Horizons/Population Council

This 2-page research update is a concise presentation of the First-Time Parents Project, which was implemented in India over a 2-year period in an effort to improve married young women's reproductive and sexual health knowledge and practices, and to expand their ability to act in their own interests. This project, carried out by the Population Council in collaboration with Child in Need Institute (West Bengal) and Deepak Charitable Trust (Gujarat) from January 2003 to December 2004 in 12 villages, was designed to respond to the high prevalence of young married adolescent girls in India. As indicated here, various social, educational, and health disadvantages are of concern; for instance, these adolescents may have not only limited contact with social networks, but also restricted access to mass media that might have otherwise informed them about obstetric risks and the like. In short, married adolescents aged 18 or younger in India are significantly less likely than women aged 19-23 to use skilled delivery, or to fully immunise their children; they also tend to experience elevated levels of obstetric risks, and are more vulnerable to sexually transmitted infection (STI) or HIV infection due to frequent and/or unprotected sex.

The communication strategies and activities shaping the programme activities designed to respond to this situation are outlined here. A key concern informing the design of the intervention was the need to involve husbands of the young women (who were newly married, pregnant, or postpartum - for the first time), as well as senior family members and health care providers who might influence them. Activities included:

1. Information provision - Outreach workers conducted home visits (women visited young women; men visited young men), providers carried out counselling sessions in clinic settings, young women's groups hosted discussions, and community-oriented celebrations took place (e.g., to mark breastfeeding week).
2. Health-care service adjustments - Government and private health providers were oriented about the special needs of this group, and refresher training on safe delivery was provided to traditional birth attendants. In addition to the provision of condoms and oral contraceptives, detailed information was offered to women and couples alongside existing antenatal services. Safe delivery planning was carried out, and postpartum home visits were provided.
3. Group formation - With facilitation by project staff, married young women's groups were formed; they met for 2-3 hours every fortnight. During these sessions, the groups adopted a participatory learning approach. Ideas for topics (e.g., legal literacy, vocational skills, pregnancy and postpartum care, available local resources, etc.) were identified by the girls themselves through activities such as community mapping. To increase married girls' contact with peers and mentors, expose them to new ideas, and help them identify and articulate their own point of view, participants visited various places in the community - such as active women's groups - and worked together on development projects, celebrated common festivals, and organised welcome ceremonies for newly married members.

Based on a quasi-experimental study with surveys at baseline and endline, preliminary findings indicate that - as expected - reaching husbands proved to be more difficult than reaching young women. However, the findings also suggest improvements in young women's social networks, reproductive health knowledge, and maternal and child health practices.

Organisers conclude that the approach investigated here is "feasible and is sustainable since it is not creating a new structure but orienting existing services to special needs of married adolescents and making links with existing programmes." Communication appears to have played a central role in that the focus is on stimulating young women's agency and social networks, their reproductive health knowledge and practices, and their partner support and communication - toward better maternal and child health practices.

Click here to access a related peer-reviewed summary on the Health e Communication website, and to participate in peer review.