. An important strategy, they say, is to “empower young people so that they demand health services for themselves.” But for this to transpire, health center personnel must first of all be welcoming, listening and nonjudgmental.

To achieve this, health workers must themselves be trained and supported, encouraged to tailor-fit their work styles to young clients so that a health clinic “is not a stigmatizing place to go to.”

Sometimes, adult health policymakers and service providers merely mouth the need for “empowerment” of young people, even as their policies and actions achieve the opposite. When we require young people to first present written permission from a parent before accessing health services, commodities or even just advice, do we seriously think we’ll ever see them again?