Synopsis of the baseline assessmentdraft report

done by

MLMC 9 Mar 2012

Background

Adolescent girls: several vulnerabilities persist and transitions to adulthood are too frequently marked by abrupt and premature exit from school, entry into the labour force, early marriage and strongly held gender norms

“Not a single intervention has focused on HIV vulnerability of adolescent girls, and few have addressed the multiple facets of girls' life. Unfortunately, while many existing interventions claim success, their experiences and lessons are poorly documented and most have not been rigorously evaluated. Hence, while promising, it is difficult to establish the effectiveness of these models and the extent to which they can be effectively replicated and up-scaled.”

… and rationale

Objectives

• The extent to which adolescent girls and boys were endowed with protective assets which will prevent conditions that are precursors of HIV;

• Practices and behaviours of adolescent girls and boys that directly aggravate or reduce their vulnerability to HIV;

• The perspectives of adolescent girls and boys about the need for programmes to reduce the vulnerability of adolescent girls to HIV; and

• The perspectives of parents and other critical adults in the community on the challenges facing girls and the feasibility and usefulness of programmes to reduce the vulnerability of adolescent girls to HIV

Study design

A pre-post evaluation study, using primarily qualitative methods, undertaken in the intervention blocks only, prior to the implementation of the MLMC project (baseline) and at its conclusion (endline) is used.

Comparison 1

PC: "vulnerable" girls, defined as those who are from “families below poverty line, scheduled castes, scheduled tribes, etc.

MAMTA: We have a exhaustive list of factors including those for HIV.

Comparison 2

PC: Would like us to have a “clean sweep” method of vulnerability mapping and intervention

MAMTA: We are following a “cluster” method of vulnerability mapping and intervention

Comparison 3

PC: Adolescent girl groups are aged 10-12, 13-14 and 15-19 ,

MAMTA: We are following the project proposal of 10-14 and 15-19

Participants

• Vulnerable adolescent girls• Brothers of vulnerable adolescent girls• Husbands of vulnerable adolescent girls• Parents and/or in-laws of vulnerable

adolescent girls• Critical adults in the community

Components

1. Drawing exercise and focus group discussions with adolescent girls and boys 10-12

2. Focus group discussions and community mapping exercises with adolescent girls aged 13-14 and married and unmarried 15-19, and brothers/husband of adolescent girls

3. Survey of FGD participants aged 13-14 years and 15-19 years, using a structured questionnaire

4. Focus group discussions with parents/in-laws5. Focus group discussions with critical adults in the

community

Profile of AD girls*

Four categories of assets: 1. social, 2. human, 3. physical, and 4. financial

*Asset building framework (Sebstad and Bruce, 2004; Bruce et al., 2011)

• Peer networks and interactions smaller for girls

• Interactions, however, became less regular as adolescents aged and were married

• membership in any organized group is non-existent among adolescents

*Asset building framework (Sebstad and Bruce, 2004; Bruce et al., 2011)

Assets of AD girls: Social

Assets of AD girls: Human

Self-efficacy: • Among younger adolescents, the majority of girls and

boys displayed self-efficacy• Among girls, a larger number of unmarried girls than

married girls displayed self-efficacyDecision-making autonomy: • limited decision-making autonomy of all adolescents,

except the husbands of married adolescent girls• a larger number of unmarried than married girls made

independent decisions

Assets of AD girls: Human

Freedom of movement : • one out of 52 girls were allowed to visit the

selected locations unescorted, many more boys were permitted to do so (19 out of 51)

• freedom of movement enjoyed by younger adolescent boys was greater than that enjoyed by older married and unmarried adolescent girls

Assets of AD girls: HumanGender role attitudes: • All participants unanimously believed that while girls

are better in performing household chores and home-based economic activities, boys are better in performing economic activities outside home

• Also believed that reversing the situation is not impossible if girls and boys so desire

• Findings also show that among both girls and boys, a larger number of the unmarried than the married adhered to egalitarian gender norms (As expected)

Awareness of SRHPhysical changes in adolescence: • All participants in most FGDs, reported that they

were not informed about physical changes that occur during adolescence (But the quotes show quite a lot of understanding)

Sex and pregnancy:• More limited among unmarried than married girls• No such differences were observed among

adolescent boys

Awareness of SRHContraceptives: • A larger number of the unmarried than the married were

informed about contraceptives[?]HIV and AIDS:• Limited awareness among all categories of adolescents,

except unmarried adolescent boys• One in four married and unmarried adolescent girls and one

in three married boys and two in three unmarried boys reported that they knew about health facilities where they could get an HIV test done[!]

• However, not a single participant had ever undergone an HIV test.

Financial AssetsAccess to money: • Younger adolescents get money from parents and

from work, in school from scholarships • Scholarships more often in MP than UPYounger spent money on:• Study materials was reported more often in the case

of boys than girls and personal grooming items was reported more often in the case of girls than boys

• Boys, spent on tobacco products and alcohol, engaging in gambling and wooing girl-friends

Financial AssetsOlder spent money on:• Mobile phones was mentioned by both boys and girls; • Various substances and purchasing household items

was also frequently mentionedYounger Savings habits: • With parents, piggy bank, safe place at home• Some 13-14 yr olds save in a bankOlder Savings habits: • Girls with parents, piggy bank, safe place at home• More boys than girls tend to save in a bank.

Financial AssetsSavings A/c:• Neither girls nor boys held a savings account in a bank

or post office. • Many felt an account could be opened only for those

aged 15 or 18 years• Reports Employment Guarantee Scheme, and a school

opening accounts for students• More boys than girls have an account because: – more boys tend to work than girls, – boys are not as restricted as girls, – parents favour sons over daughters

Livelihood opportunities• Older than younger, the married than the unmarried, and

those out-of-school than those in-school were engaged • Opportunities for job placements are almost non-existent

for both adolescent girls and boys• Girls are more disadvantaged than boys in making use of

existing schemes• Vocational skills training are limited for both girls and

boys • Girls reported training in traditional skills, while boys

reported training in traditional skills as well as modern ones like computer training

Physical AssetsSafe spaces (outside school and home):• Limited for both young and old girls • Spaces mentioned were– near the water tap or pond, – fields to collect fodder or cut crops,– the market, – places of worship

Risk-taking and health seeking behaviors and practices

Sexual experiences before and outside marriage:• Some reported that sexual relationships are widespread, others noted

that only a few engage in such relationships• Girls who engage in pre-marital sexual relationships typically have sex

with their boy-friends, or sex with extended family members• Boys more with girl friends, also with adult women neighbors, and sex

workers

Condom use: • Do not use condoms for:

– difficulties in accessing or lack of interest in using condoms, – lack of awareness – deliberate intentions to ruin the reputation of a female

• Do use condoms for fear of pregnancy and infections (~)

Risk-taking and health seeking behaviors and practices

Multiple partners:• Four unmarried boys and one married boy reported multiple

partnerships• One unmarried girl and not a single married girl reported having

engaged in pre-marital and extra-marital sex

Substance use: • Common among adolescents, especially among boys • Boys 15-19 do take alcohol, drugs, and tobacco products• Significant minorities of adolescent girls consume tobacco• Facilities to address substance use are non-existent

Access to health services and treatment-seeking practices

Access to information pertaining to HIV:• Girls are less likely than boys to access information because of

restrictions on their mobility. • Also, girls tend to have less time to seek such information, and

feel more embarrassed • Boys find it difficult to obtain information that are not tuned to

meet the needs of boys Access to condoms: • For both boys and girls limited:

– Shops were not available in all the villages; – Shopkeepers refused to sell condoms to boys; – Boys felt shy to approach even medical shops; – Lacked money to buy condoms tobacco

Access to health services and treatment-seeking practices

Access to SRH treatment services:• Both girls and boys did not like poor quality of public

sector facilities. • Embarrassed to seek treatment for sexual health • Lacked money • Lacked information about sexual health • Girls unable to go without parents escort • A sizeable number of older adolescent girls and boys

who had experienced symptoms suggestive of genital infections in the last 3 months did not access SH services

Programs to reduce HIV vulnerability

Programme content:• Modern skills such as computer training as well as

opportunities for sports and games• Some stated that HIV content would ruin adolescentsPreferred location & time for intervention: • Consensus on anganwadi centre, school, park and the

Panchayat house• Sunday as everyone will be at home and none need not

go for work or studies (for PMM)• Afternoon for girls because parents may not allow girls in

the evening, and morning or evening for boys

Programs to reduce HIV vulnerability

Joint or separate sessions for girls and boys:• Most participants suggested that the

intervention activities should be organized separately for girls and boys.

• Even young adolescents would like the activities to be held separately

• Parents may not permit their daughters to attend the sessions if they were held jointly for girls and boys.

Mothers and fathers of adolescent girlsGender difference in Time use:• A girl comprised school (if she was school going), housework, work on the

family farm or tending the family's livestock, and, in some cases, wage work, accompanying their mother for agricultural labour.

• Boys also spent time in school, but had more leisure than girls, outside the home with friends; older boys were also described as working in the village, or nearby villages, and towns

On Educating: • Both mothers and fathers valued schooling of girls and boys, many recognised

the obstacles for girls like:– limited educational facilities in villages, – schools did not go beyond Class 5 or Class 8, – restrictions on girls' mobility, – quality of public education was poor, and parents did not have the resources to enrol

children in private schools,

Mothers and fathers of adolescent girlsDecision Making:• Both mothers and fathers reiterated

– Limited decision making authority of girls, – Greater decision-making role of boys. – Girls do not have the right to take any decisions for themselves, be it

whether to work, how much education to have, or when and whom to marry.

(BD: Parents seem to think that adolescent girls are less involved in decisions than the adolescents themselves do)

Access to resources:• Girls in particular had very limited access to money or to save

money (BD: Again parents views more negative than the adolescents

themselves)

Mothers and fathers of adolescent girlsAwareness on SRH and HIV: • Mothers knew more about pregnancy than fathers• Mothers maintained that while girls should not be informed about

sexual and reproductive health matters, it was necessary to inform boys

• Girls and especially boys obtained this information on their own and so no need for parents to provide information

• Favoured provision of SRH information but being unable to communicate with their children would welcome the school or outside experts

• Denied that adolescents engaged in pre-marital sex or were at risk of HIV

• Attributed premarital sex to the inability of poor parents to marry their daughters at an (!) appropriately young age

Critical adults in the community*

Key Challenges:• Distant schools, multiple domestic responsibilities that fell on

girls limited the time they had for schooling and studying, ending up discontinued their education in Class 5 or 8

• School quality was poor in public schools; • Parents feared that their adolescent daughters may risk

bringing disrepute to the family if they mixed with or were teased by boys

Vocational Training• Typical/ gendered oriented Vocational programs suggested for

girls and boys

*PRI members, teachers, ANM, ASHA, and anganwadi workers

Critical adults in the community

Safety of girls and boys: • By and large, didnt perceive their villages to be unsafe for girls

or boys. 'Our village is completely safe' was often asserted, yet in several discussions lack of safety by night was acknowledged.

Pre marital sexual activity:• Hesitated to suggest that pre-marital sex existed in their

villages or that adolescent girls and boys in their village may be at risk of HIV.

• However, in a few discussions, it was clear that opportunities for the development of friendships between girls and boys were increasingly available

For Discussion• Good as qualitative, but what about our targets• All samples less than 100, so no %• Silent on Physical Assets; do safe spaces come

here? • Vulnerability to HIV - unpacking• Discrepancies between quote & analysis:

Physical changes• No comparisons with similar Indian studies

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