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Working with Adolescents and Young People is a particularly challenging task the world over. By definition, the term covers a wide population subgroup of those between 10-24 years of age and in countries like India, such a group comprises about a third of the total population. Even in communities within limited geographical boundaries, there is remarkable diversity in the situations of Young People. The term subsumes school going young adolescents, newly married and first time parents (especially in the case of females), a numerically large cohort marking its entry into the workforce and a group subject to migration on account of marriage and work. The Child In Need Institute (CINI), a leading non governmental organisation (NGO) in India, has been a pioneer in its work with Young People. This brief traces the evolution of CINI’s work with Young People, locating the developments in the organisational and socio-political contexts that have shaped them.
Child In Need Institute is a large, broad based NGO with its headquarters near Kolkata in West Bengal state of India. The organisation presents an interesting Journey in Public Health from a curative setup to a preventive, promotive and facilitative approach in issues related to community health and nutrition.
Adolescents as the “missing link” The community-based approach of CINI for working with mothers and other care givers to prevent child malnutrition and morbidity was useful to a large extent in early years of its journey in community health and nutrition development initiatives. However, it became increasingly clear that young parents are all too often disadvantaged themselves. Early marriage and parenthood prematurely thrust adult responsibilities on ill equipped shoulders. In the disadvantaged rural and urban communities that CINI works, adolescents are grossly ignorant of issues that have a direct bearing on their health and well being. Boys and girls grow up with myths and misconceptions related to growing up. The culture of silence on issues like menstruation, masturbation and nightfall has spawned a veritable subculture fed on fantasies and half truths.
It became imperative that work with adolescents be carried out both as a means to an end as well as an end in itself. Adolescents constitute the “missing link” in the reproductive and child health programmes. Early on its experience, CINI realised that critical indicators in birth weight, malnutrition, maternal morbidity and mortality, sexually transmitted infections (STI) and HIV and AIDS are inextricably linked with poor pre-pregnancy body mass index and anaemia, teenage pregnancy, poor decision making ability, sexual abuse and exploitation, low levels of awareness on reproductive and sexual health issues, risk behaviour and lack of access to services. Working with adolescents and young people is crucial in order to impact upon such critical indicators through programmes.
The Life Cycle Approach (LCA) of CINI stems from such organisational experience. The approach is a CINI innovation that targets three critical stages of life to secure intergenerational and longstanding gains in health and nutritional outcomes in a population the three critical stages are: pregnancy, early childhood (0-2 years) and adolescence. The approach encompasses a holistic package of interventions aimed at securing maternal, child and adolescent health. A cohort of women in an identified community is tracked through pregnancy and till the child is two years of age to ensure appropriate pregnancy and childhood care. Knowledge enhancement on RSH issues of the adolescents in the community is undertaken and their skills developed on issues like negotiation, critical thinking and decision making.
The earliest interventions of CINI with adolescents were carried out in the ‘camp’ mode. Camps were frequently organised in numerous communities where CINI worked. Boys and girls attended these camps and were taught about reproductive systems, pubertal changes and menstrual and penile hygiene. Health fairs and other community based events disseminated health messages in community settings. The camps were necessarily scattered, reaching out to populations in different geographical locations.
By the turn of the century, there was internal consolidation of diverse activities that CINI undertakes. Thematic divisions came into being, representing the broad areas of work like women’s health, child health, HIV/AIDS, etc. CINI Adolescent Resource Centre (ARC) was formed dedicated to working on Adolescent and Young People’s issues. Apart from being a reflection of diverse adolescent related activities that CINI undertakes, the setting up of the Centre was also in part a response to the increasing national and international policy attention on young people as a group to work with. CINI ARC is the first resource centre of its kind in eastern India. Three objectives guided its formation:
1] To increase knowledge and understanding of Young People’s Reproductive and Sexual Health [YRSH] issues that will contribute to future programming and in advocacy
2] To develop innovative youth-friendly programme models to address specific issues on YRSH in the lifecycle framework
3] Networking, partnership and capacity building of other agencies to develop, promote, and scale up models on priority issues linked to YRSH