Empowerment of 200000 Adolescent Girls in India

by Ashish Gram Rachna Trust: Institute of Health Management, Pachod
Empowerment of 200000 Adolescent Girls in India
Empowerment of 200000 Adolescent Girls in India
Empowerment of 200000 Adolescent Girls in India
Empowerment of 200000 Adolescent Girls in India
Empowerment of 200000 Adolescent Girls in India
Empowerment of 200000 Adolescent Girls in India
Empowerment of 200000 Adolescent Girls in India
Empowerment of 200000 Adolescent Girls in India
Empowerment of 200000 Adolescent Girls in India
Empowerment of 200000 Adolescent Girls in India
Empowerment of 200000 Adolescent Girls in India
Empowerment of 200000 Adolescent Girls in India
Empowerment of 200000 Adolescent Girls in India
Empowerment of 200000 Adolescent Girls in India

 

A  SHY NEWLY WED FINDS A CONFIDANTE IN IHMP’s COMMUNITY HEALTH WORKER!

Sunita (name changed) lived in a small village and had stopped going to school when she started her menstrual periods at the age of 13 years.

She lived with her parents and three siblings and being the elder daughter took care of all domestic chores such as cooking, cleaning utensils and washing clothes of her family members. The parents were eager to get her married as soon as possible and had found an eligible young man from the neighbouring village who worked in the city of Pune.

Within two years the parents married her off. She was 17 years old when this young bride came to live in the slums of Pune with her husband who worked as a daily wage labourer. Suddenly this young girl was faced with the hardships of living in a slum that was lacking the most basic amenities and of managing home in a temporary shelter. In addition she now had to care for her parents-in-law who were living with them.

Since she had not known her husband or the in-laws previously she was extremely shy to talk to them. She had no friends in the slum and her world was confined to one room where she lived with her husband and his parents.

Within a few days of marriage she began to have burning sensation while passing urine and having sex with her husband became extremely painful. She was terrified of this new development but suffered silently. She was embarrassed to tell this to her husband and to her mother-in-law. The fear of bringing shame on her parents due to disclosure of her symptoms stopped her from sharing this information with anybody.

IHMP’s community health worker and ANM went to her house to provide information about reproductive and sexual health. As they explained about various infections that can occur in the reproductive track she was relieved that she could now talk to these sympathetic women who were knowledgeable about symptoms that she was experiencing. She confided her problem to the nurse who advised her to visit the hospital and see the Gynecologist. But that was not the complete solution…. She knew she was not allowed to go out of the house alone!  Again the nurse and community health worker came to her rescue! “I will take you to the hospital” the community worker said. But the mother-in-law had to be told and Sunita was embarrassed to tell her. The nurse then sat the mother-in-law down and told her about the pain and burning that Sunita was experiencing.

Fortunately the mother-in-law listened attentively as these conditions were explained to her. She was concerned about Sunita’s health and immediately agreed to take Sunita to the hospital to consult the Gynecologist.

The next day Sunita and her mother-in-law went with the community health worker to the hospital. Sunita was examined and proper treatment was given to her.

After a week, a happily smiling Sunita and equally happy mother-in-law welcomed the community health worker and the nurse into their home. An open and friendly relationship was established.

Based on IHMP’s programme objectives the community health worker advised Sunita to use temporary contraceptives to delay first pregnancy and take a proper diet during pregnancy. The advice was received with enthusiasm by Sunita and her mother-in-law.

She was encouraged to speak boldly and discuss health and personal issues with her in-laws and husband. The interpersonal counseling helped her to become self confident and her self esteem improved within a short time. It is now two and half years since Sunita got married and is living in a slum. She plans to have her first pregnancy now as she feels she is ready to take on the responsibility of motherhood.

More than 70 percent women in the slums where IHMP works said that they got married before reaching 18 years and had come from a remote village. They did not have any friends, known neighbours or family members whom they could depend upon for advice and assistance. IHMP’s community health worker bridges this gap in providing an alternative to family and community support systems for these young and vulnerable newlyweds.

IHMP has been invited by the Government to expand its operations from an earlier target of 6000 adolescent girls to reach 154,000 unmarried and married adolescent girls. We hope to empower these girls, prevent child marriage, and protect them from the adverse consequences of early motherhood.

The IHMP mission statement reads, ‘Use of INNOVATIONS to EMPOWER lives and build a HEALTHY community.’

After 38 years of being involved with vulnerable communities, constantly innovating processes of training and interventions to address key issues, and scaling up these innovations to impact countless lives, we have decided to change our logo to reflect our mission and identity.

 The new logo symbolizes KNOWLEDGE AND HEALTH WITHOUT BOUNDARIES.

Please visit our new website to see our logo and to access information on adolescent girls in India.

WEBSITE: www.ihmp.org

We look forward to working with you so that together we can change lives.

We request you to share our work with your friends so that we can enlarge the network of people who would like to touch the lives of adolescent girls.

Community Health worker
Community Health worker
Health care Center
Health care Center

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Girls after completing Life Skills Education Class
Girls after completing Life Skills Education Class

Dear friends and supporters,

 Thank you for your generous donation. Your support helps us continue in our mission to empower and protect adolescent and young married women in our community. You will be delighted to learn that the Government has asked us to scale up our model for the empowerment and protection of adolescent girls. Your support will help us to scale up the project from 6000 girls to reach 154,000 adolescent girls. We will provide life skills education to delay age at marriage and deliver health services to young married women to reduce the burden of morbidity that they experience as a result of early motherhood. This quarter we have provided reproductive health services to young married women, conducted life skills education training for unmarried adolescent girls, distributed bicycles to girls for continuing their high school education and undertaken gender sensitization for young men in both rural areas and urban slums.

 In urban slums: In this quarter 285 pregnant women received antenatal care services, 47 pregnant women were referred and treated for maternal morbidity, 138 women were referred for treatment of reproductive tract and sexually transmitted infections. 309 young women were provided contraceptives to space child birth. A total of 213 unmarried adolescent girls completed life skills education. A four day workshop on Sexual and Reproductive Health was conducted for unmarried adolescent girls, which resulted in a significant increase in their knowledge of sexual and reproductive health.

 In the Rural setting: In rural area, our community health workers rendered services to 645 married adolescent girls in this quarter. Antenatal services were provided to 279 pregnant girls. The proportion of young married girls using temporary contraceptives has increased to 28 percent.

 This quarter we conducted Life Skills education training for 32 Life Skills Education teachers. Soon after their training they started classes in their villages. During this quarter we conducted a four day sexual and reproductive health workshop for 245 adolescent girls and 17 married adolescent girls. Computer and internet training was given by 26 peer leaders and a total of 142 adolescent girls were covered. Our field coordinators selected and trained 46 new peer leaders. Bicycles were distributed to another 25 girls who belong to families living below the poverty line, to continue their high school education.

Gender sensitization of young men is an important component of our project.  In this quarter, 144 group meetings were organized at the village level, with 24 youth groups. In all 2499 youth attended these meetings. In this quarter, 48 peer leaders disseminated information to 610 youth in their villages. We anticipate a measurable reduction in sexual and domestic violence.

Case Study

Kavita (name changed) was identified with 5 months pregnancy by our community health worker during their house visits. Her family was extremely superstitious. When our nurses and health worker asked her to come for an antenatal check up, her family refused to cross the road after 12 pm as they believed it would be inauspicious for the pregnant lady. The antenatal check up was done at her home by our nurses in the presence of her mother- in-law. Abdominal examination, weight and blood pressure were within normal limits at the time of the first examination.

 She did not register herself for antenatal care in a hospital. The importance of registration in a hospital was explained to her and her mother-in- law. Various danger signs during pregnancy and risks of unsupervised home delivery were told to her and her family. Nurses also explained the importance of balanced and nutritious diet for the health of the mother and the baby. Fortunately they listened attentively to everything and agreed to get Kavita registered in a hospital.

 On the second visit by IHMP’s nurse, her blood pressure was found to be quite high. Kavita had swelling over face and feet, which is one of the more grave danger signs during pregnancy. She also complained of burning when passing urine and severe headache, two other serious danger signs during pregnancy. Our nurse referred her to the hospital immediately. Kavita’s mother-in-law herself took her to the hospital. She was found to be anemic and hypertensive when she was examined by the doctors in the hospital. The attending doctor prescribed a course of injections to treat her anaemia and also advised her to get her blood pressure checked twice a day for 5 days in a nearby clinic. She was given treatment for urinary infection and high blood pressure. The doctor explained to her family the possibility of delivery by Caesarean section if her blood pressure continued to remain high.

Kavita took the medicines regularly, followed the advice about nutritious diet given by our nurse. She was blessed with a baby girl weighing 3500 gms. Kavita had a normal delivery!! She and her family were very happy. But the baby suffered from neonatal jaundice after birth. Once more this was detected very early by our nurse during her house visit and she took Kavita and her baby girl to the hospital once again. The baby recovered from jaundice within a week. Both the mother and baby are healthy and extremely happy.

Kavita is the archetype of the burden of morbidity that a majority of adolescent girls suffer as a result of early motherhood. Your support enables us to visit these girls on a regular periodic basis, detect these morbidities early and link these girls to medical facilities. This project has saved the lives of many girls and their newborn babies. Your support has encouraged us to increase our target from 6000 girls to 154,000 adolescent girls. Please share Kavita’s story with ten of your closest friends.

Family from rural setting
Family from rural setting
Girls going to school on bicycle
Girls going to school on bicycle
Sexual reproductive health workshop
Sexual reproductive health workshop
Young boys and men- gender sensitization
Young boys and men- gender sensitization
Nurse with a married woman & her mother in law
Nurse with a married woman & her mother in law

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Dear friends and supporters,

Thank you for helping us in our goal to create a “favourable” world for adolescent girls, a world in which girls are not obstructed from reaching their full potential, either by their families or their communities, a world in which girls can stay in school, get access to health services, get married and have children when they choose and realise their economic potential and aspirations. This quarter we have provided reproductive health services to married and young married women and conducted life skills education training for unmarried adolescent girls in both rural and urban area.

In the urban sector: Our Community Health Workers conducted 3530 home visits and provided comprehensive reproductive health services to 1178 married adolescent girls and young married women. In this quarter 122 pregnant mothers received antenatal care services, 70 were referred and treated for maternal morbidity, 207 were referred for treatment of reproductive tract and sexually transmitted infections and 294 young women were using temporary contraceptives to space child birth.

Life skills education classes for UAGs were conducted in 12 CHW areas in the reporting quarter. A total of 249 UAGs were covered for LSE.

190 UAGs completed 48 Sessions of LSE.

A workshop for unmarried adolescent girls was conducted during the reporting period. A film on adolescent rights was shown during the workshop. As a part of the workshop, visits to two institutions i.e. Post office and Police station was organized to orient the girls about the functioning of these two institutions. A book on “Prevent Anaemia” was distributed to all the girls.

Case Study:

Ishita (name altered) is 14 years old and lives in Vaiduvadi slum. Ishita is one of the adolescent girls, who attends the‘Life Skills Education’ (LSE) classes conducted by IHMP. Her mother works as a house maid and her father is auto rickshaw driver.

In November 2015, Ishita’s  grandmother was severely ill and bedridden. As there was no one else to look after the grandmother, Ishita’s parents coerced her to drop out of school and look after her grandmother. Ishita continued to miss school for over a month, and from that point onwards, her school education stalled till January 2016, when she was selected as a peer leader by her adolescent Girl’s club. Along with all the other peer leaders from neighbouring communities, IHMP provided special training on leadership and rights of adolescent girls to Ishita.

After being inspired by this workshop, the Community Health Worker (CHW) of her slum and Ishita decided to have a discussion with her parents regarding her education. The CHW convinced Ishita’s parents to allow her to study further. She discussed the importance of continuing her education and the adverse consequences of dropping out of school. Ishita’s parents were convinced and decided to resume Ishita’s education. Over the next few months, Ishita started attending her classes in school. Currently, Ishita is in the 9th grade and has successfully completed the course of Life Skills Education (LSE) conducted by IHMP. Ishita also received special training under the LSE program on leadership skills. Motivated by her own life-changing experience, she inspires many other girls to stand up for their rights.

In the Rural setting: In rural area, our community health workers rendered services to 544 married adolescent girls. In all 476 girls and their families were provided interpersonal communication and counseling. Antenatal services were provided to 117 pregnant girls. All the 117 deliveries were conducted in a hospital setting. From a low of 9 % the proportion of young girls using temporary contraceptives has increased to 27 percent. In this quarter 416 girls are attending life skills education. Parent’s meeting was organized in the project and 297 parents attended the meetings this quarter.

For improving their communication skills and making girls more confident, debates and elocution contests were organized in the project villages. An elocution contest on the subject ‘My Dreams’ was organized in which 300 girls participated. Simultaneously a debate was organized on the topic ‘Freedom for girls is a birth right” in which 185 girls participated. At their request, practical skills in the use of sewing machines were imparted to 120 girls.

Gender sensitization of Young men is an important component of our project.  In this quarter, 144 group meetings were organized at the village level, with 24 youth groups. In all 2471 youth attended these meetings. The topics discussed this quarter were - male participation in family planning, various manifestations of male dominance and factors associated with it. Two peer leaders have been trained for each youth group. The peer leaders disseminate information to youth that are not members of the larger group. In this quarter, 48 peer leaders disseminated information to 408 youth in their villages.

However, our project has received a setback because of a severe drought in this region. We are making a special appeal for your support to address the consequences of scarcity of drinking water.

The international media has carried accounts of the heat wave that is causing unparalleled misery in India. What has gained less attention is the paucity of drinking water.  The Marathwada region of the State of Maharashtra is suffering from the third successive year of drought, which has attained crisis proportions.

With this report we are attaching various news article dated from April 19,20, 21, 26, 30, 2016 from The Times of India, one of the largest national news papers.

IHMP is working in two out of the eight districts in this region where there is scarcity of drinking water

Women and adolescent girls are being exposed to the risk of injuries and sun stroke as they are the ones who have to walk for miles or descend into dangerously deep wells and scrape the bottom of the well to get a pot-full of drinking water for the family.

Thousands of villages are being supplied water by tankers that fill water from wells that are muddy and contaminated.

Cases of diarrhoea and dehydration have reached epidemic proportions.  On 20 April 2016, The Times of India carried a lead article entitled (please find it attached): Diarrhoea, Exhaustion hits teens and elderly

Another article in the same Newspaper on 26 April 2016 (please find it attached) reported that the problem of contaminated water is widespread as a result of depleting water sources

How is IHMP planning to address this problem?

  1. To provide water tanks to 100 villages
  2. Provide 30,000 families with water filters and a 6 month stock of Chlorine tablets for water purification at the household level
  3. Identify and treat diarrhoea cases
  4. Refer cases of dehydration to the nearest hospital 

Please help us save lives

Water tank at the community level costs                     £ 1200

Water filter at the household level costs                       £ 20

Chlorine tablets for use at household level cost           £ 5

Nurse at the Primary health care centre
Nurse at the Primary health care centre
Only 3% water level in Marathwada
Only 3% water level in Marathwada
12 year old dies fetching water
12 year old dies fetching water
Marathwada water most foul
Marathwada water most foul
Diarrhoea, exhaustion hits teen and elderly
Diarrhoea, exhaustion hits teen and elderly
Drought puts 14 year old into marriage
Drought puts 14 year old into marriage

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Adolescent girls rally.
Adolescent girls rally.

Dear Donors, thanks for helping us to help the needy. Your generous donations enabled us to empower 1500 adolescent girls through our pretested intervention of Life Skills Education. In many communities, adolescent girls often lack spaces to build their confidence and self-esteem in constructive and healthy ways, particularly when it comes to communicating their needs and wants, exercising their rights, and expressing their emotions.

Building inner strength and making good choices are two of the most important ways we can help a girl to learn. Often, inner strength is called ‘self-esteem’.

We conducted Life Skills Education (LSE) classes for unmarried adolescent girls to help them build their confidence and self esteem. It is being executed in rural as well as urban area.  The proportion of girls with low self esteem reduced from 9% to 2% and proportion with low self efficacy from 14% to 3%.

Rural: In this quarter, 46 LSE classes were conducted and on an average 455 adolescent girls attended the LSE class. Five supervisors were assigned to supervise the LSE classes.

A rally of adolescent girls on “Preventing Child Marriage” was organized in 20 villages where a total number of 1164 girls participated to make the event successful. There was one more rally conducted on “Importance of Education for Girls” in 20 villages in which 1220 girls participated. A street play was organized in the month of October in 16 villages. The theme of the play was preventing child marriage.  The chief guest for the function was Smt. Jayashree, a renowned social worker and a research person who trained girls in performing street play. An audience of 1655 people was present for this play.

In the rural sector Life Skills Education for unmarried adolescent girls is well established and evaluated as it has been implemented since 2013.  Based on this experience IHMP has adapted life skills education for adolescent girls living in urban slums.

Urban: In urban slums LSE classes for unmarried adolescent girls started in August 2015. LSE classes in the urban context are conducted over weekends considering the school schedule of adolescent girls. A total of 203 girls from 9 slums attended LSE classes. Supervision of LSE was carried out through IHMP field coordinators.

We believe that using different kind of participatory activities makes the session more interesting for everyone. Moreover it helps girls to open up and respond.

IPC to parents of adolescent girls: Home based inter-personal communication (IPC) and counseling was planned and carried out for the girls who were found to be irregular at the LSE sessions. Home based IPC was provided by the field coordinator along with CHWs. During these visits counseling on importance of LSE, topics that are covered in the LSE curricula, etc. was provided. A total of 130 IPC sessions for girls and their parents were conducted. As a result 60 girls started attending the LSE classes regularly.

Peer leader selection and training: Two girls from each LSE class were selected as peer leaders. A total of 18 girls were selected as peer leaders from 9 LSE classes. Leadership training of 3 days duration was organized for peer leaders. A total of 17 peer leaders, 9 CHWs and IHMP field coordinators participated in the training. Participatory methods were used to generate discussions among girls.

Impact of LSE on cognitive skills: A total of 206 girls participated from 9 CHW areas in the pre-test and 180 girls were covered during the post test in the urban. There was a measurable and significant increase in cognitive and practical skills among the adolescent girls.

Case Study

Kalpana is a resident of Georai. She is 16 years old and studying in 11th standard. She completed ‘Life Skills’ course from the first batch of Life Skills Education in her village. She is a member of the adolescent girls club (Kishori Mandal). Her mother has studied up to 7th standard and works as the ASHA in her village. Her father has studied up to 9th standard and he works as an agriculture laborer.

She attended ‘Life Skills’ classes regularly. She learnt about the importance of education from the Life Skills classes. She could not afford to go to coaching classes or take tuition because of the poor economic condition of her family. She decided to do self studies in 10th standard. She got 67 percent marks in 10th Board exams because of systematic study and hard work.  She also used to go to work as an agricultural laborer with her mother during holidays. The money she earned was used for buying books and stationary required by her. She wants to do general nursing after 12th standard. She has decided to get married only after completing her education.

She was selected as a peer leader by her friends because she is always willing to help others in their studies.  After attending peer leader training, she has started writing reports for the adolescent girls club (Kishori Mandal) activities in the minute’s book given to them.  She learnt how to draw ‘mehendi’ (Henna) designs in her Life Skills classes. Now if there is a wedding of a girl in the village, she is called to do henna ‘mehendi’ for the bride.  She participates in the street play and encourages other girls also to take part.

Kalpana says “because of Life Skills education, my self-esteem has improved and I realized who I am? Now I do not hesitate to speak in front of anyone and I can express my opinion very well”.

 

Adolescent girls taking part in street play.
Adolescent girls taking part in street play.
Adolescent girls applying henna art.
Adolescent girls applying henna art.
Adolescent girls on their way to attend LSE class
Adolescent girls on their way to attend LSE class

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Institute of Health Management, Pachod (IHMP) started the “Integrated reproductive, sexual health and family planning project for young married women” in urban slums of Pune city in 2015. The project is supported by Yardi Software India a Pune based IT company. Project implementation was initiated in May 2015, after conducting a baseline study. The key activities involved in the project are:

 

Monthly surveillance by the CHWs - : Community Health Workers (CHWs) recruitedby IHMP,oneper slum, for 12 slum areas, conduct monthly home visits to assess health and information needs of each household including any reproductive morbidity.

Need specific behavior change communication and communication through a social norms approach: During home visits the CHWs provide need specific - interpersonal communication and counselling. Monthly group counselling sessions are conducted for young married women and their parents. During this quarter 30 sessions were conducted and 527 adolescent girls attended the group meetings.

Life skills education was initiated at the slum level for unmarried adolescent girls. In 12 slums, 221 adolescent girls are attending life skills education classes.

Outreach services by IHMP ANMs: Primary level care for maternal and reproductive health is being provided through project staff. Sixty two clinics were organized in this quarter and 1150 young married women were provided reproductive and sexual health services.

Specialised clinic started at PUHC- Clinics for emergency obstetric and gynaecological services were started at the primary urban health centre from August 2015 to improve access to specialised care for high risk women from our slums.

Community based monitoring (CBM) through slum health and development committees (SHDC) in 12 project slums - A total of 139 slum residents from the project area are actively involved in monitoring project activities in order to ensure that young women receive the services that they require.

 

Case Study: Siddhi gets a second chance to go to school

 

Siddhi, a 13 year old girl in one of our slums had stopped going to school for the last two years.

 

She grew up in a household in Pune where she and her younger sister assumed all the household responsibilities while her two brothers were able to attend school. Siddhi left school and started helping her mother who works as a laborer at a construction site.  Her younger sister goes to school occasionally as the family cannot afford the school fees and travel costs.

 

Siddhi's father deserted the family when her mother was six-months pregnant. Her mother fell sick and couldn't work. The full burden of the household fell on young Siddhi's shoulders.

 

One of our Community Health Worker identified Siddhi’s plight and brought it to the notice of our staff and requested IHMP to find a solution. Siddhi and her sister were immediately enrolled for Life Skills Education that is provided by IHMP in their slum.  Along with basic education, the sisters were taught about nutrition, health and hygiene, as well as other topics that are useful in their day-to-day lives. 

 

After that we went to the school where Siddhi was previously enrolled and tried to get her re-admitted so that she could fulfill her dream of getting an education. However, the school was not willing to take her back unless the pending fees for the previous two years were paid. The family could not afford to pay the school fees.

 

IHMP identified donors who agreed to pay the fees and support Siddhi and her sister’s education. Today, both the girls are no longer laborers. Instead, every morning, they dress up proudly in their pink and maroon school uniforms. They carry their books in their school bags and wait for the school bus like the other children.

 

We were successful in supporting Siddhi because of our generous donors. Siddhi is excited that she is ready to catch up with her missed classes and hopes to join her friends in the ninth grade soon.

 

Siddhi’s mother says, “My children would have remained illiterate if IHMP wasn’t there. IHMP was the one that provided the opportunity for my children to lead a better life and have a brighter future. Now I really understand the value of education. It has the capability to bring an immense change in a person’s life.”

 

“Girls’ education is the single best investment we can make to fight poverty”.

 

For more information about our work please visit our

Facebook page at: https://www.facebook.com/InstituteofHealthManagementPachod

our Twitter at: https://twitter.com/IHMP_Pune.

Our website in currently being redesigned and will be completed soon.

*all beneficiary names in this report have been changed

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Organization Information

Ashish Gram Rachna Trust: Institute of Health Management, Pachod

Location: Aurangabad, Maharashtra - India
Website:
Project Leader:
Ashok Dyalchand
Aurangabad, Maharashtra India
$157,484 raised of $250,000 goal
 
1,038 donations
$92,516 to go
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