Empowerment of 400,000 Adolescent Girls in India

Pushpa lives in Bhaygaon, which is her natal village. In 2018, Pushpa regularly attended Life Skills Education classes conducted by Institute of Health Management, Pachod (IHMP).

When Pushpa was 16 years old her parents decided to marry her. She told them that she does not want to marry till she her 19^th birthday. She was in love with a boy living in her neighbourhood. She told her parents that if they insist on marrying her she will marry her boyfriend and nobody else. The boy belongs to same village so the parents agreed. Pushpa got married after completing 10 years of schooling. She lives in a joint family with in laws, and husband’s siblings.

In IHMP’s Life Skill Education, Pushpa had learnt about the adverse consequences of early pregnancy before 19 years of age and the possible risks for both mother and baby.

After getting married Pushpa told her husband that she wants to continue her education and does not want to become a mother until she turns at least 19 years old. Her husband shared Pushpa’s decision with his parents. They appreciated her straight forward opinion and agreed.

Pushpa had learnt about contraceptives during Life Skills Education. After marriage, she and her husband decided to use condoms to delay first pregnancy till her 20^th birthday.

Pushpa missed her periods after she was 20 years old. When a urine test report confirmed her pregnancy, she registered herself with IHMP’s nurse for antenatal care. During monthly household visits the ASHA and IHMP’s nurse gave her information about importance of care during pregnancy, diet, and complications that can occur during pregnancy.

The baby was in a breech position so when she went into labour, IHMP’s nurse advised to get admitted in a nearby city hospital. She had a cesarean section and a male baby, weighing 2.9 kilos, was born. Both mother and baby are doing well.

Following the advice of IHMP’s frontline workers, Pushpa planned her first pregnancy and took good care of herself during her pregnancy, as a result she gave birth to a healthy baby.

Over 200,000 thousand adolescent girls have benefitted from IHMP’s Life Skills Education and Sexual and Reproductive health services.

Due to the Covid 19 pandemic, large scale migration is taking place in the slums where Institute of Health Management Pachod (IHMP) is working. The result is that the slums continue to have new sets of families every month.

One such family migrated to Ramnagar, one of our project slums. During routine household visits to identify the health needs of married adolescent girls and young married women, the community health worker visited a family that had migrated to the slum recently.

The family members kept denying the presence of an adolescent girl in their house. After several visits, when there was no other member in the house, Komal (name changed), an adolescent girl, came running to the community health worker saying that she needs immediate help.

On inquiring, it turned out that the girl was not allowed to step out of the house, not to speak to anyone, and the family also denied her presence to the community health worker. Komal is only 18 years old, is married and has a baby. Within 2 months of the first delivery, Komal conceived again and is currently pregnant with her second child. She said that she is very weak, scared that she is not receiving any support from her family and is also not taken to a hospital for care during her second pregnancy.

Komal and her family members were counselled by the community health worker, and she was visited by IHMP’s front line worker. The health worker identified symptoms of severe anaemia.

Komal had continuous nausea and vomiting, swelling of the body and weakness. The community health worker referred her to IHMP’s pathology laboratory. Her haemoglobin level was found to be 4.0 g/dl which is dangerously low. The report was explained to her husband and mother-in-law by IHMP’s front line worker including the consequences which Komal and her child might face if proper care is not taken at this stage.

Komal was then immediately admitted to a hospital for treatment. Her haemoglobin level rose to 9.1 g/dL, and she feels better with no more weakness. She is also taking an iron rich diet as guided by IHMP’s front line worker.

Early identification of such health issues combined with interpersonal communication and counselling, and laboratory services in the community, are overcoming risks and complications that may affect these young mothers and their children.

IHMP is monitoring haemoglobin levels for all adolescent girls in the community and providing them with iron supplements and nutrition education to prevent anaemia and its consequences.