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ARSH (Adolescent Reproductive and Sexual Health)
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Adolescents Reproductive & Sexual Health (ARSH) has been identified as one of key strategies under RCH-II. Adolescents (10–19 years) constitute about one-fifth of India’s population and young people (10–24 years) about one-third of the population. However adolescents, especially those in marginalised and under-served sections of the population, face several challenges such as: structural poverty, social discrimination or negative social norms inadequate education, early marriage, teenage pregnancy. Investments in adolescents will have a positive impact on India’s health goals as well as achievement of Millennium Development Goals.
Interventions
Mamta Taruni Abhiyan
This is a community level intervention to cater the need of adolescents girls in the age group of 10 to 19 years in rural areas. This is Government of Uttarakhand initiative and an important outreach service for adolescents.
Why Mamta Taruni Abhiyan
There has been successful implementation of school health program which caters the need of school going adolescent. Maternal Health component of RCH-II covers most of the married adolescent and their needs for reproductive and sexual health and nutrition. The only group remains uncovered is out of school unmarried adolescents.
Various studies and data both from central and state level shows the poor nutrition status of out of school adolescents boys and girls, early marriages and early pregnancies, unsafe abortions and unwanted pregnancies in this group, prone to sexual abuse and violence, high risk to RTI/STI including HIV/AIDS. This all in turn leads to various mental health problems.
This is a group which has less access the health care facilities , so a community based intervention has been implemented under the umbrella of RCH-II ARSH strategy to provide health care out of school unmarried adolescent girls.
Activities
- Village Wise Enlisting of Out of School Unmarried Adolescent Girls: All adolescents' girls within the age group of 10-19 are to be registered in the defined population. Registration has to be done jointly by the AWW and ASHA. The register will be maintained at AWC. Updating of register will be done during the month of January every year.
- Services at Mamta Taruni Session: Weighing once in every quarter , Monthly IFA, nutrition supplement to all the girls who has less BMI than expected. TT vaccination at the age of 10 and 16 years, counseling for menstrual disorders, personal/menstrual hygiene, RTI/STI screening and awareness about contraceptives to be provided on the Mamta Taruni Session.
- Identification of MamtaTaruni Peer Educators: Girls with leadership qualities are trained in growth monitoring, nutrition awareness, micro nutrient supplementation, personal hygiene and basic health issues. These peer educators will then play an important role in educating and bringing adolescent girls to the Mamta Taruni Sessions and to health care facilities for treatment if needed.
Adolescent Friendly Health clinics
Adolescent Reproductive and Sexual Health strategy provides a framework for a range of sexual and reproductive health services to be provided to the adolescents. The strategy incorporates a core package of services including preventive, promotive, curative and counseling services. Effective implementation of policies and programmes has progressed from the past few years and has lead to strengthening of Adolescent Friendly clinics and subsequently the outreach programmes. There are 191 AFHS Clinics in PHC, UHC CHC , SDH and DHs . Every week, Monday for Girls and Tuesday for Boys from 2-5 p.m.) clinics are run by Medical officers and it is one point center for getting information, avail counseling and receive clinical services to adolescent girls and boys.
Service package in AFHC
Objectives
To contribute to the RCH II goals of reduction of IMR, MMR and TFR by
- Reducing teenage pregnancies,
- Meeting unmet contraceptive needs.
- Reducing number of teenage maternal deaths.
- Reducing incidence of STIs and RTIs.
- Reducing proportion of HIV positive among this age group.
Services
- Promotive Services
- Focused care during antenatal period.
- Counseling and provision for emergency contraceptive pills.
- Counseling and provision of reversible contraceptives.
- Information /advice on SRH issues.
- Preventive Services
- Services for tetanus immunization.
- Services for prophylaxis against nutritional anaemia.
- Nutrition counseling.
- Services for early and safe termination of pregnancy and management of post abortion complication.
- Curative Services
- Treatment for common RTI/STIs.
- Treatment and counseling for menstrual disorders.
- Treatment and counseling for sexual concerns of male and female adolescents.
- Management of sexual abuse among girls.
- Referral Services
- Voluntary Counseling and Testing Centre.
- Prevention of parent to Child Transmission
- Outreach Services
- Periodic health check- ups and community camps.
- Periodic health education activities.
- Co- curricular activities.
Scheme for Promotion of Menstrual Hygiene
The Ministry of Health and Family Welfare has introduced a scheme for promotion of menstrual hygiene among adolescent girls in the age group of 10-19 year in rural areas. The pilot is being implemented in 152 districts across 20 States in the country. Adolescent girls (10-19 yrs) in 4 districts are being reached with NRHM brand of sanitary napkins – Free days- pack of 6 napkins @ 6. ASHA sells the packs to girls and gets One Rupee per pack incentive.
Objective
- Increase awareness among rural adolescent girls of menstrual hygiene
- Increase access to & use of sanitary napkins by rural adolescent girls
- Ensure safe disposal of sanitary napkins in an environmentally friendly manner.
The scheme adopts 2 key
Strategies
- Demand generation through ASHA/Anganwadi
- Workers and community mechanisms.
- Supply side intervention through ensuring a supply of a product(sanitary napkin) which is reasonably priced and of high quality.
Weekly Iron Folic Acid Supplementation programme(WIFS)
Adolescent Anemia is a long standing public health problem in India which is caused by Iron deficiency. Adolescents are at high risk of Iron deficiency due to accelerated growth and body mass building, poor dietary intake of iron and high rate of worm infestation. In girls deficiency of iron is further aggravated with higher demands with onset of menstruation and also due to the problem of adolescent pregnancy and conception. Guided by the empirical evidence that weekly supplementation of 100mg elemental Iron and 500ug Folic Acid (IFA) is effective in decreasing incidence and prevalence of anemia in adolescents.
MOHFW has launched the Weekly Iron and Folic Acid Supplementation (WIFS) Programme for school going adolescent girls and boys and for out of school adolescent girls. The Programme envisages administration of supervised weekly IFA Supplementation and biannual deworming tablets to approximately 13 crore rural and urban adolescents through the platform of Govt/Govt. aided and municipal school and Anganwadi Kendra and combat the intergenerational cycle of anaemia.
Objective
"To reduce prevalence and severity of anemia in school going children of 6th to 12th standard and non school going adolescent girls in AWC”
Target groups
Weekly Iron and Folic Acid supplementation programme implemented for the following two target groups in both rural and urban areas
- Adolescent girls and boys enrolled in government/government aided/municipal schools from 6th to 12th classes.
- Non school going Adolescent Girls.
The WIFS programme also cover married adolescent girls. Pregnant and lactating adolescent girls will be given IFA supplements, according to current guidelines for antenatal and postnatal care through the existing health system of NRHM.
Strategies
- Administration of Weekly Iron and Folic Acid Supplementation (WIFS). Each IFA tablet
containing 100mg elemental iron and 500μg folic acid for 52 weeks in a year.
- Screening of target groups for moderate/severe anemia and referring these cases to an appropriate health facility.
- Biannual de-worming (Albendazole 400mg), six months apart, for control of worminfestation.
- Information and counseling for improving dietary intake and for taking actions for prevention of intestinal worm infestation.
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