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Empowerment of 154000 Adolescent Girls in India

by Institute of Health Management, Pachod, Ashish Gram Rachna Trust
Empowerment of 154000 Adolescent Girls in India
Empowerment of 154000 Adolescent Girls in India
Empowerment of 154000 Adolescent Girls in India
Empowerment of 154000 Adolescent Girls in India
Empowerment of 154000 Adolescent Girls in India
Empowerment of 154000 Adolescent Girls in India
Empowerment of 154000 Adolescent Girls in India
Empowerment of 154000 Adolescent Girls in India
Empowerment of 154000 Adolescent Girls in India
Empowerment of 154000 Adolescent Girls in India
Empowerment of 154000 Adolescent Girls in India
Empowerment of 154000 Adolescent Girls in India
Empowerment of 154000 Adolescent Girls in India
Empowerment of 154000 Adolescent Girls in India

Sunita (name changed) is a brilliant girl who was studying in the 10th class when an unfortunate incident occurred in her slum.  An adolescent couple who wanted to get married decided to run away from home but eventually ended up committing suicide. After this incident many parents were scared and reluctant to send their girls to school; Sunita’s grandmother was one of them.

 

Sunita’s grandmother thought that her grand-daughter might also have an affair and may run away with a boy. Anita’s schooling was stopped. To make it worse when she turned 16 yrs; her parents and grandmother decided to marry her with a boy who belonged to their own kinship. They were determined to arrange her marriage as soon as possible.

 

Sunita was enrolled in the life skills education being conducted in her slum by Institute of Health Management Pachod (IHMP). She told her grandmother about the risks of early marriage that she had learnt during life skills education and tried to convince her that she would never think of running away with a boy.

 

The adolescent girl’s club members visited Sunita’s house and met her family members. Initially her parents and grandmother were adamant and refused to discuss the possibility of continuing Sunita’s education. The girl’s club members made Sunita’s grandmother and parents realize that with the moral values that they had received during the life skills education; she will not even think of running away with a boy if she were allowed to continue her education. They convinced the family that their fear created from the actions of a neighbors’ daughter would unnecessarily deprive Sunita of education and the potential for a better life.

 

The next day Sunita’s grandmother visited IHMP’s community health worker’s home to inform her of the family decision to continue with Sunita’s education and delay her marriage till as long as she wished to continue studying.

 

Sunita shared her happiness by distributing chocolates to all girls in her life skills education class and the girl’s club members. She continues to go to school, and is now in the 12th class. She is happy with her achievement.

 

Every year about 5000 girls like Sunita get empowered as a result of IHMP’s life skills education. Thousands of girls have been able to negotiate with their parents and family members to continue with their education and delay their marriage.

During household visits in one slum, IHMP’s nurse, Nirmala and the Community Health Worker, Lata found a pregnant woman, Renuka (name changed) in her 2nd month of pregnancy. After the nurse registered her for pregnancy medical care, Renuka told them that she was feeling weak and lethargic since a month. Nirmala probed her for more information and found that she was only having two meals a day and her blood reports indicated that she was severely anemic.

Nirmala and Lata were quick to assess the situation and told Renuka to increase her food intake. They provided her with a daily diet intake chart designed by Institute of Health Management Pachod (IHMP), which provides the different times a pregnant woman must take meals, and the variety of food options she should choose for each meal. They told her to display the chart in her kitchen, and follow the dietary plan as closely as possible. They also explained her how to control anemia through good diet.

During their next visit, Nirmala and Lata were very pleased to see that Renuka's husband, Satish was also present and was eager to know about the dietary requirements of his wife during the course of her pregnancy. The nurse patiently explained to him about the dietary needs of a pregnant woman, and showed him the daily dietary intake chart that they had given to Renuka.

During their next visit IHMP’s nurse, Nirmala and Lata were pleasantly surprised with what they saw.

Lata knocked on Renuka's door, to be greeted by her healthy, glowing face. She led them into the kitchen and pointed to a paper stuck to the wall. The two women stared at a neat personalized, weekly, dietary intake chart that had been adapted by Satish and presented to his wife a few weeks ago. Every day Satish would go to the market and purchase food items that they had specified on Renuka’s dietary intake chart.  At the end of each day Renuka and Satish signed the chart making sure that the dietary recommendations made by the nurse had been followed. Nirmala and Lata were delighted to see that Renuka’s husband had taken such keen interest to ensure his wife’s good health.

Satish is our champion and ambassador of the month. He has been involved in sharing the dietary intake chart designed by him with the spouses of other pregnant women in nearby slums. He tells other men how his severely anemic wife improved solely with good dietary intake.  Satish epitomizes the importance of involving husbands in ensuring safe pregnancy for young women.

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For Anjana, IHMP nurse and Sangita a Community Health Worker (CHW), what started as a regular visit in Gosavi slum was about to take an interesting turn. Sangita informed Anjana of a new family that had arrived in this slum, in which a married adolescent girl, Rinki had just given birth to a baby boy two weeks ago. Anjana proceeded to visit the woman with Sangita for conducting a post-natal examination.

On reaching Rinki’s house, Anjana noted that it was a very cramped up space, most of which was occupied by a tiny bed, which was used by the mother and her newborn. The baby was very weak irritable.

After an introduction by the Community Health worker, the IHMP nurse started asking Rinki questions about her health and did her baby. Rinki told Anjana and Sangita that her baby did not drink her milk and has been crying frequently, so they were feeding him cow’s milk. Since then the newborn was having diarrhea.

Anjana was quick to ask her if she had any trouble with her breasts, to which she finally replied that her right breast was extremely painful because of which she couldn’t breastfeed her baby. On examining Rinki, Anjana found that her breast was swollen and painful, and she also had fever. Rinki told Anjana that she had attempted to get treatment at a nearby hospital but due to unavailability of beds, she was just given a few medicines and sent back home.

Anjana advised Rinki not to delay treatment any further and visit a nearby hospital right away. She heeded her advice and underwent surgical drainage of pus from her right breast after which she was admitted in the hospital for 3 days. One week later, Anjana visited Rinki for a follow up visit and was pleased to find both mother and baby were in good health. Rinki thanked her and Sangita, insisting that they had saved her baby’s life and that the doctor had said that it would have turned life threatening if she had ignored the problem any longer.

Anjana and Sangita were delighted that their timely assistance helped a woman in need.

IHMP’s nurses with the assistance of community health workers have saved many lives by detecting health problems early and taking simple steps in addressing them. IHMP would like to scale up these interventions in all the slums in this city.

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Once when Smita, an IHMP field supervisor was visiting one of our several communities where we implement our program, the community health worker in that slum told her about a certain resident, Sanjay (name changed). Sanjay is a labourer who works throughout the day and returns home late at night. He almost always avoided the community health worker when she went to speak to him. He clearly did not wish to listen to what she had to say to him. But the CHW did not cease in her efforts to communicate with Sanjay. She was adamant to talk to him.

Sanjays wife Nandini (name changed) who is just 17 years old had given birth to a baby boy 8 months ago. She wanted to begin using a contraceptive immediately after her delivery, but Sanjay was completely averse to the idea and forbade her from using any form of birth control. This behaviour resulted in Nandini becoming pregnant a mere 4 months after the birth of her first child. Due to the extreme pressure exerted on her by Sanjay and her in-laws and the fact that her husband would not listen to her pleas, Nandini went to her maternal home and underwent an abortion. After Sanjay and his family found out about this they were enraged. Sanjay continued to refuse to use any type of contraception.

After many attempts the CHW was finally able to speak to Sanjay with the help of Smita. He defended his attitude by saying that he earned enough to support his family, and that he would let Nandini undergo a family planning operation after she bore one or two more children. The CHW listened patiently to all his explanations then proceeded to tell him about the need for spacing between two children and how it would help his wife to live a long, healthy life and how it would benefit his yet to be born children by letting them lead healthier lives. She assured him that his choice would be taken into consideration while deciding the contraceptive method that would be suitable for the couple. After he was given all this information, something began to change in his mind and his concern for his wife was visible when he decided to attend the special clinic organized by IHMP.

The very next week, Sanjay and his wife came to IHMP’s outreach clinic. They were explained the ill effect of frequent pregnancies without any spacing on a woman and her new born baby. Sanjay also heard about the problem of low birth weight and its implications and finally decided to use a contraceptive to ensure a gap of 3 years between two births. The community health worker and Smita were extremely happy to hear about the couple’s decision and it strengthened their resolve to help other women who face the same problem. 

A large part of IHMP’s  work in the community has to do with changing social norms that are at the root of many of the problems faced by the married adolescent girls in these communities. Our work has to involve both the woman and her husband, sometimes even her family to bring about the change we want to see in the community. The initial patriarchal reactions our colleagues received from Sanjay are quintessential to the social norms that exist in our community. Sanjay and his family are one of many thousand couples whose lives we have been able to touch in our pursuit to improve the reproductive health status of married adolescent girls in India.

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Afreen (name changed) a recently married girl of 17 years appeared to be clueless and confused when she was asked by one of our community health workers (CHW) about the significant life changes that happen after marriage. Afreen had no idea about all this as she was married off early. She had recently shifted to one of our slums (intervention area) along with her husband Ayaz. Her husband is a daily wage worker who works in a nearby multinational company. Looking at her young age, IHMP nurse decided to ask her about her views on having children, to which Afreen said that she has no say in this matter as it completely depends upon her in-laws and her husband.

The CHW realized that not just Afreen but her in-laws and Ayaz her husband would require counseling as well. She requested IHMP’s male social worker to accompany her during her household visit to Afreen’s house. Initially it was a challenge to meet her mother in-law and husband, but our community health worker and male social worker continued to visit Afreen’s house until they could meet her husband. IHMP male social worker tried building a rapport with Ayaz and asked him some tricky questions like whether he would eat a fruit which is raw or one which is ripe? He said, “obviously a fruit that is ripe, but why are you asking me this question”. The social worker pointed out the analogy, he said “if your wife gets pregnant at a young age she would give birth to a baby that would not be fully grown and strong. It is up to you whether you want to risk her and the baby’s life or you want to wait until she is of a right age and can deliver a full term healthy baby.” The social worker further explained him about the risks involved in early pregnancy. After listening, Afreen’s husband realized the risks to which he would be subjecting his wife. He inquired how he could delay the first pregnancy? IHMP’s male social worker gave him information about condoms and other contraceptive methods which can be used to delay pregnancy.

IHMP social worker during follow up visits inquired and monitored that Afreen’s husband was taking condoms from the visiting nurse and using them regularly. He used condoms to delay Afreen’s first pregnancy. A few years later, during one of the monthly household visits of IHMP’s CHW, Afreen told her that she is pregnant. By then Afreen was more than 20 years old. She mentioned that with the help of the information shared by IHMP’s community health worker her husband had got her registered for antennal care in a nearby primary health care centre. The CHW also informed her about the appropriate diet and precautions she needs to take during her pregnancy. The CHW routinely monitored her haemoglobin level. Initially her Hb level was only 9 gms and weight was just 37 Kg but with CHWs frequent counseling on proper dietary measures her weight increased to 47 Kg. and Hb level to 10.5 gm. After completing nine months of pregnancy, Afreen gave birth to a healthy baby. IHMP nurse and social worker were very happy on seeing Afreen and her health baby.

IHMP workers have focused on counseling the spouses and other family members of married adolescent girls in order to create a family support structure for married girls like Afreen. Today there are hundreds of young men who are taking greater responsibility in providing adequate care and support to their wives, particularly during pregnancy.

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Organization Information

Institute of Health Management, Pachod, Ashish Gram Rachna Trust

Location: Aurangabad, Maharashtra - India
Website:
Project Leader:
Ashok Dyalchand
Aurangabad, Maharashtra India
$93,099 raised of $98,000 goal
 
577 donations
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