A group of adolescent men, uniformly clad in jeans and t-shirts or short sleeved shirts with fashionable hairstyles, close cropped or pompadour fade, sit cross-legged on an orange tarp in rural India. Despite the room being hot and close, thick air barely broken by a single fan spinning lazily overhead, the young men listen attentively to a peer educator discuss menstrual hygiene, early marriage and pregnancy.
A peer educator shows an image of a clay pot, fired and strong. He then flips the page to show a broken pot and spilled water, noting that this pot has not been fired, is weak, and easily broken. He uses this image to make the case that girls should not become pregnant too early, before they are strong and healthy enough to withstand the pressures of pregnancy.
The peer educator then talks about the importance of letting corn fully ripen and mature before it is harvested, an image well understood by this farming community.
I sit with the Pathfinder India team and members of the community, including two Accredited Social Health Activities in bright pink saris, on the edge of the room. Though participants occasionally sneak a curious glance at us, they are thoroughly engaged.
Sashakt: reaching the most marginalized
The peer educators are part of a Pathfinder program called Sashakt. Sashakt means “empowerment” in Hindi. Sashakt aims to improve the sexual and reproductive health knowledge and behaviors of Mahadalits, aged 15-19, in three districts of Bihar State. Mahadalits are the most socially and economically vulnerable of India’s Scheduled Castes.
Sashakt has trained 300 young men and women as peer educators. In the last nine months, these dynamic young people have reached nearly 8,000 young Mahadalits with new ideas and information on a range of reproductive health topics.
Most Mahadalit girls marry by age 15 and boys by age 18. Mahadalits are often barely literate and frequently face exclusion and social discrimination. Living in hamlets on the edge of higher caste communities, Mahadalits tend to live far from health facilities. They are often looked down upon by health outreach workers, which limits their access to health care, including contraceptive and other reproductive health services. Because of challenges in reaching them, young Mahadalits may be overlooked by more mainstream efforts to improve young people’s access to information and services.
Sashakt is leveraging multiple government health care schemes to improve the health of Mahadalits.
Enthusiasm eclipsing critics
Young Mahadalits express enthusiasm for what they are learning through Sashakt. They share what they learn withtheir friends, parents, and families. One young woman said that she told her sister-in-law what she had learned about contraception nand her sister-in-law has since started to use injectables after the birth of her third child.
Young Mahadalits remain enthusiastic about Sashakt despite criticism from community members. Young men reported that some community members expressed doubt of the value of their efforts since they are volunteering without pay. Female peer educators said that older women tell them they should be ashamed to be learning “dirty things.”
Despite criticism, participants remain adamant about the value of what they are learning through the program—things about their bodies and their health that they don’t learn in school. They said they appreciated that they can now talk openly about their desire to delay marriage and use contraception to manage childbearing.
Evidence for national scale
The Government of India continues to roll out its national Rashtriya Kishor Swasthya Karyakram (RKSK) program, which aims to improve adolescent health, using peer education as a key strategy to reach adolescents at community level. Pathfinder is working closely with the Government of India to share the Sashakt experience reaching Mahadalits, particularly the process and results of recruiting, training, supervising, and supporting peer educators. Sashakt is generating important evidence for the RKSK program about how to reach the most marginalized communities of youth that can applied to improve and scale up adolescent health interventions across the country.