Ensure adolescent health & rights, reduced anaemia & malnutrition, intervening on young people reproductive sexual health.
SRHR Issues and Improving access to safe abortion :
It is Ipas supported programme, BVA is working on issues of women health and improving access of safe-abortion among female adolescents of the age group of 15 to 24 in all 22 GPs of Bagodar block. The programme has been implementing with aiming at abolish the rural myth on abortion and aware youth section of people to have understanding about the safe-abortion and the legal acts related to the subject matter as per Indian constitutions.
Project Title: Improving Access to Safe Abortion in Bagodar Block of Giridih District.
Operational area of the project:
The project’s operational area is 22 gram panchayat in Bagodar Block of Giridih District, Jhadkhand.
Summary of the project:
Banwasi Vikas Ashram is implemented the Youth project of Ipas which envisages ensuring the accessibility of safe abortion facilities in the Bagodar block of Giridih district, Jharkhand and for augmentation of their knowledge and information on sexual reproductive health issues and the basic rights among the young women of the age group of 15-24.
Objective:
- To improve the knowledge of young women not only on the legality but also of the availability of the service facilities available for safe-abortion.
- To sensitize about the medical knowledge and clinical skills of local service-providers (doctors) and health intermediaries, both government and private, in provision of reproductive health services for young women including legal and safe abortion services.
Target Groups:
The primary target groups are:
Young women of the age group between 15 to 24 years old, both married and unmarried.
| Total young Women | New added young women | ||||
| Married | Unmarried | Total | Married | Unmarried | Total |
| 4163 | 4922 | 9085 | 1619 | 2186 | 3805 |
The secondary target groups are:
- Selected peer leaders- 60
- PRIs female members- 150
- Health Intermediaries (SAHIYAs, ANMs)
| ANMs | Sahiya | AWW | Total |
| 26 | 127 | 157 | 310 |
Key deliverables:
- 20 staffs can be re-oriented and the new staffs can gain the knowledge of the sexual reproductive health and right along with the safe abortion services.
- 8782 female young can be reached through the 3000 IPC meeting.
- 310 health intermediaries can gain knowledge to facilitate the youth regarding safe abortion services and the sexual reproductive health and rights.
- 150 elected female PRI members can be reached through 5 conducted group meetings.
- 100 mother, daughter and daughter-in-laws can be reached through 2 get together conference.
- 20 peer leaders can be selected to reach 100 female young in 4 schools through training to train them and build their capacity for the developmental change of the beneficiaries regarding their sexual reproductive health issues and rights.
Quantitative report of the key activities:
| SL.NO. | Activities | Targets | Achievements | Percentage |
| 1 | Staff Re-orientation | 20 | 20 | 100% |
| 2 | IPC Meetings | 3000 | 3018 | 100.6% |
| 3 | Re- orientation of Health Intermediaries | 310 | 227 | 73.% |
| 4 | Orientation programme for PRI members | 150 | 163 | 108.66% |
| 5 | Mother, Daughter and daughter-in-laws Conference | 100 | 95 | 95% |
| 6 | School Intervention Programme | 6 | 6 | 100% |
Staff Re-orientation programme:
Objectives:
- To improve the knowledge of the youth leaders on Safe Abortion facilities and SRHR.
- To provide detail information of role and responsibility of the youth leaders in the project work.
- To give the immediate knowledge of the most vulnerable disease called HIV/AIDs and SRH issues.
The reorientation programme was organised on dated of 13th – 15th March, 2014. It was capacity building training for all the youth leaders and the project staffs which was residential. The youth leaders were responsible for the direct implementation of the project work in the fields for the fruitful achievement of the targets. The project basically focused to improve the accessibility of safe abortion among the young women under the age group of 15-24 years in Bagodar Block of Giridih District. Project coordinator, accountant, 2 field supervisors and 16 youth leaders (kalyani Didi), all together 20 staffs along with secretary Mrs. Pushpa Shakti were presented in the re-orientation programme at Banwasi Vikas Ashram which was conducted by Mr. Samik Goswami ( coordinator- Programme) of Ipas. on time and safely from their home to the office of Banwasi Vikas Ashram. The youth leaders and the project staffs were welcome by Ms. Meenakshi Wesley (Treasurer) and also to Mrs. Puspa Sakti (Secretary) by giving the big hands thrice along with Mr. Samik Goswami (Coordinator- Program) of Ipas.
The training module was prepared to fulfill the objectives of the training. The knowledge was gained in a short duration though the three days re-orientation programme. Mr. Samik sir was explained it in a very simple way which made easy understand to all the youth leaders.
Outcome:
- The youth leaders were gained and increased the full knowledge on safe abortion and SRHR for the successful implementation of the project.
- The young married and unmarried women were sensitized and availed the services provided by public and private sectors.
- Some of the new staffs were oriented on this specific topic.
- The programme was going well and achieved the target.
Group Meeting/IPC activity:
The group meeting was conducted in the villages of Bagodar Block by creating awareness on accessibility of safe abortion facilities and also SRHR with 10 to 12 young married and unmarried women as well as one to one discussion was accomplished in case of less number of participants. At least 2-3 group meeting was organised in a day as per the daily action plan. The young women were also sensitized on the availability of the safe abortion and SRHR. The group meetings were conducted well and young women’s participation in their own interest was well organised for the achievement of the proposed activities.
Following table shows a short glimpse of the progress of IPC activity during this reporting period:
Village Level IPC Activity (with 15-24 years young women)
| # of Villages covered by youth leaders | # of group meetings conducted by youth leaders | # of young women (15-24 yrs) reached out through group meetings | # of one to one discussion with young women | # of young women (15-24yrs) reached out through one to one discussion | |||
| New | Old | ||||||
| 87 | Married | Unmarried | Married | Unmarried | |||
| 3018 | 7426 | 8424 | 3416 | 1865 | 1551 | ||
| No of villages yet to be reached out: Nill | |||||||
| # young women(15-24) reached out through group meeting | ||
| New | Repeaters | |
| Married | 1619 | 3862 |
| Unmarried | 2186 | 4427 |
| Target Audience | Adolescence and body-change | Menstrual Hygiene | Pregnancy | Contraception | Safe abortion |
| Married | 4163 | 4163 | 4163 | 4163 | 4163 |
| Unmarried | 4922 | 4922 | 4922 | 4922 | 4922 |
Description:
The re-orientation of Health Intermediaries was very important because they frequently keep in contact with the married pregnant women. HI was also provided advices regarding safe abortion and SRHR. The following process was undertaken to organise the HI re-orientation programme.
Process:
The HI re-orientation programme was organized according to their time. All the HI had the cluster meeting once in a month, the re-orientation was organized on that same day. Mrs. Vibha Kumari and Meenakshi Wesley (field supervisor of Ipas) were conducted the training which was at ICDS office and some were in the villages. The IEC materials like: booklets, leaflets, charts, posters and also some of the games were used to make brief understand about the safe abortion during the training.
Participant Feedback:
The training was organized successfully and most of the participants were shown interested to know more on the topic and it was heard from them that they had a little knowledge on the topic but after the training was organized in last year got the knowledge and they could also able to say confidently to the women regarding safe abortion and also the facilities available both in public and private sectors along with they also support to the youth leaders for carry on the IPC meeting in the villages.
Result:
HIs were gained the knowledge through the re-orientation on safe abortion and SRHR. They are also sensitized to the huge number of young women for accessible of this facilities and help the youth leaders to organize the IPC meeting in the respective villages.
Orientation of PRI members:
Process:
The PRI members were informed by the invitation letter where the dates, times and the meeting venue were conformed and also it was well organized where they were oriented and acquired the provided knowledge on access of safe abortion facilities which is available in both the public and private sectors.
Challenges:
The Lok-Sabha election was taken place during the time still the meetings were organized as per their availability and also achieved the targets.
Mother, Daughter and Daughter-in-laws conference
Banwasi Vikas Ashram had planned to organize two conferences in Bagodar Block. But only one conference was organized on dated 7th March, 2014 under Ipas project which aims to aware about different reproductive sexual health related issues and also accessible of the services provided by both public and private sector regarding safe abortion.
Objectives:
- To create awareness by providing technical knowledge about the reproductive sexual health issues among the young women.
- To create open environment in discussion among themselves in the conference and make the women society free from shyness while facing the issues on SRH.
- To help them in learning to know the problems faced by the young girls in their respective families. Therefore, this kind of activities will help the women in taking bigger responsibilities.
Description:
It was also inspired to improve the knowledge on safe abortion facilities among the young married and unmarried women of Bagodar Block. Sometimes the abortion is considered as an anomalous because of the ignorance of the technical knowledge among the rural women and also the cultural taboo is bonded the society so they are still in the superstition that discussion of SRH issues is bad. When a girl faces some problem on SRH at that time she feels shy to inform to the mother or sister-in-laws though Indian culture is known as shy culture. They don’t also inform with each other in case of infectious disease in SRH. In this conference all young women (Maa, Bohu,Beti ) under 15-25 years of age will be invited freely. It may be conducted through the staffs of Ipas project in the block. One hundred numbers of young women will be participated in the conference.
Discussed points:
- Sexual reproductive Health issues faced: The discussion of the SRH issues among them after the puberty and also during the time of menstrual cycle.
- Proper immunization: There was discussed about the accessing of the proper immunization during the time of pregnant and menstrual cycle and also broke out the knowledge of the availability of the health services.
- Information about health schemes and safe abortion: Many health schemes and safe abortion facilities are available in both the private and public sectors which information is still a little among the women.
- Encouragement: Some of the games and the competition were conducted for the encouragement.
Process:
- Welcome and lightening the candle by the chief guest and others.
- The speeches were delivered by the honourable guests.
- Youth leaders of the respective panchayats were delivered the topics on improving access of safe abortion facilities and also other related issues.
- Group discussion and chart presentation by the participants on different related given topics.
- Quiz competition and some of the encouragements.
- Vote of thanks.
Participant Feedback:
This programme is necessary to bring close Saas, Bohu and Beti among themselves and also help for the better open discussion on their SRH issues by avoiding the shyness.
Challenges:
Less number of Saas’s participation in comparison with Bohu and Beti in the conference.
Result:
All of them were sensitized about the discussed topics and also free from shy nature by discussing with each other regarding SRH issues and also gained the knowledge on safe abortion facilities and SRHR.
Detailed report enclosed annexure-2
- School intervention programme
Summary:
The school intervention programme was organized in 6 schools of Bagodar Block through which the peer leaders could able to spread the knowledge about the safe abortion and the related issues to the young girls in their age and the peer leaders were worked as the agent for change.
Objectives:
- To create awareness about the reproductive sexual health among teenagers in large scale through peer education
- To give open space to all the teenagers who are confined to their school environment. It will help them to meet the youths of other villages which will result in sharing of thoughts and ideas as well as building larger network of youth group.
- To help them in learning to take bigger responsibilities in life. As the organizing and functioning member will be the youth leaders and village based supervisor. Therefore, this kind of activities will help the youths in taking bigger responsibilities.
- Planning meeting in the state
Planning meeting was organised in the state office of Ipas, Ranchi where Project coordinator and Field supervisor of BVA discussed with the state programme coordinator and state programme officer about the successful of the school intervention programme and also discussed to sensitise the peers who will stand as a social change maker. Strategies were discussed and outlined for the better organising of the school intervention programme through which the knowledge could spread on safe abortion and SRHR.
- Meeting with the teachers
Meetings were organised with the teachers in selected 6 schools of Bagodar Block where the teachers were agreed to support for organising and implementation of the school intervention programme.
- Selection of the peer leaders
60 peer leaders were selected in selected 6 schools by the respective teachers and the students, in each school contained 10 peer leaders.
- Baseline survey
The base line survey was conducted in each selected 6 schools by the peer leaders and the research was done according to the question was prepared regarding safe abortion and SRHR by taking minimum 40 students and maximum 60 students. The report was prepared in accordance to the knowledge available with the girl students regarding the topics.
- Baseline analysis
The baseline survey was conducted in 6 selected schools among the 295 girl students which showed that 63.72% students were sensitized about the physical and psychological changes during the adolescent period out of 295. 61.69% students had knowledge about the conception and ovulation and 46.44% had a little knowledge on safe abortion facilities. Most of the students had the knowledge on physical and mental changes during adolescent period in comparison to conception and ovulation and also least knowledge on safe abortion. But it was found that the students those who had the knowledge on safe abortion, they had attended the IPC meeting in the villages and gained the knowledge from the youth leaders.
End line survey
The IPC meetings were continued for the days till the closing day of the school for summer vocation and also end line survey was conducted in six selected schools with 261girl students as per the questionnaires for the baseline survey, the same question was used for the end line survey for rating the acquired knowledge on safe abortion and SRHR by the students of the schools. Those students were attended the base line survey only that students were for the end line survey.
End line Analysis
The end line survey was conducted in 6 selected schools with 261 girl students by the peer leaders. 100% students had the knowledge about physical and psychological changes, 98.85% aware about the conception and ovulation and 96.93% got a little idea on safe abortion after the peer training was over and the completion of IPC meeting in schools by the peer leaders.
Comparative analysis
The less knowledge on physical and psychological changes i.e. 63.72% was increased to 100% after the knowledge broke out by the peer leaders in the schools, 36.28% increment is a great achievement. 61.69% students had the knowledge on conception and ovulation which was increased to 98.85%, total 37.16% knowledge was improved through the IPC meeting and also 46.44% students had a little knowledge on safe abortion but it was increased to 96.93% after the implementation of the knowledge by the peer leaders. It was the great achievement after the IPC meeting in the schools.
Detailed objective wise report :
| SL.NO. | Objective | Activity | Output | Outcome |
| 1 | Improving knowledge of young women (married and unmarried) not only on the legality but also of the availability of the service facilities available for safe-abortion.
|
· Staff Re-orientation
· IPC Meetings · Mother, Daughter and daughter-in-laws Conference · School Intervention Programme
|
20 staffs were fully gained the knowledge on safe abortion and SRHR.
More than 3000 IPC meeting were organized in villages by the youth leaders. One conference was successfully organized where 95 participants were sensitized on safe abortion. School teachers were sensitized and 65 peer leaders were trained and gained the knowledge on safe abortion and also SRHR. |
The programme was successfully organized and achieved the targets and also found the accessibility of the facilities on safe abortion and SRHR by the young women. |
| 2 | Improving medical knowledge and clinical skills of local service-providers (doctors) and health intermediaries, both government and private, in provision of reproductive health services for young women including legal and safe abortion services.
|
· Reorientation of Health intermediaries
· Orientation of PRI members |
310 HI were oriented through the training and also acquired the knowledge on safe abortion and also broke out the knowledge.
163 PRI members were oriented on accessible of safe abortion facilities. |
HI were fully supported to the youth leaders for the better function of the IPC meeting and also for delivering the messages on safe abortion facilities provided by both public and private sector in the rural villages. |
Follow up with service providers both public and private:
The meeting was organised with service providers in every month to know the case status coming and registered in a month. The service providers like doctors were followed up by the project staffs and also discussed about the safe abortion facilities and SRHR along with spread the knowledge to the young women both married and unmarried regarding the same. Dr. Mithilesh Singh and Dr. Anamika Jha were followed up and discussed about case status of MTP and also young women were referred for the safe abortion to the same doctors.
Follow up with Health Intermediaries:
Health Intermediaries were followed up by both youth leaders and the field supervisors to know the referral cases and also to support them for organising the IPC meeting in the villages and also help the women for the better understand of the facilities available for safe abortion. It is seen that there has been a positive progress among the women in these areas.
Meeting with other stake holders:
There was organised the both formal and informal meeting with the Teachers, PRI members and the community leaders to get their support and also sensitize them on availability of safe abortion for the achievement of the activities undertaken by the project.
Follow up of ARSH Clinic Bagodar:
The ARSH Clinic, Bagodar was followed up to know the referral cases registered and also provide suggestions on the issues related to SRH in every month.
Identification of new target young women:
The survey was conducted to know the new target young women and the youth leaders were identified the new target young women by asking the questions during the IPC meeting and also through the other people of the villages.
Monthly Review and Planning Meeting
Monthly review and planning meeting were organised for the better function of the project work and also where the youth leaders and field supervisors were submitted their monthly activity reports and the action plans of the each month along with discussed the challenges they faced during deliberation of the topics in the IPC meeting and also decided the targets to conduct the IPC meeting in the villages. Suggestions were made by the project staffs to tackle the challenges and omitting of the obstacles along with the doubts was cleared regarding safe abortion and SRHR.
Field observation of group meetings:
- The interest of the young women was increased a lot to know more about the safe abortion services which was found in the IPC meeting.
- Some of the new games were introduced which drags the attention of the young women to attend the IPC meeting and also to make them understand easily about the safe abortion facilities and SRH issues.
- One to one talk was carried out with the young women those were unable to attend the IPC meeting and also tried to involve them in the IPC meeting.
- All the topics were revised for the better understand on safe abortion in the IPC meeting.
- The school girl students were participated in the IPC meeting and interested to know more on the particular topics and also added the names in the file of the newly married women and also who attained 15 years old.
- Health-intermediaries are like ANMs, Sahiyas and AWWs were also supported to the project staffs for organising the IPC meeting and also to make the better understand among the women on the topics and also encouraged the young women to participate and ask question in the meeting related to safe abortion.
- The doubts were clarified through the IEC materials during the IPC meeting on safe abortion facilities to the young leaders as well as the young women.
- PRI members were also supported to the youth leaders for organising the IPC meeting.
Challenges:
- The Lok-Sabha election was postponed the PRI meeting.
- Beginning of summer season which hampered the IPC meeting.
- Annual examination of the students in the schools which delayed the school intervention programme.
State how challenges were overcome:
- The invitation letters were distributed to the PRI members by the youth leaders after the election to give information about the date, time and venue along with purpose of the meeting.
- Caps and umbrellas were distributed among the youth leaders and also decided and planned to organise the IPC meeting either in the morning or in the afternoon of the day.
- The peer leaders were trained after the examination and also conducted the IPC meeting in their respective schools.
Project Impact:
This project improved the knowledge of the young women regarding safe abortion services and SRHR. The young women were sensitized on the same and also get the facilities available in both public and private. The young women were also taken participation in different activities which was organised by the project. The youth leaders were also initiatively done the IPC meeting and also tried to involve more young women in the meeting and also sensitised them by visiting and doing one to one talk. The young women were also more conscious of their health now a day by attending in the events undertaken by the project. Most of the young women and the girl students were sensitised about safe abortion and SRHR through the school intervention programme and saaa, bohu, bati samellen. The events were organised by project of youth Ipas through which the knowledge was improved and impacted on the young women both married and unmarried.
Learning
- Maintenance of the documentations and the activity reports.
- Rapport building with the different stake holders.
- Dealing with negative behaviour person.
- Break out the knowledge to the unknown person.
- Being Creativeness and sharing innovative ideas.
- Gained the new knowledge through the training.
Conclusion:
The young women were got the knowledge through the sensitisation on safe abortion and also got the benefit of the services provided by both public and private. The young women were also encouraged and motivated to take care of their health regarding to the related issues. The young unmarried women were interested to know about the topics and also seen quite happy through receive the knowledge on safe abortion which could be help them for the future. The project is being seen a great impact for which the youth leaders were striving.
Case study/success stories
- One of the woman disguised name Bina Kumari w/o- Raja Mandal of Jarmune panchayat, a happy family and had three daughter. She was pregnant for the fourth time and frequently attends the IPC meeting and receives the knowledge on safe abortion and the SRHR issues and also always contacts the kalyani didi, one day she asked to kalyani didi about the sex selection and also told that some of the community women are forcing her for the sex selection but she replied to them it is illegal and god’s gift. She was telling to kalyani didi about this matter and kalyani didi also gave thanks to that woman and also she gave thanks to Ipas for the implementation of this project on safe abortion.
- Loksabha election was taken place for which all the PRI members were busy for campaigning, therefore PRI meeting was not organized but after the completion of the election is over PRI meeting was frequently organized and conducted smoothly. One of the PRI members is a practitioner named Ramnarayan Rana(upmukhiya, Mundro) and had attended the meeting at Panchayat Bhawan, Mundro. He provided his opinion that most of the young women sensitized on the use of contraceptives. And also knew about the pregnancy test kit and safe abortion. Because one of the young unmarried women was pregnant but she suddenly visit to him and asked the tablets by naming that. And the doctor was astonished and asked to her how did you know about the tablet along with the price of it? She replied very soon by naming Kalyani Didi and Ipas project. The doctor was also happy to hear from her about the programmme but wanted to meet the staffs of Ipas project, but did not get chance to meet with them. Then fortunately the doctor met with the Ipas staffs during the PRI meeting and gave thanks for creating awareness on safe abortion and SRHR.
- One of the young married women named Anita Devi (disguised name) age is 23 wife of Dinesh Shaab from Noba Tola of the panchayat Beko-East. She has a small family and goes for daily wage. She was attending the IPC meeting in the village and had some knowledge on SRH issues and safe abortion. One day she suddenly came to know about her unwanted pregnancy of 1.5 months. But she had known about the abortion still felt shy to inform to her husband not even to her friends. One day kalyani didi had been conducting the IPC meeting in that particular village and the focused topic was also safe abortion Anita Devi shared her problem with kalyani didi during the meeting and she was referred to CHC, Bagodar and she was prescribe to take some medicines and after completion of the dozes she had the safe abortion and She is happy now and then she gave thanks to Ipas.
- It was so hot when the field observation was going on in a panchayat named Hesla. One of the AWW (Usha Devi) was in her centre and suddenly welcome as soon as she saw to the staff. Then had the introduction about the staff and also about the project work which took a long time and she was asked to say something about the safe abortion. But some of the information was shared correctly and frankly where it was found that most of the things she is unknown. So the information was passed to her to improve her knowledge and then she asked some questions to know more on safe abortion and the SRHR. She was also informed and agreed to take participation in the HI Meeting on ahead and then felt happy and told that it is most important to spread out the knowledge among the young women on the availability of safe abortion facilities in the public and private sector and also told that to support the Kalyani Didi to conduct the group meeting. She gave thanks to Ipas for the successful implementation of the programme on safe abortion.
Vitamin A supplementation programme
With the help of CINI, BVA had trained 903 ANMs from the district Giridh Kodarma and Dhanbaab.
To Appraise ANM/AWW.
- About GOI guide lines regarding VAS.
- Formation of JPSSPM.
- National policy of VA Distribution among children.
- Time of Bi-Annual round in Jharkhand
- VIT A an micro-nutrients.
- Prevention of various diseases by Vitamin A supplement.
- About the ways and means of child mortality rate and how to decrease it in Jharkhand.
- Immunization Process.
- Different forms from I to Form IX.
- Record keeping.
- De worming procedures among children.
- Motivation for National work as selfless service.
- Outcome of the Activity –
- Skill developed among ANM.
- ANM/AWW understood every aspect of objectives.
- Post test were successfully done.
- Achievement level is 98%.
- ANM motivated and took oath for service to mankind.
- Confusion removed regarding immunization and Record keeping
- Motivation for National work
- D. Methodology Adopted:
- Participatory
- Question, Answer method.
- Written (Pre test + Post test)
- Picture demonstration.
- Group discussion.
- Display of Various forms and records.
E.Gaps Identified:
- 2 to 3 % were inactive
- Little knowledge of work.
- Insufficient textual knowledge.
- Gaps observed between authority and ANMs.
- Lack of seriousness
- Financial provisions is not sufficient in running smooth training.
- Suggestions:
- Mere training is not sufficient.
- Regular monitoring system to be developed.
- Supply of kits at regular internals.
- Stress the needs of natural Sources of VIT A
Interaction should be among the Trainers, Trainees and Victims