Creative Solutions Needed To Address Adolescents Issues, Say Experts

Many of the countries that are home to the world’s 1·8 billion adolescents are poorly equipped to address their mental health needs, with less than 50 per cent setting up mental health policies.

These troubling figures from Aiding Adolescents in Distress, the latest report by the medical journal Lancet, set the tone on the opening day of the International Association of Adolescent Health’s 11^thWorld Congress. The theme of this congress is ‘Investing in Adolescent Health – the Future is Now’.

With 253 million adolescents, India is home to a majority of this demographic, a fact that places it at an advantage over other countries like China.

“Adolescents are not written into the budget lines of any government, but India has done so and this is impressive”, said Dr Antino Costello, Department Head of Maternal, Newborn, Child and Adolescent Health at the World Health Organisation, one of the keynote speakers.

“The nationwide program, Rashtriya Kishore Swasthya Karyakram (RKSK), is an imaginative one and could help achieve many milestones in adolescent health”.

The presence of over 50 state government representatives at this congress is a sign of the growing importance being given to this vulnerable age group.

“We have made a good case for adolescent interventions,” said Dr Sunil Mehra, Executive Director, Mamta Health Institute for Mother and Child, which is organising the event. “Now we have to push this forward and mainstream it, which will be a challenge”.

Experts point to a need for interventions at multiple levels to address the specific concerns of the 10-24 years age group. They say that adopting a clinical, disease-focused approach is all wrong.

“This demographic dividend makes no sense unless we understand the aspirations of young people,” said Dr Vikram Patel, Professor, Global Health and Social Medicine at Harvard University and co-founder of Sangath, an NGO that works in the field of developmental disorders and mental health.

“There is a clash between social norms and the aspirations of the youth when it comes to matters like choice of career or partner, and this leads often to stress.”

Dr Patel advocates a creative approach, one that involves reaching out to both adolescents and parents from an early age at multiple levels – school, community, digital, family and society. “We have to recognise that care for adolescents requires specific interventions that involve parents,” said Dr Patel.

It’s a method that Sangath has adopted in many of its programs at Delhi, Goa and Bihar with successful results by training community health workers to deliver psychological therapy to help people with autism, depression and other mental health issues.

“We have a 100 million young people looking for jobs,” points out Dr Patel. “We should see this as an opportunity to train them to do this work and deliver personalized care and attention to people in distress”.

This article was appeared on NDTV Online. It can read here

Why India Needs Sex Education

In a country that reports high rates of teenage pregnancies and sexual abuse, one would think that the need for a curriculum focusing on gender equality, the importance of consent, and boundaries, would not be a matter of debate.

The reality, however, is that sexuality education for adolescents is a highly controversial topic in India. It is seen as offensive to Indian values, and concerns that it might lead to risky sexual behaviour and promiscuity.

Take the reaction when the central government in 2007 announced the launch of the Adolescence Education Programme in schools, along with the NACO, NCERT and UN agencies. Thirteen states called for an immediate ban as they felt that comprehensive sexuality education was against the Indian culture. Little has changed in the last 10 years. There is still a ban on Adolescence Education Programme in at least five states across India, and there is no uniformity in the way the subject is approached.

Sexuality education, as the UNESCO defines it, “provides opportunities to… build decision-making, communication and risk reduction skills about many aspects of sexuality…. encompasses the full range of information, skills and values to enable young people to exercise their sexual and reproductive rights and to make decisions about their health and sexuality”.

“The myth is that everyone is going to talk about sex”, says Dr Sunil Mehra, Executive Director of MAMTA Health Institute for Mother and Child which is hosting the 11^th World Congress on Adolescent Health from October 27 to 29.  “In fact, it is about knowing your body, consent, interaction with the opposite sex, colleagues and friends,” adds Dr Mehra.

Research shows that comprehensive sexuality education delays sexual initiation and leads to a fall in sexually transmitted diseases.

“The fact is that there is sexual activity going on,” points out Dr Mehra. “Earlier it was within marriage but it is still happening at an explorative level. “The more one understands that, the chances of risky behaviour are lower. So are chances of coercion and physical violence.”

This is critical in a country like India where rates of sexual violence against women are high and discriminatory attitudes towards women persist. For a meaningful social change, reaching out to boys and girls on issues like consent and gender equality becomes critical.

Programs on the ground like Ehsaas by SNEHA in Mumbai and YP Foundation in Delhi, to name a few, are trying to plug those gaps.

“We have to go beyond looking at controlling adolescent fertility from the perspective of reducing unwanted pregnancies,” says Ishita Choudhry, Ashoka Fellow and Founder of The YP Foundation.

This article was published on NDTV here

Time For India To Turn The Spotlight On Adolescent Health

In the list of health priorities, adolescent health lags far behind maternal and child health in India. It’s a dangerous oversight given that India is home to the largest number of adolescents in the world. An estimated 253 million adolescents live in India, and one in every fifth adolescent in the world is Indian.

There is enough evidence to show that the period of 10 to 24 years is a critical one as the behavior patterns that form now shapes the health for a lifetime. Yet the world over, two-thirds of the adolescent population is growing in countries that are grappling with issues like child marriages, early pregnancies, HIV/AIDS and depression.

The International Association for Adolescent Health’s 11th World Congress on Adolescent Health, which begins in New Delhi in October, will turn the spotlight on this vulnerable and neglected age group. It is held once in every four years and is themed ‘Investing in Adolescent Health: the Future is Now’.

The Congress aims to push the case for developing a stronger primary care focus on adolescent health as well as kick-start investments in the health force to better respond to the needs of adolescents.

India has many challenges specifically the rise in underage marriages, especially of girls. Despite strong laws, the situation is grim even in rich states like Maharashtra where 16 districts figure in a countrywide ranking of the top 20 districts reporting an increase in child marriages, according to a study by the National Commission for Protection of Child Rights (NCPCR).

“Investment in adolescence has huge implications for productivity and enhanced life skills which has a significant impact on a country’s overall productivity,” points out Dr Sunil Mehra, Executive Director, MAMTA Health Institute for Mother and Child, which are hosting the Congress along with a consortium of partners supported by the Ministry of Health and Family Welfare.

“India has missed out on investing in this age group, which explains the high rate of child marriage which has serious implications for infant and maternal mortality and early pregnancies.”

As a Lancet 2016 study points out, puberty sets off a process of brain development and emotional change that carry through to the mid-20s. This is also a phase where most health problems and risk factors for disease in later life emerge.

Adolescence is starting earlier now and we know better now that these years reverberate across their lives,” says Dr Susan Sawyer, President, International Association for Adolescent Health.

“If we can keep girls in school longer, their marriages will be delayed, they likely to have children later, breastfeed their babies, immunize them and this will have affect health indicators like infant and maternal mortality”.

Given their significant presence, India needs to look at building a health force targeted at adolescents. Most adolescent interventions are targeted at tobacco and alcohol use and there is a mind block about teaching sexuality education in schools.

One of the most sensitive problems in many parts of the world is that young people are sexually active outside marriage, says Dr Sawyer.

“Given the many challenges, it is important to build health care systems to deal with the challenges that come with adolescence,” she adds.

This article appeared on NDTV Online here.

 

The Silent Victims of Punjab’s Drugs Crisis

This exclusive report, carried on NDTV 24/7 and NDTV India is on the hitherto silent face of the Punjab drug crisis – the women and children in the families of male drug abuse victims. Hundreds of young mothers are struggling with their kids, in penury, battling HIV and Hepatitis C virus infections that have been passed on to them. The complete picture of the drug crisis in Punjab has emerged. Or has it? The impact on the men who have fallen victims is being routinely documented now. What is getting left behind in the big picture are the voices of the women and children in the families of these victims, who are infected and in many cases severely depressed. Dispossessed of family resources and left with hardly any healthcare support, these women are also struggling with acute depression and suicidal tendencies. The impact of the vice-like grip of narcotics in the area of women and child health, on a closer look, is grave.

https://everylifecounts.ndtv.com/video-detail/women-the-silent-victims-of-punjabs-drug-crisis-466811

HIV Drugs Shortage in India

India, which once carried the highest HIV AIDS burden in the world, has been able to bring the numbers down with its intense targeted interventions across the country. But hundreds of poor patients, especially women and children in far-flung rural areas, on Anti-Retroviral Therapy, are falling off the map because of the difficulties and distance involved in accessing the free drugs which may worsen the situation. This is a recent report I did for NDTV

http://everylifecounts.ndtv.com/video-detail/hiv-drugs-access-such-a-long-journey-457674

How Asia’s Largest Human Milk Bank In Mumbai Saves Babies’ Lives

A video report on the milk bank at Mumbai’s Lokmanya Tilak Municipal General Hospital, popularly known as Sion Hospital. It gets donations from nearly 40 mothers every day and the milk benefits 3,000 babies every year. According to doctors, breastfeeding within the first hour of birth is one of the measures to fight infant mortality.

This report was aired on NDTV’s Every Life Counts campaign, supported by the Gates Foundation

How Asia’s Largest Human Milk Bank In Mumbai Saves Babies’ Lives

How Young Boys Bear The Burden Of Patriarchy In India

Inside a community centre at Mumbai’s Dharavi slum, Umair Khan teaches a group of young boys the difference between good and bad touch.

The 20-year-old is a community organiser with Sneha – Society for Nutrition Education and Health Action. He works with the NGO’s youth programme Ehsaas which, since 2013, has reached out to over 6,000 adolescents and youth between the ages of 15-24 in Mumbai’s slums.

“Like girls, boys too are victims of sexual abuse,” says Mr Khan. “But boys rarely speak about it as they feel ashamed,” he adds.

As a young boy, Mr Khan experienced abuse. “The abusers were older boys in the neighbourhood. I was scared that I would be targeted again and it took me years before I spoke up. I don’t want anyone to suffer the way I did,” he tells NDTV.

At over 243 million, India has the largest adolescent population in the world, as per UNICEF’s 2011 report. However, down the decades, the focus of government programmes has been early marriage and early pregnancy, which is centered on young girls. Boys have been largely left out.

The National Family Health Survey (NFHS)-3 makes a compelling case for interventions among boys. Over 50% of boys between 15-24 years are in the labour force as per NFHS-3 data, while over 80% are married. One out of every five boys between 10-19 years is illiterate.

Over the years, there has been a growing realisation that there is an urgent need for specific interventions among young boys and men who too are victims of rigid gender norms. They struggle with notions of what constitutes a real man.

Being sexually active with various women is seen as a cultural sign of virility and the fallout is a lack of understanding of women’s rights.

Research has shown that men are also victims of many forms of violence, primarily at the hands of other men, and stand to gain from moving towards gender equality.

“Adolescent boys commit sexual crimes because there is a lack of appropriate orientation on sexuality and about matters like consent,” says Neeta Karaindikar, Associate Director, Ehsaas.

“Our films and advertisements show women in a very poor light and boys look at them as item numbers. We have to change this by working with the next generation, to make them see women as equal partners,” she adds.

Ehsaas does this through a mix of street plays and community meetings with adolescents and their families.

“Before I joined Ehsaas, I expected my sisters to do the household work,” says Shahid Shaikh, a community organiser.

“Now I know differently. We teach young boys to question stereotypes that allow boys to play outdoors but force girls into doing household chores. Gradually we are seeing a change,” he adds.

An impact report done six months after Ehsaas was launched in Dharavi has shown positive signs. Over 70% of boys and girls said that both genders should have equal freedom; nearly a 20% improvement.

Reaching out to boys comes with many challenges, as Pravin Katke, a coordinator with Equal Community Foundation points out. The foundation reaches out to boys between 14-17 years from low-income communities in the slums of Pune.

“In the areas that we work in, there is a high rate of school dropouts. There is also a tendency towards risky behaviour and addictions,” adds Mr Katke.

Through interactive sessions and games, the foundation tries to find out what is going on in the boys’ lives and the gender dynamics in the families.

“We have a curriculum where we talk about gender equality, violence, relationships, sexuality and adolescence,” says Mr Katke.

“We raise different situations and discuss their responses,” he adds.

To facilitate a larger change in the mindset, peer educators also meet with the parents every few weeks.

To prevent violence against women and build gender equality, one has to go back to the homes and communities where boys are raised, believes William Muir, co-founder, Equal Community Foundation.

“Boys across all environments are learning that successful men earn money and command respect through aggression and violence,” says Mr Muir.

“When you help them reflect on whether those messages are right or fair, they will start taking their own steps. The goal ultimately is to ensure that every boy is growing up in an environment where they are learning gender equality and in Pune, we are building that model,” adds Mr Muir.

This article was published on NDTV on Nov 4, 2016. http://everylifecounts.ndtv.com/how-young-boys-bear-the-burden-of-patriarchy-in-india-6556

How can Kolkata’s chaotic transport system be untangled?

After 25 years in salubrious California, Bonani and Prahlad Kakkar returned to Kolkata in the 1990s. “The Calcutta [they refuse to call it by the new name, Kolkata] we grew up in was a compact, organic city,” says Bonani, a former public health specialist. “Offices and homes were within walking distance and we had 625 parks in this city.”

They found the city of their childhood had changed dramatically. Diesel, a cheaper alternative to petrol, had made an entry, and there had been an explosion of cars, buses and auto-rickshaws on the roads. Out of deep anger and frustration, they decided to launch Public (People United for Better Living in Calcutta), a civic improvement organisation.

Down the decades, Kolkata’s chaos has been compounded with the city prioritising cars over public transport, something all Indian cities are guilty of. Traffic crawls on Kolkata’s roads at an average speed of 14 to 18 kilometres per hour, as against 22 kmph in the rest of India.

The slowdown has had an economic and environmental impact as well, something that Public is seeking to address by working with local authorities on awareness campaigns, such as encouraging citizens to lodge complaints about the worst polluters in the city with the Calcutta Police Traffic Department.

A study of 10 city roads found that just two hours of a traffic jam cumulatively costs commuters 74,000 rupees (£872). Kolkata residents breathe in air that has 3–5 times higher pollution than normal. The impact of this on public health has been studied by the Chittaranjan National Cancer Research Institute in Kolkata in many reports. One of them shows that more than 7 in 10 people suffer from respiratory diseases in Kolkata.

These factors have put Kolkata bottom of 100 world cities in the 2016 Arcadis Sustainable Cities Index, which ranks according to three dimensions – people, planet and profit.

Kolkata ranks last in planet and profit – the environment and economic indicators. On environment, it does badly on sanitation, green space and waste management. On the economic front, it rates poorly in ease of doing business, tourism, connectivity and transport, among others.

There is just 2mm of metro rail per inhabitant as against the average 14mm in our index Alasdair Cavalla, Centre for Economic and Business Research
“The parameters on the transport front are congestion ratings, kilometres of metro or light rail lines per inhabitant, and airport customer satisfaction,” says Alasdair Cavalla, senior economist at the Centre for Economic and Business Research, which provided the research for the index. “There is just 2mm of metro rail per inhabitant as against the average 14mm in our index. Kolkata’s airport does not rank in the top 100 airports by customer satisfaction.”

The hairy transport situation, experts say, is due to a lack of vision and integrity in transport planning down the decades.

Some of the policies adopted in order to ease road congestion are arbitrary. For example, two years ago, the police banned cycling on 174 main thoroughfares, when the national policy advocates the promotion of non-motorised transport.

There was outrage from green crusaders and unions of milk vendors and domestic workers, who filed a petition in the Kolkata High Court. The ban is still in place but only on 62 roads, mainly flyovers.

Kolkata needs to turn the politics of transport provision on its head, says Madhav Pai, India director for WRI Ross Centre for Sustainable Cities. “The majority of people walk and cycle, while the streets are designed for cars, and this has led to huge inequity. Kolkata needs to prioritise pedestrians, cyclists and buses. Instead it continues to invest in flyovers, expressways and more roads.”

Kolkata is exploring options to address its transport problems by sharing experiences through the C40 Cities Climate Leadership Group that helps mega-cities of similar size and population density to connect. Kolkata was the first city in south Asia to join the network in 2015. Under C40, every mega city has to identify three top priorities it wants to work on. Kolkata has identified solid waste management, transport and air quality.

“Kolkata is the first city in India to look at fare integration, which means a single ticket for bus, metro and tram,” says Sanjay Sridhar, the C40 regional director for south and west Asia. “It is looking at rationalising bus routes to help improve efficiency and reduce fuel usage.” Intermodal connectivity options, using the existing system of ferries, the metro and trams, are also being looked at.

The next decade in India is about “showing citizens that change is possible’’, says Pai. “All these measures are examples of such change being attempted in Kolkata. To see large long-term change, these projects have to succeed and give hope for new innovative ideas to be implemented.”

Thei article was published in The Guardian – https://www.theguardian.com/global-development-professionals-network/2016/oct/10/how-can-kolkatas-chaotic-transport-system-be-untangled

How Asia’s Largest Human Milk Bank In Mumbai Saves Babies’ Lives

When her son Hassan was born at 28 weeks, Saba Khan was told the baby had slim chances of survival.

“He was very weak and was rushed to the paediatric ICU. He stayed there for nearly 20 days and the doctor told me it would be nothing short of a miracle if he made it alive,” says Ms Khan.

To make matters worse, Saba was very weak and could not nurse her baby. Babies, like Hassan, who are born premature, have higher chances of recovery if they are given mother’s milk.

Luckily for Saba, Hassan started recovering quickly as he given milk from the mother’s milk bank at Lokmanya Tilak Municipal General Hospital in Mumbai. From 1.2 kg at birth, Hassan gained up to 1.8 kg within three weeks and was declared out of danger.

“The milk saved his life,” says Saba. “He is gaining weight and now that I have recovered I am able to nurse him in addition to the milk from the bank.”

Started in 1989, the milk bank at Lokmanya Tilak Municipal General Hospital, popularly known as Sion Hospital, is Asia’s first and largest such bank. It gets donations from nearly 40 mothers every day and the milk benefits 3,000 babies every year.

According to doctors, breastfeeding within the first hour of birth is one of the measures to fight infant mortality.

“Mother’s milk is a complete food. It is nutritionally optimal and protects the babies from different diseases,” says Dr Jayshree Mondkar, who heads the milk bank at Lokmanya Tilak Municipal General Hospital.

Most of the banked milk is given to the babies who are either underweight or to babies who are transferred from other hospitals with jaundice.

Dr Mondkar says there are many situations when the mothers are unable to nurse their infants after birth. In such a case, the milk from the bank is the next best option.

“We have as many as 14,000 deliveries in a week and mother’s milk is only an interim measure,” she says.

Before the milk is collected from the donor mothers, their blood reports are checked for any infections. Good care is taken to ensure that milk is collected hygienically, pasteurized and stored under the correct conditions. The banked milk can be stored for six months but is typically used up in 15 days.

“We tell the donor mothers why we are using the milk and how it is vital to keep another baby alive,” says Sister Sunanda Suryavanshi, a lactation management nurse at Sion Hospital.

“Even if there is some initial hesitation, all the mothers agree to donate when they hear that,” she adds.

This article appeared on the NDTV website http://everylifecounts.ndtv.com/how-asias-largest-human-milk-bank-in-mumbai-saves-babies-lives-6430
To watch the report http://everylifecounts.ndtv.com/how-asias-largest-human-milk-bank-in-mumbai-saves-babies-lives-6430

Afghan refugees are cooking up a better future in India

“Back home in Ghazni, I never used to cook. It was only after I moved to Delhi six years ago that I made my first biryani,” says Farhat. A single mother, she moved to India from Afghanistan in 2010 when the Taliban killed her husband, an Afghan Army officer.

She is a member of Ilham, a catering service that serves traditional Afghani dishes to people in Delhi. Ilham, which means “positive” in the Dari language, was launched in late 2015 by the UN refugee agency, UNHCR, and its partner Access. The initiative brings together seven women, all refugees from conflict-torn Afghanistan.

“There are too many restrictions on women there,” says Farhat, who tried to support herself and her six-year-old son with odd jobs after her husband’s death. “Neighbours started calling me a bad woman for leaving the house and I was afraid of attracting the Taliban’s attention. So I left for India.”

There are nearly 11,000 Afghan refugees registered with the UNHCR in India, mainly living in Delhi and bordering areas. The influx began in 1979 after the Soviets invaded Kabul and continued through the fall of the Taliban regime. The early refugees were mainly Hindus and Sikhs but with the security situation getting worse, more ethnic Afghans are coming in.

Historically too, India has been a favoured destination for Afghan traders or Kabuliwalas, who would travel across the mountains to sell spices, dry fruits and attars (perfumes), an association that has been immortalised in many Bollywood films and works of literature, including a popular short story, Kabuliwala, by Nobel Laureate Rabindranath Tagore.

“India is also an obvious choice because the government allows UNHCR mandate refugees to apply for long-term visas that regularises their stay and enhances employment opportunities and enables easier access to higher education,” says Shuchita Mehta, a spokesperson at UNHCR India.

As of August 2015, there were a total of 27,000 refugees in India registered with the UNHCR. The total refugee population across the country runs into well over 200,000. India’s liberal approach towards asylum seekers attracts large numbers but there is no specific policy or legal framework regarding refugees. The country has not ratified the 1951 convention on refugees.

Refugees registered with the UNHCR find it easier to get long-term visas and work permits. They are entitled to free education in government-run schools and free healthcare. Others face a miserable existence, confined to illegal settlements, where access to water and electricity is irregular.

Finding a steady, well-paid job is hard too. Zameera, a schoolteacher in Afghanistan, had to work as a domestic help in Delhi for years before she became a part of Ilham. “It was a struggle to communicate as I could not speak English or Hindi. I had five children to feed and educate so I was desperate,” she says.

She lives in Lajpat Nagar, home to a large number of Afghan refugees. The community is concentrated in small pockets in parts of Delhi, the ghettoisation preferable to living in a mixed colony where they stand out, their accents and clothes regarded with open curiosity, and occasionally some hostility.

“There is an urgent need for sensitisation programmes,” says Aditi Sabbarwal, project manager at Access. “People have no idea what they are fleeing from, their back stories, so there is a perception among some that they are freeloaders. The government should conduct awareness campaigns so people come to know what’s going on in their countries.” She points to stray comments on Ilham’s Facebook page pointing to the turmoil in Europe over the refugee crises and making the case that India should not take in outsiders.

The idea of starting a catering initiative was born after hours of talks between Access and the Afghan women enlisted with them. “People in Delhi are open to trying out different cuisines but there were very few that served Afghan food,” says Sabbarwal. “So we decided to try some dishes out at a fair last winter. We were sold out in less than an hour. We realised that starting this on a larger scale could guarantee them fixed employment and financial independence.”

The range of dishes is limited but great effort is taken to source the original ingredients to ensure authenticity. The American embassy in New Delhi is among their most regular customers.

The women cook the dishes at their homes and deliver to the designated pick-up centres. Given the growing demand, there are plans to set up a community kitchen.

“We make a profit of Rs 3,000-4,000 a month, which is much more than what we earned working odd jobs,” says Qadria, who left Herat in west Afghanistan six years ago after she was lashed in public for not covering her face properly.

“The orders are growing everyday and the money is good,” says Qadria. “I am able to pay my daughters’ school fees and buy them what they want. I feel happy when I see them enjoy the freedom I never had in Afghanistan.”

Ziyagul, the most vocal of the group, who has dreams of starting her own restaurant, says: “I feel so happy that I am able to share some of my culture with people here. When customers praise my dishes, I feel so confident. I realise that I am as capable and independent as any man!”

Some names have been changed to protect the women.

This article was published in The Guardian – https://www.theguardian.com/global-development-professionals-network/2016/jul/21/afghan-refugees-are-cooking-up-a-better-future-in-india?CMP=share_btn_fb