Reproductive Health of Young Adults in India (RHEYA)

A central RHEYA strategy involved simultaneously reaching and communicating with parents, in-laws, and community and religious leaders, as well as the young people themselves; the idea was to kindle changes in behaviour by fostering effective understanding within a critical mass of people. Pathfinder identified the following key challenge to be addressed through involvement with these groups: From the government's message "a small family is a happy family", many people inferred that its aim was to limit the population, and so tended to see contraception as a government need rather than as something that is to their personal advantage. Pathfinder directly addressed that perception, persuading women and men to understand contraception and the timing of pregnancies as an important means of personal autonomy and improvement in their personal lives. A second core strategy was the development of messages and means of intervention appropriate to the specific needs and interests of young people at different life stages. Finally, RHEYA worked to involve boys and men as full partners.

RHEYA drew centrally on face-to-face interactions to share information and try to shape attitudes, such as workshops and training sessions. For instance, local teachers, healthcare providers, and change agents (such as traditional birth attendants, or dais) participated in workshops designed to help them thoroughly understand key issues in reproductive health and family planning and learn how to talk about them comfortably with young people. Respected Muslim academicians conversed with Muslim leaders in workshops on the lessons of the Koran related to family life; a key message was that nowhere is family planning forbidden. Pathfinder also trained 139 peer educators and community volunteers, 134 formal trainers and 79 informal healthcare providers, and 81 school teachers and staff from local non-governmental organisation (NGO) partners and consultants. Some local women were trained to be "satisfied adopters" of birth control; they counsel their neighbours on the advantages of contraception, the differences between methods, and how to obtain them. Girls ages 12-14 participated in two 2-hour training sessions on menstruation, menstrual hygiene, adolescent anemia, and nutrition.

In addition to this type of capacity building, Pathfinder facilitated activities that were meant to be entertaining, such as a street play in which a husband mourns his very young wife who died in childbirth (his friend had told him of the dangers of early childbirth, but he ignored the warning). To cite a few additional examples of this "edutainment" approach, 3-day residential camps were held separately for boys and girls which involved a 15-hour curriculum; for instance, boys learned about sexual and gender responsibility, about treating girls as equals, and about planning children as part of responsible planning for the future. To reach newlyweds and couples without children, an "infotainment evening" and home visits were conducted by community health workers to discuss contraception and negotiation of delaying and spacing pregnancies. These visits were also carried out for mothers- and fathers-in-law, with a focus on the economic advantages of delayed marriage and childbearing. Finally, puppet shows were held for influential community leaders on the advantages of delaying and spacing children.

Children, Youth, Reproductive Health, Population.

According to Pathfinder, Indian women bear an average of 3.0 children, promising a doubling of the country's population in 41 years. The median age of marriage for girls is 16.75, well below the legal age of 18. Figures from the National Family Health Survey (NFHS) 2 (1998-1999) indicate that only 5% of married women between the ages of 15-19, and 21% between 20-24, use modern methods of contraception. India's maternal mortality rate is high (540 per 100,000 births), and adolescent girls are twice as likely to die in childbirth as women in their twenties; for those between the ages of 10-14, this risk is 5 times higher. The children of young mothers are 50% more likely to die than those born to mothers aged 20-29. A child born less than 24 months after a previous birth is nearly 3 times as likely to die as a child born after a gap of 48 months or more. Further, unwanted teenage pregnancies often lead to abortions, and 16% of maternal mortality in India is due to unsafe abortions.

Pathfinder notes that communication is complex in a conservative, tradition-dominated culture. However, the organisation argues that evaluation results "unequivocally demonstrate the fact that deeply held beliefs and traditional behaviors can be changed even among youth, families and communities that are economically deprived and less educated. And this can happen rapidly - three years in this case....knowledge is a powerful and universal driver of social change. So are the aspirations of youth and families for a more comfortable life..." (A September 2006 evaluation report may be accessed in full at Reproductive Health of Young Adults in India: The Road to Public Health [PDF].) One notable finding, from Pathfinder's perspective, is that an equally high degree of change occurred with both boys and girls - "proving that when programs involve men, and include them as partners in change, the results are great."