Annual Conference and General Meeting 8-9 November, 2010 Presented by Ms. Indu Capoor

1. Poor SRHR due to Chronic Poverty – Actual SRHR needs of women and men in India and civil society response Annual Conference and General Meeting 8-9 November, 2010 Presented by Ms. Indu Capoor Founder Director, CHETNA Centre for Health, Education, Training and Nutrition Awareness E-mail : chetna456@vsnl.net / chetna456@gmail.com

2. VisionCHETNA envisages an equitable society where disadvantaged communities are empowered to live healthy lives.MissionTo empower children, young people and women, especially from marginalized social groups, so that they become capable of gaining control over their own, their families’ and communities’ nutrition, health and well-being

3. Improving Access to Food and Enhancing NutritionEnsuring Health and Development in ChildhoodSaving the Girl ChildPromoting Sexual Health of Adolescents and YouthImproving Maternal and Newborn Health Issues Addressed by CHETNA

4. According to a new Oxford University study, 55 percent of India’s population of 1.1 billion, or 645 million people, are living in poverty. The study found that about one-third of the world’s poor live in India and Indian women and girls are among the poorest in the world Chronic Poverty and Gender Inequality leads to adverse health outcomes including poor Sexual and Reproductive Health “Receiving an unequal share out of less” Poverty is the worst form of violence. ~Mahatma Gandhi

5. What does it mean to be poor in India : Overlapping conditions

6. Under nutrition- Anaemia (more than 80% among women and girls) High maternal mortality Still births Low birth-weight baby More prone to infections Poor sexual and reproductive health Post-delivery haemorrhage and infection Poverty and lack of enough food

7. Poverty –Poor living condition Only 29% of households in India have improved toilet facilities Lack of privacy for young girls and women leads to poor hygiene during menstruation leading to Reproductive Tract Infections

8. 13 year old Rina from Jharkhand state in eastern India, is one of the few privileged girls to have ever attended school. Like many adolescent girls, she was forced to drop out of school because of lack of sanitation for menstrual hygiene . Although her school has separate toilets for boys and girls, there is often no water… while there are still many schools with no separate toilets. “During my period, there was a lot of blood,” explained Rina. “I used to face a lot of problems to keep clean.” (Source:UNICEF, 2010) Poor Sanitation due to Poverty Parents do not give complete information about SRH to their children because it is considered taboo to talk about sex related issues.

9. Poverty: Low literacy • Poor access to information • Poorly informed about prevention of sexual and reproductive health and infections • Poorly informed about SRH rights, entitlements and services • Are unable to timely access SRH services due to lack of means and mobility. • Low Literacy leads to Low Awareness and Poor Access to Health Services because women and girls are not socially conditioned to communicate their most intimate needs.

10. Low literacy leads to poor SRH Low Literacy Lead to poor SRH

11. Awareness of contraceptive methods limited among both the married and the unmarried • Contraceptive awareness universal but in-depth awareness limited • 25% of young men and 35% of young women know how frequently oral pills are taken • 30% of young women and 78% of young men know that one male condom can be used just once • Awareness limited among the married and unmarried adolescents • Source:

12. Poverty and Poor access to health services • Poor women and girls are unable to access SRH services because they cannot afford… • Cost of transport to reach health facility • Loss of daily wages • Out of pocket medical expenses • Unaffordable private health care services

13. Sexual activity is initiated early: early marriage persists • Early marriage continues among young women: one in 5 married before 15 and half married before age 18 • In comparison, lower number of young men are transitioned to marriage in adolescence; and one quarter before the legal minimum age (21) • Socio-economic reasons – dowry system Source:

14. Early marriage prevails due to social pressure Early sexual activities make them more prone to Reproductive and sexual health infections Women undergo frequent pregnancies due to son preference Poverty: Socio-economic Reasons • Realities: • Developing body of an adolescent girl is viewed as social liability (In rural areas, till a man’s daughter is married off, his honour is at stake –Religious Leader, Alwar, Rajasthan, India) • Younger daughters are married along with the older sister to save cost of marriage (I got my three daughters married; ages 15, 10 and 7, because they were maturing and it would save me money – Father, Tonk, Rajasthan, India) • Older the groom, younger the bride, lower the dowry • source: Population Council

15. Role of Early Marriage in a girl’s life Unprotected sex, RTI/STDs, Unsafe abortions

16. Young girls are forced into sex work Unsafe sex High prevalence of RTI/STDs including HIV/AIDS Unintended pregnancy leading to abortion Unsafe abortion leading to infection Death Rampant child sex abuse where boys are forced into sex work through trafficking Unsafe sex High prevalence of STDs including HIV/AIDS Poverty and high risk behaviour

17. Focussing on poverty alleviation is critical to addressing SRHR goals in India Inclusion of out of school adolescents, especially girls in school health programmes Give priority to preventive and promotive health Need for Life Skill development programmes and education initiatives, especially those on sexual and reproductive health aim at equipping young people with knowledge, self-esteem and confidence. Increase investments in health education and awareness; strategic implementation of IEC (Inform, Educate and Communicate) initiatives Recommended Civil Society Responses

18. Thank you Ms. InduCapoor Founder Director, CHETNA Centre for Health, Education, Training and Nutrition Awareness B Block, 3rd Floor, SUPATH-2, Near Vadaj Bus Terminus, Vadaj, Ashram Road, Ahmedabad-380 013 Gujarat, India Phone: +91-79-27559976, 77, Fax: +91-79-27559978 E-mail : chetna456@vsnl.net / chetna456@gmail.com Website: www.chetnaindia.org