Adolescent Reproductive Health Program:
This program offers age- and culturally-appropriate reproductive health information in a safe environment to adolescents who come from poor and middle-income families in North India. The classes cover topics ranging from puberty, anatomy, pregnancy, STIs and RTIs, unhealthy habits, violence and sexual assault. Adolescents receive unbiased and research-based information and counseling that is culturally appropriate. Youth develop skills in communication, refusal, and negotiation. Information that is medically accurate will be provided with clear goals for preventing HIV, STIs, and early pregnancy. These classes have been developed in cooperation with members of the target community and respect community values.
The pilot was implemented in Dehradun, in March 2014 – 2015, and has provided education to 5,000 participants in 30 different slum areas. The effects of these classes have been apparent. In their post-tests, participants were able to understand puberty, their reproductive organs, menstruation, transmission of Reproductory Tract Infections / Sexually Transmitted Infections including HIV. Participants had improved knowledge of their reproductive health, less misconceptions regarding myths they had been lead to believe, and a better overall attitude towards reproductive health compared to their pre-test scores.
The curriculum that the educators follow has been developed in house with the help of international public health professional.. Male educators teach male adolescents and female educators teach female adolescents. We do not like to propagate the sex differences, but the students feel more comfortable if their educator is the same sex. Pre/post test-questions are asked at the beginning to measure the baseline knowledge level and then post-test questions are asked after each topic is completed. These questions measure if objectives are being met or not met. This allows the educators to have immediate feedback and expand or repeat sections that are unclear. These pre/post test questions are administered verbally. The educators also have a written program evaluation tool. This tool is used to evaluate the program for internal review. These tools are reviewed by the educators and the program facilitator to rectify issues in teaching. It is a tool to give feedback for the class in general. The questions are not yes/ no but more critical thinking questions to really assess if the students have the knowledge that we hope to have imparted on them.
The Problem: India is home to one of the highest concentration of young people in the world, with over 300 million youth and adolescents under the age of 25. Adolescents do not receive any sort of sex education in school and have little access to quality and confidential reproductive health counseling. Adolescent girls in India are a largely invisible population and extremely vulnerable with prevailing socio-cultural customs that leaves them powerless to decide their future.. Misogynistic and ageist attitudes about adolescent girls are fairly universal across India and are manifested in key aspects of their lives: gender- based discrimination, early marriage and pregnancy, lack of education, and a dearth of formal employment opportunities. Adolescent reproductive health is nonexistent in this community. Parents, family members, peers, community and religious leaders, and politicians are either ignorant or choose to ignore the complex issues pertaining to adolescents, their sexuality, education, and the consequences of depriving them of this information. When adolescents do not receive accurate information, their knowledge instead derives from friends, media, porn, and other outlets that perpetuate unhealthy or unrealistic ideas about their reproductive and sexual health. Poor reproductive health indicators show that a lack of this kind of education directly affects physical health through high rates of unsafe abortions, STIs, and RTIs, early marriage and pregnancy, and unmet needs for contraception. Many adolescents lack autonomy and they are extremely vulnerable – they are often forced into marriage, suffer from violence at home, lack education and proper health services. . 22% of girls aged 15-19 in India face physical or sexual violence, the majority within their own homes. 43% of all women aged 20-24 are married before the age of 18. Maternal mortality among adolescents is twice the rate of maternal mortality in ages 20-34 years old Girls are essential agents of change in breaking the cycle of poverty and deprivation. By investing in girls we can delay child marriage, address multiple issues such as maternal mortality, child survival, gender based violence and HIV. Educated and healthy girls become mothers who in turn produce healthy children. Focusing on girls translates into better futures for women, children and families, thereby creating intergenerational impact. Most program do not focus on adolescents exclusively and either focus on children or mothers. Targeting girls can actually solve most problems related to women and children, especially in India.