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 

Time for a Relook at India’s flagship programs

The findings of the Global Burden of Disease 2015 study are truly depressing. The results, published in The Lancet, lists the main factors behind illness, death and disability in countries.

While deaths of children under five years has gone down between 1990-2015 from 12.1 million to 5.8 million, India still tops the number of child deaths at 1.3 million in 2015.

India is followed by Nigeria, which has over seven lakh deaths, and Pakistan with three lakh deaths. Bangladesh has done better. There were 7663 maternal deaths in 2015 in Bangladesh, which is a dramatic improvement from 21,789 in 1990. Maternal deaths in India dropped by half to 63,861 in 2015 from 1,32,239 in 1990

Neonatal mortality, which is death in the first 30 days of life, remains high. While deaths under five years have reduced, it still remains way lower than the MDG goal.

Some of the main causes given in the study are pre-term birth complications, trauma and respiratory infections. Diarrhea-related diseases are the fourth leading cause.

The study says that while government schemes like Janani Suraksha Yojana have been successful in improving access to institutional births, the reach remains patchy with large parts of rural India unable to access the services. This is the demography that remains most vulnerable. A reality we encounter everyday in news reports of pregnant women dying on their way to hospitals.

Clearly, it is time to step back and take a close, hard look at our flagship programs like JSY and the integrated child development scheme, ICDS. The ICDS was launched in 1975 and is one of the world’s oldest nutrition programs. If after 41 years of ICDS, we are still failing so many hundreds of thousands of children, something is clearly going very wrong.


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.