MLMC Meri Life Meri Choice: Baseline Assessment

1. Synopsis of the baseline assessment
draft report
done by
MLMC
9 Mar 2012

2. Background
Adolescent girls: several vulnerabilities persist
and transitions to adulthood are too
frequently marked by abrupt and premature
exit from school, entry into the labour force,
early marriage and strongly held gender
norms

3. … and rationale
“Not a single intervention has focused on HIV
vulnerability of adolescent girls, and few have
addressed the multiple facets of girls' life.
Unfortunately, while many existing interventions
claim success, their experiences and lessons are
poorly documented and most have not been
rigorously evaluated. Hence, while promising, it is
difficult to establish the effectiveness of these
models and the extent to which they can be
effectively replicated and up-scaled.”

4. Objectives
• The extent to which adolescent girls and boys were
endowed with protective assets which will prevent
conditions that are precursors of HIV;
• Practices and behaviours of adolescent girls and boys that
directly aggravate or reduce their vulnerability to HIV;
• The perspectives of adolescent girls and boys about the
need for programmes to reduce the vulnerability of
adolescent girls to HIV; and
• The perspectives of parents and other critical adults in the
community on the challenges facing girls and the feasibility
and usefulness of programmes to reduce the vulnerability
of adolescent girls to HIV

5. Study design
A pre-post evaluation study, using primarily
qualitative methods, undertaken in the
intervention blocks only, prior to the
implementation of the MLMC project
(baseline) and at its conclusion (endline) is
used.

6. Comparison 1
PC: "vulnerable" girls, defined as those who are
from “families below poverty line, scheduled
castes, scheduled tribes, etc.
MAMTA: We have a exhaustive list of factors
including those for HIV.

7. Comparison 2
PC: Would like us to have a “clean sweep”
method of vulnerability mapping and
intervention
MAMTA: We are following a “cluster” method of
vulnerability mapping and intervention

8. Comparison 3
PC: Adolescent girl groups are aged 10-12, 13-14
and 15-19 ,
MAMTA: We are following the project proposal
of 10-14 and 15-19

9. Participants
• Vulnerable adolescent girls
• Brothers of vulnerable adolescent girls
• Husbands of vulnerable adolescent girls
• Parents and/or in-laws of vulnerable
adolescent girls
• Critical adults in the community

10. Components
1. Drawing exercise and focus group discussions
with adolescent girls and boys 10-12
2. Focus group discussions and community
mapping exercises with adolescent girls aged 13-
14 and married and unmarried 15-19, and
brothers/husband of adolescent girls
3. Survey of FGD participants aged 13-14 years and
15-19 years, using a structured questionnaire
4. Focus group discussions with parents/in-laws
5. Focus group discussions with critical adults in
the community

11. Profile of AD girls*
Four categories of assets:
1. social,
2. human,
3. physical, and
4. financial
*Asset building framework (Sebstad and Bruce, 2004; Bruce et al., 2011)

12. Assets of AD girls: Social
• Peer networks and interactions smaller for
girls
• Interactions, however, became less regular as
adolescents aged and were married
• membership in any organized group is non-
existent among adolescents
*Asset building framework (Sebstad and Bruce, 2004; Bruce et al., 2011)

13. Assets of AD girls: Human
Self-efficacy:
• Among younger adolescents, the majority of girls and
boys displayed self-efficacy
• Among girls, a larger number of unmarried girls than
married girls displayed self-efficacy
Decision-making autonomy:
• limited decision-making autonomy of all adolescents,
except the husbands of married adolescent girls
• a larger number of unmarried than married girls made
independent decisions

14. Assets of AD girls: Human
Freedom of movement :
• one out of 52 girls were allowed to visit the
selected locations unescorted, many more
boys were permitted to do so (19 out of 51)
• freedom of movement enjoyed by younger
adolescent boys was greater than that
enjoyed by older married and unmarried
adolescent girls

15. Assets of AD girls: Human
Gender role attitudes:
• All participants unanimously believed that while
girls are better in performing household chores
and home-based economic activities, boys are
better in performing economic activities outside
home
• Also believed that reversing the situation is not
impossible if girls and boys so desire
• Findings also show that among both girls and
boys, a larger number of the unmarried than the
married adhered to egalitarian gender
norms (As expected)

16. Awareness of SRH
Physical changes in adolescence:
• All participants in most FGDs, reported that they
were not informed about physical changes that
occur during adolescence (But the quotes show
quite a lot of understanding)
Sex and pregnancy:
• More limited among unmarried than married
girls
• No such differences were observed among
adolescent boys

17. Awareness of SRH
Contraceptives:
• A larger number of the unmarried than the married
were informed about contraceptives[?]
HIV and AIDS:
• Limited awareness among all categories of adolescents,
except unmarried adolescent boys
• One in four married and unmarried adolescent girls
and one in three married boys and two in three
unmarried boys reported that they knew about health
facilities where they could get an HIV test done[!]
• However, not a single participant had ever undergone
an HIV test.

18. Financial Assets
Access to money:
• Younger adolescents get money from parents and
from work, in school from scholarships
• Scholarships more often in MP than UP
Younger spent money on:
• Study materials was reported more often in the
case of boys than girls and personal grooming
items was reported more often in the case of girls
than boys
• Boys, spent on tobacco products and alcohol,
engaging in gambling and wooing girl-friends

19. Financial Assets
Older spent money on:
• Mobile phones was mentioned by both boys and girls;
• Various substances and purchasing household items
was also frequently mentioned
Younger Savings habits:
• With parents, piggy bank, safe place at home
• Some 13-14 yr olds save in a bank
Older Savings habits:
• Girls with parents, piggy bank, safe place at home
• More boys than girls tend to save in a bank.

20. Financial Assets
Savings A/c:
• Neither girls nor boys held a savings account in a
bank or post office.
• Many felt an account could be opened only for
those aged 15 or 18 years
• Reports Employment Guarantee Scheme, and a
school opening accounts for students
• More boys than girls have an account because:
– more boys tend to work than girls,
– boys are not as restricted as girls,
– parents favour sons over daughters

21. Livelihood opportunities
• Older than younger, the married than the unmarried,
and those out-of-school than those in-school were
engaged
• Opportunities for job placements are almost non-
existent for both adolescent girls and boys
• Girls are more disadvantaged than boys in making use
of existing schemes
• Vocational skills training are limited for both girls and
boys
• Girls reported training in traditional skills, while boys
reported training in traditional skills as well as modern
ones like computer training

22. Physical Assets
Safe spaces (outside school and home):
• Limited for both young and old girls
• Spaces mentioned were
– near the water tap or pond,
– fields to collect fodder or cut crops,
– the market,
– places of worship

23. Risk-taking and health seeking
behaviors and practices
Sexual experiences before and outside marriage:
• Some reported that sexual relationships are widespread, others
noted that only a few engage in such relationships
• Girls who engage in pre-marital sexual relationships typically have
sex with their boy-friends, or sex with extended family members
• Boys more with girl friends, also with adult women neighbors, and
sex workers
Condom use:
• Do not use condoms for:
– difficulties in accessing or lack of interest in using condoms,
– lack of awareness
– deliberate intentions to ruin the reputation of a female
• Do use condoms for fear of pregnancy and infections (~)

24. Risk-taking and health seeking
behaviors and practices
Multiple partners:
• Four unmarried boys and one married boy reported
multiple partnerships
• One unmarried girl and not a single married girl reported
having engaged in pre-marital and extra-marital sex
Substance use:
• Common among adolescents, especially among boys
• Boys 15-19 do take alcohol, drugs, and tobacco products
• Significant minorities of adolescent girls consume tobacco
• Facilities to address substance use are non-existent

25. Access to health services and
treatment-seeking practices
Access to information pertaining to HIV:
• Girls are less likely than boys to access information because
of restrictions on their mobility.
• Also, girls tend to have less time to seek such information,
and feel more embarrassed
• Boys find it difficult to obtain information that are not
tuned to meet the needs of boys
Access to condoms:
• For both boys and girls limited:
– Shops were not available in all the villages;
– Shopkeepers refused to sell condoms to boys;
– Boys felt shy to approach even medical shops;
– Lacked money to buy condoms tobacco

26. Access to health services and
treatment-seeking practices
Access to SRH treatment services:
• Both girls and boys did not like poor quality of
public sector facilities.
• Embarrassed to seek treatment for sexual health
• Lacked money
• Lacked information about sexual health
• Girls unable to go without parents escort
• A sizeable number of older adolescent girls and
boys who had experienced symptoms suggestive
of genital infections in the last 3 months did not
access SH services

27. Programs to reduce HIV vulnerability
Programme content:
• Modern skills such as computer training as well as
opportunities for sports and games
• Some stated that HIV content would ruin adolescents
Preferred location & time for intervention:
• Consensus on anganwadi centre, school, park and the
Panchayat house
• Sunday as everyone will be at home and none need
not go for work or studies (for PMM)
• Afternoon for girls because parents may not allow girls
in the evening, and morning or evening for boys

28. Programs to reduce HIV vulnerability
Joint or separate sessions for girls and boys:
• Most participants suggested that the
intervention activities should be organized
separately for girls and boys.
• Even young adolescents would like the
activities to be held separately
• Parents may not permit their daughters to
attend the sessions if they were held jointly
for girls and boys.

29. Mothers and fathers of adolescent
girls
Gender difference in Time use:
• A girl comprised school (if she was school going), housework, work on the
family farm or tending the family's livestock, and, in some cases, wage
work, accompanying their mother for agricultural labour.
• Boys also spent time in school, but had more leisure than girls, outside the
home with friends; older boys were also described as working in the
village, or nearby villages, and towns
On Educating:
• Both mothers and fathers valued schooling of girls and boys, many
recognised the obstacles for girls like:
– limited educational facilities in villages,
– schools did not go beyond Class 5 or Class 8,
– restrictions on girls' mobility,
– quality of public education was poor, and parents did not have the resources
to enrol children in private schools,

30. Mothers and fathers of adolescent
girls
Decision Making:
• Both mothers and fathers reiterated
– Limited decision making authority of girls,
– Greater decision-making role of boys.
– Girls do not have the right to take any decisions for themselves,
be it whether to work, how much education to have, or when
and whom to marry.
(BD: Parents seem to think that adolescent girls are less
involved in decisions than the adolescents themselves do)
Access to resources:
• Girls in particular had very limited access to money or to
save money
(BD: Again parents views more negative than the adolescents
themselves)

31. Mothers and fathers of adolescent
girls
Awareness on SRH and HIV:
• Mothers knew more about pregnancy than fathers
• Mothers maintained that while girls should not be informed about
sexual and reproductive health matters, it was necessary to inform
boys
• Girls and especially boys obtained this information on their own
and so no need for parents to provide information
• Favoured provision of SRH information but being unable to
communicate with their children would welcome the school or
outside experts
• Denied that adolescents engaged in pre-marital sex or were at risk
of HIV
• Attributed premarital sex to the inability of poor parents to marry
their daughters at an (!) appropriately young age

32. Critical adults in the community*
Key Challenges:
• Distant schools, multiple domestic responsibilities that fell on
girls limited the time they had for schooling and studying,
ending up discontinued their education in Class 5 or 8
• School quality was poor in public schools;
• Parents feared that their adolescent daughters may risk
bringing disrepute to the family if they mixed with or were
teased by boys
Vocational Training
• Typical/ gendered oriented Vocational programs suggested for
girls and boys
*PRI members, teachers, ANM, ASHA, and anganwadi workers

33. Critical adults in the community
Safety of girls and boys:
• By and large, didnt perceive their villages to be unsafe for
girls or boys. 'Our village is completely safe' was often
asserted, yet in several discussions lack of safety by night was
acknowledged.
Pre marital sexual activity:
• Hesitated to suggest that pre-marital sex existed in their
villages or that adolescent girls and boys in their village may
be at risk of HIV.
• However, in a few discussions, it was clear that opportunities
for the development of friendships between girls and boys
were increasingly available

34. For Discussion
• Good as qualitative, but what about our targets
• All samples less than 100, so no %
• Silent on Physical Assets; do safe spaces come
here?
• Vulnerability to HIV - unpacking
• Discrepancies between quote & analysis: Physical
changes
• No comparisons with similar Indian studies
***