1. Life Skills – 1 Impact of Life Skills Education on Age at Marriage of Adolescent Girls Manisha Khale, Ashok Dyalchand, Kathleen Kurz 31 st Annual GHC Conference: June 1 - 4, 2004 Institute of Health Management, Pachod International Centre for Research on Women in collaboration with

2. Institute of Health Management Pachod Community Based Intervention Study Conducted in 72 Villages of Rural Maharashtra Pachod INDIA Institute of Health Management, Pachod Project supported by Christian Aid, UK, & ICCO, Netherlands Research supported by Ford Foundation & Rockefeller Foundation Life Skills – 2

3. Preparatory Phase Conceptual Model 1.Life Skills Education 2.Health Services 3.BCC: Parents and Community Interventions Expected Impact  MMR  NMR  Abortions  LBW  RTIs /STIs  TFR Outputs  Cognitive Skills  Negotiation and Communication Skills  Self-esteem and Confidence  Utilization of Health Services  Social Approval Outcome Delayed Age at Marriage Life Skills – 3 Institute of Health Management, Pachod

4. Preparatory Phase Needs Assessment - Quantitative Life Skills – 4 Proportion of Girls Married Before Age 18 Years- Rural Aurangabad……… 81 % Source: IHMP, 1997 Institute of Health Management, Pachod Proportion of Girls Getting Married Before Age 18 Years, Maharashtra Source: RCH District–wise study, IIPS, 2001 Percent girls married before 18 years

5. Preparatory Phase Needs Assessment - Quantitative Life Skills – 5 Institute of Health Management, Pachod Reproductive Morbidity Higher in Married Adolescent Girls Compared to Adult women 15.8%25.2%Domestic Violence 2.9%9.2%Abortions Adult Women (  20 years) Married Adol. Girls (  19 years) Health Indicator Source: Female Sample Survey,IHMP, 1998-99 Prevalence of Anaemia in Adolescent Girls …. 60 % Source: IHMP, 1999

6. Age Percent Girls Total Girls (N) Going to School Not going to School 11-13 Yr.73.126.9767 14-17 Yr.51.148.9472 Preparatory Phase Source: IHMP, 1998-99 School Attendance Among Adolescent Girls Drops After Age 13 Years Needs Assessment - Quantitative Life Skills – 6 Institute of Health Management, Pachod

7. Preparatory Phase Needs Assessment - Qualitative  Restriction on mobility after reaching puberty  Girls have heavy work-load compared to boys  Poor menstruation hygiene  Poor communication between mothers and daughters regarding reproduction and sexuality  Low confidence, self esteem, decision making  Married early, attain motherhood prior to adulthood Life Skills – 7 Institute of Health Management, Pachod

8. Preparatory Phase Curriculum Developed With Participation of: Life Skills – 8 Institute of Health Management, Pachod Mothers participating in planning workshop - 1999  Parents, Village Health Committees, Adol. Girls.  Experts – Lawyers, Social Workers, Doctors, etc.

9. Implementation Phase Life Skills Course  Initiated in: 1999  Target Group: Adolescent girls age 11-18 years  Duration of Course: One Year  Conducted at: Village level, 1½ hour sessions  Life Skills teacher: Village woman - 7 years educ. Community based Life Skills teachers -1999 Life Skills – 9 Institute of Health Management, Pachod

10. Implementation Phase Objectives of the Life Skills Course 1.Delay age at marriage for adolescent girls 2.Improve social status through skills related to gender, legal literacy, team building, etc. 3.Improve health status by increasing their cognitive and practical skills in health and nutrition. 4.Promote self development, increase self-confidence through community and individual projects. Life Skills – 10 Institute of Health Management, Pachod

11. Life Skills Course  225 one-hour sessions  Designed for a grassroots trainer Implementation Phase Life Skills – 11 Institute of Health Management, Pachod

12. 1. Social Issues and Institutions 2. Local Bodies 3. Life Skills 4. Child Health and Nutrition 5. Reproductive and Sexual Health 6. Legal Literacy / Women’s Rights 7. Vocational Training 8. Gender Sensitization Scope of Life Skills Implementation Phase Life Skills – 12 Institute of Health Management, Pachod

13. Implementation Phase Projects Community Nutrition Education  BCC by Adolescent Girls and Life Skills Teachers Non-Formal Education  School-going Girls Teach Non-school-going Girls Life Skills – 13 Institute of Health Management, Pachod

14. Impact Phase Impact on Community Demand Life Skills – 14 Institute of Health Management, Pachod Enrolment Increased From 450 to 2000 Girls Adolescent girls attending certificate distribution function - 2001

15. Impact Phase Median Age at Marriage and Percent Girls Getting Married Before Age 18, IHMP Project Area Source: IHMP, 1997-2001 Life Skills – 15 Institute of Health Management, Pachod

16. Impact Phase After Life Skills Education - Girls Less Likely to Marry < 18 Years Logistic regression Variables Adjusted odds ratio 95% confidence interval Mothers occupation Working Non-working + 2.42* 1 ( 1.08 - 5.42 ) Adolescent girls from Intervention area + Control area 1 3.96** ( 2.09 - 7.51 ) Pseudo R square = 0.2436 + Reference category * p <0.05 ** p <0.001 NS – Not significant Life Skills – 16 Institute of Health Management, Pachod Variables 95% confidence interval Age at the time of enrolment 11-13 Yr. + 14-17 Yr. 1 3.89** ( 2.13 - 7.08 ) Level of education Upto Primary + Middle & above 1 1.56 NS ( 0.71 - 3.39 ) School going status School going + Non-school going 1 2.87** ( 1.35 - 6.09 ) Socio-economic status Lower + Middle-Lower Middle-Upper Upper 1 1.79 NS 1.78 NS 2.28 NS ( 0.79 - 4.04 ) ( 0.85 – 3.75 ) ( 0.97 - 5.33 ) Mothers education Illiterate Literate + 1.67 NS 1 ( 0.84 - 3.31 ) Adjusted odds ratio

17. Impact Phase Pseudo R square = 0.1543 + Reference category* p <0.05 VariableAdjusted Odds Ratio 95% Confidence Interval Attendance at Life Skills Course Never attended Partially attended Fully attended+ 2.583* 2.423* 1 (1.433-4.656) (1.272-4.617) Girls Never Attended Course, 2.6 Times More Likely to Marry Before Age 18 Logistic regression Life Skills – 17 Institute of Health Management, Pachod

18. Impact Phase Meera Wagh: Learnt about HIV/AIDS during Life Skills course. Insisted that prospective husband gets tested before marriage. She made him undergo test along with herself. Life Skills – 18 Institute of Health Management, Pachod

19. Manju - 13 Year Old Girl (Name Changed) Impact Phase Life Skills – 19  Molested by a man on the road while walking home from school  Went straight to police station to lodge complaint & demanded a copy of FIR  Told police inspector she learnt about this in the ‘Life Skills’ course Institute of Health Management, Pachod

20. Policy Implications  Life Skills course of longer duration needed for empowerment of adolescent girls  Needs to go beyond reproductive / sexual health  Needs to be community based to ensure social support / approval  Programme should engage key decision makers  Replication possible in India through ICDS Life Skills – 20 Institute of Health Management, Pachod