EHSAS activities round-up

Our Adolescent Health and Sexuality Education program has a strong community focus and is implemented in three sites: Kalwa, Dharavi and Kandivali and targets beneficiaries from informal settlements aged between 10 and 19 years. The overall vision of the program is to impart gender-equitable values, health and sexuality education through a gender-transformative approach and to create youth change agents. Below is a round-up of the August EHSAS community engagement activities by Shamolie Oberoi.

Mental Health Awareness Campaign

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The EHSAS team, along with SNEHA’s Prevention of Violence against Women and Children (PVWC) team organized a mental health awareness campaign at Chatrapati Shivaji Hospital, Kalwa, upon request from the hospital authorities.

The SNEHA team conducted three street plays on mental health at three OPDs in the hospital. The street plays were performed by five of our young change agents who are active in creating awareness in their communities on issues affecting adolescent girls. These girls have been trained in theatre skills.

The girls performed confidently, clearly putting across the intended message. They portrayed the specific problems faced by adolescents, for e.g., anxiety about exam results, adding that such things are a part of life, and shouldn’t be the cause of mental health issues like anxiety, depression. However, the message was also given that anyone suffering from these must seek help, and there is no shame in doing so.

The Dean of the hospital joined in to watch the plays. She encouraged our girls to speak up about mental illnesses, and to communicate and provide assistance to those who are
suffering from such illnesses. She suggested the setting up of a newspaper library that can be accessed by adolescents in the resource centre set up by SNEHA in vulnerable communities in Kalwa.

We also played a special game of ludo, with questions related to myths about mental
illnesses along with 56 women. The myths were clarified and a discussion was held with
these women participants. The campaign thus went off successfully, and our change agents were excited about the opportunity to spread awareness about such an important issue, while also showcasing their theatre skills!

Campaigns during Ganpati season

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31 st August in Kalwa: Our team organized games and other activities as part of their Ganpati Campaign in Jai Bhim Nagar. The event was supported by Mandal volunteers. 36 boys and girls from the community participated in competitions which included essay writing and drawing. A play titled “Main Chalati Hoon”, which covered issues such as safety and mobility, was also enacted. Approximately 150 people from the community gathered around to watch the play, and many girls came forward to speak up about their rights.

While the play was on, a boy passed a comment about one of our girls. To this, the girl remarked on the mike, “If we are not safe in our community, how can we move further…nobody is interested in putting a stop to eve teasing”. Her comment was appreciated by all those present, and the Mandal members spoke to the boy in question. The campaign went off successfully and was enjoyed by all who were involved.

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28 th August in Dharavi: Our team held a street play and organized games and activities as part of our Ganpati Campaign. About a 100 children from the community participated in the event, along with around 15 Mandal coordinators, 12 staff members and 15 youth volunteers. The participants thoroughly enjoyed the games, which included 4 corners, puzzles, a GK quiz and a few one-minute games.

Our Associate Project Director, Neeta Karandikar, then spoke to the crowd about child
sexual abuse, and the difference between “good” and “bad” touches. Our Community
Organizer Hansraj Pawar sang a self-composed song on SNEHA’s work for the crowd.
At the end of the event, EHSAS’ youth group performed a moving and educational street
play on the issue of child sexual abuse, which was watched by the 100 children who
participated, as well as another 30-40 members of the community. The play sent the
message that sexual abuse happens to both girls and boys, and any child facing such abuse should speak about it to a trusted adult. Information about the Protection of Children from Sexual Offences Act, 2012, was also given to those present.

The event was a success, and the Ganpati mandal organizers felicitated SNEHA by
presenting us with a shawl and shrifal, as a token of appreciation for our efforts.

Workshops for Change-agents

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A two day workshop with 51 Change agents, organised by SNEHA and supported by UNFPA, was held at Thane on 18th and 19th August 2017. Aimed at building responsible citizenship through personal transformation, the workshop included sessions on legal rights, brainstorming on personal values, development perspective and leadership styles. The group of change agents comprised young girls who have been active in performing street plays and identification of cases of gender based violence and sexual abuse in their communities in informal settlements across different parts of Mumbai.

A churning of thoughts has begun among the young girls and they felt compelled to think about the interrelationship between social structures and individual rights that they are entitled to. Given below is a brief on the various sessions with key discussion points:

Citizenship and Legal Rights

On the first day, an excellent ice breaking session on knowing each other was followed by Rama Shyam, Program Director, SNEHA, setting the tone regarding the constitution of India, our rights and responsibilities as Indian citizens. She placed the Constitution vis-à-vis the history of India’s freedom and need for safeguarding rights of citizens in a socially diverse nation.

This was followed by an informative and interactive session by Advocate Ujwala Kadrekar where she covered the Preamble and the significance of Articles 14, 15, 19 and 21 in the context of equality before law, equal opportunities, freedom of expression and right to life with dignity. She introduced the salient features of the POCSO and Domestic Violence Acts while encouraging participants to narrate personal experiences of violation, discrimination and violence based on sex and gender.

Value Clarification and Taking Stances

Neeta Karandikar, Associate Director, Anjali Pore, Programme Coordinator and Rama Shyam from SNEHA facilitated a session on enabling the Change Agents to debate, think and share perspectives around a statement “Violence is Justified for the Right Cause”.

A long brainstorming on violence as the language for improving behavior arose during the discussion with each side debating their stand, feeling confused, changing sides and trying to defend personal stances. The key takeaway was that values may be commonly shared and perhaps each side was striving for peace, love, equality and understanding. However, the approaches were different based on different perspectives shaped owing to the differences in the environment that nurtures individuals. Participants analysed the key aspects that go into shaping values and perspectives – family, culture, social structures, school/college, media.

Development Perspectives: Power Structures and Access to Resources

The second day began with an energizer and recap from the previous day. This was followed by an exercise on distribution of and access to resources. Participants could relate with how resources such as educational opportunities, land, wealth, water, health facilities are distributed unevenly. Some participants strongly affirmed the need to work hard to access opportunities.

The next exercise was a power walk that laid bare the social and economic structures that make opportunities inaccessible. It was revealed how population segments such as the homeless, children from marginalized backgrounds, women in general and religious minorities faced discrimination and alienation. Participants cited instances of discrimination against Muslims while seeking jobs and of vulnerability of women and children within homes and outside in the society.

Leadership Styles

This session facilitated by Ms. Anjali Gokarn was extremely interactive with all the participants engaged in a small group activity that clearly brought out the three leadership styles viz. Democratic, Autocratic and Laissez Faire. The Change Agents were encouraged to share their experiences from each group before venturing into the next exercise on how each person must assume a leadership role at various points across life.

Towards the end of the session, each small group came up with a logo and slogan on what the EHSAS project means to them.

Some of the powerful feedback we received from the participants in the workshop:

“This is the first time I realised that I have a right over my body and even a husband/partner cannot violate it without consent”

“I have gained a lot of clarity on gender based violence”

“My key takeaway is that Articles 14 and 15 guarantee equality before law”

“Violence begins with language and gestures used at home and children often learn that this is the only way! Love and understanding are the only ways to break this cycle”




Ehsaas: Making Boys Part of the Solution

It is now widely recognized that improving the status of women has to involve boys and men. As much as girls, boys too are trapped in stereotypes and they need to recognize and value the importance of building equal and healthy relationships.

Unequal power not only suppresses women and girls, but also oppresses men and boys. Apart from the pressure of being the economic provider, rigid gender roles also limit men’s cultural experience. There is the pressure to appear virile and strong at the cost of suppressing emotions.

Since 2013, SNEHA’s Ehsaas program has been working among adolescents in Mumbai’s slum communities towards breaking these stereotypes. Through a mix of street plays and community sessions with adolescents and their families, gender stereotypes are questioned and challenged.

“The attitude has been to look at boys as problems”, says Neeta Karandikar, associate program director, Ehsaas. “This is especially the case after the Nirbhaya and Shakti Mills incident in Mumbai where the accused were from the slum areas. Boys from poorer communities were seen as problems. But we have to recognize the challenges they deal with”.

Traditional patriarchal attitudes, believes Karandikar, not only oppress women but act as traps for boys and men. By highlighting norms that allow boys to play while girls do hosuehold chores, Ehsaas encourages youngsters to question prevailing mindsets.

“My sisters would eat only after the men of the house would finish their meals”, says Shahid Shaikh, a peer educator with Ehsaas. ‘I never questioned that. It was after I joined the program that I realized how wrong this was and I now make sure they eat with everyone else”.

For decades, gender equality was considered a woman’s issue. Now, there is a realization that the role of men and boys in challenging and changing unequal power relations is critical. There is a stronger focus on the positive role men and boys can play in promoting women’s empowerment in the home, community, and  workplace.

To know more about Ehsaas, read this NDTV report 

Curbing risk behaviors among youth will help prevent spread of NCDs

Creating healthy behaviors among the young is key to tackling a range of non-communicable diseases like cancer, diabetes, cardiovascular issues and respiratory illnesses, according to a new report by the Washington DC-based think tank Population Reference Bureau.

Noncommunicable diseases, or NCDs, are the leading causes of death worldwide, and are among the top public health challenges. Unless action is taken, the deaths due to NCDs are likely to rise to 52 million by 2030. Asia accounts for 54% of deaths due to NCDs.

The report says that 25-29% of India’s population between the ages of 30-70 years is at risk of premature death due to the four main NCDs.

“Adolescence, or young adulthood”, says the report, “is typically when the four main CD risk factors are initiated and established…and the risks are growing, setting them up for poor adulthood. “

Given the critical role that the young play towards a country’s economic stability and prosperity, it is essential to look at investing in their health as a urgent priority. The PRB report cites data to show how NCDs already account for about 40% of all hospital stays and 35% of outpatient visits in India.

Broad policy level intervenions are needed if this is to change. Some welcome moves have been the recent legislation to introduce broader warnings on ciigarette packets and awareness campaigns against smoking. So is the ban on sale of tobacco products near schools and hospitals. But this needs stronger enforcement to be effective.

Also required is the push to create spaces where children can play or engage in physical games, a lack most noticeable in our cities where there ae no safe, public spaces for boys and girls to play games. Many Asian cities have taken steps in this regard. Beijing and Singapore, for instance, have streets with dedicated bicycle lanes, while South Korea and Japan have parks and playgrounds with gym equipment for both youngsters and odler adults.

Its time that India too focused on effective social and behavior change interventions at the school and community level to make sure the young stay healthy, active and avoid risk-free behaviors.

Guttmacher Report underlines need to meet adolescents’ contraceptive needs

Twenty three million – that’s the number of adolescents at risk of unintended pregnancies in the developing countries.

The statistic, part of the Guttmacher Institute’s May report Adding It Up: Costs and Benefits of Meeting the Contraceptive Needs of Adolescents, again points out the huge gap in contraceptive services among adolescent women. The report says that many women who want to delay childbearing are not getting the services they need.

About 40 million of the over 250 million adolescent women between 15–19 years in developing regions are sexually active and want to avoid pregnancy, yet 23 million of them have an unmet need for modern contraception. Most adolescents with unmet need are using no contraceptive method while the rest depend on traditional methods, which have been proven to be not so effective.

All this underlines the need to make sure modern contraceptives is made available in developing countries. This, according to the report, will not only prevent unintended pregnancies but also prevent the 3,000 adolescent maternal deaths reported every year in developing countries.

At 21% India has among the highest unmet needs for contraception in the world. This is despite the fact that we were the first country in the world to launch a government-backed family planning program. However, today countries like Bangladesh and Indonesia, which started their programs much after India, are faring much better.

The government has recently launched a wider pool of contraceptive choices for women. Welcome steps, but there needs to be more focus on behaviour change communication. Young women and couples want to plan their families but do not know where to get the information.

High time India invests in its demographic dividend

The Lancet Commission on Adolescent Health and Well-being report launched in London on Tuesday highlights just how fragile the state of India’s demographic dividend is.

The report says that suicides are the leading cause of death among people in the 10-24 years category, with nearly 63,000 deaths reported in 2013 alone.

This is one-third of India’s population that we are talking about – a group that many take pride in as a demographic dividend. Clearly, it is crying out for help.

We don’t need to look too far for the red flags. Newspapers, of late, have been flooded with reports of the spate of student suicides in Kota. Since 2015, 26 youngsters, boys and girls, have killed themselves, either because they cannot cope with the burden of studies or feel pushed into career choices by parents.

The district collector has written to the parents of the over 1.5 lakh students living here asking them not to place the burden of their expectations on their kids.

The study author has said the findings should be a “wake up call for new investment in the largest generation of adolescents in the world’s history.” Because this is an age group that is seen as the healthiest, it also has the poorest health-care coverage amongst any age group.

The warning signs are especially strong when it comes to mental health. The report says that in India over 28 lakh youth have suffered health losses due to depressive disorders, an aspect that is particularly neglected.

Suicides due to academic pressure or employment concerns are a major part of the problem, one that the government needs to address by creating more job opportunities.

Equally important is the need to find ways to equip our youth emotionally. Adolescents today face challenges on many fronts and there is a need to acknowledge this and work towards finding a solution to this tragic ending of so many young lives.


Pyaari Meenu -Telling SNEHA’s story through the letters of a young girl

How does one even begin to express why investing in women’s health is so vital?

Be it reducing maternal deaths, improving infant and maternal health, family planning, or tackling domestic violence, a healthy woman is at the core of a prosperous urban world, and this is effectively conveyed in Pyaari Meenu, the film by Social Access on SNEHA’s efforts to build strong, healthy and secure urban communities.

Bringing together SNEHA’s various community interventions is not easy. However, Pyaari Meenu weaves those strands together quite beautifully.

“Our challenge was to convey all the program interventions they undertake in one central thought” says Lynn De Souza, founder, Social Access, “and we did this by stepping back and driving home the underlying premise, the belief that empowers all their work. This came through in the tag line “A healthy world begins with a healthy woman”. Even men get included in this thought!”

Pyaari Meenu uses the form of letters written to an unborn child to convey these ideas. “Letters are always a nicely emotive way to tell a story from a personal point of view. They draw the viewer into the experience, as observer and participant,” adds De Souza.

Shooting the film came with its own set of challenges as the milieu had to be real to bring home a sense of the community that SNEHA works in. Pooja Das Sarkar, who directed the film, says it was shot in just one day over 17 hours, remarkable given the noise and chaos that is present in any urban settlement.

“We chose a two-storied house – one to show the life stage of a younger girl, and another to show the older woman”, says Das Sarkar. But the challenges remained. “We chose lights that were small and could be used in a smaller space. At night, people were very curious and stood outside the house commenting on “Who is the heroine”? etc. It was funny but natural and we did not let it affect the shoot.”

Helping to make the process smoother were SNEHA workers. They explained to local residents what the film was about. “We sourced the kitchen, a baby’s cot and even a baby from the community”, adds Pooja. SNEHA staffers were also roped in to act, with Nasreen playing the key part of Bharati Didi.

The result is Pyaari Meenu – a haunting, evocative film that helps the audience understand SNEHA’s work and makes an emotional connect.




Community mobilisation needed to tackle rising cancer deaths

On World Cancer Day, here are some India-specific statistics that need immediate attention.

The incidence of cancer is 70-90 per 100,000 population, with prevalence stated to be about 2.5 million cases. Over 800,000 new cases and 550,000 deaths occur each year, with over 70% of the cases being diagnosed at an advanced stage. That means when a person comes for treatment, their chances of survival are very poor.

ICMR data on site specific cancer burden reveals that in males the  most common cancers are those of the mouth, stomach and lung/bronchi. In females, it is that of the cervix, breast, mouth and oesophagus. After breast cancer, cervical cancer is the second most common cancer among women in India.

More women in India die from cervical cancer than in any other country, according to a 2014 report by the Cervical Cancer Free Coalition.  Cervical cancer kills around 72,000 women in India every year, more than 26% of the 275,000 deaths worldwide.

The report also says that the causes are closely linked to attitudes towards women and unless that changes the deaths will rise. Because it is linked to sexual contact, “cervical cancer is a taboo issue in many places”, said the U.S-based group in a statement. “Unless women’s groups and civil society come together to lead movements that break through stigma, patriarchy and other societal barriers, we will continue to see large numbers of deaths and high mortality rates,”.

Cervical cancer, which mostly affects women between 18-45 years, is linked to human papillomavirus, a sexually transmitted virus.. The virus is believed to be responsible for most cervical cancer cases — more than 80%, according to some estimates. A pap smear can spot the virus at an early stage and HPV vaccines have been developed.  In December 2014, the Indian health ministry announced that it wanted to introduce the vaccine in the universal immunisation programme at the earliest.

What is missing however is a countrywide cancer screening program to catch the disease early. Cervical cancer is a preventable disease but it can also be successfully treated if detected early.

The UNAIDS statement calling for a greater integration of health services to tackle cervical cancer is a welcome one. It says “the relationship between HPV and HIV offers significant opportunities to reduce the impact of both viruses, since existing HIV programmes could play an important role in expanding cervical cancer prevention and treatment services.” It goes on to recommend that every woman who tests HIV positive should be offered screening for cervical cancer and follow-up treatment if needed. And that HIV testing should also be offered during cervical cancer screening.

An effective intervention also calls for delivering age-appropriate programmes for adolescent girls, that includes HPV vaccines and regular screening. Steps India has to accord high priority to to rein in the galloping figures.

Time to involve adolescents in FP meaningfully

At 1.8 million, they are a significant component of the world’s population. Yet when it comes to family planning, services for adolescents are patchy in many parts of the world. And ignoring this is a serious violation of their human rights.

This is one of the central messages of the 2016 International Conference on Family Planning currently on in Bali, Indonesia.

There is growing recognition the world over that including adolescents in health services is key to any country’s economic progress. Hence, giving them access to contraceptive services, addressing myths and misconceptions and striking down laws and policies that restrict their ability to exercise choices is critical.

“This is a never before moment in adolescent health” said Dr V Chandramouli, scientist at the WHO Department of Reproductive Health and Research. “We need to ask hard questions now”.

Speaking at the opening session of the second day of the ICFP, Dr Chandramouli said the way forward was to make existing health centers in different countries adolescent-friendly rather than set up specific youth centers.

“Separate centers for adolescents are neither necessary nor sustainable”, he said. “Instead make health workers at these centers adolescent friendly. “ This he said should be done through a package of actions which includes good quality training, supportive supervision and collaborative learning.

How these messages are framed is also important. “Adolescents are discovering their bodies and this is a joyful, exciting process for them. They need health workers to help them and not always frame answers in the context of HIV”.

However, this approach calls for a rethink in how many countries approach sexuality education, which is banned in many states across India.

“The Indian government and policymakers are not seeing sex as a health, development and human rights issue”, says Ramya Jawahar, Vice Chair, International Youth Alliance of Family Planning. “They believe that if sexuality education is taught in schools, it will encourage promiscuity.”

This belief that is not backed by any data; on the contrary, various studies have shown that empowering youth with information on family planning brings down unintended pregnancies by as much as 80%. Denying them this information, on the other hand, puts them at health risk.

Break the Silence on Menstruation

Standing outside the gate leading to her school, Anjali, a resident of Ghatkopar, Mumbai, 15, points inside to a partially broken door.

“This is the only toilet in the school which has running water. Now do you understand why I prefer to stay home on ‘those’ days”?

“Those” are the days when Anjali is menstruating when she, and most of her friends miss school. That is nearly seven days every month and the frequent absences Anjali fears will come in the way of her dreams of becoming a doctor. Many girls in her neighbourhood have dropped out totally shortly after hitting menarche.

What is a natural process marking the onset of adolescence in girls is fraught with huge challenges for girls in developing countries. Studies in different parts of Africa have documented how menstruation significantly compromises the education of girls.

The same is the case with India where according to an pan-India sanitation study by Dasra and Forbes Marshall, almost 23% of girls drop out of school when they start menstruating, and as many as 66% of girls skip school during this time. The same study also highlighted that 88% of India’s 355 million menstruating women have no access to sanitary pads – a lack that affects the health of women and adolescent girls.

An unsupportive environment in schools that includes lack of adequate toilets, absence of gender-segregated facilities, poor sanitation and inadequate water is one of the main causes. Another factor that explains the low school attendance is access to sanitary products that girls, especially in rural India, face.

A recent study focused on 53 slums and 159 villages in Madhya Pradesh, Chhattisgarh and Uttar Pradesh found that 89% of girls and women used cloth during their menses, with over half of them using the same cloth for more than one period. Two per cent used cotton wool and ash. Just 7% used sanitary pads.

The reality seems to have been taken note of at the policy level. In his Teachers Day address in 2014, PM Narendra Modi expressed concern about the large number of girls dropping out of school and the need to find ways to make sure girls don’t quit school early. The Swachh Bharat, Swachh Vidyalaya mission aims to build “at least one incinerator in the girl’s toilet block and a niche to keep sanitary napkins”.

What hold out greater promise is innovations in this field. Among the most prominent are those by A. Muruganatham, the Tamil Nadu-based creator of low cost sanitary napkin making units, who is aiding the Uttar Pradesh government’s efforts to reach total menstrual hygiene.

Guided by the UP government and Arunachalam, a pilot unit was set up in the village of Mahoba in 2013 to produce low cost sanitary napkins. The unit employs only women and is part of a decentralized enterprise model. This was coupled with a massive drive on menstrual hygiene across nearly 15000 schools in the district. The program was a massive success with the demand for Subah napkins far outstripping the supply and the UP government plans to take it across the state.

Courtesy: Wikipedia

Also effective has been the UNICEF program in Kanchipuram district, Tamil Nadu, under which a vending machine disposing sanitary napkins was installed in schools.

Awareness too has to go hand in hand with affordability and availability. There is tremendous shame and stigma associated with menstruation and schools must address this, among boys and girls, to break the silence.

Family Planning is a Rights Issue

Starting January 25, thousands of activists and experts from around the globe will gather at Bali, Indonesia, for the 2016 International Conference on Family Planning. It’s an opportunity to take stock of goals that have been met with, and for countries to evaluate how to boost workforces and tweak their approaches toward achieving the new Sustainable Development Goals.

India has a lot to feel proud about. Its population growth rate has dropped considerably – from a near 22% in 1991-2000 to 17.6% in 2001-11. With a fertility rate of 2.3, we are now just 0.2 points away from reaching the replacement level. And the good news is that nearly 60% of our population lives in states where replacement fertility is already reached or will soon meet the target.

That’s the good news. There is plenty however to be done when it comes to how we approach family planning at the policy level. On this count, India lags far behind countries like Sri Lanka and Bangladesh which is surprising given that w were the first country, globally, to have a government-backed family planning program.

For one, India still reports the highest unmet need for contraception worldwide at 21%. In Bihar it is 31% among women between 15-19 years and 33% between 20-24 years. Maternal and neo-natal mortality is five times higher among girls who conceive before they hit the age of 20. They are also more likely to experience spontaneous abortions, infections and anemia.

This is largely because on the ground the emphasis on female sterilisation remains extraordinarily high. According to UN data, in India, over 37% of women between 15-49 years use sterilization as a method of contraception. Only 3.1% use a pill and 5.2% rely on condoms.

“The rights perspective on family planning is missing at the policy level and it is high time that this changed”, says Dr Pranita Acharya, gender, poverty and HIV/AIDS specialist at the International Centre of Research on Women. “It is the right of couples to decide when and how many children to have. This is only briefly touched upon at the policy level and forgotten on the ground”.

Other contraceptive choices require counseling and careful monitoring – an investment that most states find burdensome. Sterilisation, on the other hand, is a one-time, gunshot intervention. The result is that many women have been sterilized even before they need it.

There is a near complete lack of awareness when it comes to contraceptive choices among married adolescent girls and newly married couples. Filling this gap is critical given that India accounts for 17% of maternal deaths, worldwide. Educating newly married couples about various contraceptive methods could help prevent many more such deaths.

It is also important to involve men in family planning matters believes Sushma Shende, Program Director, Maternal and Newborn Health, at NGO SNEHA. This will help couples make better informed and collective decisions.

“Considering the socio-economic set-up of the areas in which we work, it is difficult for women to take decisions with respect to FP”, says Shende. “Her husband and mother-in-law play an important role in decisions regarding child bearing and family planning. Moreover, the pressures of bearing and rearing the child is considered to be the responsibility of women so increased awareness amongst the men will make them more supportive and help address misconceptions or fear”.

Going beyond lip service to adolescent girls

The stage of adolescence is a vulnerable, turbulent one, especially so for girls in India who face barriers on so many fronts – social, political and economic.

Which makes the decision to call this year’s International Day of the Girl Child “The Power of the Adolescent Girl”, a welcome one. It’s an occasion when we need to seriously examine the various fronts – social, economic and political – on which their empowerment continues to be undermined in India.

India has the largest adolescent population in the world – 25% of them are girls. These girls have the potential to become leaders and effect change but they continue to receive lesser priority compared to boys within the family when it comes to education. 70% per cent of girls between 7- 16 years drop out of school. IMG_20140402_133526

Their empowerment is also hindered due to early marriages, early pregnancies, gender-based violence and limited access to reproductive health services. India has the highest number of child brides in the world – an estimated three million a year, which is third of the number of girls who marry as children every year worldwide.

Child brides are especially vulnerable to domestic violence. Studies have shown that sexual violence from husbands is most common among adolescent wives. These are factors that compromise mental health and have even been linked to depression and high suicides according to many studies.

a class of nurse aid students

Over the decades there has been an encouraging rise in the number of programs supporting adolescent girls, especially offering home-based and vocational skills to help them earn an income and play a greater role in their communities.

What needs to be beefed up is the availability of programs that offer information and access to public services and educating married adolescent girls on sexual and reproductive health issues. The unmet need for contraception continues to be high – at 21% India reports the highest in the world.

Various studies have shown that this need felt the most among 15-19 year olds from less educated and poorer homes. Clearly there is a desperate need to provide information on, and access to, a variety of contraceptive methods.

On this International Day of the Girl Child, let us think of ways in which we can empower girls to make meaningful choices in all aspects – economic, social, sexual and reproductive – free from bias, force and violence.

Dreams unlimited

Paisa hi sab kuch hai (Money is everything). I can’t live in a chawl. I need to live in a flat,” said Sairaj Salve, 15. To break the shackles of poverty and limited means is the sentiment that echoes among the youth of Ghatkopar.

SNEHA runs a programme – Adolescents Gaining Ground– for the youth in the area to empower adolescents with the knowledge and capacity to make informed choices about their physical, sexual and reproductive health and well-being through a regular series of health and life skills education sessions. The programme also focuses on enhancing employability skills of these community youth through the provision of vocational training of their choice and interest. On the occasion of International Youth Day, which falls on August 12, some of these youths got together to speak about their career prospects, their aspirations, dreams and the challenges they have to face to achieve those dreams.

The Ghatkopar youths clearly aspired for a white collared job and a more comfortable life. Many of them held full time or part time jobs while completing their college education. Because of their impoverished backgrounds, some have even been compelled to complete their education through correspondence courses.

“I am used to working and studying now. I go to Night College and then work a full night shift. I get to sleep in the daytime. Its not that bad,” said Ratnasheel Kamble, 21, said in a nonchalant manner. Kamble works at a petrol pump.

Salve said he wants to complete his bachelor’s in banking and insurance. “It is ideal. Students get placed immediately after college,” said Salve who is studying in college.

Like all youngsters their age, these youngsters are a confused lot. They do not know what skills can help them in their future careers. SNEHA is guiding these youngsters with their career choices and is supporting their vocational training.

Ashish Gore, who is studying in first year BSc wants to study computer languages. “I want to run a business and work in a job too. There is limited income in jobs,” said Gore.

Like Kamble, many have worked in the past as sales persons, or at the call centre. These jobs are very demanding. Many had a tough time adjusting that and studies. For instance, Zubair Shah who finished his 12th standard says that he had a tough time travelling to Dombivali for a sales job of mobile cards. Many expressed that such physically jobs offer them no major monetary gain and career scope.

Some like Abdul Ansari who is studying for graduation via correspondence has no option. He says he needs to support his family.

“Sometimes I had to take very abusive calls. They wouldn’t pay us the whole salary and not even on time. I am now desperate for a job, ” said Ansari who worked for several call centres in the past.

Iron boost

After being told that both her children- Rahul, 13, and Pratik, 11, are anaemic, Meena Shukla is now constantly looking for iron-rich foods to feed them. Through a SNEHA programme at Janata Colony, Kandivali west, Shukla found out that both her children’s condition, especially about her younger son’s severe anaemia problem.

“My husband is a driver and I have to run the household on a tight budget. I worry about them. The younger one is so thin,” said Shukla.

Shukla was visibly excited when the programme co-ordinator, KK Jayalakshmi told her she could opt for cheaper iron-rich foods such as nachni, drumsticks among others. “I will try out the recipes at home,” she said.

Both children are on iron tablets since February. Since then, Shukla has made some changes in the diet at home (more vegetables and less junk food) and claims that the programme has helped Pratik has gain some weight.

The programme has identified about 150 adolescents who are anaemic in slum. Almost an equal number of boys and girls have been affected by the condition. Anaemia, or iron deficiency is caused by the lack of iron in the diet among others. Its symptoms include tiredness and lethargy, pale complexion, headache and coldness in hand and feet. The programme provides iron supplements for the children suffering from anaemia (which they are supposed to collect each day), regular check-ups, and counselling about how to improve the diet among others.

Nazreen, 17, for instance, would return from college tired and would go to sleep immediately. Her two other siblings, a brother and sister are also anaemic.

“These children do not eat well. Most of them skip breakfast, and directly eat at lunchtime. They also eat a lot of junk in between meals,” said Jayalakshmi.

The community organisers have to coax the children to take the iron supplements. Many complain of nausea, stomach ache, among other side effects and some have even dropped out of the programme. But the community organisers are persistent and counsel them on how to reduce the chances of side effects with the supplements.

Many children and their parents are also happy with the programme. “Two girls who would get very irregular periods have started getting regular cycles now. One girl said she doesn’t feel dizzy any more after taking the supplements,” said community officer, Najma Shaikh.

(Names of the children and parents under the programme have been changed to protect privacy)

Safety as a human right

When one talks of “access to toilets”, the first thought that pops in the mind is “sanitation”. In Dharavi, however, the immediate association with “access to toilets” is “safety of women and girls”. Why ‘safety’, you ask?

SNEHA’s toilet painting campaign

‘Safety’ because:

– groups of men and boys are always hanging around outside public toilets, loitering, drinking, gambling, sexually harassing women and girls.

– men and boys sexually find toilets an easy place to target a large number of women. Men and boys see public toilets as opportunities to stare, ogle, pass comments, whistle, grope, pinch, abuse, rape women and girls.

– women and girls feel uncomfortable, violated, targeted, harassed, denied of their basic human rights of access to safe toilets and a life free from violence.

– women and girls (and their families) feel like the onus is on them to ensure their own safety.

– women and girls are the ones who are forced to find solutions to ensure their safety such as going to the toilet early in the morning to avoid harassment and their harassers or going in a group with friends or with a family member or avoid going to the toilet several times during the day.

The 2011 Census of India found out that nearly 12 per cent of urban households resort to open defecation and another 8 per cent use public or shared facilities. Not only is this a health hazard, but it undermines the dignity of women and girls and makes them vulnerable to harassment and violence.

SNEHA addresses both, the issue of health of women and girls and the issue of gender-based violence in Dharavi, through campaigns, street theatre, meetings, support groups and vigilance groups. We raise awareness of these basic human rights in the community, and encourage and support collective, indigenous responses to combat violations of these rights. SNEHA’s men’s group members also act as vigilantes against sexual harassment of women and girls in public places, which includes the areas where public toilets are located.

Toilet tales from Dharavi

Last month, two sisters from Badaun district, Uttar Pradesh were allegedly raped and murdered when they went to answer the call of nature in the fields at night. Most people in Dharavi do not have toilets in their residence.We asked four adolescents in Dharavi how safe they felt when they visit the nearby toilet. 

Pratibha, 14, studies in class 9

We have a mori at home where we can have a bath and pee. For bathroom (meaning WC), I have to walk about five minutes.  I go just once a day in the morning. I do not feel the need to go after that.

I heard about a girl being molested there. Some boy who was on the way to the toilet caught her. I also heard of a five year old girl being molested there. It became a police case.

If the boys say or do something, it spoils our reputation. Our fathers too.

If I have to use the toilet in the night, my mother comes with me. Or else a friend comes along.
Hetal, 13, studies in class 6

We have a bathroom at home, not a latrine. For that I have to step out and walk for five minutes. We have to pay one Rs to use the latrine. I use it around 2-3 times.

I never go to the toilet alone if I can help it, especially in the night. My mother has told me that whether it is night or day, take someone along to the toilet. She usually comes with me, or else I go with my friend. Only when she is sick, I go alone.

I have heard of rape cases in that area. When I was a child, I was told that there was a bus which stopped there and picked girls for begging.

There are always boys on the way to the toilet. They come around 9 pm every night. They come with bikes sometimes. They say things like – palat ke dekh (turn around and look at me).  I once shouted back at them and said – Ghar main ma behen nahi (Do you not have mothers and sisters at home)? My mother had told me never to confront those boys, but I was very upset that day.

It is not fair that we do not have toilets at home. One of my friends did not use the toilet all night because her mother was not at home and her friend refused to come. Her stomach started hurting.

Boys have nothing to be scared of. They are the ones who trouble us. We girls have to be careful.


Kruti, 18, goes to college.

I do not live in a nice area. Many people who I grew up with left the area. It is not safe for girls. Many people in my area already have bathrooms inside their houses. There are hardly any people using the public toilets any more.

Till recently we had a horrible public toilet. It used to be so dirty. I would not like to go there. I would wait for half an hour to an hour to just use the toilet. Many times I have been late for school. Now we have one toilet for every ten houses. It is easier to keep to it clean and I do not have to wait long to use it.

I go to the toilet alone. It is just two minutes away. On the way to the toilet, we always find men around. Sometimes they just say something obscene and walk away. Men play cards or match (cricket) near the toilet. They always make comments.

I do not pay attention if someone makes a comment. If I confront that person, people will point their fingers at me only. They will say she must have done something to provoke the boys. It is best not to say anything.

One girl I know confronted these men who were passing obscene comments. But when she went home and told her parents about it, she was told – Tujhe hi sahi se jaana chahiye (You should have stepped out decently). They told her that she should not have worn jeans and T shirt.

I felt bad for her. She did not wear those clothes to show anything or provoke. She just stepped out to go to the toilet. In any case, even if you wear a dupatta and leave, you cannot hide your body. The men are going to comment anyway.

There is no light near the toilet or inside the toilet in the night. The bulb just does not switch on. We have to take a torch. It is just fully dark. I have to take someone along if I want to use the toilet at night.

My mother has always told me not to talk to my friends near the toilet. If I go to the toilet in the afternoon, I feel weird. There is no one there.


Vineet, 14, studies in class 9

The toilet is just one minute away. There are men smoking cigarette and drinking liquor there. My father has told me not to talk to anyone there. I am a little scared of them. They could beat me up if they want to. I always go with my father.

The toilet is sometimes very dirty. I have to wait for it for about 45 minutes to an hour. I sometimes get late to school. I do not go to the toilet even if I want to sometimes. It gives me a stomach ache.

I have seen girls being molested near the toilet. It is horrible. The boys sometimes pull their clothes, their hair. We try intervene sometimes. But, such incidents scare me. These incidents should not happen.

(Names of the adolescents withheld to protect identity)

Nursing dreams

“I never thought that I could become a nurse and comfort patients. I had once dreamed of becoming a doctor, but I never stood a chance with my low marks. I am happy that I can help patients as a nurse”– a student from Nurse-Aid Course at SNEHA, who is successfully employed in a nursing home who passed out in 2013


From being a high school drop-out to becoming a nurse-aid is a huge high for the girls who pass out of Nurse Aid School at SNEHA. For the girls, typically from the poorest of families in Mumbai’s slums, this opportunity builds their self esteem and also boosts their position in society where they are treated with more respect.

Tapping into the growing demand of nurses in Mumbai’s health care sector, SNEHA started the Swasthyasevika programme in 2004 to train school dropouts to become nurse-aids. The programme was an important means of providing economic opportunity for these adolescent girls. The programme has trained over 300 nurse-aids over the years and most of these girls are employed. The programme is run in three centres of Mumbai including Santacruz, Govandi, and Kandivali.

“This programme gives these girls a tremendous psychological boost. Their entire body language changes. They dare to dream big. Some of my girls are doing very well for themselves. Some are even trying to complete their studies,” said Shibani Bagchi who runs the programme.

The SNEHA team conducts several mobilisation programmes in several slums of Mumbai to enroll adolescent girls and women in the course. The SNEHA staffers go door to door and try convince parents and girls to do the course. Many parents do not see the point of sending their girls for a whole year and feel it is a “waste of time”. Also, many families are conservative.

“Sometimes girls really want to enroll, but their families are against it. I recall a case where the brother was taking care of the sister who wanted to study with us. I told the brother that he may think that marrying off his sister is good enough for his sister. But god forbid, she gets into trouble in her marriage, or her husband is not able to earn, what will she do?,”said Bagchi. The brother not only sent his sister, but also sent several other girls in the family for the course.

Apart from lessons on anatomy, and several aspects of medicine and nursing, the course also includes computer training and English speaking classes. The course also includes practical training and an internship at a nursing home where the girls earn a stipend. Most of the girls manage to get a job with nursing homes in Mumbai after the course.

nurse aid students attending computer classes
nurse aid students attending computer classes

Becoming a nurse is also a huge boost for the social status of the girl. Take the case of Sunita (name changed) who was allowed to go for this course only after three years of persuading her family. She was married when she was just 15 years old.

After the course, almost giddy with excitement at the prospect of work, she writes, “When I become a nurse, I will get up early everyday and finish the household work and go to the hospital. I love wearing the nurse’s clothes, I love being called a nurse, I will do my work diligently. when I get the monthly salary, I will contribute to my household. My relatives will love me.”

For the students who do not end up working, the course teaches them basic science and understanding of the nutrition, hygiene among other things that can help them keep their family healthy.

“I feel if we change the mindset of one girl, it has a ripple effect on the entire family,”said Bagchi.

Family planning in Dharavi

A vasectomy surgery is the end of “manhood”. A Copper-T can prick the body, rust inside the body, or ride up to the chest. Condoms give no “satisfaction”. Oral contraceptive pills can cause weight gain.

These are the the notions and misconceptions that SNEHA team working on the Family Planning programme has to deal with and dispel effectively. The Family Planning unit of SNEHA has been working hard in Rajiv Gandhi Nagar, Dharavi to dispel these misconceptions and notions since 2011 and have induced behavioral changes in many women and men in the area. As per SNEHA estimates, as much as 46% of the population has an unmet need for family planning.

For instance, Karishma, 30, (name changed) was reluctant to use any form of contraception, till she conceived again. She already had two children. She then approached a SNEHA community organiser who helped her get an abortion at Family Planning Association of India (FPAI) at nominal rates. The incident motivated her to get Copper-T fixed to avoid pregnancy for five years.

Social exclusion and lack of information limit access to services such as family planning which are crucial for reducing unwanted pregnancies, saving lives, reducing poverty and slowing population growth. A woman’s ability to control her fertility directly impacts the quality of her life and that of her children. Access to family planning can reduce the number of maternal deaths and child deaths.

“Instead of sermonising to the community to have less children, we have adopted a different approach. We tell them that having fewer children, it is easier to feed and educate them. We tell them that their families can be better and healthier,”said the programme coordinator, Family Planning, SNEHA.

SNEHA has adopted the Peer-educator model, whereby women from the community have been roped in to educate the other members and also provide contraceptive such as condoms, oral contraceptive pills and other services at the doorstep. SNEHA also gives the community information about safe abortion practices, post-partum family planning, spacing between two children and using methods of contraception by choice and mutual decision making. It has also strengthened the referral system to service providers such as municipal hospitals, and FPAI.

Some of our peer educators have made good choices and have fewer children. They help demonstrate the benefits of family planning in the community,”said Bapat.

There is also intervention by way of events and campaigns, group meetings, and home visits. Women who avail of SNEHA services and referrals to FPA agree to speak in group meetings that help in motivating other members of the community.

SNEHA also involves men in the project, a neglected target group of most family planning interventions. Men are important to target becuase usually they make all the decisions regarding family planning. To effectively deal with men in the area, SNEHA hired a male community organiser who conducts group meetings with men and is able to engage with men in the area well.

For instance, a SNEHA personnel were counselling a man who was in a live-in relationship with a woman. When the girlfriend recently got pregnant, SNEHA personnel helped her get an abortion and also helped the man understand the importance of using contraception to avoid such unwanted pregnancies.

“It is important not to judge such people and provide intervention whenever necessary,”said the programme co-ordinator.

Scene from a cricket field

Shivani Singh, 18 wondered if she will be able to play cricket. She had come from “all the way” from Kandivali to Dharavi to participate in a cricket match. She was one of the two girls selected by SNEHA to play in the three-team tournament in Dharavi. The three teams were selected from communities at Dharavi, Kandivali, and Ghatkopar where SNEHA works extensively.

“I can dance. I have never played cricket,” said Shivani who goes to college.

Nagesh Kori, 17, another collegiate in her team quipped, “That’s because you’ll never play with us. We play galli cricket all the time.” They were watching their team-mates open the batting against Ghatkopar team.

Shahid Sheikh on the extreme left cannot take his eyes off the match. Rohit Kanojia, Nagesh Kori and Shivani Singh pose for a snap while waiting for their turn to bat

“Rubbish! When did you boys allow us to play?” Shivani told him making a face.

In the meanwhile, one of her team-members, Rashida Shaikh, 18, gets out on the first ball. As per the rules, it was compulsory for one girl to open an innings.

“You please don’t get out like this,” said Shahid Sheikh, 17, Shivani’s teammate. He rolls his eyes when Shivani asks him questions related to the rules of cricket.

Soon, Shahid was cheering for Rohit Kanojjia, 19, who had stepped in to bat for the team. Sure enough, Rohit hits many sixes and fours much to the glee of his team members.

In the third over, Mayuri Mhasde, 15, a puny girl from Ghatkopar team started bowling (it was compulsory for the girls to be given one over in the match).

Rohit happily hit the first two balls for four and a six. In her third ball, she bowled him out. Rohit looked at the wicket in disbelief. The team eventually made 138 runs.

Mayuri was however, disappointed. “I could have taken another wicket. It turned out to be a no-ball,” she said.

Mayuri Mhasde on the left and Kajal Yadav next to her talk about their love for cricket

She has been playing cricket for over two years now. “We play every day between 2 pm to 4 pm. Even my sister who is a complete recluse plays with us,” said Mayuri.

Her sister, Sonali, 18, who studies in college, also plays cricket, and is part of NCC cadet. “I want to join the army after I finish my graduation,” she said.

Another girl from Ghatkopar but from a different locality, Kajal Bhandare said that in her locality, girls are not allowed to play. “My brothers take me everywhere. So I got to play cricket,” she said.

When Mayuri went out to bat for Ghatkopar, she got out soon. “My captain, Shashank Uthale asked me to get out. I can play well. I can hit four easily. Hitting sixes though is tough for me,” she said vehemently. The team got out making less than 51 runs with most batsmen making less than one run.

“What Dada, I told you I can play? Why you didn’t let me?” asked Mayuri. Shashank had no answer.


The three team tournament was organised by SNEHA on April 2. The intention was to select a winner for a tournament organised by Indra Darshan Society, Oshiwara. The Society runs a cricket tournament every year to help raise funds a non-profit of their choice. This year, they have chosen SNEHA.

The victorious Dharavi team

After six matches, Dharavi team emerged the winner. The team will represent SNEHA in the Oshiwara match. In this team, both the girls and boys played in harmony. They practiced for days before the match.

Talking gender in Dharavi

Pointing at posters of Hrithik Roshan, a 13-year old boy said that he is “fittest” and “good-looking”. Kareena Kapoor, the boy said, is beautiful because she is “fair”and has “smooth skin”. On the other hand, Bharati Singh, though a very good comedian, is “fat” and Vinod Thakur, the dancer is not the best looking as he does not have legs. The boy was participating in a SNEHA workshop on sexuality and gender.

In a bid to get adolescents to talk openly about sex, sexuality and gender, SNEHA has organised a series of 18 workshops for adolescents in Dharavi. As part of the programme- “Managing Sexuality”-a Ford Foundation grant project, these workshops delve in topics related to body image, puberty, sexual health, gender violence, relationships, among other adolescent issues. This session about body image is one of them.

The teenagers were also explained the difference between gender and sex. While sex is defined as biological and physiological characteristics that define men and women, gender is a socially constructed roles, behaviors and attributes that a society considers appropriate for men and women.

“Women cannot lift heavy weights. Men cannot have long hair. These are examples of gender constructs,”explained Jayshree Belwade, programme officer who conducted the session with the children.

In the session, the children were shown images of actors without make-up and also a video about how make-up and photoshop can transform an image of a person.

“The before-after images really shocked the children. We wanted them to understand that we should love people for their qualities and not for the way they look,”said Belwade. This workshop also stressed that self esteem should be based on one’s achievements and not on superficial qualities such as good looks. The children were encouraged to talk what they like about their bodies, and their friends.


The need for the workshops for teenagers was felt after preliminary research showed that the gender discrimination in the community was very large. “In the focus group discussions, what really surprised us was that most of the teenagers, their parents and community leaders felt that rape was the woman’s fault. They blamed it on the woman’s clothes or behavior among other reasons. Only if the survivor is a child, they felt the perpetrator is at fault,”said Sneha Kupekar, project co-ordinator, Managing Sexuality.


The SNEHA team believes that these workshops will open communication channels for these children to talk about difficult issues of sexuality in safe environments and help them cope better with realities of life.