Sabawn’s comment is an indication of the challenges that lie ahead for the Maharashtra government, corporates and NGOs who have come together in a first of its kind partnership called the AHAR project. A project that aims to change the face of Dharavi, a densely packed slum, home to over a million people, mostly migrants. A well-known Mumbai landmark, immortalized in the Oscar-winning film Slumdog Millionaire, the slum is a maze of narrow lanes, shanties and overflowing gutters.

Not surprisingly it reports among the highest rates of malnutrition in the city. About 35 % children between the critical 0-3 years are malnourished.  While anganwadis or day-care centers have been set up as part of the government’s Integrated Child Development Scheme (ICDS) to provide nutrition, education and health services, the workers here are overburdened and poorly paid, with the result that many children are left behind.

It is here that the non-profit group SNEHA or the Society for Nutrition, Education and Health Action plays a critical role by training sakhis or community link workers who go door to door and advice women on nutrition, breastfeeding, family planning and maternal health.

“Imagine this is your baby” says sakhi Mangal Shinde pointing to a lifeless doll hanging on one end of a scale used to weigh vegetables.  At the other end hangs an empty bag. “What you put inside this bag decides your baby’s future,” she says adding factsheets with pictures of healthy foods for children. As the bag gets heavier, the doll rises. The women smile and clap. Sabawn still looks sceptical and clearly requires several more sessions!  Convincing her is critical as she wields tremendous influence in the community.

“It’s not easy,” admits Dr Evelet Sequeira, Head of Nutrition with SNEHA. “We tell the mother her milk is for her baby and this milk will help in brain development. So when the baby weighs 3.5 kgs at birth it has already passed Class 10. If she were to breastfeed exclusively until 6 months, the baby has cleared Class 12. For every mother her child’s intelligence is very important and this helps drive home the point.”

Simplistic though the approach may sound, it is showing results. Rates of exclusive breastfeeding have gone up. So has immunization. “More and more women are delivering in institutions,” says Priya Agarwal, Senior Advisor with SNEHA. “ Earlier women would register at the local health center in the last trimester of pregnancy. Now it’s in the first trimester.”

Another critical service SNEHA provides is crèches where working mothers can leave their babies. Now mothers no longer leave their infants with neighbors or older siblings when they go back to work. Instead they drop them off at the crèche where their health is closely monitored and they are given supplementary meals.

SNEHA believes the Dharavi experiment will lead to a sustainable model which can be replicated in urban slums across the country. “We have the government and ICDS on board and we are looking at global protocols that have been tried worldwide to see how we can adapt it to our settings”, says Dr Sequeira.

Words that hold out possibilities to thousands of children like Mehboobi, who at 2 years weighed 8 kilos, the healthy weight of a 6-month-old. When she came to the crèche last year, she would not lie down. Tests showed she had spinal TB and suffered from severe back pain. Today she is nearly 3 and weighs 10 kgs.  She has a long way to go.  Watching her perky, shining face shout out alphabets, there is hope she will get there.

“Girls cannot do well at math and science.”

 “Since girls have to get married, they should not be sent for higher education.”

These are views that hold huge currency in India even today. Look at our sex ratio. It speaks volumes. In 2011, 914 girls were born to every 1,000 boys. We may pride ourselves on electing a woman Prime Minister way before many developed countries and bask in the achievements of our women corporate leaders. But the fact is boys are preferred to girls. Girls don’t carry on the family name, entail huge dowries and are less than equal at the workplace.

Worldwide, there is growing recognition that it is critical to reduce gender inequality for a country’s overall development. The best way to do this is to reach out to the youth. In India, however, there has been a limited attempt in this regard. Schools, where youth spend a large part of their time, more often than not, end up reinforcing gender stereotypes.

An important initiative showing the way forward is the Gender Equity Movement in Schools started in 2008 by the Committee of Resource Organization for Literacy (CORO), Tata Institute for Social Sciences (TISS) and the International Centre for Research on Women (ICRW). GEMS works in 45 public schools in Mumbai reaching out to 8000 girls and boys between the ages of 12 to 14.

Through campaigns, role-playing games, discussion based lessons, comic strips and interactive activities, students are encouraged to rethink social norms and question gender biases. Led by facilitators, the children talk about puberty and what makes for healthy relationships.  Initially girls and boys were placed in separate groups to help them open up. From the second year, they were mixed, in response to requests from the students themselves.

The GEMS approach is recognized worldwide as an effective way means to reach out to the youth. At the recent International Conference on Family Planning at Dakar, Senegal, I had the opportunity to listen to Pranita Acharya, ICRW Gender, Poverty and HIV/AIDS specialist who administers the GEMS program. To an audience packed with adolescent sexuality experts and activists from across Africa and Asia, she explained why a school-based approach could work.

 “Classroom discussions help students think about and question social norms”, says Acharya. “Facilitators encouraged them to challenge stereotypical ideas about men and women. Those interactions clearly moved students to look at their world differently.” 

A facilitator describes a group session on “Labeling” held with 40 boys. At the beginning, they were noisy and restless. They were told to write a label they used or knew of on the blackboard. There were many responses, based on physical descriptions such as “sukdi” (malnourished), and “takli” (bald) and some with sexual innuendoes like “raand” (girl who has sex with many men), pataka (fire cracker) and bayalya (a feminine boy).

The boys were then asked to close their eyes and imagine that these terms were being used on them. They said they felt “angry “, “hurt”, “like hitting someone” and wanting to ask “what did I do wrong.” The facilitator then asked if these terms were used often against girls. The boys agreed that girls were often on the receiving end. The facilitator then went on to say that if a word could hurt so much, perhaps it was time to think about why we use them. The last question asked was, “Is labeling a form of violence?” The class fell silent and after a while the hands started rising slowly. The class agreed that labeling was indeed violence.

At the start of the program, little over 20% of boys and girls supported gender equality. A year later, this grew to 53% of girls and 39% of the boys. There was greater support for girls pursuing a higher education and marrying later, and of boys helping in the household work.

At her presentation, Acharya recounted the words of a 13-year-old. “I used to think that only boys should do outdoor chores. Now I think they should help women at home.”

The program also teaches the children how to fight back when faced with violence, be it physical or verbal. A 14-year-old girl said, “I could not stop harassment in the past. Because of the sessions we got to know that harassment of girls should be stopped. Boys should understand the feelings of girls. And girls should oppose violence.”

The GEMS experiment, experts say, shows that group activities can be effective in opening up discussions on sensitive issues linked to gender inequality. Encouraged by the results, the program has been started in 1200 civic schools in Mumbai. And over 600 schools in the states of Rajasthan and Goa.

Some 25 odd years later, nothing has changed. Sex education remains a taboo for most schools.  Health experts say this needs to change. They point to the countrywide National Family Health Survey 2006 figures, which show that one in six teenagers in India between 15 to 19 years had conceived or given birth.  Most of these girls knew little about contraceptive measures or the consequences of unsafe sex.

Take the recently reported case of a 15-year-old living in a colony in suburban Mumbai. The girl, who comes from a middle class family, was in a relationship with a boy in her school for over a year. They used birth control rarely. She knew nothing about it and the boy claimed it was not required. She found out she was pregnant when her mother noticed a swelling on her stomach and insisted she gets tested. She is 4 months pregnant, too late to have an abortion. Her boyfriend has been arrested and she has dropped out of school.

“Sex before marriage is definitely more prevalent today, than say 10 years ago”, says Dr Duru Shah, former president of the Federation of Gynecologists and Obstetrics Societies of India. “Earlier people got married very young so sex was within marriage. Now they marrying later and they are having premarital sex. But most of them know little about protection. “

Dr Shah further adds,” People are going to have sex. Spreading information on safe sex will not increase sexual activity. It will ensure people have safe sex.”

Lack of information from proper channels forces teenagers to turn to the Internet or friends.  “My 12 year old daughter came from school and told me babies are born when papas rape mamas”, recounts the mother of two teenagers. “I had rather they heard about sex from the school than the school bus. “

Media consultant and mother of two, Reeta Gupta believes sex education is “an important intervention that explains the consequences of reckless experimentation amongst adolescents.”

However, that’s not an attitude shared by most parents and schools. Information about sex, they believe will encourage promiscuity. “One school did not want me to even mention condom,” says social psychologist and sexuality educator, Chandni Parekh.  ‘Some schools may call a gynecologist but there is no room for Q &A.” Parekh’s module on sexuality education for school and college students encourages discussion on forbidden subjects like masturbation, menstruation and HIV AIDS.  “We tell them about pregnancy and sexually transmitted infections.  It’s about forming values that are respectful towards relationships and intimacy.”

Three years ago, education authorities at the central government level proposed starting an ‘Adolescent Health education” program in schools around the country. That has since gone into cold storage.  It’s time to take a serious look at it because sexuality education is critical to save lives. Studies have shown unsafe sex is a huge health risk leading to sexually transmitted infections, including the deadly human papilloma virus or HPV, infertility and neonatal deaths.

I am posting some links on FGM from around the world which I found interesting. I had posted them at the end of my last blog but they need to highlighted as they offer useful insight into the practice elsewhere in the world. It would be great if you could post links to the issue as well.

Let’s keep the campaign going!

FGM in Pakistan - published in the Newsline, written by Farahnaz Zahidi Moazzam

http://www.newslinemagazine.com/author/farah-zahidi-moazzam/

FGM in the United States, by Mariya Tahar

http://www.runwayjunkie.com/articles/view/female-genital-cutting-is-rare-in-americaor-is-it

To hear the presentation, click on Session One: Women and Violence -

http://iwdsummit2011.com/dev/summit/#c

Marieme Bamba

Born in Soudiane in rural Senegal in West Africa, Marieme Bamba was 13 when she got married. At 14, she gave birth to her first child. Today she is a solar engineer who has helped set up sustainable and low-cost electricity in many villages in her country. And has trained many other women to do so. Her story, and that of hundreds of women like her in countries in West Africa, is a testament to the efforts of Tostan, an NGO that has helped bring about sustainable development and social change in these parts. In Tostan’s approach, lies a valuable lesson for India, which is grappling with similar problems.

Tostan, in the Senegalese language Wolof, means “breakthrough” as well as “spreading and sharing”. It was founded by American Molly Melching who decided to stay on in Senegal while pursuing her degree in African studies in capital, Dakar. Through its “Community Empowerment Program”, started in 1995, the NGO offers “participatory human rights education to adults and adolescents who have had no access to formal schools.”  It helps them devise their own solutions to their struggles.

Molly Melching

  At the core of Tostan’s approach lies Respect. Essential when it comes to communicating ideas that    involve change. Take female genital cutting, practiced widely across parts of Africa. Melching prefers to call  it  the less judgmental term, cutting. “Cutting”, says Mulching “was practiced because mothers loved their daughters. They did not want to hurt them. There is great social stigma attached to not cutting and mothers wanted to protect their daughters from this.”  Despite the pain, families forced their daughters so they would not be seen as “unclean” or “not marriage worthy.”

Through community meetings on human rights of women and children, the health risks they faced due to cutting were highlighted. Eventually some villages adopted resolutions to put an end to the practice.

To ensure the impact is widespread, Tustin adopts the “social diffusion” approach, the brainchild of Demba Diawara, a respected religious figure and community leader.  African villages are closely linked and Demba realized it was important to create a network of villages for a change to take root. With a team of community leaders, he visits different villages to talk about the benefits of banning FGC . Today 6000 communities in six countries in Africa, apart from Senegal, have abandoned the practice.

Young girl at Kieur Simbara village, Senegal

Tostan’s efforts in other areas like ending child marriage, community micro credit programs, promoting maternal and child health have been widely acknowledged. Issues large parts of India grapple with even today.  There are a few NGOs in India whose approach is similar to that of Tostan, and their successes are acknowledged worldwide. Organizations like SEARCH in Gadchiroli in Maharashtra and the Comprehensive Rural Health Project in Jamkhed, Maharashtra have been able to make a breakthrough where government programs have failed.  Rather than a blanket Central scheme which benefit a few, engaging with communities to understand their specific needs could help find a long term solution.

To learn more about Tostan, visit http://www.tostan.org/

It was accounts like these that has spurred a Mumbai based woman to start an online petition seeking to put an end to female genital mutilation. A ritual not many people are aware is observed in India.

Tasleem, who describes herself as an educated woman in her 40’s, is from the Dawoodi Bohra community where the practice, called khatna, is a rite of passage. She plans to forward her petition to the community high priest Dr Syedna Mohammed Burhanuddin, asking him to put an end to it.

Tasleem declined to meet or even speak on the phone as she fears exposure. In a detailed email interview she explains what pushed her to speak out.  The Dawoodi Bohra community, while highly educated, is strongly conservative, and her step is a bold one. Tasleem says she was not circumcised, but the stories she heard made her “boiling mad”.

Khatna involves removing the clitoral hood, and in some cases, the entire clitoris. Today, it’s mostly done after birth, when the baby is four days old by community doctors. “The idea behind this is to curb her sexual pleasure. The belief is that otherwise the girl will go astray” says reformist Bohra scholar Dr Asghar Ali Engineer. “Unlike the male circumcision ritual which is celebrated, this is done in a hush-hush manner,” explains Dr Engineer.  There are some who have resisted, but they are a tiny minority. Nasreen (name changed) refused to let her 14 year old be circumcised.  “We are seen as an educated community, but the truth is our girls are put through such barbaric rituals even today”, she says.

The petition which is acquiring growing online support has sparked off a debate within the 10 lakh strong Dawoodi Bohra community, spread across the states of Maharashtra, Rajasthan and Gujarat.  The practice has huge support from many who say FGM is mandatory under the Bohra Sharia (law).  A notion noted Islamic scholars like Dr Zeenat Shaukat Ali question. “Nowhere in the Koran or the teachings of the Prophet is the act shown to be legal. This is completely unIslamic. Bohra Shariat also springs from the Koran. The prevalence shows the pre-dominance of patriarchy. Traditions like these which are anti-women have to be questioned,” says Dr Ali.

According to the World Health Organization, globally, nearly 150 million girls and women have undergone FGM.  More than 3 million girls are at risk in Africa alone. Apart from Africa, it is practiced in a few countries in Asia and the Middle East. Seventeen countries have laws specifically banning FGM.

The harmful impact of FGM has been widely acknowledged. The WHO says FGM can lead to haemorrhage, tetanus and open sores. Long term consequences include infertility, risk of childbirth complications and newborn deaths.

To learn more about Tasleem’s campaign click on

http://www.change.org/petitions/hh-dr-syedna-ban-female-circumcision-ladkiyon-par-khatna