Adolescence is a vulnerable phase in human development as it represents a transition from childhood to physical, psychological and social maturity. During this period, adolescents learn and develop knowledge and skills to deal with critical aspects of their health and development while their bodies mature. Adolescent girls, especially younger girls, are particularly vulnerable because they face the risks of premature pregnancy and childbirth. Since the beginning of 2000s, however, there has been an increase in adolescent births in East Asia and the Pacific regions (UNICEF, 2019[1]). The Global Strategy for Women’s, Children’s and Adolescent’s Health 2016‑30 was launched to foster a world in which “every woman, child and adolescent in every setting realises their rights to physical and mental health and well-being, has social and economic opportunities, and is able to participate fully in shaping prosperous and sustainable societies” (WHO, 2015[2]).
The 1.3 billion adolescents (10‑19 years) in the world today represent 16% of the global population, and the regions of South Asia, East Asia and the Pacific have the largest number of adolescents in the world with more than 660 million (UNICEF, 2024[3]). In 2022, more than 910 300 adolescents died (WHO, 2024[4]). Injuries (including road traffic injuries and drowning), family, domestic and sexual violence, self-harm and maternal conditions are the leading causes of death among adolescents and young adults. Half of all mental health disorders in adulthood start by age 14, but most cases are undetected and untreated (WHO, 2023[5]).
Thinness in adolescents is associated with adverse health consequences throughout their life course. While the prevalence of overweight and obese children and adolescent in high-income countries and territories was two times the prevalence reported for lower-middle- and low-income Asia-Pacific countries and territories (see indicator “Overweight and obesity” in Chapter 4), the prevalence of thinness was high in lower-middle- and low-income countries in the region. It was high among male adolescents compared to female adolescents in all Asia-Pacific countries and territories. In India, where the prevalence was the highest, almost one in four male adolescents and almost one in five female adolescents were thin (Figure 4.9).
Risk factors for non-communicable disease (NCD), the leading cause of premature adult deaths, are often acquired in adolescence. They include alcohol or tobacco use, and lack of physical activity. While alcohol use or lack of physical activity lead to an increased risk of overweight, obesity and diabetes and tobacco use to an increased risk of diabetes, they ultimately lead to a higher risk of NCDs across the life course (see indicator “Tobacco” in Chapter 4. WHO recommends at least 60 minutes of moderate‑ to vigorous-intensity physical activity accumulated every day (WHO, 2020[6]). However, the majority of adolescents in Asia-Pacific countries and territories do not carry out sufficient amount of physical activities every day, and the prevalence of inactivity in the region is the highest in the world (Guthold et al., 2020[7]). Globally 31% of adults and 80% of adolescents do not meet the recommended levels of physical activity (WHO, 2024[8]). In Korea and the Philippines more than nine out of ten adolescents were inactive, while in Bangladesh about three out of ten adolescents did the recommended physical activity daily. In most of the countries and territories in the region, inactivity was more prevalent among female adolescents than male adolescents (Figure 4.10, left panel).
Adolescent pregnancies are a global problem that occurs in high-, middle-, and low-income countries and territories. Around the world, adolescent pregnancies are more likely to occur in marginalised communities, commonly driven by poverty and lack of education and employment opportunities. For some adolescents, pregnancy and childbirth are planned and wanted. However, for many adolescents, pregnancy and childbirth are neither planned nor wanted. Adolescents face barriers to accessing contraception including restrictive laws and policies regarding provision of contraceptive based on age or marital status, health worker bias and/or lack of willingness to acknowledge adolescents’ sexual health needs. Adolescents face also difficulties in accessing contraceptive methods because of lack of adequate knowledge of these methods, and transportation and financial constraints. Adolescent pregnancy remains a major contributor to maternal and child morbidity and mortality, increased preterm births and low birthweight and to intergenerational cycles of ill-health and poverty. Adolescent pregnancy can also have negative social and economic effects on girls, their families and communities. Around 3.9 million unsafe abortions among girls aged 15‑19 years occur each year, contributing to maternal mortality and lasting health problems (Darroch et al., 2016[9]). Unmarried pregnant adolescents may face stigma or rejection by parents and peers and threats of violence. Similarly, girls who become pregnant before age 18 are more likely to experience violence within marriage or a partnership. With regards to education, school-leaving is often the consequence when adolescent girls become pregnant, and this hinders their likelihood of returning into education and future employment opportunities (WHO, 2020[10]).
Adolescent birth rates vary widely across Asia-Pacific countries and territories. In Lao PDR and Bangladesh, more than 70 out of 1 000 adolescents gave birth, whereas in Hong Kong (China), DPRK, Korea and Macao (China), the birth rate was as low as 1 out of 1 000 adolescents. On average across lower-middle- and low-income Asia-Pacific countries and territories, about 1 out of 20 women aged 15‑19 gave birth, over twice the average rate reported for upper-middle-income countries and territories and 10 times the average rate reported for high-income countries and territories (Figure 4.10, left panel).
