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A consultation on Adolescent Reproductive and Sexual Health with the Government of Bihar and Development Partners

Game On: Explore 5 Playful Pedagogical Approaches

Magic Bus organised a two-day State Consultation on Adolescent Reproductive and Sexual Health with the Government of Bihar and other NGOs at Patna in Bihar on the 6th and 7th of June, 2013. The Consultation was part of a planning grant provided by the David and Lucile Packard Foundation to Magic Bus.

“We started this as an earnest attempt to initiate an innovative programme focusing on adolescents and youth of Bihar using the unique Sport for Development approach,” said Yuveka Singh, who manages the programme from Magic Bus. “Over the two days, however, we saw this transform into a rich dialogue among representatives from the Government including the State Health Department, Women and Child Development, international donor agencies like UNFPA and UNICEF, and a range of NGOs who have been working for years in Bihar on the topic.”

The main objectives of the Consultation included:

  • Laying the foundation for building new partnerships to meet the needs of adolescents in Bihar and create a better tomorrow
  • Becoming aware of the Government of Bihar perspective on adolescent health and development- Policies, Programmes, Schemes and Vision for the future
  • Reviewing the situation of adolescents in Bihar – their issues, needs and concerns; their reproductive and sexual health needs and the need to have adolescent-friendly policies, programmes and strategies
  • Sharing experiences of NGOs working with adolescents in Bihar
  • Creating a shared vision for working with adolescents in Bihar
  • Outlining possible programme strategies to collaboratively work towards developing an adolescent-friendly programme model that builds the self-confidence, knowledge and skills of young people and empowers them to begin to shape their own sexual and reproductive health outcomes and well-being

The highlight of the consultation however, came in the form of the clear voices of 12 adolescents from significant intervention programmes in Bihar. As individuals and as a collective representation of the voice of 10-to-19-year-olds, they expressed their hopes, aspirations and their challenges, exhibiting a combination of insight and candour that was a tremendous motivation for the other attendees.

This session was called Hear Our Voice and was moderated by Binod Bihari Singh, Project Leader, PRACHAR, Prachar, Pathfinder International. Main observations of this session were:

  • Adolescents are interested and capable of being peer leaders and change makers on a range of issues related to the lives of those between the ages of 10 and 19
  • They are able to rationalize and have a thoughtful discussion on complex issues pertaining to reproductive and sexual health, when they are mentored and invested in systematically
  • They are willing to make changes in the ways they think about sex, marriage and gender relationships, and are able to explain the journey that enabled this change
  • They can be reflective and are able to articulate their feelings. Sometimes they need help to understand why they feel a certain way
  • While technically, there is some amount of education regarding the body and emotional issues during adolescence in school, little of this is actually explained or discussed in the classroom. So sources of information remain peers and youth, who do not always have access to complete information
  • They all wanted to learn more, and expressed an enthusiasm to do so through play, rather than through classroom learning

Chaired by Dr Veena Pandey, Ex State Health Education Officer, Government of Bihar, the next session aimed to understand the Government of Bihar’s perspective in view of policies, programmes and schemes for adolescents as well as its vision.

“At Daily Yuva Clinic at Patna Medical College youth were counselled and also provided with medical advice when required. However, there is a lack of trained counselors for Yuva clinics and there exists a clear need for the same,” said Dr Devendra Prasad, Assistant Clinical Pathologist, Patna Medical College and Hospital. Dr Prasad also highlighted the importance of counselors in medical institutions, as often this gap has to be filled in by the doctor.

Dr MP Sharma, State Programme Officer, State Health Society Bihar shed light upon the four components of the Adolescent Health Programme in accordance with the Government of India provisions. “Adolescent Reproductive and Sexual Health, Rashtriya Bal Suraksha Yojna, Menstrual Hygiene and Weekly IFA supplementation form the four components of the programme,” he said. He emphasised on the substantial role that Magic Bus’ Sport for Development model could play in identifying and training peer educators for Yuva Clinic, a potential innovation in ARSH programme. “24% of the total population in Bihar comprises of adolescents in the age group of 10-19 years. Adolescent Department of Health and Family Welfare has taken the initiative to improve the health of adolescents in Bihar,” Dr Sharma explained.

Dr MP Sharma deliberates on the State Health Society’s initiative in the field of ARSH in Bihar

“There is an immediate need to create many more platforms where the adolescents can discuss their issues and problems freely,” pointed out Radheshyam Ram, Manager, Capacity Building, WDC, while sharing his experience on adolescents programme.

The next session sought to share experiences from the field from the NGOs’ Perspective. Models, best practices, lessons learned and impact of working with adolescents in Bihar were discussed and deliberated upon.

Malay Kumar, Programme Manager, BVHA apprised the participants of his organisation’s efforts towards spreading knowledge around ARSH and shared the status of health indicators of Bihar. “Early marriage is followed by early pregnancy. Most girls were married by the age of 16-18 years, and one of them even had a son. Married adolescents are less aware about contraceptives and also have family pressure to conceive early,” said Mr Kumar.

“The main characteristic of the PRACHAR project was community approach. To bring about a significant change in the life of the adolescents everything cannot suit everybody. What needs to be checked is that we promote age-appropriate, need-based and life-stage specific messages and skills,” said Binod Bihari Singh, Project Leader, PRACHAR, Pathfinder International.

M K Verma, Director, IDF shared his experiences of working on ARSH in 2001. He emphasized on the approach: “A focused approach is needed to work with the adolescents. We need to segregate the groups for specific messages. In the age group 10-19 years there is a segment of married and unmarried adolescents, school going and non-school going, having one child and no child etc. Their curriculum should address the needs of all these various groups,” he said.

Pravind Kumar Praveen shares Oxfam India’s approach towards ARSH

Arpan, State Coordinator, CEDPA said, “As part of the Tarang project which operates in 9 districts and 809 secondary and senior-secondary schools and is incorporated in class IX and X curriculum, teachers are trained and the parents, media and the civil society are sensitized. Consequently, an Adolescent Education Cell has been established at SCERT with a Nodal officer in charge.”

Pravind Kumar Praveen, Regional Manager, Oxfam India said, “Even if we want to do the 100% delivery in the institution it’s not possible as the state is not sufficiently equipped to handle the same. There are some societies which are excluded from the mainstream in every aspect. In these situations, a more holistic approach needs to be followed aiming to uplift these types of communities.”

The session was followed by some real-life stories by young people from the Magic Bus programme.

Rameshwar, a 17-year old local youth volunteer at Magic Bus shares his experience

Disha from Magic Bus shares her story of change

Rameshwar, a 17-year old local youth volunteer at Magic Bus from North Delhi said while sharing his experience, “My outlook towards women and specially girls has changed significantly since I joined Magic Bus over three years ago.” Disha, also a 17-year old local youth volunteer shared that she has gained immense confidence in the last two years, since she joined Magic Bus. “My awareness about sexual health helped me to prevent one of my friends from getting married at the age of 17,” said Disha.

While discussing the global perspective on working with young people, Rupali Tripathi, Consultant, UNFPA presented the UNFPA Global Adolescent and Youth strategy, which includes:

  • Evidence-Based Advocacy, Policy Development and Accountability
  • SRH Services
  • Comprehensive Sexuality Education
  • Adolescent and Youth Leadership
  •  Innovative Initiatives to Increase Inclusion

She also shared some of the strategies for implementation, which include establishing management structure for programme implementation and supportive supervision; capacity building of service providers to deliver quality adolescent friendly health services; awareness creation and generation of demand for services; making available quality and accessible adolescent reproductive and sexual health services; and establishing efficient monitoring system.

Day 2: Participants penning down their vision for an ARSH programme in Bihar

“Peer educators, ASHA orientation, incentive for ASHA, ANMs (Auxiliary Nurse Midwife) and Adolescent Health Day are some of the innovations in the context of Bihar,” Rupali said. The concluding day comprised of a workshop with participants divided into groups to discuss:

  • Areas in which interventions for adolescents exist in Bihar and possibilities for further work
  • Their vision for an adolescent programme in Bihar
  • Action plan for the same

The day began with a warm up game and a guided visualization exercise that enabled participants to tap into their own memories and experience as adolescents. This helped ensure that the perspective for the day was firmly through the lens of adolescence, rather than adulthood.

This was evident in the kind of visioning statements that the groups came up with. Each statement included the sentiment of ‘empowerment’; each one saw the adolescent as part of a larger context that must be engaged with in order to ensure change.

Each organisation then participated in a quick activity, putting colour coded bindis/stickers on a huge map of Bihar – thus enabling the group to know where interventions currently exist, and where they’ve existed in the past as well. This exercise revealed clearly that there are some districts which are heavily invested in (Patna, Vaishali, Gaya, Nawada, Jahanabad) while in others there is negligible NGO intervention (Rohtas, Saran, Bhabua, Shivhar).

Dr Arundhati Misra facilitated the session on adopting an adolescent-friendly lens

Magic Bus received an encouraging stream of positive feedback from participants on the Sport for Development approach. Many found the workshop participatory and freeing, enabling all to delve upon the topic. The strong adolescent-centered focus was appreciated, as was the extent to which Magic Bus heard and encouraged the sharing of on-ground experiences and challenges

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