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A Researcher’s Diary: Is There Healthcare For Adolescents On The Margins?

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By S. Ram Aravind:

Note: Placing adolescent health at the heart of urban planning, PRIA, University of Glasgow (UoG), and Gurugram University have come together to undertake Participatory Action Research with communities residing in urban informal settlements in Gurugram. In this six-part series that explores the relationship between cities and health, Ram Aravind, from PRIA, will take the readers through the process of conducting participatory research with adolescents and how collective action with stakeholders makes for an effective strategy for effecting change at the grassroots.
Research fieldwork in Gurugram.

On the first day of fieldwork, I encountered a young girl who had migrated from Jharkhand to Gurugram, after the pandemic-induced lockdown restrictions were lifted. I observed her from a distance. She was engrossed in serious business on her mobile phone, unconcerned by the ‘gaze of research’.

The digital revolution had made owning a mobile phone affordable. Adolescents, in Gurugram, had access to mobile phones, and information from around the world was just a click away. The irony lay in the fact that their access to information about their health needs in itself was limited.

The Challenges For The Youngest Generation

One in five adolescents in Southern Asia is out of school, according to a paper by the UNESCO Institute of Statistics (UIS). Mere access to information on the internet was not empowering adolescents when it comes to their health. They remain powerless, voiceless, and neglected in a city and in its planning to provide health services.

Reaping the benefits of India’s demographic dividend will be central to India’s economic development, but the largest generation of young people in human history face enormous challenges towards realizing their potential to contribute to the growth story. The Lancet Commission report titled, ‘Our Future’ had identified ‘adolescence’ as a “critical phase in life for achieving human potential” and concluded by recommending that only substantial investments in improving adolescent health and well-being would aid in India’s progress towards achieving the UN Sustainable Development Goals.

But how do we generate evidence into priority areas of public policy that would ensure the holistic development of adolescents, especially those belonging to marginalized communities? Drawing upon PRIA’s prior experience of engaging with youth, the study titled ‘Our Health, Our Voice’ seeks to advance the use of participatory research methodology into the thematic area of adolescent health. Through the active participation of adolescent boys and girls living in urban informal settlements in Gurugram, the evidence is expected to generate fresh insights into their lives from the perspective of urban migration.

For many, the name Gurugram (erstwhile Gurgaon) is synonymous with the entrepreneurial boom that has now gripped India. However, Gurugram is home not only for the well-heeled but also people fighting it out in the fringes, hoping to eke out bare minimum sustenance. In a pattern that is typical of rapid urbanization, a vertical expansion of Gurugram to accommodate the deluge of migrant workers had followed. Construction workers, drivers, domestic workers, gardeners, gate-keepers, and the ones labeled as ‘criminals’ and ‘delinquents’; you will find possibly all of them here. Otherwise known as ‘urban informal settlements’, the term has its genesis in the economics of the city.

The Dearth in Adolescent Health Studies

The development economists are guided by the philosophy ‘what gets measured gets done’. The existing literature on adolescent health is populated with studies that evaluate gaps in adolescent health service delivery or awareness among adolescents on various health issues. Studies that explored the phenomenon were few. There appears to be a dearth of studies on adolescent health that combines theory, practice, and advocacy.

As a methodological and thematic novice, I look forward to combining the three, to innovate on techniques and methods of action research and deepen our presence in working with India’s youth.

The practice of converting the numbers into tangible results on the ground distinguishes the participatory research methodology from the more traditional methods of research. Further, the respondent or participant in the study is not kept distant from the research. In fact, their stakes are much higher in Participatory Action Research. To engage in a process of research that gives agency to the community to have control over the factors that affect their lives! How exciting is that?

That would include sharing the results of a study with the respondents, interviewing the multiple stakeholders involved in health service delivery, working with local elected representatives, gaining perspectives on existing practices from parents, all the way extending into behaviour change communication with the community that they live in.

Over the coming months, as the adolescents in the community transition from being respondents of questionnaires to owning their stake in the process that seeks to transform health service delivery through policy advocacy, the journey seems long and arduous, but transformative. For me as a researcher and hopefully, for them as active participants. Their experiences, their stories—those will contribute to the discourse.

And, beyond all the literature that I had reviewed, read, and built my understanding of the research topic, it is an opportunity for me to learn how to research not for people, but with them.

Read more about ‘Our Health, Our Voice’ here. Learn more about Participatory Research Methodology here.
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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

Read more about his campaign.

Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Read more about her campaign. 

A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Find out more about the campaign here.

A native of Bhagalpur district – Bihar, Shalini Jha believes in equal rights for all genders and wants to work for a gender-equal and just society. In the past she’s had a year-long association as a community leader with Haiyya: Organise for Action’s Health Over Stigma campaign. She’s pursuing a Master’s in Literature with Ambedkar University, Delhi and as an MHM Fellow with YKA, recently launched ‘Project अल्हड़ (Alharh)’.

She says, “Bihar is ranked the lowest in India’s SDG Index 2019 for India. Hygienic and comfortable menstruation is a basic human right and sustainable development cannot be ensured if menstruators are deprived of their basic rights.” Project अल्हड़ (Alharh) aims to create a robust sensitised community in Bhagalpur to collectively spread awareness, break the taboo, debunk myths and initiate fearless conversations around menstruation. The campaign aims to reach at least 6000 adolescent girls from government and private schools in Baghalpur district in 2020.

Read more about the campaign here.

A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

The Transmen-ses campaign aims to tackle the issue of silence and disregard for trans men’s menstruation needs, by mobilising gender sensitive health professionals and gender neutral restrooms in Lucknow.

Read more about the campaign here.

A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

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