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

Tackling the diabetes challenge

That the Indian government is thinking on the lines of imposing a tax on sugary drinks and junk food is welcome news. Given the alarming rise of diabetes in India, there is active intervention needed to control the rise.

A WHO report says that the number of people with diabetes in India is likely to cross 101 million by 2030, while Lancet published a study  just a day before World Health Day that said there has been a fourfold increase in the number of diabetics from 1980 to 2014 – from 108 million to 422 million. It ranks China, India and the US are among the top three countries with the most number of people with diabetes.

Prevalence has more than doubled for men in India and risen 80% among women. While the incidence is higher in urban areas with states in the South reporting especially high rates, what is worrying is the rise in rural India, a result of rapid urbanization.

Of special concern is Gestational Diabetes Melitus (GDM), which remains neglected in India and has a severe impact on child and maternal health. G
DM is linked to hypertension, eclampsia and obstructed labour, and is among the leading causes of maternal deaths.

India has one of the highest rates of GDM in the world, with over five million women affected every year. While the worldwide prevalence figure is 15%, in India it is 22 to 25%.

The increasing prevalence of GDM is linked to growing urbanization, reduced levels of physical activity, and changes in dietary patterns and rising obesity

Women with gestational diabetes are also more likely to develop Type 2 diabetes in the future and therefore special attention needs to be paid to this population in India.

A 2013 study by the Kerala-based Achutha Menon Centre for Health Science Studies found that women diabetics are even more vulnerable as they cannot abandon their role of looking after the family and are expected to put the health of other family members above their own. This leaves them with far less time and resources for their own health.

One major reason for the rapid rise in India is lack of awareness. A 2012 study by the Brussels-based International Diabetes Federation found that over 60% of diabetics in India had never been screened or diagnosed because of this, while over 63% were unaware of the complications that arise from the disease.

A combination of food patterns, sedentary lifestyles, obesity and genetics makes Indians more vulnerable to diabetes. It is time we acknowledge that and tackle the problem at a war footing.

Apart from nationwide screening programmes, early detection and treatment must become a part of primary health services. Awareness has to be created about dietary habits as well, with greater emphasis on fiber rather than sugar and starches.

This article was published on the SNEHA website 

Why India needs a sex positive approach

At 1.8 billion adolescents and youth form a significant part of the world’s population; the numbers are expected to grow even faster in the developing world. Which makes it critical that we invest in their education and health, and that includes sexual and reproductive health.

 

About 16 million adolescents in developing countries between the ages of 15-19 years give birth annually; many of them are unplanned pregnancies. One-third of girls are married before 18 years, and 12% by the age of 15. An estimated 33 million young women between 15-24 years have an unmet need for contraception.

The global consensus statement at the recently concluded International Conference on seeking to expand contraceptive choices, even long acting reversible contraceptives, for young people acknowledges this critical gap. A significant number of adolescents and youth are sexually active and want to prevent or delay a pregnancy. But access to contraception and ability to choose from a variety of methods is limited.

“I believe the terminology “family planning” needs to be modified”, says Dr C.M Purandare, president of the International Federation of Gynecology and Obstetrics, FIGO. “Because adolescents are not family planning—they have no family. But they are looking at contraception. When the terminology was decided, maybe 20 years ago, the situation was different. Then, we were talking about population reduction”.

The statement calls for providing evidence-based information to policymakers, ministry officials, service providers, communities, family members and young people on the benefits of contraceptive options.

At its very core, it demands a rethink in how many countries, including India, approach sexuality education.

With one fourth of our population between 10-19 years, India is the youngest country in the world. We are likely to have 358 million young people in the next three decades.  Young people, by accident or design, are experimenting with sex but is there enough being done to ensure that they are informed about it in an appropriate manner?

Findings from the latest National Family Health Survey findings are not very promising. Data collected from the 13 states surveyed in Phase 1 show that 82% women and 70% men lacked comprehensive information about HIV/AIDS and safe sex practices.

Sexuality education, as defined by UNESCO, “provides opportunities to… build decision-making, communication and risk reduction skills about many aspects of sexuality.  The term 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”.

However, in India, the subject of sexuality education has been a controversial one. In 2007 when the  Centre, along with the NACO, NCERT and UN agencies announced the launch of the Adolescence Education Programme in schools, 13 states announced an immediate ban who felt comprehensive sexuality education is against Indian culture. Presently there is a ban on AEP in five states across India, and there is no unformity in the way the subject is approached.

Successful sexuality education programmes start with children between the ages of 5-8 years. Children are curious about their bodies, and ideas of shame and silence are internalized at a young age. It is important, say experts, to educate children early on on the need to understand issues of consent, body image/shame, preventing abuse, establishing good communication skills and gender norms.

There is a need to adopt a “sex positive approach” and go beyond looking at sexuality education as a “means of controlling adolescent fertility because we want to reduce unwanted pregnancies or make sure families are planned better”, says Ishita Choudhry, Ashoka Fellow and Founder of The YP Foundation, a youth-led organization that has worked with adolescents and young people in India in settings, both urban and rural, on many development issues, which include sexual and reproductive health and rights.

“The fact is that adolescents are discovering their bodies and this is a joyful, exciting process for them”, says Dr V Chandramouli, scientist at the WHO Department of Health and Reproductive Research. “They need information that will help them make safe, informed choices and this is not to be always framed in the context of HIV”.

But most parents do not talk to their kids about sex and believe they will figure it out by themselves at some stage. They fear that incorporating it in the school curriculum will encourage promiscuity although innumerable studies show otherwise.

“From our experience we find that most adolescents are getting to know about sex from porn videos”, says Ramya Jawahar, Vice Chair, International Youth Alliance for Family Planning. “These videos don’t talk about safe sex or respecting boundaries so the messages going out to these adolescents is that its OK to not wear a condom or treat women in a disrespctful manner”.

Policymakers and the government, says Jawahar, have to start looking at sexuality education as a health, development and human rights issue and not through a morality prism.

“It is high time we move past our individual discomfort in acknowledging sexuality as a human desire and started considering adolescents as people with agency”, says Chaudhry. “Until then we will keep looking at ways of regulating sexuality across different health outcomes instead of empowerment.”

This article was published in the Business Standard. To read click here

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.

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.

This blog was published in healthyurbanworld.com 

Breastfeeding promotes a smarter, healthier & equal world

The lives of over 800, 000 children and 20 000 mothers could be saved each year with universal breastfeeding says a new series by the respected medical journal The Lancet.

Breastfeeding leads to fewer infections, enhanced IQ, probable protection against obesity and diabetes, even breast cancer prevention in mothers, says the series which has been hailed as the most in-depth analysis done so far into the health and economic benefits that breastfeeding can lead to. It also highlights that breastfeeding leads to economic savings of 300 billion dollars

The data published is based on analysis led by scientists at the Federal University of Pelotas in Brazil who looked at data from previous research.

Reporting on the findings, The Independent, a UK daily, quotes the study head Professor Cesar Victora as saying, “There is a widespread misconception that breast milk can be replaced with artificial products without detrimental consequences…. The decision not to breastfeed has major long-term negative effects on the health, nutrition and development of children and on women’s health.”

However, globally, only 37% of children under the age of six months are exclusively breastfed in low and middle-income countries.

Women avoid or stop breastfeeding due to many reasons ranging from medical, cultural, and psychological, to physical discomfort. Turning to formula milk, which is heavily pushed by multinational companies and many hospitals, becomes a convenient option.

There is a need to create a supportive environment for a mother who is breastfeeding says Dr Armida Fernandez, Founder, SNEHA. This includes addressing the many myths and misconceptions that are still widely prevalent.

“Mothers, and this includes women from poor backgrounds, want to breastfeed their babies. But if their baby keeps crying, and this happens due to many reasons, they feel it’s because they are not producing enough milk and so they resort to formula or diluted cow’s milk leading to malnutrition”, says Dr Fernandez.

She believes that doctors need to aggressively and consciously encourage breastfeeding.

“I find many doctors do not support it at all. The moment the baby is a little underweight they tell the mother to start a top feed. “ Dr Fernandez suggest that health centres and clinics must have counsellors on their staff who actively encourage women to breastfeed.

Currently India is still some distance away from reaching its targets on improving infant nutrition as per an assessment report by the Breastfeeding Promotion Network of India (BPNI) and Public Health Resource Network (PHRN) published in late 2015.

The report says that nearly 15 million babies, who comprise of 55% of newborns in India annually, are deprived of optimal feeding practices in their first year after birth.

The assessment also points to gaps in policies and programmes outlined for enhancing breastfeeding rates. Countries like Afghanistan, Bangladesh and Sri Lanka fare better than India in comparison.

Aggressive promotion of baby foods by companies, lack of support to women in the family and at work places, inadequate healthcare support, and weak overall policy and programmes were some of the reasons identified as responsible for lack of improvement in infant and young child feeding practice indicators.

This article was published in healthyurbanworld.com 

Taking Community Health to the Market

As she rocks her restless baby, Tia Pertiwi listens as three women with aprons imprinted with images of the reproductive system explain how contraception works.

Besides her are some 20 odd women, most of them market vendors, and the atmosphere is relaxed and carefree with many asking questions and cracking jokes.

Pertiwi, 25, who recently gave birth to her first child, wants to delay the second by a few years but is not sure what birth control method to adopt.

Fortunately, the answers are available close at hand; at the Pasar Badung marketplace where Tia works at a fruit stall.

Guiding her with information about contraceptive options is the Yayasan Rama Sesana, a health clinic situated inside Pasar Badung, a traditional marketplace in the Bali capital Denpasar, where Tia works as vendor at a fruit stall.

Since 2004, YRS, a non-profit, sexual and reproductive health clinic has reached out to thousands of low-income group women in Bali. Most of them, like Tia, work in traditional market communities with an average daily income of US$5.

The YRS started in 1999 and initially worked in the field of AIDS prevention among risk groups in 1999. It later developed a plan to open health centers to provide information and services on breast and cervical cancer prevention, HIV/Aids, family planning, prenatal care and sexually transmitted infections.

“Breast cancer is the leading cause of cancer-related deaths in Indonesia and over 9000 women die of cervical cancer in our country every year”, says Dr Luh Putu Upadisari, founder, YRS. “Early detection is key to prevention but women lack information and they don’t have the time and money, especially towards preventive care”.

To ensure maximum reach, these health clinics were set up at traditional marketplaces. “They are open 24 hours a day and thousands of people – girls, women, housewives in particular – come here. This creates a supportive environment to inform them about their reproductive health and empower them,” says Upadiseri.

The YRS has two such clinics at Bali and also runs mobile clinics that carry out monthly visits to markets around Bali. The services offered are on a donation basis and include breast exams, Pap smears, STI and HIV testing, and counseling.

The centers report about 520 clients per month on average – over 67% are women. Their location draws a wide variety of clients – not just market vendors but laborers, cleaners, office workers and shoppers.

Trusting women with information about their health not only empowers them but also helps save lives. And the Balinese approach of reaching women directly at their workplace is one that has the potential to benefit thousands of women in India as well.

Like Indonesia, India reports a high death incidence due to cervical cancer. According to a 2014 study by the Cervical Cancer-Free Coalition, it tops the world in cervical cancer deaths with nearly 73,000 women dying every year. It is also the second most common cancer in women aged 15–44 years.

Cervical cancer is treatable if found early but in the absence of a nationwide screening program in India, there are widespread disparities in screening, treatment as well as survival.

“Early detection is essential as it is completely curable at that stage but we do not have a comprehensive screening program with the outreach required to provide access to services to underprivileged women”, says Dr Aparna Hegde, founder of NGO ARMMAN, which is behind several maternal health initiatives in Mumbai and other parts of the country.

ARMMAN’s mMitra project uses mobile phone technology to take preventive health care information directly to the phones of pregnant women through pregnancy and infancy.

Hegde says innovative approaches could offer the way forward as traditional models of caregiving leave a lot to be desired.

“Initiatives like YSR emphasize preventive care and this paradigm shift essential because our health care system has almost always focused on curative services”, adds Hegde. “Preventive care will prevent overloading of our public health system and help them provide better care to the patients who access it.“

This article was published in the Business Standard on January 27, 2016

Greater contraceptive choices for youth – key to economic growth

One of the key statements to come out of the 2016 International Conference on Family Planning is the Global Consensus Statement supporting the expansion of contraceptive choices for young people to include long-acting reversible contraceptives or LARCs. Over 40 leading global health and development organisations have endorsed this statement.

1.8 billion – that is the estimated number of adolescents in the world and a significant number of them are sexually active and don’t want to get pregnant until they finish their education, get a job or they want to space their children. However, the limited access to LARCs restricts their ability to exercise full contraceptive choices. Lack of information, myths and misconceptions, lack of availability and poor community support are some of the key barriers.

Speaking at a press conference, C.M Purandare, president of the International Federation of Gynecology and Obstetrics (FIGO) said that the goal of heir organisation is to encourage midwives, gynaecologists and obstetricians to work towards removing barriers in their countries to the use of LARCs to meet the reproductive needs of young people.

“We have women who get pregnant and who come for an abortion and are not given information about the basket of contraceptive choices”, said Dr Purandare. “After a few months she is back for the same thing. If we do not provide her with information and contraceptives, we are failing her for the second time”.

In many countries it is hard for adolescents to walk into hospitals and ask for contraceptive advice. “Injectables are a boon to adolescents and efforts have to be made to ensure the knowledge is available as widely as posisble”, added Purandare.

At the very core it boils down to a question of agency and autonomy for young women believes Ramya Jawahar, Vice Chair, International Youth Alliance for Family Planning who is from Bangalore, India.

“Women are shuffled between the homes we are all born into and those we are married into”, says Jawahar. “Now that LARCs are in the health centres, the challenge will be to get women into these centres and getting the men on board”.

The safety of LARCs for adolescents also came up for discussion at the conference. There are misconceptions and myths relating to the impact of long acting methods on the health of adolescents.

“Adolescents are eligible to use all methods like adults”, said Dr V Chandra-Mouli of WHO-HQ, pointing to a WHO study which said there was no medical evidence to support the perception that implants or any other LARCs impact fertility.

“The most important rationale for investing in young people is demographics”, he added, pointing to countries like Hong Kong and South Korea that have invested in education and health. “Investing in young people is good for them, their families and their countries”.