24.M. Workshop: Deprived adolescent children access to health
Authors:   Organised by: EUPHA Migrant and ethnic minority health section, EUPHA Child and adolescent public health section, Public Health Program Open Society Foundations,   Chair persons: Bernadette Kumar – EUPHA-MIG, Danielle Jansen - EUPHA-CAPH
Published: October 2020

Abstract
Adolescence is a vulnerable phase in human development. The age of the mother is essential for normal pregnancy and delivery with a good outcome. Sixteen million of mainly deprived adolescents give birth each year, constituting 11% of all births world-wide. Maternal and newborn health is one of the key markers of health inequalities worldwide. It has been ranked as the third leading source of funding for health and reproductive health with an investment of US$ 12.6 billion between 2013 and 2015. This workshop with five panelists will raise the importance of using the right data for analysis and advocacy on improving preventive health program effectiveness targeting deprived minor adolescents globally, by highlighting the case of Roma adolescents' in Bulgaria. Moreover, the Bulgarian law does not allow an independent access to gynecologist for anyone below 16 years, which includes the most at risk children with no supportive formal guardians or parents. Sanofi Espoir Foundation's evaluation of a decade long investments on reducing health inequalities will highlight the importance of adjusting preventive health programming to specific needs of the excluded adolescents globally by emphasizing irregular outcomes and often no real and sustainable impacts, despite numerous stakeholders, significant amount of energy and money engaged. Additionally, presentation on Bangladesh comparing trends of perinatal mortality in two rural Areas of Matlab over nine years, and on Nepal focused health impacts of parental migration on left-behind adolescents will share magnitude of insufficient attention to addressing access to health of deprived adolescents, especially in connection to their sexual and reproductive health. There is also an insufficient adjustment of preventive health programming targeting excluded Roma adolescents in Europe due to an insufficient application of the UN CRC participation principle in these programming. An example of Bulgaria shows a disproportional disadvantaged experience of deprived Roma children particularly visible in relation to health. Adolescent girls of Roma origin are particularly vulnerable because they face the risks of premature pregnancy and childbirth and premature childbirth. The percentage of low birth weight infants is more than four times higher among Roma children which carries a range of grave health risks for children. More than half of Roma women between the ages of 20 to 24 years were married before the age of 18. Prevalence of teenage parenthood among Roma girls is higher and the immunization coverage among segregated Roma communities is far below recommended 90%. The perspectives of the children who are the most in need of preventive health services is very often missing in the design, implementation and monitoring of these, as these programming is predominantly done through schools, even though these children are frequently outside of educational systems especially in teenage years.

Key messages
Deprived adolescents out of schools should be included in all phases of health programming that is their immediate concern including planning, implementation and evaluation phase. Health laws limiting access to health for minors should be adjusted for children with disadvantaged socio-economic background.