Addressing the SRH needs of married adolescent girls:Lessons from a case study in India

K. G. SanthyaShireen J. Jejeebhoy

Population Council, New Delhi

Outline

Situation of married adolescents and key factors underlying vulnerability

Intervention for newly married, first time pregnant and postpartum young women, Gujarat and West Bengal

Lessons learned

Situation of married adolescents

Majority of sexually active females are active within marriage

Source: IIPS and ORC Macro 2000

% of young women aged 20-24 married by age 13, 15, 18

20-24

Proportion ever married 78.8

% married by age 13 8.9

% married by age 15 23.5

% married by age 18 50.0

% married in adolescence (by age 20)

67.1

SRH situation of married adolescents

% married women 15-19 with 1+ children: 48%

Early pregnancy: >1 in 5 by age 17

19% of TFR contributed by 15-19 year olds

Nearly 15% stunted and 20% anaemic

High rates of maternal morbidity and mortality

Neonatal mortality (63 vs. 21) and low birth weight

RTIs, STIs among “low risk” young married women

HIV rates high among youth

Key factors underlying vulnerability

Lack of awareness

60

33

75

40

0

10

20

30

40

50

60

70

80

Aware of condoms Ever heard of AIDs

adolescents adult women

Source: IIPS and ORC Macro 2000

13.810.2

45.6

38.7 39.937.4

28.1

20.8

58.1

49.3 50.746.2

0

10

20

30

40

50

60

70

not needingpermission to

go to amarket

not needingpermission tovisit friends

access tomoney

decide onown health

care

decide onpurchase ofjewellery

decide onvisits to

parents/natalkin

%

15-19 20-34

Limited autonomy

Source: IIPS and ORC Macro 2000

Limited peer networks and connections

96.0

25.0 23.0

67.3

6.8

41.2

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

Having friends in natalhome

Having friends inmarital home

Meeting friends inmarital home often (of

those who havefriends)

Gujarat West Bengal

Source: IIPS and Population Council, 2004

26

8

27.131.8

41.637

45.5

19.2

65.8

35

67.7

43.4

0

10

20

30

40

50

60

70

80

soughttreatment for

vaginaldischarge

using anycontraceptive

method

unmet needfor

contraceptionfor spacing and

limiting

receivingatleast oneantenatalcheck-up

institutionaldelivery

attended bytrained health

personnel

%

15-19 years 20-34 years

Limited use of services

First Time Parents Project

Intervention for newly married, first time pregnant and postpartum young women, Gujarat and West Bengal

Objectives

To develop and test an integrated package of health and social interventions focused on the period surrounding new marriage and first birth that would:

•Enable young women to access social support

•Enable young women to participate in decision- making and act in their own behalf

•Improve married adolescents’ reproductive & sexual health knowledge & practices

•Improve providers’ capacity to meet the special needs of young couples

Partners and sites

Partners

Child In Need Institute, Kolkata, West Bengal

Deepak Charitable Trust, Vadodara, Gujarat

IIPS, Mumbai

Sites

12 villages (23,000 population) in Kolkata

12 villages (24,000 population) in Vadodara

Intervention components

Group formation/ social networking

Provision of SRH information

Facilitating utilization of health services

Orienting health care providers

Group formation and social networking

How and what: Community organizers identify potential participants via

health workers and help to smooth girls participation with mothers-in-law, husbands, etc

With facilitation by project staff, groups establish participant roles

Groups typically meet for 2-3 hours fortnightly

Members learn to identify their needs & concerns

Cont…

Group formation and social networkingCont…

How and What:

Participatory games for gender sensitization, reproductive health, relationship issue, life-skills development

Nutrition demonstration classes etc

Organizing welcome ceremonies for newly married members; couple outings etc

Exposure visits to offices of local elected officials (panchayats), banks, health facilities etc

Provision of SRH information: HOW?

Home visits

Written materials

Clinic counseling

Group discussions targeted at young women and husbands

Opportunistic interactions with other influential adults

Provision of SRH Information : WHAT?

    Recently married

First time pregnant

First time mother

 

1. Planning for a baby XX   XX 

2. Contraception XX   XX 

3. Voluntary, safe sex including HIV transmission routes 

XX XX XX 

4. How husband can be supportive, sharing responsibilities, gender sensitivity 

XX XX XX 

5. Danger signs and pregnancy care   XX   

6. Developing a birth plan   XX   

7. Male-female decision-making & communication etc. 

XX XX XX 

8. Post partum care     XX 

9. Infant care     XX 

Facilitating utilization of health services

Recently married

First time pregnant

First time mother

1. Providing condoms and OCs through peers and clinics

XX XX

2. Improved antenatal services through NGO clinics and government sub-centres

XX

3. Counseling to young couples XX XX XX

4. Encouraging couples to develop a delivery plan

XX

5. Encouraging skilled attendance at delivery

XX

6. Postpartum home visit within 6 weeks, with bimonthly follow-up visits

XX

Orienting providers

How:

Regular workshops to orient providers about special needs of married adolescents and young couples

Training of traditional birth attendants on safe delivery practices

Supplying contraceptives, safe delivery kits etc

Observations from monitoring data

Over 750 young women participating in group activities

Formation and management of emergency health funds by some groups

Livelihoods identified as a priority and skill building opportunities demanded and training initiated

Observations from monitoring data

Over 1700 young women and 1100 young husbands reached with RH information

Improvements in reproductive health practices, e.g., institutional delivery

Improvement in spousal interaction and intimacy

Lessons Learned

Lessons

Diversity within the subset of married adolescents needs to be addressed

Reaching out directly to young women with information & services is essential

Involving husbands increases spousal intimacy, gender sensitivity and male involvement in FP and pregnancy related care

Programme offers opportunity to engage young couples in safe sex discussions and HIV related counselling

Addressing married girls’ social disadvantage is possible but requires specially directed efforts

Orienting health providers about the special needs of married adolescents is critical