Meri Sehat Mera Nirnay:Laying the Foundation for Future Health

A BCC Campaignof SIFPSA Empowering Adolescents Girls to make Informed HealthDecisions

Adolescents, often termed as a 'generation of hope', play a vital role in the health status of any country, their behaviors, attitudes, and beliefs shaping societies of the future. Therefore, to promote healthy practices during adolescence and prepare the adolescents for transition to adulthood is of utmost importance. Reproductive behavior of adolescents has been a concern especially during recent decades. The fertility pattern and contraceptive use among adolescents help us to understand the implications for adolescent reproductive health in a society; it also gives insight to the future fertility situation in the country.

Uttar Pradesh is one of the major contributors to maternal and neonatal deaths in the world. As per SRS 2014, about 292 mothers die per 100,000 live births due to causes related to pregnancy and childbirth, while as many as 32 infants out of every 1000 live births die within the first month of birth. Early childbearing increases the risk for both mother and newborn. Several research studies conducted globally have established that teenage mothers between 15 to 19 years of age are twice as likely to die during pregnancy or child birth than those over age 20 while girls under age 15 are five times more likely to die due to pregnancy and child birth related reasons. Adolescent maternal mortality, therefore, remains an overlooked crisis globally and UP is no exception. Similarly, studies have also indicated that infants born to mothers under 20 years of age face a 50 percent higher risk of being still born or dying in the first few weeks versus those born to mothers aged 20-29 and above. The younger the mother, greater the risk to the baby. Newborns of adolescent mothers are also more likely to have low birth weight, with the risk of long-term adverse effects.

Uttar Pradesh unfortunately continues to witness nearly one in every three girls being married off before the age of 18. Numerous studies have brought forward credible evidence that delaying age at marriage and age at first birth helps in reducing incidence of teenage pregnancy and its associated heath risks in terms of high rates of maternal mortality, morbidity, increased incidence of low birth weight babies and increased infant mortality rate. Married adolescents also experience increased incidences of domestic and sexual violence, and are more vulnerable to sexually transmitted infections. The adverse socio-economic and personal repercussions of adolescent marriage and childbearing significantlyimpact opportunity costs - educational and lifetime opportunities for self-advancement. The teenage mothers' ability to exercise reproductive choice is limited and in most instances care seeking is often constrained.

The RMNCH+A program framework of the National Health Mission provides adequate attention to the adolescent health issues.A review of youth centers, a popular approach for reaching unmarried adolescents, reveals only a small fraction of young population being served. Those served are primarily young men who attend school or college and are often older than the target age, and only a miniscule proportion of users of reproductive health services at youth centers are young women, who again are likely to be older than the target age group. Use of these services also was generally found low.

Taking the above into account, equipping adolescents, particularly school going girls, with complete information and knowledge of reproductive health and family planning, seemed the need of the hour, propelling SIFPSA into designing and implementing a hugely successful BCC campaign titled 'Meri Sehat Mera Nirnay' (my health - my decision) in 750 Government and Govt. aided girls schools in Uttar Pradesh. The entire operationalization of the project was done in coordination with the education department wherein ten madhyamik colleges were identified per district for implementing the program.

The campaign has two pronged objectives- to create awareness, promote the right age at marriage and delay in first pregnancy, and to capacitate the adolescent girls in taking decisions concerning the right age at marriage and right age for first pregnancy to maintain a healthy life style. To achieve these objectives, comprehensive workshops are conducted for school going girls from classes VIII to XII across the state. These workshops are facilitated by trainers/counselors (two per district) from FP, RMNCH+A, AFHS, ARSH and staff nurses/ASHA trainers, who had been specially oriented on adolescent's personal hygiene and cleanliness, nutrition, family planning, age at marriage and delay in first pregnancy during a state level TOT.

The workshops are a combination of audiovisual films, motivational talks, oath taking, slogan writing, discussions and debates by participating adolescent girls as part of the workshop methodology, making them comprehensive and engaging for the adolescents, followed by street plays or nukkad natak around the theme. At the end of the workshop, feedback is obtained on a format on 'Kitna Jaana Kitnaa Manaa' from the adolescents who participate in the workshop. Prizes and take away gifts with logo of Meri Sehat Mera Nirnay and messages are also distributed among the adolescent girls as a reminder medium. The workshops are regularly monitored by division and state level SIFPSA officials. In the first quarter of the campaign, 164 workshops across 12 divisions-Gorakhpur, Lucknow, Faizabad, Kanpur Nagar, Bareilly, Meerut, Saharanpur, Jhansi, Azamgarh, Varanasi, Allahabad and Mirzapur, actively participated by more than 21000 adolescent girls, have already been conducted.

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