Since 1999, ICRW has been collaborating with partners in India on multi-site intervention studies on adolescent reproductive health in India. The intervention study by Swaasthya (1998-2001) focussed on increasing life skills and confidence of young, unmarried girls, to improve their sexual health, and their ability to negotiate their environment. This study was the second phase of a larger 3-part study on adolescent health and development. The first phase, from 1996-97, involved qualitative, community-based research designed to determine unmarried adolescents' needs, constraints, and questions. Based on the results, the study described here was conducted.

Qualitative evaluation data included focus group discussions and in-depth interviews with participants. Two cross-sectional surveys of unmarried girls age 12-22 years were undertaken, at the beginning of the intervention (S1) and 18 months later (S2). For each, a different sample but of the same size (401) was drawn using simple random sampling technique. In both S1 and S2, data was collected on social and demographic variables, and on all outcomes of interest. In the second survey, questions on the extent of exposure to the Swaasthya interventions was also included. Bivariate and multivariate analysis assessed the effect of Swaasthya interventions on outcomes.

The analysis showed that the knowledge of reproductive and sexual health, and knowledge of legal issues, were particularly effective in increasing perceived self-determination. These intermediate outcomes, in turn, were key aspects of the intervention. Swaasthya addressed adolescent girls and their immediate environment through a participatory, community development approach. Specifically, a set of 7 Skills Building Modules was designed to build girls' understanding of "self" and to increase their capacities and life skills to deal with social and health-related "real-life" situations. Second, information was disseminated by interpersonal communication with trained Swaasthya field workers and through indigenously made videos aired on local television. Finally, organisers created a support network for the girls by forming women's and adolescent community groups that met monthly to increase understanding between mothers and daughters.

Youth, Women, Reproductive and Sexual Health, Life Skills Development.

Organisers found that the intervention increased perceived self-determination regarding ability to decide whether and when to marry and when to have a first child. Other increases were found in perceived support from gatekeepers such as parents; knowledge of reproductive and sexual health; knowledge of legal issues; and positive perspectives on sex.

Still ahead for organisers is the third phase of this project, which will involve replicating Swaasthya's adolescent development model in Naglamachi slum (basti), Delhi. The goal of this phase is to test the feasibility of replicating the model by transferring it to, and training staff from, a quasi-government agency (National Institute of Urban Affairs), and then to scale it up to multiple sites in Delhi and elsewhere in the country.