Social audit reveals poor adolescent health in Jharkhand Rajasthan

Seven of the 85 villages audited in Jharkhand and Rajasthan had adolescent-friendly health services, 11 provided quality sanitary napkins accessible to all young women, 37 – less than half – had clean, usable and separate toilets for children. girls in public schools, and five had awareness campaigns on the dangers of child marriage and teenage pregnancies, social audits conducted between July and September revealed.

Investing in adolescent health is crucial for India to reach the Sustainable development goals set by the UN, improve the health outcomes of adults nationwide and add productive adults to the workforce.

The countryside

A team of 300 girls visited 63 villages in six districts of Jharkhand and 22 villages in three districts of Rajasthan to educate adolescent girls on child marriage, sexual health, education, safety and nutrition. The countryside, Ab Meri Baari, was launched in early 2019 by the Collaborative for adolescents 10 to 19 years old, a group of non-profit organizations working on adolescent issues in India.

The team, led by Dasra, a strategic philanthropic organization based in Mumbai, working with 10to19 Adolescents Collaborative, traveled 3,296 km and spoke to primary health workers, doctors, public health officials and other adolescent girls. The team also visited Uttar Pradesh to carry out awareness campaigns, but no social audit was organized at the UP.

Adolescents understand 22.2% of the population of Jharkhand, 22.9% from Rajasthan and 24.5% of UPs. Together, the three states are home to 28.5% of India’s 253 million teenagers.

Child marriage, early pregnancy

In 2015-2016, nearly one trimester of Indian women aged 20 to 24 were married before they were 18, and 8% of adolescent girls aged 15 to 19 were already mothers or pregnant, according to data from the National Family Health Survey, 2015-16.

Early marriage leads to abandonment, childbearing at a young age, and a higher likelihood of domestic and sexual violence. Teenage pregnancies lead to adverse pregnancy outcomes, such as seizures during pregnancy known as eclampsia, low birth weight, neonatal death, and birth defect. Pregnant adolescents are also more likely to drop out of school, which affects their future and that of their family.

In 2010, the Ministry of Women’s and Children’s Development launched SABLA, an adolescent empowerment program, in 200 districts of the country. As part of this program, each district should conduct awareness campaigns to sensitize adolescent girls to early marriage.

Yet there are gaps.

According to the National Family Health Survey, 2015-16, in 2015-16, Jharkhand had the 5th highest proportion – 12% – of adolescent girls aged 15-19 who were already mothers or pregnant and the Rajasthan had the 18th highest – 6.3%. Likewise, Jharkhand had the third highest proportion – 38% – of women aged 20-24 who married before the age of 18 and Rajasthan had the fourth highest – 36%.

Yet 80 of the 85 villages audited in nine districts of Jharkhand and Rajasthan did not conduct proactive awareness campaigns on the effects of child marriage, according to social audits conducted between July and September 2019.

Family support

Swati Kumari, 16, is a grade 11 student in Barasloy village in Simdega district in Jharkhand. Her friend was forcibly married at the age of 14 and had to drop out of school to live with an alcoholic husband. She had a child at 15 – her in-laws forced her despite their opposition. “Due to so much at a young age, she was mentally weak,” Kumari said. In 2018, Kumari’s friend committed suicide.

Her experience prompted Kumari to take action. She is now part of the Ab Meri Baari campaign and, along with other team members called ‘champions’, she helps publicize child marriage through street theater plays.

Awareness campaigns on child marriage, teenage pregnancy and the dangers associated with it were carried out in anganwadi centers in only 47 of the 63 villages of Jharkhand where the social audit was carried out. In only three villages, this information was proactively shared and explained through regular campaigns. In 10 villages, nothing was done to raise awareness, the team noted.

The situation was similar in Rajasthan. Only two of the 22 villages audited have organized regular campaigns of anganwadi centers to raise public awareness of child marriage, teenage pregnancies and the associated risks.

“I got married when I was 7 or 8, but I still live with my parents,” said Seema Jat, now 19, who lives in the village of Udaipur Khera in Rajasthan. “I continue my studies thanks to the support of my family, but not everyone.

Jat’s friend, Maya, was also married at a similar age. “Before his gauna [ceremony after which the bride is sent to the husband’s house and the marriage is consummated] could be celebrated, in class 12 she gave birth to a daughter, ”said Seema Jat. “Her studies were stopped and her husband did not support her. “

To raise awareness

Only in 19 of the 63 villages audited in Jharkhand were adolescents educated on the Protection of Children from Sexual Offenses Act and the Juvenile Justice Act (Care and Protection of Children), in island hospitals or community health centers by posting information or awareness campaigns. In 41 villages, the team found no form of awareness raising or dissemination of information on these laws among adolescents.

In 37 of the 63 villages, adolescents received information on sexually transmitted diseases and acquired immunodeficiency syndrome. Only in five villages did they receive information on sexual health and hygiene.

In only two of the 22 villages audited in Rajasthan, teachers carry out regular campaigns to disseminate information on reproductive health and rights. In six villages, this information is explained to the pupils; in seven villages this information is only displayed; and in five villages it is not even posted. None of the villages have campaigned to disseminate information on the settlement of grievances in cases of sexual violence. This information was only displayed in 10 villages.

Sanitary towels, separate toilet

In only nine of the 63 villages audited in Jharkhand, quality sanitary napkins were available at health centers and accessible to all adolescent girls. Not everyone had access to sanitary napkins in 17 villages. While sanitary napkins were not of good quality in two villages, they were not available in 35 villages.

Sanitary napkins were not available at anganwadi centers or health centers in Kunjora village of Deoghar district in Jharkhand, said Kumari Priyanka Pandey, 21, a village resident. However, her village has a school where sanitary napkins are provided to girls. “We have to travel outside the village to buy towels,” Pandey said.

Swati Kumari, the The champion of Ab Meri Bari also has to travel outside her village to Simdega district in Jharkhand to buy sanitary napkins – each pack costs Rs 35-40. “Our school does not distribute sanitary napkins and they are not available in the anganwadi center,” she said.

In Rajasthan, anganwadi centers did not have a regular supply of sanitary napkins. In six villages, people did not know that sanitary napkins could be available at Anganwadi centers. In five villages, people knew about it but did not ask for sanitary napkins. In just seven villages, people requested towels from anganwadi centers.

Often, with the onset of menstruation, adolescent girls drop out or attend school less often due to lack of hygienic toilets, lack of water and sanitary napkin disposal in schools. In rural India, 23% of girls listed menstruation as the main cause of dropping out of school.

Public schools in only 25 of the 63 villages audited in Jharkhand had separate toilets for girls that were clean, safe and usable. In 10 villages, not all girls had access to separate toilets. In 13 villages, separate toilets for girls were neither clean nor usable. In 15 villages there were no separate toilets for girls. In Rajasthan, public schools in only 12 of the 22 villages audited had separate toilets for girls. In two villages, the separate toilets were neither clean nor usable.

The solution

The campaign team suggested solutions to address these challenges. Recommendations include a call for appropriate adolescent health centers in each block and the provision of separate and safe toilets for girls in public schools. It also emphasizes providing nutritious food to adolescent girls and pregnant girls. He suggested that health centers should educate adolescent girls about family planning, sexually transmitted diseases, contraceptive methods and drugs; that sanitary napkins be available in anganwadi centers; and awareness of child marriage and sexual abuse laws. Adolescent girls should also play an important role in village child protection committees, the campaign team suggested.

This article first appeared on The health check.

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