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Impact Data - Reproductive Health of Young Adults in India (RHEYA)

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Pathfinder International launched the 7-year RHEYA initiative in 4 states of India in 1999 in an effort to change the attitudes and behaviour of both in- and out-of-school, married and unmarried, economically poor Indians aged 12-19 related to reproduction, and to empower them with the information and skills to take control over their reproductive lives and health. RHEYA used a variety of interpersonal communication strategies, such as training/workshops for a variety of community change agents, "infotainment" house visits to reach young couples and in-laws, residential camps for youth, and street plays.

The project was motivated by figures such as these (provided by Pathfinder): Indian women bear an average of 3.0 children, promising a doubling of the country's population in 41 years. The median age of marriage for girls is 16.75, well below the legal age of 18. Figures from the National Family Health Survey (NFHS) 2 (1998-1999) indicate that only 5% of married women between the ages of 15-19, and 21% between 20-24, use modern methods of contraception. India's maternal mortality rate is high (540 per 100,000 births), and adolescent girls are twice as likely to die in childbirth as women in their twenties; for those between the ages of 10-14, this risk is 5 times higher. The children of young mothers are 50% more likely to die than those born to mothers aged 20-29. A child born less than 24 months after a previous birth is nearly 3 times as likely to die as a child born after a gap of 48 months or more. Further, unwanted teenage pregnancies often lead to abortions, and 16% of maternal mortality in India is due to unsafe abortions.

Methodologies
Girls: Intervention area: 170 (mean age 16.7 years); control area: 114 (mean age 16.6 years)
Boys: Intervention area: 239; control area: 197 (mean age for both groups: 17.2 years)
Practices
According to Pathfinder, behaviour changes in all communities were dramatic. In one intervention area of 3,225 young couples, 300 were interviewed in an endline study. Of these, 30% had adopted contraception to space the second child, compared to only 14% in a non-intervention area. The mean age at first birth in the intervention area was 21.3 years, compared to 20.7 years in the non-intervention area, and the interval between marriage and first child was 27.1 months in the intervention area and 24.9 months in the control area. Similarly, the mean interval between first and second child at endline was 35.2 months in the intervention area and 33.9 months in the control area.

In the slums of Delhi, 14.6% of newlyweds adopted contraception to delay the first child, compared to 1.4% in the control area.
Attitudes
  • Among girls in the intervention area, the percent who believe that even if the husband is not willing the wife should use a method is 51%, compared to 10% among control group girls. Among boys in the intervention area, the figure for this indicator is 65%, compared to 43% in the control group.
  • With regard to the percent who intend to wait for 2 years after they marry before they have their first child, the figure was 85% of girls in the intervention area, compared to 55% in the control group. Among boys, these figures were 73% and 57%, respectively.
  • Forty-three percent of girls in the intervention area intend to use contraception immediately after marriage to delay their first child, as compared to 19% in the control area; 44% of intervention boys have this intention, versus 27% of boys in the control area.
  • The percentage of girls in the intervention area who disagree that a young woman who uses oral contraceptive pill will have difficulty in conceiving her first child is 42%; only 10% of girls in the control group disagreed with this statement. For boys, the figures were 44% and 16%, respectively.
Access
RHEYA reached nearly 22,000 adolescents with training and knowledge, and 3,571 young couples with information and skills to delay the first child and space later pregnancies. It has educated and sensitised more than 2,800 parents and other influential adults, and has reached nearly 23,000 other individuals through community street plays, workshops, and other activities.
Source
Email from Pathfinder International to The Communication Initiative on November 2 2006; and Reproductive Health of Young Adults in India: The Road to Public Health [PDF], by Jennifer Wilder, Rekha Masilamani, and Annie Mathew, Pathfinder International/India, September 2006.

Click here to access a related peer-reviewed summary on the Health e Communication website, and to participate in peer review.