Empowerment of 400,000 Adolescent Girls in India

Once when Smita, an IHMP field supervisor was visiting one of our several communities where we implement our program, the community health worker in that slum told her about a certain resident, Sanjay (name changed). Sanjay is a labourer who works throughout the day and returns home late at night. He almost always avoided the community health worker when she went to speak to him. He clearly did not wish to listen to what she had to say to him. But the CHW did not cease in her efforts to communicate with Sanjay. She was adamant to talk to him.

Sanjays wife Nandini (name changed) who is just 17 years old had given birth to a baby boy 8 months ago. She wanted to begin using a contraceptive immediately after her delivery, but Sanjay was completely averse to the idea and forbade her from using any form of birth control. This behaviour resulted in Nandini becoming pregnant a mere 4 months after the birth of her first child. Due to the extreme pressure exerted on her by Sanjay and her in-laws and the fact that her husband would not listen to her pleas, Nandini went to her maternal home and underwent an abortion. After Sanjay and his family found out about this they were enraged. Sanjay continued to refuse to use any type of contraception.

After many attempts the CHW was finally able to speak to Sanjay with the help of Smita. He defended his attitude by saying that he earned enough to support his family, and that he would let Nandini undergo a family planning operation after she bore one or two more children. The CHW listened patiently to all his explanations then proceeded to tell him about the need for spacing between two children and how it would help his wife to live a long, healthy life and how it would benefit his yet to be born children by letting them lead healthier lives. She assured him that his choice would be taken into consideration while deciding the contraceptive method that would be suitable for the couple. After he was given all this information, something began to change in his mind and his concern for his wife was visible when he decided to attend the special clinic organized by IHMP.

The very next week, Sanjay and his wife came to IHMP’s outreach clinic. They were explained the ill effect of frequent pregnancies without any spacing on a woman and her new born baby. Sanjay also heard about the problem of low birth weight and its implications and finally decided to use a contraceptive to ensure a gap of 3 years between two births. The community health worker and Smita were extremely happy to hear about the couple’s decision and it strengthened their resolve to help other women who face the same problem. 

A large part of IHMP’s  work in the community has to do with changing social norms that are at the root of many of the problems faced by the married adolescent girls in these communities. Our work has to involve both the woman and her husband, sometimes even her family to bring about the change we want to see in the community. The initial patriarchal reactions our colleagues received from Sanjay are quintessential to the social norms that exist in our community. Sanjay and his family are one of many thousand couples whose lives we have been able to touch in our pursuit to improve the reproductive health status of married adolescent girls in India.

Links:

• Like us on FB!
• Follow us on Twitter!
• Visit our website to know more

Afreen (name changed) a recently married girl of 17 years appeared to be clueless and confused when she was asked by one of our community health workers (CHW) about the significant life changes that happen after marriage. Afreen had no idea about all this as she was married off early. She had recently shifted to one of our slums (intervention area) along with her husband Ayaz. Her husband is a daily wage worker who works in a nearby multinational company. Looking at her young age, IHMP nurse decided to ask her about her views on having children, to which Afreen said that she has no say in this matter as it completely depends upon her in-laws and her husband.

The CHW realized that not just Afreen but her in-laws and Ayaz her husband would require counseling as well. She requested IHMP’s male social worker to accompany her during her household visit to Afreen’s house. Initially it was a challenge to meet her mother in-law and husband, but our community health worker and male social worker continued to visit Afreen’s house until they could meet her husband. IHMP male social worker tried building a rapport with Ayaz and asked him some tricky questions like whether he would eat a fruit which is raw or one which is ripe? He said, “obviously a fruit that is ripe, but why are you asking me this question”. The social worker pointed out the analogy, he said “if your wife gets pregnant at a young age she would give birth to a baby that would not be fully grown and strong. It is up to you whether you want to risk her and the baby’s life or you want to wait until she is of a right age and can deliver a full term healthy baby.” The social worker further explained him about the risks involved in early pregnancy. After listening, Afreen’s husband realized the risks to which he would be subjecting his wife. He inquired how he could delay the first pregnancy? IHMP’s male social worker gave him information about condoms and other contraceptive methods which can be used to delay pregnancy.

IHMP social worker during follow up visits inquired and monitored that Afreen’s husband was taking condoms from the visiting nurse and using them regularly. He used condoms to delay Afreen’s first pregnancy. A few years later, during one of the monthly household visits of IHMP’s CHW, Afreen told her that she is pregnant. By then Afreen was more than 20 years old. She mentioned that with the help of the information shared by IHMP’s community health worker her husband had got her registered for antennal care in a nearby primary health care centre. The CHW also informed her about the appropriate diet and precautions she needs to take during her pregnancy. The CHW routinely monitored her haemoglobin level. Initially her Hb level was only 9 gms and weight was just 37 Kg but with CHWs frequent counseling on proper dietary measures her weight increased to 47 Kg. and Hb level to 10.5 gm. After completing nine months of pregnancy, Afreen gave birth to a healthy baby. IHMP nurse and social worker were very happy on seeing Afreen and her health baby.

IHMP workers have focused on counseling the spouses and other family members of married adolescent girls in order to create a family support structure for married girls like Afreen. Today there are hundreds of young men who are taking greater responsibility in providing adequate care and support to their wives, particularly during pregnancy.

Links:

• Like us on FB!
• Follow us on Twitter!
• Visit our website to know more