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Yuvashakti :

ADOLESCENT REPRODUCTIVE AND


SEXUAL HEALTH

Reference handbook for community based


Adolescent Reproductive and Sexual Health
Programme

Samraksha
Contents

Contents .............................................................................................. 2
Section 1 : The Yuvashakti Programme ............................................... 3
Section 2 : Mass Awareness Programmes:.......................................... 6
EARLY MARRIAGE................................................................................................6
OTHER MASS AWARENESS ACTIVITIES ........................................................10
Section 3 : Catalytic Sessions with Adolescents ................................ 13
UNITY IS STRENGTH...........................................................................................13
GENDER AND GENDER DISCRIMINATION ....................................................15
OUR BODY.............................................................................................................19
PHYSICAL AND MENTAL CHANGES...............................................................20
MENSTRUATION ..................................................................................................22
GOOD TOUCH BAD TOUCH ...............................................................................24
COMMUNICATION: BRIDGES AND BARRIERS .............................................27
ASSERTIVE COMMUNICATION ........................................................................30
TWO WAY COMMUNICATION/OPEN COMMUNICATION...........................33
DECISION MAKING .............................................................................................35
EARLY MARRAIGE..............................................................................................37
PREGNANCY AND CHILDBIRTH ......................................................................39
PRE AND POST PREGNANCY CARE.................................................................42
FAMILY PLANNING.............................................................................................46
SAFE ABORTION ..................................................................................................51
STI/RTI ....................................................................................................................53
INFERTILITY .........................................................................................................55
HIV/AIDS ................................................................................................................56
Section 4 : Workshop with older women and young men ................... 58
EARLY MARRIAGE..............................................................................................58
MEN’S RESPONSIBILITY IN WOMEN’S HEALTH (SESSION FOR MEN) ...61
MEN’S ROLE IN WOMEN’S HEALTH (WORKSHOP FOR OLDER WOMEN)
..................................................................................................................................64
Section 5 : Samraksha’s experiences in using this material with the
community ......................................................................................... 66
Section 1 : The Yuvashakti Programme

Yuvashakti, an adolescent reproductive and sexual health programme of Samraksha arose when
Samraksha’s experiences in working on HIV/AIDS and subsequently Reproductive and Sexual Health
highlighted the vulnerability of adolescents to HIV, STI and RTI. Young people, specially young women,
were not only physiologically more vulnerable to these infections, there was also a lack of space for
them to discuss issues related to their sexuality and its various forms of expression, and a lack of
articulation of reproductive and sexual rights and responsibilities.

The community stakeholders involved:


Yuvashakti started with the larger goal of promoting the reproductive and sexual health rights of
adolescents, through a community based approach. Based on our prior experiences in working with
rural and urban communities on the issues of HIV and RSH, we understood that information alone was
not sufficient to initiate and sustain change within any targeted group, and it was necessary for change
in attitudes of the larger community to create community norms and pressures to initiate and sustain
change. Adolescent expression of their reproductive and sexual rights were shaped by numerous
influences within the community; therefore the programme not only worked directly with adolescents,
but also with other groups within the community. Specifically, the programme identified young men (25-
30 years) and older women (above 25 years). These groups were identified as gatekeepers to the
community, who could help the adolescents exercise their rights in a responsible way. The older women
not only spent most time with the adolescents, but also significantly molded their values and attitudes.
Younger men (25-30) emerged as another group to work with, who could influence the RSH rights of
adolescents, and who may also serve as role models for the adolescent boys and influence their
behavior.

The strategies used for the different groups:


The primary strategies adopted by the programme were mass awareness, catalytic education sessions
and workshops. Different strategies were used with different groups of people.
• Mass awareness activities were designed to attract attention and reach out to the entire
community and was broad in its content. It created a visibility for the organization within the
community and set the stage for talking about Reproductive and Sexual Health, and also
brought up issues like early marriage and men’s involvement in women’s health into the public
discourse, as an issue, which was not happening within the homes, but an issue with wider
social implications, regarding which the community had to evolve its own norms and values.
• Catalytic sessions with adolescent boys and girls, which were a mix of information giving
sessions, games, puppet shows and discussions, provided a space for the adolescents to
articulate their concerns, seek information on RSH related issues, and clarify different myths
and misconceptions. These sessions, which were interactive, and information giving, operated
within a rights based framework, with an emphasis on supporting and strengthening
youngsters to make informed, responsible choices, rather then directing them towards pre-
decided choices.
• Interactive sessions/workshops with older women and younger men focused on the issue of
early marriage, and involvement of men in woman’s health, particularly during pregnancy and
childbirth. These sessions were designed as group discussions, aided by pictures and
situational stories.

Materials/Activities Developed:
The methodology has been to have certain frameworks but use ever-changing communication material
that reflects the concerns that come up in our interactions with the communities, that is interactive and
also which is fun.

Some of these materials have been developed based on Samraksha’s own experiences in working with
HIV, and RSH in general communities also contributed to the material development. In addition to this,
the Yuvashakti staff also developed some interesting material, which were easy to use, maintained the
interest of the group and were easy to carry into the community.

Towards the latter stages of the programme, the community members were themselves involved in the
development of the different materials, like audio tapes, where they would create the script, and also
play the different roles, and record the programme to be played in public spaces during mass
awareness programmes.

Some magic tricks were used by the staff, in order to highlight or reinforce a point. The staff had all
been trained by professional magicians, and used some of the conventional magic tricks, and built it
around a specific context, so that it could provide or reinforce the information being provided by the
programme.

Some of these materials have also been drawn from different organizations, which are working on
issues of adolescent reproductive and sexual health rights. Material from Pathfinder, specially flipcharts
on different RSH issues like pregnancy, contraception, safe abortion etc. were adopted to the local
languages and used in the catalytic sessions. Materials on soft skill development, like communication,
and decision making, was adopted from the material of Life Planning International. Some exercises
were also adopted from Pachod, Oxfam etc. Translation and adaptation of material was made, with due
permission from the original publishers.
This handbook is a collection of the different IEC material used by Samraksha while working with on the
issue of adolescent reproductive and sexual rights, using a community based approach, involving
multiple stakeholders in the community. Yuvashakti programme, including flipcharts, games, activities,
group discussions, and magic. A set of pre and post session questions, which were used by the staff, in
order to assess the impact of the session has also been provided. These are however, just some
sample questions, and other questions can also be framed.

The material is organized thematically, and the different activities used with the different stakeholder
groups are organized separately. This material can be adapted by other organizations working on
similar issues, to suit their own communities. Samraksha’s own insights in using this material with the
community is presented in the concluding chapter.
Section 2 : Mass Awareness Programmes:
EARLY MARRIAGE

Activity : Playing audio cassettes or puppet shows


Source : Samraksha
Material : Audio tape with the story recorded. Puppet dolls (numbers based on the script being played)
Time: 30 minutes
Group Size : Suitable for big groups
Purpose : Bring the issue of early marriage into the public discourse
Method: Either play an audio cassette in a public place, with the recorded script, or enact this script
using puppets

Story 1 : The story of Taseem


MIL : Taseem Taseem, where were you till now? The baby is crying. You don’t take care of him, you
don’t clean the house, you say you are sick and cannot do anything. You don’t look like you are 18
years old, you look and behave like an old woman.
DIL : Why do you say that? I am doing all work, I clean the house, I do everything here. Why are you
complaining and fighting?
MIL : How dare you talk back to me? Wait, when my son comes in the evening, I will tell him about this,
I will ask him to beat you and send you out of the house.
DIL : Why wait till your son comes in the evening. I am going right now to my mother’s house.
MIL : You are going, go. Take your son and go.
Taseem walks out of the house and goes to her parent’s house.

Father : What happened Taseem, why are you crying and coming?
Taseem : Nothing. They give me a lot of mental torture. They don’t give me food. She scolds me
everyday, that’s why I took the baby and came.
Father : Look daughter, it is not nice for a married woman to leave her husband and come like this.
What will people say? You should not keep fighting with your husband and coming home.
Taseem : What, whatever they do I should keep quiet is it ? Did I ask you to get me married? I was
studying in a school. You got me married. If I had studied well I could have stood on my own feet. I
could have married in a better way. I refuse to go to that house again.
Mother Give her an answer
Father : This is your fate. You can’t do anything about it.
Mother : Don’t say that. It is not fate. She was studying well, you got her married. Now console her.
Father : Yes it was my fault. I should not have gotten you married so early. I realize my mistake. I will
tell other fathers and mothers, don’t get your daughters married early.
Mother : Taaseem, your husband is coming. You don’t say anything. I will talk and send him.

Story 2 : The story of Raju and Gopi

Gopi : Raju! You have come to our house; you seem to be very happy?
Raju : I am planning to get married, Gopi, that is why I am so happy.
Gopi : Marriage! Are you in the age to get married ? How old are you
Raju : I am 19 years old, why, am I not tall, don’t I have a moustache and beard, what is wrong in
getting married.
Gopi : Look Raju, one does not become big because one is tall or has a moustache or beard. You
should be able to stand on your own legs. That needs time, marriage is not a play. Anyway, who are
you marrying?
Raju : Hema, the girl in the next house. My family know why half the area knows about it. That is why
her parents said get married soon.
Gopi : She must be just 16. She was in 10 class last year. She is very young.
Raju : She is not young, she has attained puberty. What is wrong in getting married?
Gopi : Look Raju, if a house has to be strong, the foundation has to be strong. How long should you wait
after the stone is laid to build the house?
Raju : Yes, that does take time.
Gopi : In the same way, it does not mean the girl should marry when she has attained puberty
Raju : Then should she marry when she is an old woman
Gopi : No, that is not what I meant. She has to be independent, make the decision about the marriage
herself. That needs time, then she can marry
Raju : What shall I do Gopi, Hema and I like each other a lot, our families have also agreed. That is why
we want to do it early.
Gopi : I also thought like you and got married. Then understood how many problems there are in getting
married early. In one year, I had a child, the responsibility increased. My wife could not go to work.. Now
I know, getting married early has a lot of problems. I made a great mistake.
Raju : What went wrong ? What could have happened ?
Gopi : I could have given my wife some training,, also looked for a good job. I shouldn’t have had a child
also so early.
Raju : What shall I do? All preparations for the wedding are happening. Her parents have agreed. I love
her a lot. What you say is true. I am scared that everything will slip off someday.
Gopi : You will appreciate what I said. You speak to Hema, tell her there is no hurry for wedding.. Then
speak to your parents and her parents.
Early Marriage Pamphlet
Samraksha is the HIV sector of Samuha, a developmental NGO. It has been working in the HIV sector
in rural areas of Raichur, Koppal and urban areas of Karnataka for more than one decade addressing
programmes of Prevention and Care. Yuvashakthi project works for the issues of reproductive health of
young people for awareness access to service & sensitize community at large. This project is spread in
Shadabnagar, Shampur, Doddannanagar, Idgamohalla, Modigarden, Manorayanapalya pockets of
Sultanpalya area in its various programs where youth issues are addressed.

You can be apart of this Youth movement by

1. Sending your all girls & boys to education session conducted daily at various places in your area
where they can learn about Reproductive Rights and Health to protect them
2. You can be a part of the community group discursion and bring out your concern for the youth.
3. Join for the workshop and share as a community on ways to eradicate out the challenges of early
marriage, early pregnancy, abuse and gender disparities
4. Participate in the various mass awareness programs to help every body sensitize towards
reproductive sexual health issues of young people.

Often we find young people struggling with life & its responsibilities as in situations described below
Situation-1
Hema’s parents married her off at an early age of 16 years. Within a year she got one child. She is
unable to manage her family & care for her child. Hema often falls sick and is looking anemic and weak
day by day. She comes back to her mother’s house unable to handle her family situation. Hema’s
parents pressurize her to go back to her in- law’s house. Now Hema is physically & mentally stressed.
How we can prevent this situation & what action we will take?

Situation-2
Raju & Gopi are friends. Gopi was married when he was 18years old. Now he is father of one child. He
has to support, his parents and his young sisters. His wife s health remains unstable. He has to spend a
lot of money for medicines. Raju his friend is 19 years now and is all set to marry his childhood love
Jaya who is only 16 years old! Raju helps Gopi to understand the challenges of early marriage and
suggests to delay the marriage.
How can prevent Raju from getting into a situation like that of Gopi.

Are we familiar with such situations in our neighborhood?

Some questions we can think aloud could be


Why are young people not being able to make right choices & decisions?
Who is their guiding light?
Are their friends capable of guiding them?
Are elders/parents able to have discussion with their adolescents?
Are elders/parents able to understand them?
Do young people try to understand their family & parents?
What can we do to avoiding situation1&2 in our community?
Today in India the with legal age of marriage is 18-for girls 21-for boys, BUT
In Bangalore 37% of girls get married before 18
….. % of girls have one child within 20 years.
Can we help future generations to be more responsible and conscious of their rights and needs?
Come let us join the movement of change! Let’s make a difference from our homes, from our community
for our society.
OTHER MASS AWARENESS ACTIVITIES

Snake and Ladder Game for communicating messages


Source: Samraksha
Material : Giant sized Snake and ladder game board, dice, messages on a cardboard
Time : 45-60 minutes
Group size : 4 people at least
Objective : Get the community involved in the issue, and bring it into public consciousness

Method :
Stick relevant messages regarding any specific subject, in different squares in the game chart.
Select four people from the group and start playing the game.
As the participants throw the dice and start moving the dice, read out the message in the relevant
square.
Discuss the messages in the group, their own experiences and take feedback
The participant who reaches 50 first is declared the winner

Different sets of messages used on the boards


Decision making messages :
• Let the decision yours, let the advice be others, then the result will be good.
• Think of the consequences before making a decision
• With encouragement, opportunity and authority, anyone can make decisions.
• Its easy to make decisions, harder to adhere to them.
• No matter how much pressure you get from cinema, TV, or friends, the decision is yours only
• Make good decisions.
• A decision without thought, can lead to disaster
• If something good happens, we did it, if something bad happens, we blame it on fate.
• But our achievements and our failures are a result of our decisions
• Think of the consequences, since you have to bear them
• Sometimes, one wrong decision can push you into hell
• You will not always get a second chance in life.

Messages on gender:
• If a man learns, he is the only one who learns, if a woman learns, the entire family learns.
Educate the girl child
• If you give the woman authority, opportunity and decision making power, then she can also
achieve
• Say no to dowry, preserve your self respect
• Woman’s equality is the beginning of progress
• If we do away with discrimination for women , then only we will have a just society.
• A society which does not respect its woman has not progressed
• When a boy is born we are happy, when a girl is born we are sad,
• Like this , one day, we will stop to be a human society
• Discrimination between men and women is the road to mankind’s destruction
• Man gets first preference, but women get all the responsibility
• Dowry deaths, rape, female foeticide, everything is for women, why is woman the victim of all
abuse

Communication messages :
• Anger, scolding and fighting, harm good relationship between people
• Speaking with humility, open communication and making the other person understand builds
bridges for good relationship
• Are your children not listening to you. Trust them, be with them, still
• With courage, faith and support, it is possible to build very strong relationships
• Lie, complaints, or sarcasm will not prosper for long
• It is important to listen carefully to what is being said, otherwise wrong messages will be
understood
• A person who eats well is free from disease
• A person who speaks well is free from quarrels

Activity : Children’s physical, social and psychological needs


Method : Using different pictures and stories to illustrate children’s needs
Source : Samraksha
Material : Pictures of children in different age groups
Time : 45-60 minutes
Group size : 5-10 people
Purpose : This serves as an initial activity to introduce the programme into the community
Show the picture of a young child, give it a name, and start the story.

Lakshmi and Suresh have a girl child, Sunita. She is now 6 years old.

Ask the group to list the physical, emotional and social needs of this child.
Note the responses from the group. If any points are left out in the responses, include them

Physical needs : cleanliness, good nutritious food, vaccination, breast milk till the right age to wean
away.
Emotional needs : An older person being with the child always, giving right answers to the child’s
questions, love, affection, opportunities to play.
Social needs : Protection of child rights, enrollment in school, good environment for the child

Next show the picture of an older child (7-10 years)

Physical needs : Good food, cleanliness, injections


Emotional needs : Playthings, love and affection
Social needs : Sending the child regularly to school, good environment for growing

Show the picture of Sunita as an adolescent. Now what are her needs? Since this is a very sensitive
topic, spend more time discussing the responses
Physical needs : Good food, personal hygiene, knowledge about menstruation, understanding of body’s
growth, reproductive and sexual health, and reproductive and sexual rights.
Emotional needs : Since children are entering puberty, there are lots of emotional needs at this time.
Children are likely to fall in love easily at this time. This is not wrong, what is important is how we deal
with it, and what we do about it.
Social needs : Higher education, good environment, good friends

Finally show the picture of Sunita at 19-21. What are her needs now?
Physical needs : Good food, good medica facilities, clean environment
Mental needs : Respecting the child’s feelings, teaching good conduct, and respect for the elder and the
child
Social needs : Good education, good work, good company, good friends, and avoiding bad company
Section 3 : Catalytic Sessions with Adolescents
UNITY IS STRENGTH

Activity : Building with stones


Source : IHMP
Material : Stones in different shapes and sizes
Time : 45-60 minutes
Group Size : 5-10 people
Purpose : Emphasizing the importance of working in groups, team building
Method :
Ask each participant to bring one stone each.
Ask them to see what kind of stone each one has brought. The group will note that each of them has
brought stones of different shapes and sizes.
Ask the group to arrange the stones to give it a structure and involve all members of the team in the
activity.
All the stones need to be utilized.
Once the group has arranged the stones discuss with them the message behind the activity. Each stone
because of its size and shape would have contributed in a different way to the resulting structure even
though initially they were all very different from each other. This activity illustrates how different people
will contribute in their unique way to the team and that each person will have some talent that will
contribute significantly to the team.

Activity : Rope Game


Material : One rope, one whistle
Time : 45-60 minutes
Group Size : 5 to 20 people
Method :
Divide the participants into 2 groups. Ask each group to line up on opposite sides and hold the two ends
of the rope. Tell the groups they have to pull their ends of the rope towards themselves as soon as they
hear the whistle. Blow the whistle to signal the groups to start pulling. After some time, ultimately, the
group which is stronger will pull the rope towards them. This activity can illustrate how there is strength
in working as a team.
Pre Activity and Post Activity Questions
1. Is it possible to achieve something alone?
1. Yes 2. No

2. Why do you need a group ?


1. For unity 2. To fight 3. To motivate

3. What is the strength of groups?


1. Diversity 2. Unity 3. Gossip 4. No responsibility
GENDER AND GENDER DISCRIMINATION

Activity : Who makes the decisions?


Source : USAID (Oxfam Gender Book)
Material : Flashcards highlighting different situations, a collage of women doing different things, KG
Cardboard
Time : 45-60 minutes
Group Size : 5-10 people
Purpose : To highlight social barriers which hinder women from making decisions.
Method :
Read out each of the different situations, highlighted in the card to the group.
Ask the group who in their homes makes the decision with regard to each of these situations.
On a chart paper, make two columns, men and women. Write down the situations where the group says
men make the decision, and where women make the decision.
Read out the different situations which the group has identified as men making decisions, and women
making decisions.
Ask the group to identify the differences in these two groups of situations.
Ask the group who makes more important decisions. They will respond that it is the men.
Ask the group why only men make decisions involving greater power and authority. The group might
respond that since the men have the money and the authority, they also have all the power.
Ask the group if it is possible for women to have this kind of power.
The group may say yes, or no. Probe the reasons behind the answer.
At the end, show the collage with women in different professions, to show that women are capable of
doing many things.
Underscore the point that with education, and proper opportunities, it is also possible for women to have
money, authority and decision making power.

Examples of different situations that can be used in the flashcards :


Sending the daughter to school
Deciding about the marriage of the son/daughter
Decisions regarding taking loans or giving loan to someone
Decision about building a house
Deciding what to cook at home.
Activity : Career cards
Source : USAID (Oxfam Gender Book)
Material : Flashcards showing different professions/jobs, like doctors, engineers, nurses, teachers etc.
K G Cardboard, collage of women in different roles
Time : 45-60 minutes
Group Size : 5-10
Purpose : To help the group understand gender discrimination and know that it can be changed
Method :
Create two columns for men and women in the cardboard
Show each card to the group. Call out the profession/job in each card. Ask them who does the job: Men
or Women? Note it in the respective column in the cardboard.
If the group says both men and women can do a job, write it in a separate column
Ask the group why certain job have been seen as men’s jobs, some as women’s and some as both
Pointing to the column showing work both men and women do ask the group if this was the case 25
years ago
Ask them why it has changed now
Ask the group if there is a difference in men’s and women’s work
Highlight the difference in the economic power and decision making power in the kinds of jobs which
men and women do.
Ask the group who decides what jobs a woman does and what a man does. The group will say ‘society’
Ask the group if this can be changed.
If the group says no, ask them how things had changed from 25 years ago.
Explain that with education, there are more opportunities
It is possible to change attitudes and behavior. Society decides on gender discrimination. This can be
changed
Natural differences between the sexes cannot be changed
Finally show the collage of the women in different roles
It is important to highlight how society shapes many of our beliefs, and how we can change them. It
might be difficult, but its not impossible.

Activity : Story telling


Source: USAID
Material : Collage of women in different roles
Time: 45 to 60 mins
Group Size: 5 to 10 members
Purpose : How gender discrimination is present even in our imagination
Method :
Start narrating the following story
A father and son are traveling in the car. The father is a surgeon. They meet with an accident. The
father dies on the spot, and the son is seriously injured. He is rushed to the hospital, and is in need of
immediate surgery. He is taken to the operation theatre. The surgeon reaches the theatre, and looks at
the patient and immediately says, “I cannot do this operation. This is my son”.

Ask the group, “Who is the surgeon “


The expected answer is “His mother”, but the group might come up with different answers (Second
father, uncle, father’s ghost etc.)
Ask the group why it cannot be the mother.
Ask the group if it is possible for women to be surgeons.
Discuss about how being men or women is natural, and cannot be modified, but behaviors can be
modified.
Discuss how we need to start changing our thinking, along with changing roles.
Finally show the poster of the women in different roles, to emphasize that women are capable of
excelling in all fields

Activity: Magic
Source: Samraksha
Material : Long, blank paper
Time : 45 to 60 minutes
Group Size 5-10
Purpose : Demonstrate gender discrimination in society, using the medium of magic
Method:
Show the piece of paper and compare it to society.
Start talking about discrimination against girls.
Start talking about discrimination in different fields, at home, in education, taking decisions etc) As you
mention each point, tear out the sheet.
Later fold the sheet into a small pack (like kumkum packet) and open out the full paper.

Pre and post activity questions


1. Between men and women, who makes more decisions ?
1. Men 2. Women 3. Both

2. What is required to be able to take decisions ?


1. Information 2. Opportunity 3. Experience 4. Self-confidence
3. Difference between males and females are
1. Biological 2. Social

4. Is there any difference in the behavior of males and females


1. Yes 2. No 3. Don’t know

5. The difference in the behavior of males and females is because of


1. Society 2. Education 3. Environment

6. The difference between boy’s and girl’s behavior is due to …..


1. Society 2. Education 3. Environment

7. Of the differences between boys and girls, what can be changed ?


1. Biological 2. Social
OUR BODY

Activity : Film stars collage


Source : Samraksha
Material : A collage of different film actors/actresses and a chart of the internal part of the human body
(male and female) chart paper
Time 45-60 minutes
Group : 5 to 10
Purpose: To know about the internal organs of the human body and their functions and to initiate free
and uninhibited talks regarding one’s own body.
Method :
Arrange the collage and chart in such a way that the collage opens into the chart.
First show the collage, and ask the group to identify the different film stars.
Ask the group if there is any difference between the film stars and the rest of us.
The group will start identifying some differences, economic, social, physical etc. Start making note of all
of them in a chart paper.
Then ask the group if there are any similarities between the film stars and us.
The group might give a lot of response but eventually say they are also men and women like us.
Start talking about how there are some more similarities between us and them, in our internal organs.
When they say yes, open the collage and show the chart of the human body and ask them to identify
different parts.
If the group is not able to identify any part, explain the part.
Finally ask the group if they would be interested in seeing the internal parts of the opposite sex (if it’s a
boys group, then the girls internal parts, if it’s a girl’s group, boy’s internal parts). If they say yes, show
them the relevant picture.

Pre and post activity questions :

1. Why should we know about our body ?

1. For fun 2. Not necessary 3. To understand how it works

2. Identify different genital parts of men and women, and state their function
Ejaculation menstruation
Urination Pregnancy
Ovulation
PHYSICAL AND MENTAL CHANGES

Activity : Magic bag


Source: Samraksha
Material: A magic bag with different items (lipstick, nail polish, mirror, photo of a popular hero, bra,
sanitary pad for girls, razor, condom, photo of a popular actress etc. for a group of boys.
Time: 45 – 60 minutes
Group Size: 5 to 10 people
Purpose: To understand and accept physical and mental changes in the body during adolescence
Method :
Make the participants sit in a circle, and pass the magic bag to one another, to the beats of a music/bell
played by a facilitator in the background. When the music stops, the person holding the bag should pick
up one item from the bag with their eyes closed.
The facilitator then asks questions about the item picked out. For instance, if it’s a lip stick, why is it
used, etc. The group’s answers are recorded in a piece of chart paper
Once an item is removed, it is kept outside, and not put back in the bag. The music starts again and the
game continues. At the end, when all the things have been picked out, and discussed, ask the group to
identify if each item serves a physical, emotional or mental need.
Classify the responses on the sheet of paper.
Based on the responses, ask the group to identify which need has received most attention in their
classification. It will be seen that emotional needs are the most common needs.
Discuss about how in adolescence a few physical changes also signals many emotional changes.
These emotional changes are natural, there is nothing wrong with them. But the decisions we make in
the wake of these changes is very important and we need to be careful about it.

Activity : Magic
Source : Samraksha
Material : Feather Stick
Time : 20 minutes
Group : 5 to 10 people
Purpose : Use the medium of magic to show how physical and mental changes occur simultaneously in
adolescence
Method :
Show different colored feather sticks out of a magic tool kit to show that along with physical changes,
mental changes also occur. Push one feather stick inside other, to create a different color, and explain
that both physical and mental changes together cause changes in attitudes and behavior.
Pre and post activity questionnaire:
1. Do you know the physical changes that happen during adolescence?
1.Yes 2. No 3. Don’t know

2. At what age does the physical changes occur/


1. 10-12 years 2. 13-15 years 3. 16-18years 4. On coming to high school

3. After a particular age the menstrual cycle stops


1. Yes 2. No 3. Don’t know
MENSTRUATION

Activity : Flash cards and Uterus model demonstration


Source: Samraksha
Materials : Flashcards, uterus model, menstruation cards ( a set of flashcards, showing the girl in
puberty, the different ceremonies associated with it, the behavior associated with it
Time : 45-60 minutes
Group : 5-10 members
Purpose : Explain menstruation and menstrual cycles using a model of the uterus
Method :
Show the flash card showing a young girl seated in the traditional ceremony to celebrate puberty, and
ask the group to give the girl a name.
Ask the group if there are similar customs in their homes, and what is this function called.
Ask the group when a girl starts menstruating.
Then show the different flashcards to the group, which show the girl after the physical changes of
menstruation (breast development etc.) the mother sitting and explaining to the girl etc. Ask them what
they feel bout the picture in it and then show the reverse side of the card, where an explanation is given
for it.
Show the model of the uterus and ask the group what it is. If they don’t know explain to them what it is
Ask the group where the uterus is located in the human body. Prompt them to the right answer.
Ask them if they are interested in seeing the internal parts. If they are, open the model and show them
the internal parts, and explain the functions.
Through questioning and interaction elicit myths and misconceptions regarding menstruation and clarify
them. If some misconceptions are not shared by the group, but are known to be prevalent in the
community, initiate discussion on it and clarify them also. Also discuss the importance of good nutritious
food during menstruation.
Activity : Story Telling
Source : Samraksha
Time : 45-60 minutes
Group Size : 5-10 people
Purpose : Promote more open discussion and clarification of doubts regarding menstruation
Method :
Narrate the following story to the group :

Sunita is the only daughter of Mohan and Lakshmi. She is 12 years old and studying in 7 Std. Sunita’s
parents go to work and she is always alone at home and likes it. She doesn’t have any friends even in
school.
One day, when she is getting ready to go to school, she has severe stomach pain. But she has an
important exam that day and has to go to school. She is in great pain during the exam and when she
goes to the toilet she sees a lot of blood discharge. Sunita is very scared, she doesn’t know what to do,
she has never had anything like this. She thinks she has some disease. She cannot tell anyone and she
is scared and shy. She does not tell her teacher. She does not write her exam well. After she reaches
home, the bleeding continues. But she doesn’t tell her mother. She feels her mother will say she had
done something. The bleeding continues for seven days, but she never tells anybody. She does not
perform well in the exam, and fails that year.

Ask the group these questions :


What has happened to Sunita ?
Why did she fail in the exams ?
What could have stopped her from failing in the exams, and who could have done that?

Pre and post activity questions


1. You can use any kind of cloth during menstruation?
1.Yes 2. No 3. Don’t Know

2. Why do women get periods ?


1. To release bad blood 2. To release unfertilized egg 3. Because of childbirth

3. Which part is responsible for menstruation


1. Stomach 2. Uterus 3. Pituitary Gland
GOOD TOUCH BAD TOUCH

Activity : Drawing exercise


Source : Samraksha
Material : Chart paper
Time: 45-60 minutes
Group : 5-10 people
Purpose : Explain the concept of good touch bad touch through a drawing exercise
Method :
Ask the group to start drawing the human body. If it is a group meeting in a large space with lots of
privacy, ask one of the members to lie down on a big sheet of paper, so that the body is traced.
Ask the group to identify to what extent different parts of our body can be touched by different people
Facilitate discussion on what one should do if a person we don’t like touches us or sees us in a bad
way. Ask the group what we can do to ensure that this does not happen, or if it happens should we
share it with anybody. What will happen if we don’t share it.
Explain that we have the right over our body and even touching us in ways we don’t like can weaken us.
This can happen with people we know as well as other people. We should be conscious of the way they
touch us. If they touch us/see us in a way we don’t like, we should tell them that and also tell some elder
Facilitate discussion, clarify doubts and encourage the group to share any such instances with elders,
so that the situation can be addressed.

Activity : Magic
Source: Samraksha
Material: Rope
Time: 30 minutes
Group: 5 to 10 people
Purpose: To illustrate how a bad/unwanted touch can affect us and what should we do in this situation.
Promoting disclosure to parents/adults.
Method :
Show the rope and say, this is Sunita, 13 years old, and in 8 standard. She has started menstruating.
She goes to school by bus, when she goes to the bus stand, there are three young men who keep
taunting her/touching her. Sunita is sensitive, she does not know what to do. In the bus some boy
stands next to her and touches her. She does not know what to do. She is scared that her parents will
blame her, if she tells them. She does not want to go to school.

Ask the group what her problem is and what can be done. Elicit the responses from them. The
responses can be like:
We should build the courage to face the situation in Sunitha. She must be encouraged to discuss her
problems with the elders that she should be taught how to react and cope with the teasing.
The bent rope should be straightened after the issue is resolved.

Activity : Puppet show


Source: Samraksha
Material : Puppets
Time : 45-60
Group : 10 people
Purpose: Explain about good and bad touch and our rights to refuse a person, through the medium of
puppets
Method :
Introduce the characters Geeta, a 14 year old studying in 9 standard, and Kavita, a 13 year old studying
in 8 standard.

(Geeta is standing outside Kavita’s house and calling her.)


G : Kavita, Kavita
(Kavita comes out)
K : What is it Geeta ?
G : What are you doing ?
K : I am doing my homework ? What is the matter ?
G : Nothing ! Can you come near my house for some time?
K : Why what is the matter Geeta ?
G : Kavita, did you know ? There are two madams from Samraksha, they come and take some classes
for girls and tell them a lot of useful things .
K : What do they teach ? Why is it useful to us ?
G: Its very useful. It’s about our body, our body’s growth, what changes happen in uor minds. How we
should behave then, how we should talk to elders, how to decide about right and wrong. How if
someone is physically abusing us, we should take care.
K : Is it so ? Do they teach all these things ? No one has ever taught us all these things.
G : Yes. You know what happened one day. I went to the neighboring aunty uncle’s house, aunty was
not there. The uncle kept touching and patting me while talking, I felt bad. I didn’t know then, but we
should not let anybody touch our body. I came to know only after I went there. Now I know what to do if
someone tries to abuse me in bus, or road.
K : Is that so ? Come, I will also come to this class.
Pre and Post Activity Questions :

1. WE have the right over our body


1. Yes 2. No 3. Maybe

2. What shouel we do if someone touches us in a way we don’t like ?


1. Keep quiet 2. Go away 3. Oppose it 4. Inform the elders 5. To vocally oppose it
6. Tell them you don’t like it
COMMUNICATION: BRIDGES AND BARRIERS

Activity: Group Discussion


Source: Life Planning Education
Time: 45 – 60 mins
Group : 5-10 people
Purpose: To understand what is communication? Types of communication. Bridges and Barriers in
communication and good communication skills.
Method:
Ask the group how they express their feelings and how they learn or come to know about their
surroundings, feelings of others and their opinion.
To this the group would answer
by talk by poster by newspaper
by action by computer by T.V.
by media by letters by phone
This list is then segregated and explained to the group as verbal and non verbal communication.

Then the group is told that the discussion to follow will be emphasizing on verbal communication.

Now ask the group the question:


"From your family and neighborhood, your favorite actors, actresses, artists etc. whose way of speaking
impresses you ? And why?
The group members will give their choices and reasons.

Now ask the group "whose way of speaking they dislike and why?"
Make a list of the positive and negative attributes given by the group. This list could be as

POSITIVE NEGATIVE
Speaks with eye contact Mistrust
Listening carefully Blame
explaining Scold
Telling the consequence Accuse
Easy language Threaten
Gives room to ask doubts Lie
Gives privacy Interrupt
Body language is pleasant Sarcastic
These attribute the need to be looked upon as bridges and barriers for communication.
• Positive traits will be bridges as they bring positive results.
• Negative traits will be barriers as they hinder communication.
• Communication is good if there is proper balance between bridge & barriers.

Activity : Role- play:


Source: Life Planning Education
Time: 45 – 60 mins
Group : 5-10 people
Purpose: To understand the importance of good communication.
Method :
Divide the participants into groups. One group is instructed to tell a small story and the other group is
instructed to not to listen to them but speak loudly amongst themselves and turn their back towards the
first group. After the story is told each group is questioned regarding their experience and bridges and
barriers explained.

Activity: Group Discussion


Source: Life Planning Education
Time: 45 – 60 mins
Group : 5-10 people
Purpose: To understand how communication effects family, friends and society
Method:
Is it difficult to express feelings honestly and directly? Can you give example?

Give the group the following situations.


You and your friend have decided to go for a movie. For getting tickets for the movie, you had to be at
the theatre 1 hour before the show. How ever your friend turns up 1/2 hour late with an excuse. And
now you know you will not get tickets.

Ask how they would respond in this situation. Make list of the all their responses.
Expected responses :
‘Why are you so late, we missed the movie because of you.’’
Ask the group how their friends would respond to that kind of communication.
Explain that positive communication means choosing words carefully.
Beginning communication with me rather than YOU.
Expressing our feelings honestly and clearly without threatening or putting them down.
Now ask the group to try and make their expressions positive like
"I am disappointed that you are late. I am angry that we won't get to see the movie?'
Now ask the group how their friend would feel if told this way.
The group is then given few other such statements to make positive statements.
"Don’t' shout at me".
“Nobody cares that I work”
"You always ignore me when we're with your friends".
ASSERTIVE COMMUNICATION

Activity Situation analysis


Source: Life Planning Education
Time: 45 – 60 minutes
Group : 5-10 people
Purpose: To learn the difference between assertive, aggressive and passive communication.
Method: Read out the following situation to the group
Situation:
Gita / Ganesh (depending on the group if boys / girls names can be chosen) in waiting in a queue for
bus pass / kerosene / water. Just 5 more people to go for Gita / Ganesh term and few people come in
and show great acknowledgement of the person standing in front of Gita / Ganesh. They join the line in
front of Gita / Ganesh.

What do you think Gita / Ganesh should do?


Take each one's response and form groups based on their response.
Group 1 Group 2 Group 3
Get angry and keep standing Call names and threaten the girls. Speak up to the girls and tell
them to go back in the queue.

Ask the group following questions:


How will Gita / Ganesh feel about the each of the response?
How would the people who came in between feel about each of the response ?
What worst can happen to Gita / Ganesh about the response ?

Take the responses of these questions and form three groups on the chart and give them the heading.

Passive Aggressive Assertive


Ans. 1

Ans.2

Ans.3

Now explain to the group what these 3 groups mean and its consequences.
ASSERTIVENESS SURVEY
Objective :
To assess assertiveness, make these signs reading
"Most of the time" , "Sometimes", "Almost never". M

Create a poster with following score


You need to practice S A
You are doing okay, but could use some practice
You are doing very well. Keep it up.

Tell the group that assertiveness is the best way of communication. Let us find how assertive they
already are.
ASSERTIVENSS SURVEY (STATEMENTS 1-15)

Read each statement and ask the teens to stand at any of the signs which show what they usually do.
Now let each of them count number of times they have been on "M" which will help them to assess their
assertiveness.

SURVEYING YOUR ASSERTIVENESS


If I disagree with a friend, I say so, even if it means she or he might not like me.
I ask for help when I am hurt or confused.
I tell my friends what I honestly think about alcohol and other drugs, even if I know my ideas are not
popular.
I let people know when they disappoint me.
If a friend borrows money and is late paying it back, I remind her or him.
I say no when classmates want to copy my homework or test answers.
If a friend is talking or making noise in a movie, I ask her or him to be quiet.
If I have a friend who is always lat, I tell him or her how I feel about it.
I ask my friends for a favour when I need one.
When someone asks me to do something unreasonable, I refuse.
I express my views on important things, even if others disagree.
I don't do dangerous things with my friends.
When I don't understand what someone is telling me, I ask questions.
When I disagree with someone, I try not to hurt that person's feelings.
When people hurt my feelings, I let them know how I feel.
Score ratings 0-5 needs to improve 6-10 better 11-15 best

Please Note:
When we teach them to be assertive, we need to also teach them to assess their situations and to
consider their personal safety. In some situations, speaking up and communicating assertively can be
dangerous (If someone is drunk, extremely angry or having a weapon and so on)
You don't want to encourage them to behave in a way that could have unpleasant consequences for
them in their culture or family. However there are certain situations which will yield positive results being
assertive (eg. Resisting peer pressure, from romantic partners to have sex, use alcohol, drugs etc.)
TWO WAY COMMUNICATION/OPEN COMMUNICATION

Activity : Situation analysis


Source: Life Planning Education
Time: 45 – 60 mins
Group : 5-10 people
Purpose: To understand importance of open communication.
Method:
Give each member a paper and pen, and then give the group the following directions. While giving the
directions turn your back to the group and draw as per the instruction yourself on a piece of paper.
FIRST TIME 1. Draw a Circle
2. Draw a triangle outside the circle.
3. Now divide the circle in 4 parts.
4. Draw dots in one part of the circle.
5. Draw lines in another part of the circle.
6. Now draw a square inside the circle.
No questions or explanations are allowed

SECOND TIME 1. Draw a Circle


2. Draw a triangle outside the circle.
3. Now divide the circle in 4 parts.
4. Draw dots in one part of the circle.
5. Draw lines in another part of the circle.
6. Now draw a square inside the circle.
Now face the group and the group is allowed to ask for clarifications but answers will be only YES / NO

THIRD TIME 1. Draw a Circle


2. Draw a triangle outside the circle.
3. Now divide the circle in 4 parts.
4. Draw dots in one part of the circle.
5. Draw lines in another part of the circle.
6. Now draw a square inside the circle.
The same process as 2nd time is followed with more explicit clarifications and even showing the
picture which the instructor has drawn.
Now the group discusses the process followed in all these steps and hence the difference in the picture
drawn. The group is encouraged to understand the importance of open communication.
DECISION MAKING

Activity : Group Discussion and Situation analysis


Source: Life Planning Education
Material: Paper and pen, chart paper
Time: 45 – 60 mints
Group: 5-10 people
Purpose: Learning to take good decisions and understanding the consequences of bad choices.
Learning about different kinds of decisions that can be made and the results that can be
expected of those decisions.
Learning to make decisions that are tough
Learning to take the correct decisions with regards to one’s sexual life
Learning to stand firm on one’s decision and not to yield to another’s insistence
Method:
First the group is asked to list out the problems in their life. Then the participants list the choices to
manage the problem. The positive and the negative consequences of each choice are noted down.
Select a choice as the solution. Analyze why the decision was taken and why was that particular choice
selected. Make the participant to guess the future consequences.

Activity : Predictions
Source: Life Planning Education
Material: Paper and pen, chart paper
Time: 45 – 60 mints
Group : 5-10 people
Purpose: Learning to think about the consequences of the decisions that we make
Method:
Give the group certain decisions that are taken and ask them to predict the consequences
1. Raju decides to steal a sweater from a shop
2. Kasim decides to try to smoke ganja once
3. Sheela decides to elope with her lover
4. Kavita decides to quit midway through 10th standard
5. Ali decides to do drugs due to peer pressure

In the above decisions list the best possible consequences and the worst possible consequences
The story of Asif and Anita
Asif and Anita are good friends and they later fall in love. Asif is determined to marry Anita. One day
Anita goes to Asif’s house when Asif’s parents and others in the fanmily are away. Asif and Anita are
alone in the house and they start watching TV. When watching the hot scenes on the television Asif
asks Anita to kiss him. Anita trusts loves and is attracted strongly to Asif. Now what decision should she
take.
What may happen if Anita agrees?
What may happen if Anita disagrees?
If Anita agrees why will she agree?
If she disagrees why will she disagree?

Is it possible to change decisions?


Yes no
If the decision is changed from yes to no or from no to yes who or what may be the influencing factors.

Story of Anita
Anita’s brother is a thief and Anita has decided not to steal anything. Once Anita and her friends visit a
shop and Anita’s friends steal small items like lipstick, nail polish rings and hair clips fro the shop. Anita
doesn’t and gets teased by her friends for not doing so.
How will this influence Anita’s decision on not to steal?
How can Anita overcome the influence?

Taking a decision is easy but it is difficult to keep acting on it.

Note: We should take any decision after considerable thought. We should take decisions after
completely understanding the situation and analyzing the consequences. We are responsible for any
decision that we take. We cannot claim the decisions when there are good consequences and blame
others when the consequences are bad. We are accountable for the decisions that we take and it’s
consequences.

Pre and post questionnaire


1. When taking decisions what are the things that need to be considered?
1. Understanding 2. Analyzing the consequences 3.listing choices

2. We should take our own decisions


1. Yes 2. No
EARLY MARRAIGE

Activity : Story telling


Material : Tape recorder and audio cassette with the story recorded
Time : 45-60 minutes
Group : 5-10 people
Purpose : To illustrate the ill effects of early marriage through a story
Method :
Play the tape narrating the story of Hema/Tasim
Ask the group what they have understood from the story? Why did Hema marry early, what were the
problems because of that ? Who all suffered because of that ?
Ask the group, “What is our responsibility to ensure that early marriage does not occur ?”

Puppet Show:
MIL : Taseem Taseem, where were you till now ? The baby is crying. You don’t take care of him, you
don’t clean the house, you say you are sick and cannot do anything You don’t look like you are 18 years
old, you look and behave like an old woman.
DIL : Why do you say that? I am doing all work, I clean the house, I do everything here. Why are you
complaining and fighting ?
MIL : How dare you talk back to me? Wait, when my son comes in the evening, I will tell him about this,
I will ask hm to beat you and send you out of the house.
DIL: Why wait till your son comes in the evening. I am going right now to my mothers house.
MIL : You are going, go. Take your son and go.

Taseem walks out of the house and goes to her parent’s house.

Father : What happened Taseem, why are you crying and coming ?
Taseem : Nothing. They give me a lot of mental torture. They don’t give me food. She scolds me
everyday, that’s why I took the baby and came.
Father : Look daughter, it is not nice for a married woman to leave her husband and come like this.
What will people say? You should not keep fighting with your husband and coming home.
Taseem : What, whatever they do I should keep quiet is it ? Did I ask you to get me married. I was
studying in a school. You got me married. If I had studied well I could hve stood on my own fee. I could
have married in a better way. I refuse to go to that house again.
Mother: Give her an answer
Father : This is your fate. You can’t do anything about it.
Mother : Don’t say that. It is not fate. She was studying well, you got her married. Now console her.
Father : Yes it was my fault. I should not have gotten you married so early. I realize my mistake. I will
tell other fathers and mothers, don’t get your daughters married early.
Mother : Taaseem, your husband is coming. You don’t say anything. I will talk and send him.

Ask the group the following questions :

What do you understand from the story ?


Why did Taseem get married early ?
Who all suffered because of the marriage ?
What is your responsibility to ensure that early marriages do not occur?

Note: The legal age for marriage in India is 18 years for the girl and 21 for the boy. The girl and the boy
should agree to the marriage and should not be coerced into it. They should be physixcally, emotionally
and socially prepared for the marriage and should know the responsibilities that come with marriage.

Activity : Magic
Source: Samraksha
Material : Three blue kerchief and one yellow kerchief
Time : 45-60 minutes
Group : 5-10
Purpose: Illustrate the problems of early marriage through magic.

Use the handkerchiefs when relating the story.


Show 3 handkerchiefs, 2 blue and 1 yellow to indicate Gopi, Hema and Raju.
Gopi and Raju are friends. Both are 20 years old. Gopi likes a girl called Hema and wants to marry her.
But Raju tells him not to marry at such a young age. (Elicit why early marriage is not good from the
group. Not yet able to support a family etc). But Gopi does not listen to him. He stops taking to Raju,
and later he elopes with Hema and marries her.

Seperate the yellow handkerchief to indicate the rift between Gopi and Raju
Within one year, they have a child. Then they realize the wisdom of Raju’s words. Make the 2
handkerchief into three to indicate child.
Pre and post questionnaire
Why should we marry? Why is marriage important?
What is the legal age for marriage ?
Who among you have decided to marry soon?
PREGNANCY AND CHILDBIRTH

Activity : Group discussion using picture/flip chart


Source : Pathfinder
Material : Flip chart
Time : 45 to 60 minutes
Group : 5 to 10 people
Method :
Have an interactive lesson using the flip chart giving the following information:

Signs/symptoms of pregnancy
• Feeling of nausea or vomiting
• Feeling tired
• Not having periods
• Slight enlargement of the breasts
• Increased urination

Pregnancy can be confirmed through tests in the hospital or at home. Home pregnancy test kits are
available for about 4—45 rupees in medical shops.

Thing to take care of during pregnancy


• Good care and good health of the mother can ensure the health of the child
• The mother should eat more nutritious food everyday. Both child and mother survive
on the mother’s food.
• It is good to rest for some time in the evening.
• If the mother has had any health problem before pregnancy, or if you are having
persistent cold cough or fever, she should seek treatment.

Precautions during pregnancy:


• It is good to get examined by a nurse or doctor at least three times during the pregnancy. This
can help detect potential problems like handicap in child, if there is no weight gain in the child,
High BP or anemia in the mother, and also if the child is in the right position.
• Iron and folic acid tablets should be taken everyday for at least 100 days. This reduces
possibilities of anemia. Iron tablets can cause black or brownish color stools, but they should
not be stopped.
• At least two shots of tetanus vaccination must be taken to avoid tetanus infection in the mother
or the child during pregnancy.

It is possible to have sex during pregnancy, but the following things need to be noted:
• The couple should ensure that there is no pressure on the woman’s stomach.
• It should not hurt or otherwise trouble the woman
• If it creates pain, the sexual activity can be performed in alternate ways
• One should be very careful with sexual intercourse in the first three months of pregnancy
• If the man has any symptoms of STD, he should seek treatment for its complete cure
• It is good to use condom in every intercourse, since it will reduce the chances of infection to
the mother and child.

Signs of danger during pregnancy

It is important for the family members to observe the pregnant woman for any dangerous signs and
symptoms so that immediate action can be taken. Some signs to watch out for :
• Face getting black, the nails and the eyes losing color, feeling tired frequently are signs of
anemia
• Feeling tired
• Dizziness
• Blood discharge
• Swelling of hands and legs, indicated by the bangles and anklets getting tight.

If any of these signs and symptoms are noticed, contact a health professional immediately.

As the date of delivery approaches, start preparing for the delivery. It is possible to have a safe
delivery at home itself. But the following things need to be noted :

• A clean place
• The person supervising the delivery must wash her hands thoroughly
• A clean thread
• A clean new blade
• Once the baby is born, and the umbilical cord cut, it should be cleaned thoroughly.
• It is good to take the help of a trained person. Keep a clean cloth ready, to wrap the child when
it is born.
In every family with a pregnant woman, the following arrangements should be made for
emergencies :
• Hospitals in the area where the woman can be taken if needed should be identified.
• Note the address and phone numbers of these hospitals.
• Vehicle arrangements need to be made to take the pregnant woman to hospital.
• Financial arrangements to meet the expenses need to be made.
• Make arrangements for donating blood to the woman if needed.
If any signs of danger are noticed, the woman should immediately be taken to the hospital, and the
vehicle taking her should be ridden slowly.

Despite all these precautions, there are the following complications possible in Pregnancy
• Prolonged labor (Having pain for more than 12 hours is a dangerous sign)
• When the position of the child in the uterus is changed (Breach birth)
• Excessive bleeding during pregnancy
• The activity of the child inside the uterus suddenly increases/decreases.

Some danger signs during pregnancy/childbirth.


• If the umbilical cord does not come out totally.
• Water breaks but there is no labour pain
• Green or brownish discharge
• Fever or tiredness

Pre and post activity questions :

1. When can a woman become pregnant ?


1. Before marriage 2. After Marriage 3. Before menstruation 4. After menstruation
2. Which is the right age to become pregnant ?
1. 15 years 2. 18 years 3. After 20 years
3. Who is responsible for determining the gender of the baby ?
1. Mother in law 2. Doctor 3. Men 4. Woman
4. Is it legal to determine the sex of the fetus?
1. Yes 2. No. 3. Don’t know
PRE AND POST PREGNANCY CARE

Activity: Discussions through showing of pictures


Source : Adapted from Pathfinder International
Material : Flip Chart
Time: 45-60 mins
Group: 5-10
Purpose: Create awareness about pre and post pregnancy care
Method: Use the flip chart to facilitate an interactive discussion on the issue

Care of the new born


• It is important to care for both the baby and the mother after delivery
• It is very important to take very good and constant care of the infant in the first week of it’s
birth.
• Soon after birth clean the face and nose of the child and examine if the child is breathing
• Keep the umbilical cord clean. Don’t cover it up.
• It is important to breastfeed the child
• Weigh the child
• Keep the child covered in a clean cloth and make the child warm and comfortable.
• Look out for birth defects

Importance of breastfeeding
• It’s is important to breastfeed the child within half an hour of birth
• The yellow colored milk that comes after delivery is very good for the child. It helps the child
fight infections.
• The child learns to suck when breastfed
• Protects the child from infections and stunted growth
• Helps to contract the womb and lessens bleeding
• Lessens the chances for breast and ovarian cancer in the mother
• Builds the bond between mother and child
• Breast milk is the best food for the child
• The mother should breastfeed the child at least until the child is six months old and important
to feed the child exclusively on breast milk.
Care of the mother
• The mother should take complete rest for the first 15 days and not do any strenuous work
• Bathe everyday
• Keep the reproductive organs clean
• Walk gently
• Eat all kinds of food
• Breastfeed the baby

Correct way to feed the baby


• The major part of the nipple has to be in the mouth of the child
• Mother should eat nutritious food
• Mother should feed from both the breasts
• Mother should be comfortably seated while breastfeeding. She can also lie down

Sexual relations and contraceptive use after delivery


• The couple can resume sexual relations after 30 days of delivery with use of contraceptives.
• If the couples have unprotected sex within 30 days of marriage there is a high risk of
pregnancy
• It is not advisable for the couple to resume relationship within a month as the uterus of the
women will be still coming back to normalcy and also there is a high risk of getting infections. If
the sexual relations are resumed then it is compulsory to use condoms.
• Copper T can be inserted within 48 hours of delivery or after 6 weeks.
• DMPA injections can be taken within 45 days of delivery.
• The contraceptive pills should not be taken in the period when the child is being breastfed as
the hormones may mix with the milk.

There are various misconceptions regarding the use of contraceptives after delivery like:
• The belief that women do not conceive right after delivery since menstrual bleeding is not
there. Women can conceive before the menstrual cycle restarts.
• The belief that women can’t conceive because they feed the child is again wrong.
• It is possible to conceive even after one intercourse so it is essential to use contraceptives
consistently.
Look out for the following indicators in the infant and the mother and contact your health
provider immediately
• If the child doesn’t defecate or urinate before 24 hours.
• If the skin of the child looks yellow
• Frequent vomiting
• Dehydration
• If the child is crying constantly and not drinking milk
• If the child is bent like a bow
• If the body cools suddenly or if there is high temperature
• Mother
• If there is dryness in the face of the mother
• Smelly discharge from the vagina
• Vomiting, tiredness, fever in the mother
• If the mother is excessively angry, afraid or depressed
• Stomach ache and swollen stomach
• Pain during urination
• Uncontrolled urination or defecation
• Migraine
• Dizziness and fainting
• Excessive bleeding or the blood being thick during bleeding
• Pressure on the heart and breaths becoming slow
• Shooting pains near the heart and in feet
• Repeated vomiting
• Pain in the genitals

The child is prone to many infections in the first year. It is the responsibility of the parents to keep the
child vaccinated against all potential infections. Some vaccines may result in a low-grade temperature;
this is normal and not a matter of concern.
Vaccine list

At birth BCG OPV


I month DPT OPV Hepatitis B
II month DPT OPV Hepatitis B
III month DPT OPV Hepatitis B
IX month Measles
XV month MMR
XVIII month DPT Booster OPV
V year DPT Booster OPV
Between 10th and 15th year Booster

Pre and post activity questions:

1. Who should care f or the pregnant woman?


1. She herself 2. Husband 3. Parents 4. Family members
2. How should we care for her?
1. Treatment 2. Healthy food 3. Mental torture
3. Is it good for a pregnant woman to go to work?
1. Yes 2. No
4. For how long after delivery should the woman take rest?
1. One day 2. One month 3. Three Months 4. One year
FAMILY PLANNING

Activity : Group discussion with the aid of pictures


Source: Pathfinder
Material : Flipchart
Time: 45-60 minutes
Group: 5-10
Purpose: Awareness about pregnancy
Method: Facilitate interactive discussion using the flipchart
There are various safe and simple methods to avoid pregnancy. Every couple or an individual can adopt
a contraceptive method of their choice. It is possible to have mutual pleasure without intercourse. Other
contraceptive choices are also available. We need to think about contraceptives at three important
stages in our life.
Pre marriage: Before marrying it is very important to decide when to have children based on the
physical, emotional and economic factors. To aid this it is important to decide before which
contraceptive method to use and use contraception from the first intercourse. The couple can use
condoms, contraceptive pills (start one month before marriage from the 5th day of menses). DMPA
injection (before two days) or follow the natural rhythm method where they should abstain from sex
during from the 8th to the 19th day of the menstrual cycle.
After delivery: there should be some spacing between two children. This is necessary for the health of
both the mother and the child. There should be at least 3 years difference between two children.
Spacing also helps the child get more attention from the mother. A woman can conceive after 30 days
from the date of delivery so it is important to use contraception.
When deciding not to have more children: Couples may want to stop after having one or two
children, then they can go in for a permanent method.

Different choices of contraceptives available and their use

Condom
This is the most simple and safe way of contraception and is used by me.
This prevents both conception and STIs.
It is made of thin rubber and is worn on the penis prior to intercourse.
It prevents the sperm from entering into the vagina and thus prevents pregnancy
Condom comes under various brands: Nirod, Masti, Saavan, Kamasutra, Kohinoor, Ehsaas etc.
Nirod is available free of cost or at a maximum cost of Rs.3
Before using condom check for the expiry date and tear from the end of the cover. Squeeze the top end
of the condom that resembles a nipple to take out air, this prevents the condom from tearing during the
intercourse. Condom should be sheathed when the penis is aroused and removed before it shrinks.
After use tie a knot, wrap it up and throw it away. It is important to use a new condom for every
intercourse. Some men feel that pleasure is lost because of using a condom or that putting on a
condom takes long time. In fact sexual pleasure can be enhanced by using a condom and also condom
helps in the arousal.

Contraceptive pills
Contraceptive pills are one of the most easy, simple and safe ways of contraception that females use. In
each strip there are 28 tablets. Tablets should be taken at a particular time. Tablets should be taken
from the 5th day of the menstrual cycle.
There may be vomiting, headache, dizziness and weight gain. In order to avoid these problems, it is
advisable to take the tablets at a specific time, preferably at night.
These tablets can be stopped any time, you decide to have a child. Conception can occur within one or
two months of stopping.
Different tablets which are available include ek roz, pearl, mala d and mala n.
Many of these tablets are available free of cost, a few of them are priced.
Saheli, is one oral contraceptive, which can be taken once a week. The first tablet should be taken on
the first day of the menstrual period, and for the first three months, the tablet has to be taken twice a
week. From the fourth month onwards, the tablet can be taken once a week.

DMPA Injection
This is an injection has to be taken by the women every three months.
It is a simple safe method, and can be taken confidentially.
It is available in private hospitals for a fee of Rs. 75 to 250.
This can lead to some side effects like irregular menstruation, and inter menstrual spotting/bleeding.

Rhythm Method
This method can be utilized only if the woman has regular menstrual cycle (26 to 32 days).
Sexual intercourse should be avoided from the 8 day of the menstrual period (day counted from the
point when menstrual bleeding started) upto the 19 day.
Observe the menstrual cycle for a period of six months, to note the patterns, in order to start this
method.
Couples can either avoid having intercourse at this time, or if they want to have sexual relations,
practice safe sex practices, or use a condom
Copper T
It is a simple, easy to use method, for women.
This is used inside the uterus. It is shaped like the word T, and made of plastic, a copper coil wound
around it.
There are two kinds of copper T available, once which ensure protection for 3 years, and a newer one,
called multi-load which offers protection for 10 years.
Copper T should only be inserted by a trained person (doctors, ANMs etc). The insertion should be
done in a clean environment.
Once inserted, it is possible to check if the device is secure, by inserting the fingers.
The device can be removed, if pregnancy is desired.
In the case of white discharge, before insertion, this has to be treated, before inserting Copper T
If symptoms like inter menstrual spotting, lower back or abdominal pain, or heavy menstrual bleeding,
persist for more than six months, or if any other symptoms are noted, then, the doctor must be
consulted.

Male Sterilization :
This is a method which can be adopted by men, and is a permanent method.
Through an operation, the seminal tract (epidedymis) is cut and tied together. Thus, the man cannot
impregnate the woman.
The operation is relatively simple and easy, and the man can return home within half an hour, and
resume normal activity. There are no problems in intercourse also.

Female Sterilization:
This is a permanent method, which can be adopted by women.
Through an operation, the woman’s fallopian tube is cut and tied together, therefore blocking
pregnancy.
Woman should not do any heavy work, or carry weight, for two weeks after the operation date.

Options and correct use of contraceptives for couples at different stages


Contraceptive options for a newly married couple

Since a couple are embarking on a new life when they get married, if the wife gets pregnant very fast, it
will add another dimension of change to cope with. Moreover, having a child before the woman is 21,
can have a negative impact on both the mother and child. Therefore, it is advisable to use
contraception.
Options
• Condoms
• Contraceptive Pills
• DMPA injections
• Calendar methods

Contraceptive options for a couple, post delivery :

It is advisable to have at least three years gap between children, since the mother’s body needs the
time, to return to a normal state. It is also necessary to give this time to the child, to ensure proper
growth and development.
It is possible for a woman to conceive, 30 days after delivery, whether she has had a menstrual period
or not.
It is advisable not to have sexual intercourse for 30 days after delivery, since the reproductive organs
need to return to the normal stage. Having intercourse at this time can lead to some infections. If one
desires to have intercourse after 30 days, it is advisable to use condoms. One can indulge in
pleasurable activities other than intercourse, in this time.

Options:
• Condoms: Used in every sexual contact
• Copper T: Can be inserted within 48 hours of the delivery or after 6 weeks.
• DMPI : this injection can be taken 45 days after delivery
• Contraceptive Pills: One should not use contraceptives for 6 months after delivery, since this
can affect the breast milk.

Some common misconceptions:

Many women believe that it is not possible to conceive immediately after delivery, since menstrual
periods have not resumed, however, it is possible for a woman to conceive, 30 days after delivery.
Breast feeding the child does not impact future conception, and a woman is ready to conceive 30 days
after the delivery.
Many women decide not to have sexual relations with their husbands for a few months after the
delivery, as the preferred method, however, this is difficult to maintain, and a woman can conceive even
after one sexual contact. Hence it is advisable to take precautions.
After having an abortion :

Women would generally not prefer to have a child, immediately after having gone through an abortion.
Therefore it is advisable to use some contraceptives. Contraceptives can be used 10 days after the
abortion (two days after the bleeding has stopped), when sexual relations can also be resumed.

Options :

• Condoms : Have to be used in every intercourse


• Contraceptive pills : These can be used within 7 days of the abortion.
• Copper T : This can be inserted within 7 days of the abortion
• DMPI : This can be injected within 7 days of the abortion.

Pre and Post Session Questions :

1. It is the right of a new couple to decide their family size


1.True 2. False
2. What are the contraceptive options available for newly married couple?
1. Condom 2. Operation 3. Copper T 4. Contraceptive Pills
3. Who can decide on the choice of contraceptives?
1.Husband 2. Wife 3. Mother in law 4. doctor 5. Friends
SAFE ABORTION

Activity : Group discussion using a flipchart


Source : Pathfinder
Material : Flip chart
Time : 45 to 60minutes
Group size: 5-10
Objective : To inform and educate about safe abortion
Method: Facilitate an interactive session using the flip chart
In some situations, women may want to discontinue their pregnancy, and in such situations, she can opt
for an abortion. It is legal to have an abortion in our country, within certain time, and any woman,
whatever be the age or marital status, can have an abortion.
The procedure must be performed by a trained doctor.
• Abortion must be performed, within 12 weeks of conception, as soon as possible.
• Abortion must be performed in a clean environment
• One must not put any sharp instrument, or plants into the vagina.

Protection against infections or pregnancy after abortion


One should not have sexual intercourse for 10 days after the abortion, and no instrument should be put
inside the vagina.
Couples can indulge in other safe practices during this time. If at all they indulge in intercourse, they
have to use condoms.
The couple can have intercourse 10 days after abortion, but have to use some contraceptive method.
A woman can conceive, 10 days after the abortion, hence a couple must make a choice of
contraceptive, within this time, and start utilizing it.

Contraceptive Options:
Couples can resume intercourse ten days after the abortion (two days after the bleeding has stopped)
and the following contraceptive options are available:
• Condom : Used every time of intercourse
• Contraceptive : Can be started within 7 days of the abortion
• Copper T : Can be inserted within 7 days of the abortion
• DMPA: Can be injected within 7 days of the abortion.
Pre and post session questions

1. Is it legal to have an abortion?


1. Yes 2. No 3. Don’t know

2. What are the consequences of repeated abortions


1. Prolapsed uterus 2. Infertility 3. RTI 4. Family size will be small
STI/RTI

Method : Group discussion using flipchart


Source : Pathfinder
Material : Flipchart
Time : 45-60 minutes
Group Size : 5-10 people
Objectives : To create awareness about STI/RTI
Method: Facilitate interactive discussion, through the flipchart.
Many times, men and women have problems in their external and internal reproductive and sexual
organs. These infections are generally spread through sexual contacts.

These problems might have many observable signs and symptoms.

Signs and symptoms observed in men


• Scrotal swelling
• Ulcers and boils in the genital region
• Lower abdominal pain
• Discharge from the genital organs
• Burning sensation
• Painful intercourse

Signs and symptoms among women


• Lower abdominal pain/swelling
• Boils and ulcers in the genital areas
• Vaginal discharge which is more than normal
• Burning sensation
• Painful intercourse

When these signs are observed :


• Immediately contact the doctor/hospital
• Both partners have to be treated, otherwise there are chances of re-infection
• It is important to take correct and complete treatment, otherwise, it can cause complications.
In order to prevent these diseases :
• One can be faithful to one’s partners.
• If you suspect that the partner has an infection, use condom in every act of intercourse.
• Couples can also practice other forms of sexual pleasure seeking, rather than only intercourse.

Points to note :
• Every person must be alert to signs and symptoms of STI/RTI
• Most STDs are spread through sexual contact only
• Condom is the only way to prevent STI
• Condoms can protect against unwanted pregnancy as well as STIs
• STI can affect the fetus in the child’s womb.
• Most STI are treatable, and need to be identified and treated early for cure. HIV/AIDS is a STI,
which can be treated but not cured.

Among new couples, burning micturation and painful intercourse are common. This may also be due to
some infection in the urinary tract, which needs to be identified, and treated early.

Pre and post session questionnaires

1. Reproductive organs cannot get infected


1. True 2. False 3. Don’t know

2. It is possible to prevent reproductive organ infections


1. Yes 2. No 3. Don’t know

3. Only married people can get reproductive organ infections


1. Yes 2. No 3.Don’t know
INFERTILITY

Activity : Group discussion with a picture


Source : Samraksha
Material: Flip chart
Time : 45-60 minutes
Group Size: 5-10 people
Purpose : Giving information on infertility

Method :
Ask the group different questions regarding infertility. What is it, why does it happen, what can be done
about it?
If some wrong notions emerge from the discussion, for instance, women are responsible for infertility;
infertility can be cured by going to some shaman etc. correct them.
Use the Flipchart to provide more information on infertility.
Infertility can be the result of problems in either the man or the woman. Therefore it is important for both
of them to get tested, and seek services together for infertility.
There are different reasons for infertility, many of which are curable. So it is important to take treatment
as a couple.
It is wrong to blame the woman for infertility, and abuse them.
In some cases, it may not be possible to cure infertility, in which case, the couple can consider adopting
a child.
Encourage the group to share some of the experiences on this issue. Many people are likely to share
instances where women have been held responsible and faced different forms of difficulty in their
homes.

Pre and Post Session Questions:


1. Infertility happens only to women.
1. Yes 2. No 3. Don’t Know

2. Infertility is curable
1. Yes 2. NO 3. Don’t Know

3. Infertility is a curse
1. Yes 2. No 3. Don’t Know
HIV/AIDS

Activity : Group discussion and risk game


Source : Samraksha
Material : Three cards saying high risk, low risk and no risk. 15-20 Cards bearing different professions
like politician, teacher, housewives, drivers, doctors, youth etc.
Time: 45-60 mints
Group Size : 5-10 people
Method :
Assess how much the groups know about HIV/AIDS/ who is at risk of getting HIV/AIDS
Invite questions form the group on HIV/AIDS, and clarify doubts and misconceptions

Content of the discussion


• Unsafe sexual contact
• From parent to child
• Unsafe blood
• Through needles and syringes

Ways of prevention:
• Having sexual relations with one partners only
• Abstinence
• Not taking untested blood
• PPTCT for pregnant mothers
• Use new needles and syringes
Misconceptions :
• HIV does not spread by eating together.
• HIV does not spread by mosquito bite
• HIV does not spread by sleeping together
• HIV does not spread by sharing a toilet.

Care and support : A person living with HIV needs love and support, and should not be discriminated
against.
Method 2

Take three cards marked high risk, low risk and no risk and place it in three different corners. The
remaining cards, each of which bears one profession, for instance, police, politician, women, youth,
social worker etc. should be distributed in the group. The group members should be asked to place
their card depending on what they think is the risk of that group to get HIV infection.

Then discuss the placement of each card in the different groups. Lead the group to discuss and
understand that risk can be there for any group, and no group is exempt from this infection.

Main points of the discussion :


HIV can happen to anyone, to me and you, it mostly spreads through sexual contact. It can also spread
through needles, blood and from mother to child. In order to prevent it, use condoms in sexual contact,
be faithful to partners, use new needles and syringes, and use only tested blood. There are also
medicines to prevent transmission from mother to child. It is not possible to see a person and say if her
has HIV or not, this is possible only through a blood test.

Pre and post session questions


1. How does HIV spread?
1. Mosquitoes 2. Blood 3. From mother to child 4.Sexual relations 5. Needles and
syringes

2. How does HIV not spread?


1. Eating together 2. Working together 3. Living together 4.Sleeping together 5. Shaking
hands 6. Kissing
Section 4 : Workshop with older women and young men

EARLY MARRIAGE

Activity : Story telling


Material : Tape recorder and audio cassette with the story recorded/relevant puppet dolls
Time : 45-60 minutes
Group : 5-10 people
Method : Group discussion
Play the tape narrating the story of Tasim. This can also be played out as a puppet show

Script :
MIL : Taseem Taseem, where were you till now ? The baby is crying. You don’t take care of him, you
don’t clean the house, you say you are sick and cannot do anything You don’t look like you are 18 years
old, you look and behave like an old woman.
DIL : Why do you say that? I am doing all work, I clean the house, I do everything here. Why are you
complaining and fighting?
MIL: How dare you talk back to me? Wait, when my son comes in the evening, I will tell him about this, I
will ask him to beat you and send you out of the house.
DIL: Why wait till your son comes in the evening. I am going right now to my mother’s house.
MIL: You are going, go. Take your son and go.
Taseem walks out of the house and goes to her parent’s house.

Father: What happened Taseem, why are you crying and coming?
Taseem: Nothing. They give me a lot of mental torture. They don’t give me food. She scolds me
everyday, that’s why I took the baby and came.
Father: Look daughter, it is not nice for a married woman to leave her husband and come like this. What
will people say? You should not keep fighting with your husband and coming home.
Taseem : What, whatever they do I should keep quiet is it ? Did I ask you to get me married? I was
studying in a school. You got me married. If I had studied well I could hve stood on my own fee. I could
have married in a better way. I refuse to go to that house again.
Mother Give her an answer
Father : This is your fate. You can’t do anything about it.
Mother : Don’t say that. It is not fate. She was studying well, you got her married. Now console her.
Father : Yes it was my fault. I should not have gotten you married so early. I realize my mistake. I will
tell other fathers and mothers, don’t get your daughters married early.
Mother : Taseem, your husband is coming. You don’t say anything. I will talk and send him.
Questions to facilitate discussion:

Ask the group what they have understood from the story?
Why did Taseem marry early, what were the problems because of that? Who all suffered because of
that?
What is the situation of Hema’s husband? What is his age likely to be ? Can he take responsibility for
the family ?
What would you do if you were Hema’s parents?
What could Hema’s husband have done to prevent this?
What can you tell Hema’s mother in law ?
Should they have had a child at this age ?
Could someone have talked to them about family planning ?
What is our responsibility to ensure that early marriage does not occur ?

The story of Raju and Gopi


Gopi : Raju ! You have come to our house, you seem to be very happy?
Raju : I am planning to get married, Gopi, that is why I am so happy.
Gopi : Marriage ! Are you in the age to get married? How old are you
Raju : I am 19 years old, why, am I not tall, don’t I have a moustache and beard, what is wrong in
getting married.
Gopi : Look Raju, one does not become big because one is tall or has a moustache or beard. You
should be able to stand on your own legs. That needs time, marriage is not a play. Anyway, who are
you marrying?
Raju : Hema, the girl in the next house. My family knows why half the area knows about it. That is why
her parents said get married soon.
Gopi : She must be just 16. She was in 10 class last year. She is very young.
Raju : She is not young, she has attained puberty. What is wrong in getting married?
Gopi : Look Raju, if a house has to be strong, the foundation has to be strong. How long should you wait
after the stone is laid to build the house.
Raju : Yes, that does take time.
Gopi : In the same way, it does not mean the girl should marry when she has attained puberty
Raju : Then should she marry when she is an old woman
Gopi : No, that is not what I meant. She has to be independent, make the decision about the marriage
herself. That needs time, and then she can marry
Raju : What shall I do Gopi, Hema and I like each other a lot, our families have also agreed. That is why
we want to do it early.
Gopi : I also thought like you and got married. Then understood how many problems there are in getting
married early. In one year, I had a child, the responsibility increased. My wife could not go to work. Now
I know, getting married early has a lot of problems. I made a great mistake.
Raju : What went wrong ? What could have happened ?
Gopi : I could have given my wife some training, also looked for a good job. I shouldn’t have had a child
also so early.
Raju : What shall I do. All preparations for the wedding are happening. Her parents have agreed. I love
her a lot. What you say is true. I am scared that everything will slip off someday.
Gopi : You will appreciate what I said. You speak to Hema, tell her there is no hurry for wedding. Then
speak to your parents and her parents.

Discussion questions:
What problems did Gopi face by marrying early ?
Why did Raju want to marry early ?
IF you were Raju’s friend, what would you tell him ?
Why is Gopi a good friend of Raju ?
If such a situation had occurred in real life, with all preparations for the wedding, and if the invitations
were distributed, what could have been done ?
What can you do to avoid these situations ?
What would you have done, if you were Raju’s parents ?
Should Gopi have had a child at that time ?
Could anyone have told them about family planning ?

Pre and post session questions

1. Why do people get married/or get others married ?


2. At what age and in what manner should the marriage happen ?
MEN’S RESPONSIBILITY IN WOMEN’S HEALTH (SESSION FOR MEN)

Activity: Discussion, situation and stories


Source : Samraksha
Material : K G Sheet, pins
Time : 45-60 minutes
Group Size : 10-20 people
Objective : To encourage men’s involvement in women’s health, especially during and post pregnancy
Method: Start narrating this story
The story of Gopi and Geeta
Gopi and Geeta are married for six months. Now she is pregnant. In this time, she has vomiting,
frequent tiredness, she is not able to work much. At that time, Gopi supported her, when she felt
nausea, he helped her. When she was tired and slept, he massaged her legs. He cooked when she was
not able to for both him and for her. Sometimes, when she couldn’t stand the smell of cooking, he got
sambar from the hotel. He took her to the hospital, whenever there was a problem. He did most of the
house work. When her father came from the village, and asked to take her home for delivery, he said
that is a village, without facilities, let her stay here. For 8-9 months, he took good care of her,
encouraged her to walk, eat well, gave her fruits and also nutritious food. He also went regularly to work
at that time, and put aside some money for the delivery expenses

What do you think of the house work Gopi did ?


Should women be helped at that time ?
Is there any problem with men doing such work ?
Can you say that the woman’s plight has no bearing on you ?

The story of Raju and Hema


Raju’s wife is Hema. They have been married for a year. Now she has a child. For Hema, the child’s
care is more important now. If the child cries at night, Raju gets irritated and goes out. Hema is busy
feeding the child, changing its clothes etc, and gets very tired. It is difficult to to do the cooking and other
work in the day like washing clothes dishers etc. But Raju says this is not my work, you should only do
it. My work is all outside. Raju is not understanding his wife’s problem or helping her in any way.

What do you think of Raju?


Positive: He may have a lot of work. He cannot forego sleep. He is scared of what others will say.
Negative: He does not love her. He does not want the children. The man should also look after the child.

Is it possible for you to be like Raju?


What else can you do?
What do you think of Gopi?
Would you behave like Gopi ?
What else would you have done?

Discuss this issue by putting up these points on a flipchart/kg sheet etc.

Three important things to do :


• Go in for check up at least once in three months. Monitor the child’s weight.
• Know the blood group of the woman and self.
• Discuss what contraceptives should be used after the delivery.

Discuss this questionnaire with the group


Are you ready to be a father: Use this questionnaire to decide?
Do I have these things :
• Stable job
• Stable home
• Savings

Have I thought about being a father ?


Can I take care of the child ?
• Can I provide clothing
• Keep the child in a clean place
• Provide food
• Take part in the household work
Is my relationship strong enough to have a child ?
Have I discussed it with my partner?
Can we share responsibilities together?
Am I capable of spending for the child’s growth ?
Am I doing a good job, or do I need a better one?
Do I have enough money to meet the expenses?
About the child
• Do I have a sex preference for the child ?
• What if I don’t get what I wantt ?
• How can I support my wife, if others do not approve of it ?
• What if the child is disabled?
• Will I get angry with the child, if it is crying always ?
• Have I decided what contraceptive to use, after marriage ?

Sex during pregnancy


Discuss the issue of sex during pregnancy and clarify misconceptions. This material can be used for this
purpose.

Sexual relations even during pregnancy is an important part of a couple’s life. But this is frequently
ignored, and many people have questions regarding this.

Is it possible to have sexual relationship during pregnancy ? is it safe for the woman ? Will penetration
during pregnancy cause harm to the child? Can it lead to abortion ? Will sexual intercourse cause pain
to the foetus? Can condoms be used during pregnancy?

It is OK to have sexual relationship during pregnancy, if both partners mutually desire this. If either of
them are finding it troublesome, they can also adopt a change of behavior. Having intercourse cannot
hurt the child, which is protected inside the uterus by a layer and certain chemicals. However, it is
important to use condoms during pregnancy, in order to avoid STI for the women, which can also harm
the child.

Pre session questions


1. When a girl is pregnant, all responsibilities for caring for her lies only with her parents,
1. Agree 2. Disagree
2. If a man takes responsibility for his wife, then his status and importance will reduce
1. Agree 2. Disagree

3. Men do not know how to take care of the woman during pregnancy and after her delivery
1. Agree 2. Disagree
MEN’S ROLE IN WOMEN’S HEALTH (WORKSHOP FOR OLDER WOMEN)

Activity : Group discussion, situational stories


Source : Samraksha
Material : K G Sheet, pins
Time : 45-60 mins
Group Size : 10-20
Objective : Encourage men’s involvement in woman’s health, particularly during pregnancy and child
birth
Method: Group Activity:
Discuss the following questions with the group
How much responsibility do the husbands take, when a woman is pregnant ?
Some common responses:
• Leave all the responsibility to the girl’s parents
• Only the mother takes care of the child
• If the couple has had a love marriage, then the man is more involved.

What should be the role of the husband during pregnancy and after?
Some common responses:
• He should accompany her for check up at least once in three months.
• Be aware of his own and wife’s blood group
• Be aware of the different vaccinations, and weight monitoring of the baby
• Know about child’s growth and development.
• Decide about what contraceptive to use, after the child is born, after discussion between the
husband and wife
• Take responsibility for the other child, and other members of the family
• Help out with household chores
• Ensure nutritious food.
• Have sexual relations, only after the wife has consented and after seeking doctor’s opinion.

Activity: Making a collage


Ask the two groups to prepare a collage based on the two questions:

What is the responsibility of man in woman’s health during pregnancy and childbirth currently ?
What should be the responsibility of men in woman’s health ?
Men should also take part in woman’s health and the child’s upbringing. Do you agree or disagree.
If no, then why
Men should not do these things
Society will not accept it.

If yes, why
It is important to understand and satisfy women’s needs
He also has responsibility for the child
To show concern for h is family
Since men have more decision making power, and control the money

The statistics from around the world show that if men are involved in women’s health during pregnancy
and childbirth, maternal mortality, illness during pregnancy or among new mothers considerably
reduces.

What can you as a woman, as a mother in law, mother, sister, sister-in-law, or in any other role do to
encourage men’s involvement in woman’s health.

Pre and post session questions:

When a woman is pregnant, all the responsibility for her welfare rests with her parents

Yes No

If a man takes responsibility for his wife, then his status and importance will reduce

Yes No

Men don’t know/don’t understand how to look after women when they are pregnant

Yes No
Section 5 : Samraksha’s experiences in using this material with
the community

Samraksha implemented the Yuvashakti programme in the different slum pockets of the designated
slums of Sulthanpalya, under the Sulthanpalys IPP8 centres : Dodannanagar, Eidgah Mohalla,
Shadabnagar, Shyampura and Modi Garden. Muslims formed a significant section of the population,
and in some places like Dodannanagar, migrants from Tamil Nadu were a significant section.

This was a challenging community to work with, mainly because of its linguistic and culturally
heterogenous population. The material also had to be translated into different languages (Kannada,
urdu, Tamil) and staff had to have the capacity to facilitate sessions in different languages. Frequent
migration also meant that it was difficult to have sustained interventions with some groups, with different
pockets of the slum having different levels of awareness or openness to the issue.

The issue of early marriages was the focus of the programme, as the qualitative baseline before the
programme identified it as a burning issue. Over the course of the programme, the team realized that
the issue of early marriage was very complex and had many dimensions. Different socio-cultural norms
dictated the marriage choices for boys and girls. While family pressures to marry early was one problem
related by young people, parents were equally concerned about young men and women eloping and
marrying at very young ages. Within the community, while there was awareness about the legal bar on
early marriages, the community had not quite related to the physical, social and psychological
implications of early marriages. These were the issues, which were brought into public articulation
through the mass awareness programmes, as well as the catalytic sessions and workshops with older
women and young men.

Mass Awareness Programme :

When Samraksha started the programme in the community, a series of FGDs were conducted with
different groups in the community. In one FGD with older women, they suggested that an orchestra
show would be an ideal launch for the programme. Different youth groups were encouraged to take part
in organizing the event. An attempt was made to involve religious leaders, but this did not materialize,
due to lack of availability of a common time. But the event proved to be a good platform for introducing
the programme to the community on a large scale.

Subsequent mass awareness events primarily used the medium of auto awareness, where an auto was
fit with a loud speaker and a tape recorder playing stories and songs on the issue of early marriage.
This activity was drawn from Samraksha’s earlier experiences of using auto rickshaws to spread
awareness about HIV/AIDS.

While auto awareness proved effective in attracting a large audience, and interacting with them, it
restricted the reach of the programme to larger streets and roads where the autos could pass through.
An alternate strategy of umbrella awareness programme was used for streetwise coverage. This
essentially consisted of pitching a beach umbrella in a specific stop and having some tapes, puppet
shows, etc. playing in the area. This ensured that the smaller streets, gallis and other difficult to reach
areas where autos could not enter was also covered. Umbrella awareness programmes were also less
glaring public events, and therefore attracted more women, who were restricted from attending larger
community events like auto awareness. In areas like Eidgah Mohalla, large number of women and girls
took part in these programmes and shared their concerns. Umbrella events were also more cost
effective, and logistically easier to manage, compared to auto awareness.

Catalytic Sessions with adolescent boys and girls

For this methodology, a group of 10-15 was an ideal number. In the context of the community, the
availability of the groups for regular sessions was itself a challenge. After lots of brainstorming, it was
decided that while for the girls, a series of sessions will go on with the same group, for boys a different
strategy would be adopted. Boys who were part of youth groups (Yuvaka Sanghas) would be
approached through regular sessions. For the other boys, it would focus more on one shot sessions, in
critical spaces in the community, like the playground where the boys gathered, tea stalls etc. Activities
would include sports activity, film shows and competitions, all of which centered round the issue of RSH.

With girls, it was relatively easier to form the groups, and carry on the sessions, because they had
lesser mobility during their leisure time. Specially, the younger girls (11-16 years), who were school
going, were very keen to get involved. With the older girls, their involvement was restricted because
many of them were also doing part time jobs, along with studies. But in general, the girls were also very
keen to be involved in the group, selecting a name for the group, keeping track of absentees etc. This
activity satisfied a vital need for the girls to be involved in some kind of larger group. The girls also liked
the sessions on personal growth including assertive communication, challenging gender stereotypes
etc.

With boys, it was far more difficult to organize them into groups, since there were existing cliques in the
community, with a mix of boys of all ages, and married and unmarried. It was therefore difficult to give
age appropriate communication to them. In many cases, they were not even interested in these
sessions. One major challenge was that boys were not even interested in sitting down for a session,
they preferred standing and walking about. The team realized that structured sessions were not suitable
for the boys, and used different events like games, sports programmes etc. to attract the boys, and
retain their attention. Sustained group activities with the same group over a period of time was possible,
to a limited extent among the boys between 11-15, but far more difficult among the older boys, who
might attend a few sessions, but later on seek out the team only to seek more information on specific
issues like high risk behavior, STI/RTI etc. Towards the end of the three year programme, when the
team had developed good rapport with the community, an alternative approach was tried. A tent was
pitched up in a public place, and the boys could come in there in the late evening, after their working
hours, for sessions and discussions.

The youth groups provided a relatively more organized structure to work with boys, and involving them
in the organization of the activities created a sense of ownership. But there were few active youth
groups in the community. Working with youth groups to organize cricket matches, republic day events,
and later competitions for all the people who had participated in the programme was effective. However,
one major challenge was that many of these groups had political leanings, and retaining the focus on
the issue was difficult.

Another major challenge for both boys and girls was the lack of space to have sessions. Although for
the girls, a room was offered in one of the houses, it was difficult for the girls to open up and speak
about RSH issues in an environment, where the community members were also present. For boys,
open spaces was an alternative, but here too there were frequent interruptions, and it was difficult to
explore topics like our body and body mapping in these spaces.

Boys and girls also differed in the way they related to the sessions, and what they found interesting.
Many of the girls enjoyed sessions on personal development,.

The initial sessions on unity, gender roles and discrimination served as good ice-breakers, specially for
the girls. The sessions on the value of unity, helped the group understand the need to appreciate
differences among them. In one of the groups, the girls discussed that during this session, they had
come to know that one of the group members who was visually challenged was a very good singer. The
girls shared that they had now understood the need to appreciate such talents among their peers.

The sessions on gender discrimination, and gender power differentials in decision making was received
in different ways among the different groups, and also threw up some interesting patterns on gender
dynamics operating within the family. For the girls, specially the younger ones, the session, specially
the posters showing women in different professions was very motivating. Some of the older girls, who
were already married felt disheartened, thinking such avenues were closed to them, but were
encouraged by the group saying such options was still open to them. Among the boys, during these
sessions, they shared that patterns of gender were more complex and were also changing within their
homes. For instance, some boys said that their father was an alcoholic, but would give the money to
the mother to run the house, and she made all the decisions. Some others said that since the mother
was earning more, she was the decision maker, in matters of their education, etc.

Girls were extremely enthusiastic during the sessions on communication, decision making etc. and the
younger school going girls were particularly more interested in trying to assess their own patterns of
communication, and where they needed to improve.

The session on ‘Our Body’, using a collage of popular actors and actresses and cricket stars, was
appreciated by both the boys and girls. This was an effective way of easing the group into a sensitive
subject of their body, specially their reproductive organs. The collage captured the interest of the group,
and the subsequent session, where the internal organs of men and women were explained, through
pictures and models, helped them understand their body better. The link with the collages underscored
the essential similarity of all men and women, and also motivated the groups to respect and care for
their body, so that they too could be attractive like the film stars.

Another popular activity developed by Samraksha was the magic bag, an adaptation of the popular
game of ‘Passing the Parcel’, where a bag containing different items used by adolescents like lipstick,
razor, sanitary pad etc. was passed around in the group and the group members would pick out
different items. Some of the girls would hesitate to pick up items like sanitary pads, but they were
eventually picked up by the other group members. When each item was picked there was reflection on
why this item was used. At the end the group would identify which of these items satisfied physical
needs, and which satisfied emotional and social needs. The activity helped them understand, that
during adolescence, a time of considerable physical change, the accompanying mental and social
changes were equally important and needed to be dealt with

The session on Good Touch-Bad Touch was effective to communicate the idea that our body was
precious, we had complete right over it and any kind of abuse of it by even touching, should not be
tolerated. Drawing and mapping grouping the different parts of the body, based on whether only we
could touch it, or let some others touch it or let all others touch it, helped the group understand the
concept of inviolate boundaries. Many of the girls shared some instances, where their boundaries had
been transgressed without their consent. This session was also appreciated by the boys, many of
whom had never understood that inviolate boundaries applied to them also, and they had the right to not
allow others to touch them. They shared that there had been many such instances where people had
touched them in ways which they found uncomfortable, but they were never able to articulate it as
something wrong.

The girls were understandably more interested in the sessions on menstruation. For most of the post-
pubescent girls, this was an opportunity to thoroughly understand the body implications of menstruation,
and clarify their doubts. They appreciated the uterus model, which helped the understand their body
cycle better. The girls also shared some of their day to day problems relating to menstruation, like not
being able to change menstrual cloth in schools, and lack of space to dry the menstrual cloth, being
forced to sit separately during the menstrual periods etc. Among the boys, this session received some
interest, with some of the boys who had sisters at home, actually having some understanding of these
issues.

Girls were also open to discussions on pregnancy, childbirth, care for the new mother, family planning
and safe abortions. Specially the older girls in the group, some of whom were already married, were
able to relate to the issues much better. It was also possible to have structured sessions with the girls
on this subject, and stick to the lesson plan. With the boys, structured sessions were always difficult.
Also when such topics were introduced to the boys, they always were more interested in clarifying their
doubts about STI/RTI, risks associated with exposure etc. It was thus difficult to stick to the scheduled
lesson plans, but information was being communicated through larger discussions on the different
questions asked by the boys.

It was also interesting to note that most of the participants had heard of HIV. This was a subject which
was supposed to be taught in schools, and the participants had learned many things by rote like ways of
transmission, prevention etc. However, they had not analysed or processed this information, and our
sessions helped them do this, and clarify their misconceptions.

The team also realized that appropriate audio visual material was an effective way of getting the girls
and boys involved in the programme. But there was a lack of appropriate audio-visual material,
designed specifically for adolescents. Many of the youth in the urban area are exposed to TV, and
demand AV inputs, but most of the material available, were general material related to HIV
transmission, and not addressing wider RSH issues of adolescents.

Workshops with young men and older women

Workshops with young men and older women have been called “Banni Matadi” (Come lets talk). Just
the name of this activity has been helpful in communicating the need to talk about these issues openly.
The two major issues which were focused during these sessions were early marriage and man’s
responsibility in women’s health, specially during pregnancy and childbirth.

The issue of early marriage which was a constant theme in all the different kinds of programmes carried
out by the organization, and these sessions were helpful in opening up discussion on the topic giving
the older women a chance to articulate what pressures they were under to get their children married
early, and also why they disapproved of the adolescent’s own decisions to elope and marry. Young men
also spoke of their own desires to marry early, their fears regarding the same, and the need to make a
prudent choice regarding their marriages.

The session on men’s responsibility in woman’s health evoked very vocal responses from the older
women, many of whom recounted their husband’s neglect during their pregnancy. The sessions used to
become quite heated, and many of the women were of the opinion that their husbands must be made to
sit during these sessions, and answer their questions. The young men, on the other hand, were open to
learning about what they could do for their wives, but at the same time, also spoke about some practical
issues, like the fact that they didn’t have time, and they had their own work pressures. Most of them
appreciated that there was a need to be involved in their wife’s welfare.

Conclusions :

The programme reinforced the fact that there are critical gaps in information and spaces for adolescents
to discuss their concerns about Reproductive and Sexual Health, and there is a need to Adolescents
require information on RSH in order to be able to exercise their rights, but it is also necessary to
concomitantly work with other important stakeholders in the community, in order to promote their RSH
rights.

Many kinds of material are now emerging for adolescents, under the larger umbrella of life skills
education, but there is still a need for more material, specially audio-visual material, with a specific focus
on RSH, which can give young people appropriate sensitive inputs on RSH. This material may also
need to be designed differently for boys and girls, girls are more interested in the softer skills of
personality development, would like to receive structured inputs in groups. Being part of these groups
also seemed to satisfy some other social needs of the girls. For boys, however, who were already in
their own cliques, they did not feel the need to be part of any of these groups, and they were more
interested in specific kinds of information, which would clarify their doubts. Pre-structured lesson plans
did nt work here. The team had to be creative, and ensure that maximum information was given to the
boys, as their doubts were clarified.