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Story and Perspective

Sashakt: Empowerment – and strength – for marginalized adolescents to take control of their reproductive health

Marta Pirzadeh, Yordanos Molla

In Hindi, the meaning of Sashakt is “Empowerment,” and it connotes strength. That’s exactly what Pathfinder’s Sashakt program did: empowered adolescents by giving them the strength to access sexual and reproductive health care.

Sashakt worked with more than 8,000 Mahadalit adolescents in Bihar State of India since 2015, addressing the numerous challenges they face to accessing sexual and reproductive health care. Mahadalits are the lowest ranking subset of the Dalit Scheduled Caste. They often live far from health facilities, lack financial resources, and face stigma from providers and social discrimination more broadly.

In Bihar, more than 40% of women marry before they turn 18, and 37% of those begin childbearing by 19. Mahadalits and other adolescents from scheduled castes are more than twice as likely to have a child by 19.

What is a scheduled caste?

Formerly referred to as “untouchables,” now officially designated as Scheduled Castes in the constitution of modern India. Many Scheduled Caste groups prefer the name Dalit, which literally translates to “Crushed” or “Oppressed.”

The Sashakt program worked in three districts of Bihar (Purnea, Katihar, and Araria) to address some of these barriers, building on learnings from the success of its program Promoting Change in Reproductive Behavior of Adolescents (PRACHAR).

Over three rounds between 2015 and 2020, Sashakt gave unmarried adolescents sexual and reproductive health and life skills trainings, and followed up with peer-educator-led monthly group meetings to extend their knowledge and impacts, while married adolescents were trained on healthy timing and spacing of childbirth in addition to receiving home visits by community health workers, or ASHAs.

Transformative Work

Uttam Kumari, a 19-year-old peer educator, felt it transformed her life. Kumari first attended Sashakt trainings as a participant and was later chosen to be a peer educator. “Now I feel well informed and the community respects me,” she says. “Sashakt has not only provided me opportunities to learn but also helped me become who I am today.” Growing up in the isolated community of Katihar, Kumari worked as a Sashakt peer educator to spread awareness about menstrual hygiene, adolescent sexual and reproductive health, and combating early marriages in her community. Through her discussions with other adolescents at school and monthly meetings, Kumari took up the fight against taboos, sociocultural restrictions, and the myths and misconceptions associated with menstruation right to the heart of the community.

Sashakt adopted parts of Pathfinder’s larger state-of-the-art youth-friendly services approach. Pathfinder developed Sashakt through adaptations to the approach it used with PRACHAR.  The PRACHAR approach, which was implemented for 10 years, resulted in young women being nearly four times more likely to utilize contraception—demonstrating that community-based interventions result in lasting improved sexual and reproductive health outcomes.

Pathfinder’s Sashakt program adapted PRACHAR’s community-based approach  but found unique barriers within the Mahadalit community. These challenges included:

  • A high level of male migration.
  • A lack of motivation and discriminatory attitudes among frontline health workers toward the Mahadalit population.
  • Continued stigma around discussing sexual and reproductive health topics with Mahadalit women, leading to poor interaction in sessions.

Over the course of the program, Pathfinder learned how to better serve the community and continuously  tailored program approaches  to the local context of Mahadalit adolescents. Given widespread labor migration, for example, Pathfinder began to adhere to the migration calendar―a tool developed to monitor the migration of families―and adjusted the timing of activities, such as home visits and community meetings. Pathfinder also conducted intensive mobilization to recruit boys for trainings.

Youth-Friendly Service Delivery at Pathfinder

Pathfinder has piloted innovative approaches to youth-friendly service delivery across its global programs. This includes Pathfinder’s popular curriculum for training service providers on how to administer youth-friendly reproductive health care. Pathfinder’s manual provides up-to-date technical content in line with globally agreed upon standards of care, taking participants through an array of interactive activities.

View the interactive manual.

What We Learned

Pathfinder learnings under the program may be useful to other organizations serving Mahadalits.

  • In the future, digital solutions will be key to engaging boys in sexual and reproductive health programs for adolescent Mahadalits, as the majority of boys have access to mobile phones.
  • Significant groundwork must be laid to cultivate understanding and acceptance of Mahadalits among health workers. Though frontline health workers’ attitudes shifted and became more positive throughout the program, many continued to hold discriminatory attitudes towards Mahadalits, attributing to the population “obstinance” and “unwillingness to listen,” and creating challenges to the program’s success.
  • Sashakt found that intensifying the training for peer educators in interactive activities, as well as hiring more experienced peer educators, leads to better program outcomes.

The Sashakt program reached thousands of Mahadalit adolescents, empowering them to take charge of reproductive health decisions for themselves. Today, Uttam Kumari continues her critical work. She now works as a master resource person under JEEVIKA, an initiative of the government of Bihar that works to develop rural livelihoods, and she is beacon of hope for other girls in her village. Because of her start with Sashakt, Kumari today is continuing to disseminate knowledge to change long-standing barriers for these adolescents in her community.

Read the full learning brief, Reaching the Most Marginalized Adolescents: Lessons from a Sexual and Reproductive Health Project for Mahadalit Youth.

Read the brief, Strengthening Adolescent and Youth Sexual and Reproductive Health; an experience with Mahadalit Community in Bihar, India.

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