India: Adolescent Girl Outreach Program

For a full report please see attached PDF.

Teach Girls Health: Empowering Rural In-school Adolescent Girls
Project Completion Report – Operational Phase: October 2014 – October 2015

Ethnographic Background of Nimar Region of Madhya Pradesh, India

The Nimar Region of Madhya Pradesh,  India lies south of the Vindhya Range, and consists of two portions of the Narmada and Tapti river valleys, separated by a section of the Satpura Range, about 15 miles (24 km) in breadth. On the highest peak, about 800 ft (244 m) above the plain and 1800 ft (549 m) above sea-level, stands the fortress of Asirgarh, commanding a pass which has for centuries been the chief highway between Upper India and the Deccan.

The Nimar region is home to the Nimadi language, which is related to the Malvi language of Malwa as well as the other Rajasthani languages.

Nimar formed a district of British India, in the Nerbudda Division of the Central Provinces. The administrative headquarters were at Khandwa; but the capital in Muslim times was Burhanpur.

Nimar was also a district in the princely state of Indore lying west of the British district on both banks of the Narmada. After Indian independence in 1947, the former British district became the Nimar District of the new state of Madhya Pradesh, with its administrative seat at Khandwa; the Nimar District of Indore state became the Nimar District of the new state of Madhya Bharat, with its administrative seat at Khargone. When Madhya Bharat was merged into Madhya Pradesh on November 1, 1956, the former Madhya Bharat District became West Nimar District, while the eastern district became East Nimar District. West Nimar District was split into the districts of Barwani and Khargone on May 24, 1998 and similarly East Nimar District was split into the districts
of Khandwa and Burhanpur on August 15, 2003.

Real Medicine & Nutrition Trust, India's presence in the Nimar Region

Background to Adolescent Health

Adolescents worldwide and more so in developing countries are at greater risk of reproductive health's adverse consequences. Every year adolescents give birth to 15 million infants and globally girls aged 15-19 years are twice as likely to die from childbirth as are women in their twenties, while girls younger than age 15 face a risk that is five times greater([1]).  More adolescent girls die from pregnancy related causes than from any other causes. This risk is aggravated by their lack of information about reproduction and sexuality, misconceptions and little access to family planning and reproductive health services. What happens in their future depends to a large extent on the decisions taken by adolescents as they enter their reproductive years.
 
Adolescent girls in India are given little information about the changes that are normal to experience physically, emotionally, and socially when transitioning from childhood to adolescence.

The State Madhya Pradesh, India

The female population of the state of Madhya Pradesh, a central Indian state is 49% of the total population of the state. The life expectancy of women is 56.7 years, which is lower than that of males. The All India life expectancy for the period 1998-2002 for males is 61.6 and for females is 63.3, whereas the life expectancy for the same period for Madhya Pradesh for males is 57 and for females 56.7 years (Source: RGI).
 
In DLHS-3, the status of menstruation and menstruation related problems experienced by
unmarried women in the three months preceding the survey were collected. About three out of every ten women (29.6 percent) had menstruation related problems during the last three months preceding the survey (Table 8.6). 89 percent of the unmarried women had painful periods while 10.7 percent had irregular periods.  Some women had problems like prolonged bleeding (8.9 percent).  The practices followed during the menstruation period are important from the consideration of RTI and personal hygiene. Currently menstruating women were asked about the practices followed during the menstrual period. Almost all women (90.0 percent) of the currently menstruating unmarried women used cloths while 9.4 percent use sanitary napkins and 7.7 percent used locally prepared napkins (DLHS 3).
 
As per National Youth Policy 2003, the state government reiterated its commitment to strengthening Adolescent Reproductive and Sexual Health (ARSH) services.  The department undertakes to establish multipurpose youth friendly centers and incorporate the health components recommended in the National Youth Policy 2003 on a pilot basis. The Adolescent Reproductive and Sexual Health services (ARSH) would be incorporated in schools through involvement of teachers, parents and students. Improved BCC activities on issues such as child marriage, age at marriage and precautions for preventing RTI/STI among adolescents will be carried out (Medium Term Health Sector Strategy, MP Document).

Background to Real Medicine & Nutrition Trust's Intervention on Empowering Girls

Real Medicine & Nutrition Trust (Real Medicine Foundation India – RMF India) has been working in south-western Madhya Pradesh for more than a decade, and has established and sustained its malnutrition eradication programs. Its extensive health outreach programs extend up to household levels.  The RMNT outreach model is entirely inclusive in the way that it converges closely with the frontline governmental service providers. In the process of its community interventions, RMNT noticed a gap with respect to specific outreach and health information for adolescent girls. 
 
In September 2012, RMNT conducted a workshop with 44 adolescent girls in the community hall in Bhagyapur Village in Khargone District.  With the help of two books and a curriculum published by a National Level Government Organization for the Purpose of Adolescent Education, the content of the workshop was created.
 
The contents covered in the workshop were:

• What is Adolescence?
• The Changes in Adolescence – Physical, Emotional, Psychological and Social
• Iron Deficiency – Anemia
• Diet in Adolescence – Importance of Diet
• Menstrual Cycle – Misconceptions (Role Play)
• Personal Hygiene

The highlight of the day was a play enacted by RMNT facilitators that centered on a village girl who had attained puberty and had started experiencing stress and confusion about sudden changes in her body. She approached the Auxiliary Nurse Midwife (village nurse) and the ANM clarified her doubts, answered her questions, and ensured her that there was nothing abnormal in those changes. The girls could relate themselves to the character of the girl in the role play and responded very well to the example.
 
Giving adolescent girls the opportunity to ask questions, find their voice, and understand their feelings leads to the self-confidence they need in order to become healthy, strong women.

RMNT's Approach

Having established a viable need-based connection of the Community Nutrition Educators (CNEs) with the school system, RMNT builds on the following to reach out to educate adolescent girls on health, which reinforces the need for integrating health education as part of the regular teaching curriculum:
 

• Train Community Nutrition Educators (CNEs) on life cycle approach
• Identify schools for the coverage
• Conduct group-specific survey of adolescent girls in identified schools to ascertain actual numbers to be covered
• Seek formal concurrence of Education Department of the Government of Madhya Pradesh for conducting such school-based health education for adolescent girls
• Draw a project roll-out, including session plan as per the number of students per group per school
• Train RMNT team on management information systems (MIS) & reporting
• Roll-out the program, monitor and document

RMNT – Catapult Fund Collaboration for Teach Girls Health: Completion Report

• Trained 19 RMNT staff on  adolescence, health, and other topics for school workshops
• Conducted 497 in-school training sessions at 67 schools across 3 districts
• Sensitized 131 school teachers on issues of adolescent health
• At the end of October 2015, RMNT had trained 1,966 in-school adolescent girls, as against the project target of 1,500.

District-wise Coverage

District Barwani

• Total number of adolescent girls to be trained: 500
• Total adolescent girls trained: 621
• School training session details:

• Total number of schools covered in the district: 25
• Total number of school teachers, who attended RMNT sessions. 51

District Alirajpur

• Total number of adolescent girls to be trained: 500
• Total adolescent girls trained: 640
• School training session details:

• Total number of schools covered in the district: 18
• Total number of school teachers, who attended RMNT sessions: 32

District Khandwa

• Total number of adolescent girls to be trained: 500
• Total adolescent girls trained: 705
• School training session details:

• Total number of schools covered in the district: 24
• Total number of school teachers, who attended RMNT sessions: 48

Teach Girls Health Intervention: Stakeholders Reponse

The in-school adolescent health empowerment project was undertaken in close collaboration with the government school functionaries.  In the process of program roll-out, RMNT staff received optimal cooperation from every school.  In many cases, RMNT team observed the school faculties attending different sessions themselves. All training modules on life cycle approach were articulately dealt with, by individual Trainers and received applauds by School Principals and Teachers.  The RMNT team, at the end, was interested in collecting responses from several school-based stakeholders to the training inputs given to these young community audiences.  Mingling with the girls at the conclusion of all training modules to find out their level of learning was to draw inferences on how life skill training was helpful in taking them one step forward on the ladders of their lives. The RMNT team collected substantial evidence on how different stakeholders perceived these trainings adding values to their learning and overall knowledge about being healthy.