With 15.69 million adolescents, Rajasthan contributes to about 22.9% of the adolescent population of India. Against this backdrop, the NFHS 4 reports that 35.4% women (20-24 years) reported being married before the age of 18. Furthermore, 77.4% of never-married women responded saying they had never sought help or spoken about violence they had experienced. A study by Population Council revealed that 63.8% girls had been forced into entering their first sexual relationships by male partners.
While adolescent Sexual and Reproductive Health is meant to be addressed under the Rashtriya Kishor Swasthya Karyakram (RKSK), the status of its implementation is at disparate levels across the country. The lack of political will due to the fear of societal backlash are further challenges to advancing adolescent sexual and reproductive health. These issues contribute to the dearth of information and provision of ARSH services in the state of Rajasthan.
Udaan uses the Human-Centred Design approach to supplement government programmes in addressing the sexual and reproductive health and rights of adolescents in India. The evidence generated through the pilot phase of the project will be used to engage with the government for integration of the final model within the RKSK. Furthermore, this evidence will bolster rights-based efforts to typical public health programming.
The programme uses participatory research to converse with a wide range of stakeholders in the adolescent health ecosystem - adolescents, parents, service providers, teachers, among others. The programme also engaged with stakeholders from districts of Rajasthan to understand how topographic and demographic diversity can impact health-related attitudes and behaviours of communities in Rajasthan. This repository of data and information is an invaluable resource and can be used as a case study to inform future ASRH programming efforts in Rajasthan.
Formative research phase of the project began in mid-December 2018 with an orientation training of the design team on the use of the research tools. Over the course of the next month, intensive on-ground research was conducted with multiple stakeholders who are a part of the adolescent health ecosystem in Dhaulpur.
Validation of Hypotheses was conducted in two diverse districts of Rajasthan, Udaipur and Barmer, as well as by secondary data research in January to February 2018.
March 2018: An ideation workshop was organized to brainstorm intervention ideas for increasing the knowledge, attitude, and practices of unmarried adolescents in Dhaulpur. The workshop participations consisted of professionals from different organisations having work experience including but not limited to Sexual and Reproductive Health. A structured ideation process was used to come up with a bucket list of potential interventions catered to the findings from Dhaulpur. The bucket list was filtered down to about 20 ideas, broadly categorised as:
Ujala 2.0: Making adolescent friendly health clinics and other RKSK services more accessible for adolescents.
Adolescents +: Creating safe spaces for adolescents and integrating SRH information into broader and more relevant narratives for their lives.
Collective Action: Leveraging community spaces, schools, and peers to increase buy-in from community members and generate more conversations around SRH
March 2018: The research findings and potential intervention ideas were presented to Rajasthan RKSK and NHM officials in a state-level
April to June 2018: interventions models were refined and further developed as prototypes. Prototyping was a cyclic process involving co-creation of prototypes with adolescents and health service providers, collection of feedback from community, and integration of feedback in subsequent iterations to ensure that the final product is tailored to consumer needs. During live-prototyping, The YP foundation managed and evaluated the in-school and community engagement strategies of prototyping.
The near-final strategies were run on ground and evaluated on a number of parameters to inform the yearlong future pilot phase that was kicked off in September 2018.