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<ul><li><p>8/3/2019 A a a a a a a a a a a a a a a a a a a a a a A</p><p> 1/28</p><p>1. The effects of postnatal health education for mothers on infant care</p><p>and family planning practices in Nepal: a randomised controlled</p><p>trial</p><p>Abstract</p><p>Objectives: To evaluate impact of postnatal health education for mothers on infant care and</p><p>postnatal family planning practices in Nepal.</p><p>Design: Randomised controlled trial with community follow up at 3 and 6 months post partum</p><p>by interview. Initial household survey of study areas to identify all pregnant women to facilitate</p><p>follow up.</p><p>Setting: Main maternity hospital in Kathmandu, Nepal. Follow up in urban Kathmandu and a</p><p>periurban area southwest of the city.</p><p>Subjects: 540 mothers randomly allocated to one of four groups: health education immediately</p><p>after birth and three months later (group A), at birth only (group B), at three months only (groupC), or none (group D).</p><p>Interventions: Structured baseline household questionnaire; 20 minute, one to one healtheducation at birth and three months later.</p><p>Main outcome measures: Duration of exclusive breast feeding, appropriate immunisation of</p><p>infant, knowledge of oral rehydration solution and need to continue breast feeding in diarrhoea,knowledge of infant signs suggesting pneumonia, uptake of postnatal family planning.</p><p>Results: Mothers in groups A and B (received health education at birth) were slightly morelikely to use contraception at six months after birth compared with mothers in groups C and D</p><p>(no health education at birth) (odds ratio 1.62, 95% confidence interval 1.06 to 2.5). There were</p><p>no other significant differences between groups with regards to infant feeding, infant care, orimmunisation.</p><p>Conclusions: Our findings suggest that the recommended practice of individual health education</p><p>for postnatal mothers in poor communities has no impact on infant feeding, care, orimmunisation, although uptake of family planning may be slightly enhanced.</p><p>Key messages</p><p> Health education is widely promoted in primary care, but there have been few rigorousevaluations of its impact, especially in developing countries</p><p> A randomised controlled trial of postnatal individual health education for mothers givenby trained female health workers showed no significant impact on maternal knowledge</p><p>and practices of child care or on infant health outcomes, but there was a small</p><p>improvement in uptake of family planning at six months after birth</p></li><li><p>8/3/2019 A a a a a a a a a a a a a a a a a a a a a a A</p><p> 2/28</p><p> The efficacy of health education interventions that rely solely on giving people</p><p>information to bring about a change in health behaviour is unproved; interventions should</p><p>be evaluated before being implemented on a large scale</p><p> Alternative strategies for health promotion in developing countries such as interactions</p><p>within families, peer groups, or communities may be more effective but are costly and</p><p>difficult to implement on a large scale</p><p>2. Attitude of Mothers towards Sex Education of Adolescent GirlsDr Padma Shetty, Dr Shobha Kowli and Ms Vidula Patil</p><p>Introduction</p><p>ADOLESCENCE is a crucial phase of life. It is a stressful period in which the adolescent tries toadjust to his/her varied physical, emotional and psychological changes. The adolescent is curious</p><p>to ask many questions but the problem is: whom to address these questions? Since talking about</p><p>sex is a taboo in the Indian society, the adolescents cannot freely approach his/her parents forguidance. Also, those who seek guidance from parents are not satisfied because the latter try to</p><p>evade discussion or are not able to give satisfactory answers. A few of them try to gatherinformation through books, films or from friends but a majority do not have access to such an</p><p>information. Many a time, the adolescent receives wrong information and these myths andmisconceptions are carried throughout their lifetime. Therefore, there is a need to provide adolescents</p><p>with information so as to enable them to cope better with these changes. Though there is a need to</p><p>educate the adolescents on sex education, parents oppose such educational programmes due to thefear that imparting sex education would lead to experimentation with sex. Any attempt to gather</p><p>adolescent girls in the urban slum community of Mumbai for such a programme could be</p><p>successful only after the mothers were approached, informed and convinced. The present papernarrates the experiences, attitudes and expectations of the mothers regarding adolescent health</p><p>education programme.</p><p>Aim of the Study</p><p>The objectives of the study were:</p><p> To assess the attitude of mothers towards imparting of sex education to theiradolescent daughters;</p><p> To find out what information is imparted by mothers to their daughters at the time of</p><p>menarche and marriage;</p><p> To find out the appropriate age for imparting sex education for adolescent girls as</p><p>perceived by the mothers, and</p><p> To find out what the contents of sex education should be according to the mothers.</p><p>Materials and Methods</p><p>This particular study was conducted in an urban slum, Malavani, situated in the north-west part of</p><p>Mumbai. The urban slum has been adopted by the Department of Preventive and Social Medicine,</p><p>KingEdwardMemorialHospital, as a field practice area. The slum population consists predominantly</p><p>of Muslims.</p></li><li><p>8/3/2019 A a a a a a a a a a a a a a a a a a a a a a A</p><p> 3/28</p><p>Through community health workers a group of 9-12 women having adolescent daughters were</p><p>invited to participate in the focus group discussion (FGD). Three such focus group discussions</p><p>were conducted in the community with an average duration of 70 minutes. Guidelines for FocusGroup Discussion were prepared to assist in conducting the focus group discussion. The</p><p>guidelines contained questions pertaining to-</p><p>Scope of education and job opportunities for girls</p><p> Sex education</p><p> What information is imparted by the mother to the girl at the time of attainingmenarche and marriage?</p><p> Whether to be imparted or not?</p><p> At what age should it be imparted?</p><p> What should be the contents?</p><p> Who should impart sex education?</p><p> Marriage</p><p> Girl-boy relationship</p><p> Attitude towards an unmarried adolescent girl.</p><p>In order to make the mothers feel at ease, the discussion started with the introduction of each of</p><p>the participants. The mothers may not answer properly if questions directly pertaining to their</p><p>daughter are asked, on such a sensitive issue. Therefore the mothers were asked to discuss aboutthemselves when they were adolescents and, later on, the questions were directed towards their</p><p>adolescent daughters.</p><p>A team comprising one moderator, one note-taker and one observer was formed for conductingthe focus group discussion. The moderator introduced herself, the note-taker and the observer to</p><p>the participants. The moderator explained the aim of the group discussion to the participants who</p><p>were then asked to introduce themselves.</p><p>The rules of the focus group discussion were explained to them-</p><p> As far as possible, only one person should talk at a time so that each participant could</p><p>be heard clearly.</p><p> It was important that each one of the participants takes part in the group discussion so</p><p>as to make it lively and enriching.The participants were informed that the discussion would be recorded in writing by the note-</p><p>taker so that this information could be used in developing the educational programme for the</p><p>adolescent girls.After this initial introduction, with the help of the FGD guidelines, the moderator conducted the</p><p>FGD. The proceedings of FGD were recorded in writing by the note-taker. The documentation of</p><p>the proceedings of the FGD was used in assessing the attitude of the mother towards sex education,formulating interview schedule and Information Education and Communication package.</p><p>Results and Observations</p></li><li><p>8/3/2019 A a a a a a a a a a a a a a a a a a a a a a A</p><p> 4/28</p><p>There were 9-12 participants in each group with ages ranging between 30 and 45 years. The</p><p>majority of the participants were illiterate. There were a total of 32 participants.</p><p>Attitude of mothers towards education of girls</p><p>All the participants felt that education was important.</p><p>A minimum of S.S.C. (Secondary school certificate) is a must for all. If she wants to studyfurther, she may continue.</p><p>Some mothers had discontinued their daughters study after seventh standard and had cited the</p><p>following reasons for doing so:Because of financial constraint</p><p>Schools do not give them proper education. As a result, we have to send our children for tuition.</p><p>We don't have so much money to spend on tuition. Therefore, by seventh or eighth standard we</p><p>discontinue their studies and put them into vocational training classes. Here they will be able tolearn the skills to make themselves financially independent to a certain extent.</p><p>The participants felt that girls should be financially independent to face any crisis in life.</p><p>Girls need to be independent as one never knows what kind of a husband she will get. If her</p><p>husband leaves her, she should be able to earn money herself.The participants were reluctant to send their daughters to work as they felt it was not safe. They felt</p><p>that, as far as possible, the girls should try to earn money at home. In circumstances where therewas no alternative, the girls could go out to seek a job.</p><p>Girls can earn money by taking tuition at home.</p><p>If it is not possible to earn money by staying at home, then she should go out for a job.</p><p>If the character of the girl is good and she is not going to behave irresponsibly, she can go outfor a job.</p><p>Attitude of mothers towards marriage of their daughters</p><p>Opinion was divided opinion amongst the participants regarding marriage of their daughters.</p><p>Some felt that it was essential to take into consideration the girls opinion about marriage</p><p>whereas some had still a very conservative attitude.Nowadays girls choose their own partners.</p><p>If parents choose the husband for their daughters without taking their opinion, they blame the</p><p>parents if any marital problems occur later.Sometimes girls threaten to commit suicide or she may elope with the boy. It is better that we</p><p>get the girl and the boy married rather than losing our daughter.</p><p>If the girl chooses her own life partner, we will try to explain to her, but if she refuses to listen,</p><p>we will resort to beating.The right age for marriage is 16-20 years as the girl matures and can think what is right and</p><p>what is wrong for herself.</p><p>Information imparted by mothers regarding menstruation</p><p>The girls were not given any information about the physiology of menstruation and other</p><p>physical changes occurring in the body.We will tell her it is a monthly occurrence, how she should maintain hygiene. She should not let</p><p>her father and brother come to know about it.</p><p>One of the participants daughter complained of pain in the chest during breast development for</p><p>which the participant told her that it happens and she should not mention it to anybody.</p></li><li><p>8/3/2019 A a a a a a a a a a a a a a a a a a a a a a A</p><p> 5/28</p><p>Girls should be told about menstruation only after attaining menarche.</p><p>If the girl is told about menstruation before attaining menarche, then she will keep asking us</p><p>constantly about when she will start her menses.Knowledge about menstruation was poor among the participants. This was admitted by the</p><p>mothers.</p><p>Even if our daughter asks us more questions, we are not able to clarify their doubts as weourselves do not know.</p><p>Information imparted by mothers at the time of marriage</p><p>At the time of marriage, the girls were only told about maintaining good relations with members</p><p>of the husbands family.</p><p>I will talk to her about how she should behave with her family.</p><p>We will tell her that she should listen to her husband and parents-in law.Nowadays girls already know a lot; there is no need for us to tell them. If they do not know,</p><p>they will ask their friends.</p><p>We cannot tell the daughter about the number of children she should have as it depends on her</p><p>husband and in laws.If she has any health problem after marriage (pregnancy, abortion), then I will give her</p><p>guidance.</p><p>Attitude of mothers towards girl-boy relationship</p><p>The girl is told not to talk to boys as she was now a grown-up. Talking to boys was considered</p><p>wrong.If I find my daughter talking to a boy, I will explain to her that it is wrong and that she should</p><p>not talk to boys. If she does not listen to me, then I will beat her; her father will also beat her.</p><p>Girls can only talk to boys in their neighbourhood.If the boy is her classmate, she can talk to him.</p><p>Attitude of mothers towards an unmarried girl</p><p>Though the participants felt that both the girl and the boy were responsible, the girl was the one</p><p>who is to be blamed.</p><p>Both the girl and the boy are to be blamed.It is the girls fault.</p><p>It is the mother's responsibility to see that her daughter does not commit any mistake.</p><p>Society always blames the girls; so we have to see that our daughter does not commit any such</p><p>mistake and therefore we have to place restrictions on girls.</p><p>Attitude of mothers towards imparting sex education</p><p>The mothers were reluctant to talk about sex education to their daughter as they found it</p><p>embarrassing to discuss these issues.If girls are given sex education, the girls become smart (hoshiyaar) and may experiment with</p><p>sex.</p><p>My daughter is innocent, how can I talk to her about sex. It will create a bad impression on hermind.</p><p>I cannot tell my daughter about such things. It is embarrassing for us. Such information could</p><p>be got from friends, elder sister and sister-in-law.</p></li><li><p>8/3/2019 A a a a a a a a a a a a a a a a a a a a a a A</p><p> 6/28</p><p>Who can impart sex education?</p><p>There was a general consensus in all the groups that sex education should be imparted by</p><p>doctors, teachers and health personnel. Information could also be gathered from friends and eldersisters.</p><p>What should be the contents of sex education?</p><p>The mothers felt that information should be imparted on menstruation and conception. The girls</p><p>should also be told about how to behave with their husbands family.</p><p>Discussion</p><p>A programme of family life education should consider political and socio-cultural implications.</p><p>One of the prerequisites for starting a programme on family life education for young people isthe mental preparation of the adult population, especially the parents.1</p><p>In 1989-90, the Family Planning Association of India, Pune branch, carried out a study of the</p><p>opinion of parents on problems of introducing family life education courses in secondary</p><p>schools. 89.3% of the parents felt that there was a definite need for family life education insecondary schools.2 The level of communication between the parents and their adolescent</p><p>children in homes in Nigeria was studied. Only a few aspects pertaining to family life educationwere discussed by the parents. Mothers were initiators of family life education in a majority of</p><p>the families. Some parents did not feel competent and others felt that raising such issues might</p><p>encourage undesirable behaviour by youth.3</p><p>The present study shows that mothers have a favourable...</p></li></ul>

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