Empowerment of 200000 Adolescent Girls in India

Monali (name changed), a 17-year-old newlywed, lives in Wahegaon. She got married when she had just turned 17 years. Her husband is a marginal farmer, and their financial condition is not good. They live in joint family with Monali’s in-laws.

During her routine household visit, Alka the community health worker (ASHA), identified Monali as a newlywed adolescent girl who had recently come to her village. During Alka’s visit, Monali looked scared and reluctant to talk. Her in-laws home, the neighbours, the village where her in-laws live, everything was alien to her. She did not have any friends from whom she could get information.

When Institute of Health Management Pachod (IHMP’s) frontline workers visited her home along with the ASHA, they asked her if she had thought about pregnancy and childbirth. She told the workers that her husband and in-laws wanted her to have a baby as soon as possible. The workers discussed with Monali, the risks of pregnancy for an adolescent girl. She said her in-laws may not agree to delay childbirth. Monali said she would discuss contraceptive use with her husband and get back to Alka the ASHA in her village.

IHMP’s workers told Monali that they would return when her husband came back from their farm. On their next visit they counselled him about the risks of early motherhood. After much discussion Monali’s husband agreed to convince his parents.

When asked about family planning, IHMP’s staff found that neither Monali nor her husband knew anything about family planning or contraceptive use. Recognizing their need, the staff counselled Monali and her husband about the most suitable contraceptive for the couple.

Monali’s husband agreed but her in-laws were insistent that they wanted a grandchild as soon as possible. The ASHA along with the front-line workers made another visit, this time to meet Monali’s in-laws. The ASHA met with Monali’s in-laws and counselled them about the dangers to the mother and her unborn child, if Monali were to become pregnant at such an early age.

Monali her husband and her in-laws all agreed to postpone childbirth till she reaches 20 years of age. Monali’s husband is using condoms to avoid pregnancy. The ASHA ensures a steady supply of condoms.

Changing the social norm that forces girls to prove their fertility, soon after they get married, is not easy to change. It requires several visits and counselling of key decision makers in the family.

IHMP has established an effective reporting system for marriages. As soon as a marriage takes place in the village the ASHA enrols the couple. Thereafter, counselling begins for the girl, her husband, and her in-laws.

There are over a million ASHAs in India. They can delay first birth and save the lives of thousands of married adolescent girls and their new-born babies.