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October 2016, Volume 66, Issue 10

Letter to the Editor

Adolescent girls empowerment can save their future

Hina Ahmed  ( Fatima Memorial College of Medicine and Dentistry, Lahore, Pakistan. )
Inayat Thaver  ( Al-Shifa School of Public Health, Rawalpindi. )
Roomi Aziz  ( Nur Centre for Research and Policy, FMS, Lahore. )
Abbass Munir  ( Nur Centre for Research and Policy, FMS, Lahore. )

Madam, Pakistan is going through a phase of \\\'demographic transition \\\'with a big portion of population comprising of children.1 Adolescent health is one of the areas of major health concern in Pakistan2 which constitute 32.6% of Pakistan\\\'s population: 65% of them live in rural areas. According to Pakistan Demographic and Health Survey (PDHS) 2012-2013, the median age at first marriage has increased, about 50 % of Pakistani women are married off at the average age of 19 years, with 13 % married by the time they are 15, and 40 % by the age of 18 years.2


Emphasis is being made on delaying these types of marriages and pregnancies by the civil society and in fact Province of Sindh has passed a legislation for this.3 Adolescent girls in Pakistan are considered the responsibility of the families and the husbands. Education partly play a role in making health related decisions. Majority of them get married between the age of 15-19 years, are illiterate, not working and have a family income of between 10,000-15000/month.3 However, they are also availing health services through government health facilities.  It is noteworthy, that school teachers are playing an important role in offering guidance to their reproductive and social rights, including, decisions for marriages and continuing their education.3


It appears that challenge of adolescent marriages and its consequences can be addressed by increasing the secondary and post-secondary schooling enrolment. Article 25-A of the constitution of Pakistan states that free compulsory primary education shall be provided to all.4 However, it is imperative to invest in secondary education of young girls if not done would leads to early marriage resulting in social exclusion; furthermore it can enhance a young girl\\\'s chance of being involved in economic activities.5 Thus female adolescents\\\' education need lot of advocacy at higher level and mobilizing communities at grass-root levels. There is a need for further in depth studies for identifying the decision making process of the adolescents (both for health seeking and reproductive health) and whether it\\\'s the adolescent herself or their parents\\\' empowerment which makes a difference. 

References
1.Durr-e-Nayab. Demographic Dividend or Demographic Threat in Pakistan? Pak Dev Rev 2008; 47: 1-26.
2.Butt KM, Naveed S. Causes and Consequences of Child Marriages in South Asia?: Pakistan\\\'s Perspective. 2015; 30: 161-75.
3.Sarfraz S, Akhtar T, Aziz R, Gul M. The Snapshot of poor adolescent girls nutrition and related issues in Pakistan. Research and Advocacy Fund Report March 2014. [Cited on October 2015]. Available from URL: https://issuu.com/ncrp/docs/raf_research_summary_report.
4.Awaz Foundation Pakistan: Centre for Development Services. Impact of Early Age Marriages on Girls\\\' Right to Education 2010. [Online] [Cited 2014 Mar 19]. Available from URL: http://www.endchildmarriages.org/wp-content/uploads/2014/11/Early-marriage.pdf.
5.Presler-Marshall E, Jones, N. Charting the future: Empowering girls to prevent early pregnancy. [Online] [Cited 2014 Mar 19]. Available from URL: http://www.odi.org.uk/sites/odi.org.uk/files/odi-assets/publications-opinionfiles/7724.pdf.

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: