Listen in to this new ditty that’s being sung in Tentulikhunti block of Odisha’s Nabarangpur district: “Gagar bayele ke TT suja/Rang matra nani pasri na ja/Magur machke aamat jhol kesri bali ke jatan kar.” Roughly, this translates as: “Don’t forget tetanus shots for pregnant women and red tablets for adolescent girls/ Just as sour flavouring makes fish gravy delicious, so does the well-being of adolescent girls impact society’s well-being.”
A survey on the status of adolescent girls was conducted in two blocks of Odisha – one in the tribal-dominated Tentulikhunti block in Nabarangpur district and another in the coastal Balianta block of Khorda district. The numbers in Tentulikhunti were not good. It was discovered that of the 501 adolescent girls tested there, 281 girls were severely anaemic, with levels below 7 grams. Balianta fared only a little better. It was to meet this challenge that the state rolled out the Adolescent Anaemia Control Programme (AACP) in 2009.
The programme, implemented jointly by the state Departments of Health and Family Welfare and Women and Child Development, has several components, ranging from screening teenagers for moderate and severe anaemia, counselling them on good eating habits, preventing intestinal worm infestations and, most importantly, ensuring the administration of weekly iron-folic acid supplements of 100 mg elemental iron and 500 mg folic acid.
Importance Of Intervention In Odisha
Why is this intervention so important in this neck of tribal Odisha? Take the case of Budei Jani, 20, of Damaguda village in Tentulikhunti block. She got married last year and is now expecting a baby. In 2007, her haemoglobin level was as low as 4.4 grams. Recalls Budei, “I must have been around 16 or 17. My periods were irregular and sometimes I felt so weak that I couldn’t walk properly. The ‘didi’ at the local anganwadi advised hospital care. After that I was given iron and folic acid tablets every week, and I slowly recovered under this treatment.” She can now look forward to having a safe delivery and a healthy baby. Unfortunately in India, anaemia in the mother is a major cause of low birth weight in the child.
This is just one story among many in these parts where young women have been given another chance to lead a productive life. In Panaspadar, another village in Tentulikhunti block, Babita Jani, 19, is presently studying for her Plus Two course at Nabarangpur College. In 2007, her haemoglobin level was 5 grams and chronic fatigue made her constantly skip school. Her parents, small farmers whose rain-fed patch of land could only support the cultivation of ragi and some pulses, were too poor to ensure proper nutrition for their three children. Says Babita, “In our home my father and brother always ate first, and we – my mother, my sister and myself – managed with what was left.” Things started changing once the AACP took off and a rejuvenated Babita began picking up her books again.
The 2011 Census has revealed that there are at least 12.2 crore adolescents in India, in the age group of 15-19 years, of which 5.7 crore are estimated to be girls. Of these, 3.2 crore are anaemic. Read this along with data from the National Family Health Survey-3 (NFHS-3), which indicated that 2.3 million of about 3.7 million adolescent girls in Odisha are anaemic. Worse, half of them become mothers at an early age; and 69 per cent of pregnant women in the state are anaemic against the national percentage of 58. Anaemia, which results in the decreased ability of the red blood cells to provide adequate oxygen to body tissues, is one of the primary reasons behind high infant deaths and maternal mortality rates.
But why is anaemia in adolescent girls such a concern? The fact that adolescent girls and boys have a need for extra nutrition as they grow and develop rapidly, and that an inadequate diet can delay or impair healthy development is not well understood. In girls, poor nutrition can delay puberty and lead to the development of a small pelvis. Malnourished anemic adolescent girls who have babies at a young age are more likely to experience, and will be less able to withstand, complications because the body has not yet reached maturity.
Manorama Majhi, the Child Development Project Officer (CPDO) of Tentulikhunti block, explains, “There are many reasons for anaemia among young women in tribal Odisha. Early marriage and childbearing is one. General hygiene is also very poor, with open defecation the norm. This means chances of infections and diseases are very high. Then there are other factors like poor nutrition, faulty eating practices, poverty and the general lack of education and awareness.”
According to Majhi, the AACP uses the direct observational approach, which means that everybody congregates at the anganwadi centre on Saturdays for a meeting, and is given a tablet each. “In this way, all the girls get 52 tablets in a year,” she says.
The programme is embedded in the institution of the Balika Mandal. There are 186 mandals in the 15 panchayats of Tentulikhunti block. Each Balika Mandal brings together 12 to 20 local girls every Saturday in various programmes and activities, including those that focus on building health awareness.
The Importance Of Nutrition
While the programme seems to be working in Tentulikhunti block, other parts of the district don’t show such encouraging results. For instance, Pravati Majhi, 14, of Raighar block says she goes to her local anganwadi centre on Saturdays to get fruit – which she simply loves – but she cannot explain why it is important for her to take her iron pills. “One of our biggest challenges is general illiteracy and lack of information. But we continue trying our best,” admits Kanan Kumari Das, District Welfare Officer, Nabarangpur. Her data indicates that some 47,085 girls – both school going and non-school going – are being covered under this project at the state level.
Encouraging results are not widespread
Although the AACP initially began in nine districts – Mayurbhanj, Koraput, Malkangiri, Nuapada, Kalahandi, Bolangir, Raygada, Nabarangpur and Sonepur – it has recently been extended to 21 districts. According to Anu Garg, Health and Family Welfare Secretary, Government of Odisha, iron and folic acid tablets will be supplied to adolescent girls in all 21 districts, with weekly haemoglobin check ups in both tribal and regular schools run by the School & Mass Education Department of the state.
But the hurdles cannot be overlooked. Arti Ahuja, Secretary-Commissioner, Women & Child Development Department, admits that even if the tablets are supplied, there is no guarantee that they will be consumed. “We need to also monitor the consumption of these tablets if the situation is to improve and back this effort with sound nutrition and health education,” she observes. According to her, high anaemia levels in Odisha are not only due to under-nutrition but also chronic conditions like malaria and hookworm infestations.
But the response from the ground in Tentulikhunti block provides cause for some cautious cheer. Says Garg, “We hope our efforts prove successful and the health profile of our adolescent girls improves.”