Seven of 85 villages audited in Jharkhand and Rajasthan had adolescent-friendly health services, 11 provided quality sanitary pads accessible to all young women, 37 – less than half – had clean, usable and separate toilets for girls in government schools, and five had proactive awareness campaigns about the dangers of child marriage and early pregnancy, social audits conducted between July and September found.

Investing in adolescent health is crucial for India to attain the Sustainable Development Goals set by the UN, improve the country’s adult health outcomes, and add productive adults to the workforce.

The campaign

A team of 300 girls visited 63 villages in six Jharkhand districts and 22 villages in three Rajasthan districts to raise awareness about child marriage, sexual health, education, security and nutrition of adolescent girls. The campaign, Ab Meri Baari, was launched in early 2019 by the 10to19 Adolescents Collaborative, a group of non-profit organisations working on adolescent issues in India.

The team, led by Dasra, a Mumbai-based strategic philanthropy organisation, in collaboration with the 10to19 Adolescents Collaborative, travelled 3,296 km and spoke to primary health workers, medical officers, government health officials and fellow adolescent girls. The team also visited Uttar Pradesh to conduct awareness campaigns, but social audits were not held in UP.

Adolescents comprise 22.2% of Jharkhand’s population, 22.9% of Rajasthan’s and 24.5% of UP’s. Together, the three states are home to 28.5% of India’s 253 million adolescents.

Child marriage, early pregnancy

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

Early marriage leads to dropouts, motherhood at a young age, and a higher probability of domestic and sexual violence. Early pregnancies lead to adverse pregnancy outcomes, such as seizures during pregnancy known as eclampsia, low birth weight, neonatal death and congenital malformation. Pregnant adolescents are also more likely to leave school, affecting their and their family’s future.

In 2010, the Women and Child Development Ministry launched SABLA, a scheme to empower adolescent girls, in 200 districts of the country. Under the scheme, each district has to conduct awareness campaigns to sensitise adolescent girls about 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 women aged 15-19 years who were already mothers or pregnant and Rajasthan had the 18th highest – 6.3%. Similarly, Jharkhand had the third highest proportion – 38% – of women aged 20-24 who were married before they were 18 and Rajasthan had the 4th highest – 36%.

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

Family support

Swati Kumari, 16, is a class 11 student in Barasloy village of Jharkhand’s Simdega district. Her friend was forcibly married off at the age of 14 and had to dropout from school to live with an alcoholic husband. She had a child at age 15 – her in-laws forced her despite her opposition. “On account of going through so much at a young age, she was mentally weak,” Kumari said. In 2018, Kumari’s friend killed herself.

Her experience pushed Kumari to act. She is now part of the Ab Meri Baari campaign and, along with others in the team referred to as “champions”, she helps spread awareness about child marriage through street plays.

Awareness campaigns about child marriage, early pregnancy and the related dangers were found in anganwadi centres in only 47 of the 63 villages in Jharkhand where the social audit was conducted. Only in three villages, this information was proactively shared and explained through regular campaigns. In 10 villages, nothing was being done to spread awareness, the team found.

The situation was similar in Rajasthan. Only two of the 22 villages audited had regular campaigns by anganwadi centres to spread awareness about child marriage, early pregnancy and associated risks.

“I got married at the age of 7 or 8, but I continue to live with my parents,” said Seema Jat, now 19, who lives in Rajasthan’s Udaipur Khera village. “I am continuing my studies because of my family’s support but this is not the case with everyone.”

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

Spreading awareness

Only in 19 of the 63 villages audited in Jharkhand were adolescents being educated about the Protection of Children from Sexual Offences Act and the Juvenile Justice (Care and Protection of Children) Act, in block hospitals or community health centres through display of information or awareness campaigns. In 41 villages, the team found no form of awareness or information dissemination about these laws among adolescents.

In 37 of 63 villages, adolescents were given information about sexually-transmitted diseases and Acquired Immunodeficiency Syndrome. Only in five villages were they given information about sexual health and hygiene.

In only two of the 22 villages audited in Rajasthan, school teachers conduct regular campaigns to spread information about reproductive health and rights. In six villages, this information is explained to students; in seven villages, this information is only displayed; and in five villages, it is not even displayed. None of the villages had campaigns to spread information about grievance redressal in cases of sexual violence. This information was displayed only in 10 villages.

Sanitary pads, separate toilets

Only in nine of the 63 villages audited in Jharkhand were quality sanitary pads available in health centres and accessible to all adolescent girls. Not everyone could access sanitary pads in 17 villages. While sanitary pads were not of good quality in two villages, they were not available in 35 villages.

Pads were not available in anganwadi centres or health centres in Kunjora village of Jharkhand’s Deoghar district, said Kumari Priyanka Pandey, 21, a resident of the village. However, her village has a school where pads are provided to girl students. “We have to travel outside the village to buy pads,” Pandey said.

Swati Kumari, the Ab Meri Bari champion, also has to travel outside her village in Jharkhand’s Simdega district to buy pads – each packet costs Rs 35-40. “Our school does not distribute pads and they are not available in the anganwadi centre” she said.

In Rajasthan, anganwadi centres did not have a regular supply of sanitary pads. In six villages, people were not aware that sanitary pads can be available at anganwadi centres. In five villages, people were aware but did not demand sanitary pads. In only seven villages did people demand pads in anganwadi centres.

Often, with the onset of menstruation, adolescent girls drop out from school or attend less frequently because of a lack of hygienic toilets, lack of water and a pad-disposal system in schools. In rural India, 23% of girls listed menstruation as the chief reason for dropping out of school.

Government schools in only 25 of 63 villages audited in Jharkhand had separate toilets for girls which were clean, safe and usable. In 10 villages, not all girls had access to the 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, government schools in only 12 of the 22 villages audited had separate toilets for girls. In two villages, separate toilets were not clean or usable.

The solution

The campaign team suggested solutions to combat these challenges. The recommendations include a call for proper adolescent health centres in every block and provision of separate, safe toilets for girls in government schools. It also highlights providing nutritious food to adolescent and pregnant girls. It suggested that health centres should educate adolescent girls about family planning, sexually-transmitted diseases, contraceptive methods and medicines; that sanitary pads should be available in anganwadi centres; and spreading awareness about child marriage and sexual abuse laws. Adolescent girls also need to have an important role in village-level child protection committees, the campaign team suggested.

This article first appeared on The Health Check.