Health is (national) wealth

Statistics show that for every dollar spent on interventions for reproductive, maternal, newborn and child health, about $20 in benefits could be generated. The six finalists are trying to ensure that girls have the right information on issues like nutrition and health and reproductive and sexual health.
Hindustan Times | By KumKum Dasgupta, New Delhi
UPDATED ON MAR 03, 2014 06:06 PM IST

There are 113 million adolescent girls in India. Statistics show that for every dollar spent on interventions for reproductive, maternal, newborn and child health, about $20 in benefits could be generated. The six finalists are trying to ensure that girls have the right information on issues like nutrition and health and reproductive and sexual health.

In 1979, Ashok Dyalchand, an alumnus of Christian Medical College, Vellore, set up the Ashish Gram Rachna Trust (AGRT), and since then the organisation has been providing healthcare services in rural areas.

In 2003, that AGRT started working with adolescent girls and over the last one year, the organisation has adopted an integrated approach that comprises protecting young married women from the adverse consequences of early marriage, changing attitude of young men towards women and increasing the agency of young unmarried adolescent girls through life-skills education. In addition to these, the programme also attempts to create attitudinal changes in married and unmarried young men and thus change their attitudes towards women, and also empower unmarried adolescent girls through life-skills education.


The IMHP leverages the networks of public health workers to implement their programmes. In return, it trains them on how to conduct surveys, improve interpersonal communication skills and counsel women on maternal and neo-natal health, family planning and contraceptive use. The health workers also taught to undertake surveillance on health and information needs and morbidity among married adolescent girls and provide counseling to households to generate demand for services.

The life skill component of the programme for unmarried adolescent girls includes participatory group engagements pertaining to health and it builds life skills of adolescent girls and tries to impress upon them the need to have a continuous formal education.

"I joined the life skill course in 2000. I was 13 then. It is in this programme that I learnt about the consequences of early pregnancy. So when I got married, we consulted AGRT's doctor and used contraception. Finally when I was 19, I gave birth to a healthy girl child," said Anjana Gawade, 20, a beneficiary of the programme.

Dyalchand, who also has a doctorate in public health form Johns Hopkins University, Baltimore, says that AGRT never faced any opposition from parents when it came to discussing issues related to contraception, sexual health etc. Instead, he added, parents are actually keen that such vital information should be shared with girls above 14 years.

India has higher maternal mortality and morbidity rates than its Asian neighbours despite having a far stronger economy. "The main reason behind this is the non-implementation of the State's health policies. There are many barriers to family planning: poor quality of health care services, stigma and misconceptions regarding family planning, distrust of government healthcare facilities, lack of access to family planning facilities and easy access to abortion pills," said Collette Smith, vice-president, Bella Health Care Charitable Trust (BHCT).

The Trust's Adolescent Reproductive Health Education Programme offers age and culturally-appropriate reproductive health information to adolescents who come from poor and middle-income families.

Collette Smith
Collette Smith

The programme is delivered through four educators and cover topics ranging from puberty, anatomy, pregnancy, sexually transmitted infections and reproductive tract infections, unhealthy habits, violence and sexual assault. The pilot was implemented in Dehra Dun in 2013, and since then the Trust has provided education to 5,000 participants in 30 different slum areas.

The beneficiaries are adolescent girls between the age 13-21 in public or private schools/ colleges in and around Dehradun. "Adolescents are receptive to information on health. Some are shy at first, but eventually open up and share their feelings, concerns and stories," Male educators teach male adolescents and female educators teach female adolescents.

Evaluating the programme, Israte, an adolescent girl from Rampur, told HT: "I was ignorant about my health and menstrual hygiene. But the programme taught me about my body and how anemia is associated with irregular menstruation," she said. "The style of teaching in these classes is informal and it has changed my view about my health. I don't ignore symptoms and have adopted healthy life style."

One of the main aims of the United Nations Millennium Development Goals is the reduction of maternal and infant mortality. Keeping in line with this goal, INDCARE launched its Kishori 2 Kishori (K2K) Yojna in 2011. The programme aims to increase awareness of adolescent girls in the areas of health, hygiene, nutrition, sexual health and livelihood. It uses a participatory approach to transform trainees of the programme into future peer educators, ambassadors for the programme, and change makers for society.

"Through our programmes, we seek to create a world where women and girls have the right to live with dignity and self-respect," Reeva Sood, executive director, INDCARE told HT.

For its K2K programme, INDCARE selects 100 adolescent girls based on their vulnerability (illiterate or school dropouts), learning ability, eagerness to participate in the programme and willingness to become future trainers. Once the course is over, 10 girls are selected to become future peer educators.

Each of these trainers is expected to train another 100 girls. "There is a potential to train up to one lakh girls with the target pool of 1,000 peer educators," added Sood.

INDCARE's programmes also focus on organising various capacity-building programmes and health camps for urban slums, as well as supplying nutritious food to adolescent girls with the involvement of local Self-Help Groups.

"More than half of girls have very little understanding of menstrual hygiene and associated healthcare, leading to severe health risks."

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Menstrual Hygiene is a neglected area of reproductive health and rights in India. Only 12% of India's 355 million menstruating women/girls use sanitary napkins and the rest resort to unhygienic alternatives such as unsanitised cloth, ashes and husk sand.

Unsurprisingly, about 70% of menstruating women/girls suffer from infections. Inadequate menstrual protection makes adolescent girls (12-18 years) miss five days of school in a month and around 23% of these girls drop out of school after they start menstruating. Talking about menstrual health is still a societal taboo.

Aaina was established in 1998 with the aim to improve the health of adolescent girls. Through mobilisation, awareness and training, AAINA promotes menstrual hygiene, breaks the culture of silence and encourages girls to raise concerns related to reproductive and sexual health. There is a special aspect of the programme: the organisation not only works with rural women, adolescent girls but commendably with another group that is often forgotten: girls with disabilities (between 15 to 35 years).

"I believe information is power and only by disseminating the right information on hygiene practices to only on the adolescent girls but also their mothers and grandmothers can we ensure healthy practices and end taboos," Mishra told HT. "And my project is just trying to do that".

Evaluating the project, Laxmi, a beneficiary, said: "I found the menstrual health project interesting as it dispelled many wrong notions. Moreover, I now refuse to accept certain restrictions that are put on menstruating women. My dream is to establish an information centre in our villages where girls are made aware about their rights".

The Lok Swasthya Sewa Trust (LSST) has been working with adolescents since the 1990's but it was in 2008 that it began its interventions with adolescent girls. The Yuva Swasthya Programme (YSP) was formalised in 2010 and is being implemented in 42 villages in Ahmedabad.

The programme, which seeks to empower adolescents and youth for their health security, has a health-plus-plus approach, which includes the following aspects: health education and awareness; anatomy and reproductive physiology, with an emphasis on the menstrual cycle, contraception and family planning; how to increase nutritional value of diet; preventative health; occupational health; government public health programs and services and social and cultural issues impacting health, through a gender equality lens.

"We hold 'Know Your Body' sessions with adolescents and these sessions are a safe space for the girls to speak out, share their concerns, to develop their leadership and learn about their bodies. They collectively undertake health action like cleaning up their villages or encouraging girls to stay in school," said Mirai Chatterjee, director, SEWA Social Security.

Already, 30 beneficiaries of the programme have been invited to be members of their own Village Health Sanitation and Nutrition Committees, and are slowly raising issues that concern women and girls, like the skewed sex ratio. They also have begun to demand their entitlements for public health programmes and use the services of the nearby health centres.

"Young girls should maintain personal hygiene and have nutritious food, attend health centres and eat the food provided by the ICDS anganwadis. When we were young we did not know this. After SEWA's training we recognized the importance of eating properly," said Renuka Parmar, one of the beneficiaries.

The Sharda Mahila Vikas Society (SMVS) was set up in 2002 with the objective of empowering women to achieve their potential through economic and skill-building activities. Its Adolescent Girls Programme started as a natural transition from the SMVS' activities focused on women.

The programme aims to reduce the prevalence of anemia among girls by 15%; improve personal hygiene practices, increase awareness about the hazards of addictive substances, improve menstrual hygiene and build capacity of girls to deal with sexual harassment.

The SMVS implements the programme directly with the communities in five villages of Jhagadia block in Gujarat, as well as in 25 schools in these villages. In all, the organisation reaches out to 1,400 adolescent girls. The reason for the dual approach of going directly into the villages as well as working in schools is the large population of out-of-school girls in Jhagadia - 41% of adolescent girls have dropped out of school to join the labour force or help with household work, and the only way to reach them is to work with them in their communities.

"Through community-based intervention aimed at developing a cadre of peer educators and designing innovative solutions we are successful in overcoming common health problems faced by tribal adolescents such as anemia, lack of personal and menstrual hygiene, tobacco addiction, sexual harassment," said Shobha Shah, programme coordinator, SMVS.

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