Action Research & Training for Health (ARTH)

How adolescents deal with menses in rural Rajasthan: more than just hygiene products We were curious to explore how adolescent girls in rural Rajasthan manage menstruation. Once they enter schools and colleges, there's an unspoken assumption that they know how to handle their periods. But what does that experience look like for them? Are schools truly equipped to support their needs? In our conversation, the girls expressed feelings of anxiety and uncertainty when their periods began, often without adequate guidance. Many described challenges such as insufficient disposal options and a lack of privacy in school restrooms. Read more about their experiences in our recent article: https://lnkd.in/dBzTFXya

World Breastfeeding Week (1-8 Aug 2024): What makes exclusive breastfeeding so difficult? Exclusive breastfeeding from birth till 6 months is recommended for optimal nutrition and health of the infant . An added benefit to the mother is lactational amenorrhea ( which has a contraceptive effect that does not require the woman to use any device or incur additional cost. The lactation amenorrhea method (LAM) is categorized as a modern method of contraception, and is effective till 6 months after delivery, provided two conditions are fulfilled – the woman’s periods have not resumed and she exclusively breastfeeds her infant. However, the reality at least in in rural-tribal southern Rajasthan appears to be very different. For a survey conducted during 2019-21, we contacted 804 women 12-23 months after their last delivery. We found that the proportion of women exclusively breastfeeding their infants reduced over the months, from 96% right after delivery to only 5%, 6 months later. We also found that 53.4% of women’s periods had resumed within 6 months after delivery. Thus, LAM as a contraceptive method would not be effective for the majority of women. So the question is, why is exclusive breastfeeding so brief and limited in this area? In rural-tribal southern Rajasthan, women unfortunately cannot stay at home for long. after delivery -- they need to collect firewood, fetch water, and manage several other household chores. Many eventually venture out for wage-labour, to bring additional income to the household. Such a situation requires grandparents to take care of the infant left behind at home; they feed them liquid items like water and raab (boiled corn and buttermilk gruel), etc. This results in a break in exclusive breastfeeding, which also compromises nutritional intake of the infant. This also means that the woman’s periods will resume sooner, and that makes her vulnerable to another pregnancy. We were under the assumption that in a low-resource setting, LAM would be a convenient and easily acceptable option for postpartum contraception. However, the data tells a different story. This year, let us look at the issue of failure to exclusively breastfeed from the woman’s point of view – after all, the dual burden of child care and preventing pregnancy falls mostly on her shoulders. In what way could we ensure a supportive environment which eventually would lead to good health for both mother and child? #breastfeeding #postpartum #mnch #contraception #breastfeedingweek

In a time of demographic transition, we need to look out for older persons According to NFHS-5 (2019-21), India’s total fertility rate (TFR) has declined to 2, a significant reduction from 2.7 in 2005 (NFHS-3) and 2.2 in 2015 (NFHS-4), with the annual population growth rate having dropped to 0.62% in 2021 (WHO). This is evidenced by families becoming smaller, with those of the current generation having fewer siblings than their parents. Additionally, with improvements in the socioeconomic status of people and increased access to health care over the years, people are living longer – life expectancy was 67 years in 2014, in comparison to 62 years in 2000. What all this means is that a demographic shift is taking place – with lesser children being born and people living longer, the proportion of older persons is increasing. Currently, the share of older persons is around 8% of the country’s population. It is estimated that by 2050, this will increase to around 19.5% of India’s population (World Population Projections). We therefore need to ask the critical question – are current societal systems capable of handling this shift? On World Population Day, let us take a moment and think about older persons, not just in our families but also in the larger community. Are they healthy? Do they have family support? Or are they isolated, left to fend for themselves? With an ageing population, the number of working people will reduce along with an increasing burden on social assistance and pensions. Is our country equipped to handle an increased dependency ratio? It all comes to down to the part we play - this isn’t just the government’s responsibility, it is ours too. And yet, there is no denying the fact that India needs the right policies and investments to ensure that basic needs of older persons are met, at a time when they become progressively vulnerable. We need to evolve solutions which ensure that people remain healthy as they age, and have the required family and community support. This will require a range of interventions at the level of families, neighbourhoods, villages, towns and cities. This will be possible only if a community spirit runs through us all. To know more about what ARTH is doing on this issue, please click the link below: https://lnkd.in/dg3Hy_kQ #healthyaging #communityhealth #ageing

Yoga Week with older persons We are all aware of the important role that physical activity plays, in the maintenance and improvement of physical and mental health. This is especially true of older persons, for any form of exercise can help to maintain their strength and mobility as they age. On the occasion of International Yoga Day this year (21 June 2024) ARTH has been conducting Yoga Week (17-22 June, 2024) sessions in 110 villages of Udaipur and Rajsamand districts in southern Rajasthan. This is being done through the ‘Prabal Yatra Manch’ – a village based platform of older persons who meet and support each other in living and remaining healthy. The aim of Yoga Week is to encourage older persons to add yoga and exercise to their daily routine. On each dayof the week, our field team has visited villages to conduct 1 hour sessions involving older men and women. Each such session includes demonstration and practice of a set of easy-to-perform yogasanas in the presence of a few invited guests including panchayat representatives and government officials. The aim is to gently motivate them to start practising yoga on a regular basis . We realize that changing lifestyle in the latter decades of life is indeed a challenging task, and yet hope that the draw of Yoga Day will provide some of the needed impetus... #health #elderlyhealth #healthyageing #yoga #internationalyogaday

Over 70 years after independence, specialized midwifery training commenced in 2018 at National Midwifery Training Institutes (NMTIs) in India (Midwifery Services in India report, NHM). Were there no midwives up to that point? Indian women had since centuries been served by traditional midwives (dais) and relatives, and more recently by doctors and nurses. Nurses in India actually are trained as nurse-midwives, although the midwifery component of their pre-service course tends to be shorter and less intense. Two decades ago, we witnessed large scale in-service training of nurse-midwives as Skilled Birth Attendants (SBAs), in a bid to rapidly reduce maternal-perinatal mortality. While maternal and perinatal mortality did progressively decline, the concurrent, irrational increase in proportion of caesarean deliveries (to as much as 54.1% in Telangana and similar states) evoked concern about the over-medicalization of childbirth. This catalysed a move towards midwifery care. Yet in a large country that needs at least a couple of million midwives, will the recently introduced NMTI training scale up to meet national needs within the foreseeable future? More importantly, will the trained midwives be licensed and professionally empowered to provide independent care in an environment that has historically privileged doctors with clinical decision-making roles, including during pregnancy and delivery? In working for over 27 years to improve maternal-newborn health services in rural-tribal southern Rajasthan, we retrained existing nurse-midwives to provide rational and empathetic care. Our experience encourages us to visualize a Basic Midwifery Model that could complement current approaches to humanize safe childbirth nationally. To know more, go to: https://lnkd.in/d-aNXCCJ #midwifery #nursemidwives #health #primarycare

India's fifth National Family Health Survey (2019-21) confirms progressive increase in the use of reversible contraceptive options, including hormonal pills, injections and intra-uterine devices. Over time, many of these are known to trigger menstrual changes. Research shows that contraceptive-induced menstrual changes (CIMCs) affect user satisfaction and influence decisions to continue or switch methods. So how do women perceive and deal with these changes? Do they prefer maintaining a monthly menstrual cycle or do they find scanty or no menses to be a welcome break from the bother of monthly bleeding? Read about this in our recent blog published in Sexual and Reproductive Health Matters https://lnkd.in/dnXxSf2s

Is the emergency contraceptive pill meant only for emergencies? India’s 5th National Family Health Survey reported high awareness of emergency contraception among women of reproductive age group, yet the utilization of emergency contraceptive pills over a one-year period by married women was extremely low at 0.4%. This discrepancy appears intriguing, particularly when market surveys suggest large sales of emergency pills in the country, estimated at over 30 million doses per annum. Is the 'emergency' label contributing to stigma and hence hesitancy among those in stable partnerships? Except for cases involving sexual assault or rape, sexual encounters occurring within casual or stable relationships are largely consensual. The spontaneous nature of sexual intimacy means that it is most often not planned or scheduled, hence the corollary use of a contraceptive also might remain unplanned. In instances where contraception is not already being used, the term "emergency" creates stigma around sexual encounters and for those involved, especially the woman. Furthermore, couples experiencing infrequent sexual activity, such as older couples or those with a migrant partner, might not perceive the need for continuous contraception. A single-dose pill could meet their need, as and when required. To delve deeper into the issue of emergency contraception in the current era, Action Research and Training for Health (ARTH) in collaboration with Population Foundation of India (PFI) organized a webinar on "Repositioning Emergency Contraception in India" on 8 December 2023. We looked at issues such as availability, efficacy, safety, and acceptability of self-use options for levonorgestrel emergency contraceptive pills, and explored the potential for expanding access and use for those having consensual encounters or infrequent sex. Speakers included experts from the fields of health research, law, clinical medicine, sales & marketing, and communication1. The key takeaways were: 1. Levonorgestrel emergency contraceptive pills being safe for repeat use, provide a viable option for couples with infrequent sexual activity. 2. One approach to reduce stigma around emergency contraception is through rebranding and promoting this option in a way that reduces stigma. The innovation of renaming it as "Turant Goli" in rural Rajasthan serves as an example of such rebranding. 3. We need more research to understand user experiences with emergency contraception in the Indian context. You can access the summary report of the webinar here: https://lnkd.in/dYuCzRf5 1 Dr Shrinivas Darak (Senior Research Fellow, Prayas), Ms Anubha Rastogi (Independent lawyer, Mumbai), Dr Mario Festin (Professor of Obstetrics & Gynecology, College of Medicine, University of the Philippines), Mr Vivek Malhotra (Chief Executive Officer, Population Health Services India), Ms Vithika Yadav (Founder, Love Matters India and TeenBook)

Action Research and Training for Health in collaboration with Population Foundation of India is organising a webinar on "Repositioning Emergency Contraception in India" on 8th December 2023 from 3:00pm to 5:00pm (IST). We request you to block your valuable time to participate in this webinar. The webinar will include eminent speakers like: 1. Dr. Shrinivas Darak, Prayas 2. Ms. Anubha Rastogi 3. Dr. Mario Festin, Professor (Obstetrics & Gynecology), College of Medicine, University of the Philippines 4. Mr. Vivek Malhotra, Population Health Services India 5. Ms. Vithika Yadav, DevCons. The discussions will be moderated by Dr. Suneeta Mittal, Director (O&G), Fortis Hospital, Delhi, Mr. Anand Sinha, David and Lucile Packard Foundation, Ms. Poonam Muttreja, Population Foundation of India and Dr. Sharad Iyengar, ARTH. You can join the webinar using the link: https://lnkd.in/dAYh4te9 #reproductivehealth #contraception #emergencycontraception

Prabal Yatra - a community-based intervention to promote healthy ageing in southern Rajasthan According to population projections, the global population of older persons will double to 1.5 billion by 2050; in India it will increase from 8.6% to 19.5% of the population. With rapid reduction in fertility and increase in life expectancy, the proportion of older persons in the population will increase, leading to a change in the dependency ratio. Systems need to be in place to ensure that older persons remain healthy, have access to health care as needed and go through life’s journey with zest and comfort. In rural-tribal areas of southern Rajasthan, awareness and access to health care for older persons is limited. ARTH has worked on health of older persons in the region since 2018, providing access to care for chronic illness via monthly health camps, referral to higher institutions and home care by field staff. Our experience reveals a lack of self-care and a dominant societal narrative that as people become older, they are expected to progressively decline and fight a losing battle with life. Meanwhile, the current focus of health systems is on facility-based geriatric care, with less attention to prevention, rehabilitation or community care. We felt the need to introduce a positive narrative to ensure that older persons enjoy a safe, healthy and dignified life. On 1 Oct 2023 (International Day of Older Persons) ARTH launched ‘Prabal Yatra’ – a community based approach to enable healthy ageing among older persons in southern Rajasthan. The intervention is meant to facilitate timely access to health care as and when needed. The objectives of this intervention are: 1. To maintain/enhance functional capacities of older persons living in towns and villages of 8 blocks of southern Rajasthan 2. To develop and pilot a community-based model for enabling healthy ageing, elements of which could be replicated in similar parts of the country Six internal capacities are key to ensuring healthy ageing – mobility, nutrition, vision, mood/social connect, hearing and cognition. In the launch phase of our intervention we will work only on the first four domains. All activities under this programme will be undertaken through the 'Prabal Yatra Manch' – a village based platform where all older persons of the village can connect with each other and with ARTH or any similar agency that wishes to invest in improving their lives/health. Prabal Yatra has started in 104 villages with a total population of around 2 lakhs, that includes and estimated 14,000 older persons. We plan to establish the intervention in these villages before expanding further. We also connected with political representatives and government officials in the area and received an enthusiastic response, stating that this intervention has begun at just the right time. #healthyageing #health #communityinitiative