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Building Capacities of Women’s
Groups on Women's Health
District Level Training Modules
August '99
Developed by
CHETNA, Ahmedabad
for
Ministry of Health and Family Welfare, New Delhi
■S’"
HF
\
A List of Modules
No. of Hours
1. How to use this module
2. Nutrition and Women's Health
4
3. Women's Work and Health
3
4. Violence and Women's Health
4
5. Women's Mental Health
3
6. Access to Government Services
3
7. Panchayati Raj and Women's Health
4
8. Traditional Health and Healing Practices
4
9. Malaria and Women's health
2
10. TB and Women's Health
4
11. Water and Sanitation & Women's
5
Health
12.Reproductive Health
33.30
Our Growth (Th<>e Female A Male Reproductive System)
2
Conception
2
Adolescent Health & Development
4
Care During Pregnancy
4
Child Birth A Care After Child Birth
3.30
Abortion
2
Infertility
2.30
Contraception
3
Reproductive Tract Infections
3
HIV/AIDS
4
Cancers: Cervical Cancer
2
Breast Cancer and common tobacco related cancers
Total Hours
District Level Training Module
2
67
Nutrition and Women ’5 Health
Nutrition and Women's Health
District Level Training Module
4 hours.
Learning Objectives
At the end of the session the participants will learn about
> p^esen^nuthents3 funCtions’ how to increase nutritive value of foods and how to
> XXjSation*li,e CydS and dUrin3 SpeCifiC conditions such as "Bnstruation,
causes of under/malnutrition especially anaemia etc
> ways to work towards better nutrition
Design
Time in
minutes
Topic
30
Food groups and its functions, how to
increase nutritive values of food and how to
preserve nutrients
Nutritional needs in a life cycle and special
conditions of woman
Causes of under/malnutrition
___
60
30
40
60
Nutritional deficiency diseases-Anaemia,
Calcium deficiency and iodine deficiency
Ways to work towards better nutrition
20
Revision and evaluation
Training method <S
material
Demonstration and
discussion, Activity 1
Discussion and role
play_________
Activity 2 -Case study,
Discussion
Discussion, Activity 3~
Songs
Sharing of
experiences and
thought provoking
discussion
Activity 4 Quiz
Material Required
Collect locally available vegetables, fruits, grain pulses and nuts Whor
you may collect non-vegetarian foods too For Activity 1 cost rarH
(approximate 25), musical instrument fdholakt nr
1
*
i
. !
d SIZe Cards
Consume’
newsprint paper and marker pen or black board and chalk3 S
^poon' For Activity 4,
questions, small basket or any container.
d
k’ Paper S Ips to wite the
, District level Training Module
1
Nutrition and Women's Health
Note for the Trainer
EESSE“ -
ine laooos related to foods, before providing them new knowledge.
“Dear Friends,
h^alth dePsnds on what we eat and how much we eat Today let us discuss
US make a lisl o,dilfa™‘
' daily UMate a^iSS*5,!!0.".? d0Wn dmerent kinds of ,00ds lhal
consume
S
Y0d
™*ch those foods Mth the
>
Ask them to tell you the reasons on why do we eat food? This question will give you
mav di^foP^ht?^
°f f°OdS- BaSed °n ths information odle'ed you
may give them the five basic functions of the foods and then categorize the foods
disicussed accordmg to food groups. Explain the concept of balanced diet Also at
the nitSnts301"35
h°W t0 lncrease the nutritive values of foods and preserve
Li
I lUll Id llo.
> You0 S ^wdiJ,t0 e?hUre the'r leamin9 ab°Ut f00d 9roups and their Unctions.
H
d
he imPortance °f food and requirement of women in a life
Vn d SPS^ ^ndJtl0n llke Pregnancy, lactation etc. To know the existing beliefs
nra_ ab°°s related t0 f00ds ask the Participants to perform a role-play on local food
foe mfo hIav 9 Pre9r,a"7 and lacta‘ion. Based on the information collected from
Xnn hfliS/
\by addin9 thS scientific information and try to remove the
9 b' f and taboos bV g|V|ng scientific reasons. Some of the common beliefs
and taboos are given in section “Points to remember”.
> thTn the..case study 9'ven 'n Activity 2. At the end of the case study you may ask
case study you may ask
the questions given along with it and encourage them for discussion. After the
them tncha ^th
partlcipants> do they come across similar cases? Encourage
„ ■ i sb
their experiences. This exercise will give you an opportunity to discuss
social, economic and religious reasons of undernutrition.
> Discuss causes, prevention and treatment of anemia. You may encourage them to
sing songs on anemia given in Activity 3. Also briefly talk about calcium and iodine
Utix 11 ul tJ[ IC/V,
> Discuss the importance of Public Distribution System (PDS) and its linkages with
women's health. You can take the participants to nearby PDS shop. Ask questions
about how it runs and what are the difficulties faced. You can also discuss ways to
improve its functioning.
y
> At the end ask the participants to participate in a quiz to revise their learning.
District level Training Module
2
I
How to use this Module
This training module is designed to help you train district level trainers in your
State.
Each module includes:
•
•
•
Training design along with a note for the trainer
Content to be covered during the training is given under "Points to be
Remember by Participants".
Hands on activities for participants to get sensitized on the issues related
to women's health and learn new knowledge.
Useful references are listed at the end of each module, which can be used
by the district level trainers to conduct the village level training.
Before you begin....
Each module is designed as stand-alone module. It is up to you to decide where
begin. For your convenience we have sequenced them. You may not have to
conduct the session in order.
Know your audiencel
Interact with your participants. What is their interest? Where are the naps in
ther knowledge? Let the participants help you to decide where to begin”you
tXhe X’zrf pre °"d
Be creative!
his framing module provides you with a set of tools to help you to get started
You are welcome to modify the activities, add your own mateHals and
‘
create/utihze new exercises to meet the needs of your participants Ensure
daily feed back on the training session. This can be done by appmnting a feeda
back committee every day in the morning. This committee can also develop a
also develop
newsletter or wallpaper on the day's learning and display on
the wall next day
morning for other participants to read.
District level training module
1
Ready, Set. Go ...
Each module is organized to assist you as a trainer to facilitate the session.
Guidelines suggesting how to facilitate each session are presented as follows
Learning objectives:
Summarize what the participants should be
expected to know by the end of the
session.
Time
Time estimates required to conduct the entire session have been made. You may
require more or less time depending on your situation.
Design
A sample design to conduct the session with topic and method is given along
with the time required.
Material
List of material required to carry out session is listed.
Activities
Suggested activities for the trainer to conduct with participants.
District level training module
2
Nutrition and Women fs Health
Points to Remember by the Participants
Every day we eat food to grow and to keep us healthy. Different foods have different
functions.
Food and its Functions
Functions
Foods
Provide Energy
All cereals and tubers, sugar, jaggery, oil and
clarified butter(ghee)
Growth and development
Milk and milk products like yogurt and butter milk,
pulses, ground nuts, meat, fish and poultry
Protection from illness
All vegetable, fruits, milk and milk products, meat,
fish, poultry, and germinated cereals and pulses ’
Keeping blood healthy
Green leafy vegetables, jaggery taken along with
sour fruits and germinated pulses
Keeping eyes healthy
Milk and milk products, dark yellow and orange
fruits and vegetables, green leafy vegetables
egg and liver
How to Increase the Nutritive Value of Food
> Prepare foods by mixing cereals and pulses
> Germinate pulses
> do™UXXe/c.^'5 and PUlSeS and make local fermen,ed
—
be
Please note:
On the day of nutrition r'
session, you may arrange to serve germinate d
pulses for breakfast. Try to
n serve nutritious foods during the training.
How to Preserve Nutrients
°f
vegetables',ike cucumber, carrots, tomato radish etc
Wash fruits and vegetables before cutting them. Never wash the veqetables after
cutting, all the water-soluble vitamins wifi be lost.
vegetables after
> Do not cut the vegetables in water
> Always cut big pieces of vegetables for cooking
> Do not remove
'•omovo a thick peel from fruits and vegetables
> Do not wash rice repeatedly before cooking
Do not throw away the water from cooked rice. Utilize the same
> Cover the vessel and cook on slow fire. Do not over cook
Do not heat food repeatedly
Do not add baking soda to food
>
District level Training Module
3
Nutrition and Women *s Health
> Keep cooked food covered
> Add lime juice or sour vegetables after cooking food
Nutritional Needs of Women in Life Cycle
Infancy and Childhood:
0-5 years
Put the baby to the breast immediately after birth.
> Till the age of 4 months, children require only mothers milk.
> Breast-feed the child whenever she/he demands breast-milk.
>
enmentary feedin9 from the
of 4-6 months but continue breast feeding
the child till 2 years old, if desired, even longer.
> Give home cooked foods to the child.
> First feed the child and then breast- feed her/him.
> Prior to feeding the child, wash your own hands and the child's hand with clean
water and soap.
t
> Avoid bottle feeding the child unless there is a medical reason for it.
(
Girl child
I
5-12 years
>
At this age child need energy, protein and iron rich foods. Give them plenty of
cereals, pulses, milk and milk products and green leafy vegetables.
> Never discriminate girls in quantity and quality of food
> Always feed the girls along with other family members to ensure adequate food
intake
Adolescent
12 to 18 years
(
> This is a accurate growing phase, feed a variety of energy rich foods to the child
> Do not discriminate girl child in terms of quantity and quality of food
> Feed plenty of iron and calcium rich food to the child like green leafy vegetables
banana, milk, cereal, pulses.
> To ensure adequate food intake adolescent girls need to eat along with other family
members
(
(
Adult women
18 to 45
>
Adult women require adequate food intake (both in quantity and quality) to carry out
her daily routine
y Due to menstruation a woman looses blood every month. To replace the loss she
needs iron rich food.
>- She needs adequate calcium intake, as she due to biological reason she has more
chances of getting Osteoporosis (when bones become brittle).
> A woman must eat with all the family members to avoid eating last and the least.
District level Training Module
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4
i
Nutrition and Women’s Health
Pregnancy
> A woman needs one extra helping of family food during pregnancy
> prele^hVrVorlgT^7 °f
vegetables- Pulses' j^gery, groundnuts to
>
She needs energy rich food too, like oil, nuts, cereal, ghee
Entity1)'6 th3t 3 Pre9nant W°man has adeguate fooci in her Pl^e (both quality and
A 3 years gap between two births is important to regain the loss of nutrients from
he
body and ensure optimum health.
Nursing Women
>
“ZSXXr quan,i,y ,han the "°rmal f°°d
She needs
nknedmirfOth needS ,0 C°nSUme 10,5 of “dsZ“X* a"
ye.^ and ora„,e
She needs to eat green leafy vegetables.
Older Women
Above 45
> th! nSe? ? 6at adecluate f00d >n terms of her energy output.
t0 prevent Oste°Porosis (when bones
become brittle)^nd7ro^^^
If she has a tooth problem, she needs to eat soft, but energy rich food
Causes of Under Nutrition 4mong Women:
Social
WcemlnS;eXa;2%Us^ft"
> MakeUofl™OmOeS„rela,ed '0
>
fedd^
™l9 nepers.
dUdn9 differenl StaSes °f life. ™her restrict the food
Girls are given less food in comparison to their brothers
Religious
> Women are expected to fast for the benefit of their family. This reduces her food
' milk"9 menSlrua,ion reli*" does not permit intake of certain nutritious foods like
> There is food restriction for the older women especially for women who are widows.
District level Training Module
5
.
Nutrition and Women’s Health
Economic
'
"res°urces are limited' —
Lack of awareness and lack of utilization of government facilities
' rented tlo7reOZZand?aSioSnenSi,i2a,i°n' W°men
U""2e
' ificiency Diseases
non Deficiency Anaemia
laemia is a major health concern of women. More than 70% of women are found to be
offering from anaemia (when blood becomes pale).
Symptoms of Anaemia
>
>
>
>
Feeling tired, dizzy and breathless even on doing light work.
Paleness of the tongue, nails, inner portion of lower eyelids and skin
Flattening of nails.
Swelling of feet.
Causes of Anaemia
Dietary
Iron is required to make hemoglobin, which is found in dark green leafy vegetables
jaggery, bajn and ragi.
y
Protein is another essential nutrient to form haemoglobin. Non vegetarian foods like
meat, egg liver and milk and milk products are important for making good blood If
nOt eaten In the re^uired Quantity a woman may become anaemic
>
f absorPtion- ln order t0 ensure adequate absorption of iron
sweet lime e°c '
neCeSSary t0 eat Sour fruits like 9uava' lime. am|a, oranges,
PhT h"9
^^ediate|y after meal hampers the absorption of iron therefore tea
should not be taken along with meals.
> There are several beliefs related to diet during menstruation, pregnancy and
lactation, which are incorrect.
y
^'l|k’
anCi °ther White col°ured foods can not be consumed, as it is
fn nrnN
h
® Y’!' accumulate on the ^ace of the baby’s body, which will lead
to problems during delivery.
If a woman is fed more during pregnancy, she will have difficult delivery
Green leafy vegetables should not be consumed as it leads to green diarrhoea.
District level Training Module
6
Nutrition and Women’s Health
Related to Bleeding and Menstruation
>
Woman may become anaemic if they bleed excessively during periods because of
the loss of iron in blood and an inadequate dietary intake to replace this loss.
> Woman loses blood during and after childbirth, which may result in anaemia. Along
with this there are several dietary restrictions during pregnancy, which increase the
risk of anaemia.
> Anaemia may also result due to excessive bleeding as a result of an accident.
Social causes
>
Due to secondary status women lack self-confidence and self respect and are
unable to give priority to their nutritional needs.
'
They are socialised to eat after feeding the rest of the family as a result of which
very little food is left for them.
> Girls are given less quantity of food to slow down
their growth. This allows for a
delay in their marriages. But this is the time when due. to
.J ca ’growth spurt their nutrient
needs increase and an inadequate diet results in anaemia.
> nZn cthl'dh°od a 9'rl is socialised to sacrifice for others, not to think of her own
needs to feed everyone else in the family first.
> ~n!JSriarChal SOciety a woman must 9've birth ‘o a male child. This leads to
repeated pregnancies and abortions, resulting in severe anaemia.
Some other causes of Anaemia
Illness
Reason for anaemia
Malaria
The red blood cells get destroyed
Hookworms
Hookworms suck blood
Menstruation or problems
related to the womb
Excessive blood loss during
menstruation
Piles
Blood loss from piles
Consequences of Anaemia
> There are more incidences of illness
> bxXiveTiilrii„b?TS' birth °f 8 dead baby' prema,ur9 birth' maternal death
Excessive bleeding during menstruation in adolescent girls
" ofsSlf coSceS amOn9St Ct,ildren' la"in9 behind in games and
Treatment of Anaemia
> Eat iron and protein rich foods.
District level Training Module
7
(
(
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Nutrition and Women's Health
>
PZCand nuX0.?0" ,ab'elS aS Per doc,or,s advice- F°r
who are
I.
Hea,ih
> If one isTff6 °f 7edlCines to remove hookworms from the body
~ -st be
Enhance the status of girls and women in the house as well as in the societv
quaZ^XXT' W"h thS reS* °f *he fami,y “,ha',hey
adepuate f°°d On
> Ensure equal work equally amongst all members of the family.
Prevention
(
Include following foods in your diet to prevent iron deficient anaemia
(
Iron rich foods:
(
> Green vegetables, Fermented foods, Meat, liver, fish, Jaggery
>■ Cooking in iron vessels also increases the
i— content
■
1.’.- iron
of~~
food.
Vitamin C rich food
.(
(
> Citrus fruits like, Amala, guava, lime, goose berry,
Protein rich foods
> Milk and milk products, pulses, ground nuts, grams egg, meat.
Folic acid (folate)
> Dark green leafy vegetables, whole grains,
mushroom, liver, meats, fish, nuts, peas
and beans, eggs.
Other tips to Prevent Anaemia
>
>
>
If malaria parasites or worms are^causing
:
the anaemia, treat these diseases first,
Avoid drinking tea or coffee with food especially within an hour of eating’meals.^1
u i
. r
:--------- «----- —•••unii an hour of eating meals.
To
preventwhile
hookworm
—wet laX
....
especially
walking infestation
or woki’ng cn
St°01'
f00tW8ar
>
Space births at least 2 years apart. Use birth control devices.
Please Note: Sickle cell anaemia is common in tribal areas. It is
dangerous to give iron pills to a person suffering from sickle cell
anaemia. If you are working in a tribal area be aware about his fact.
Calcium Deficiency
To make bones and teeth strong, every one needs calcium. Girls and women especially
T-fT-tT3 5alcil<m- Thls is because women give birth to children. Due to repeated
childbirth and inadequate intake of calcium, women may suffer from osteoporosis (when
bones become weak and brittle) in later years of her life
District level Training Module
8
!
Nutrition and Women's Health
Needs of Calcium for Women in Different Stages of Her Life
During childhood: Calcium helps in development of bones and helps the girl's pelvic
size increase, which is important to give birth safety when she is fully-grown.
A wom®n needs en°ugh calcium to help the baby’s bones grow, and
to keep her own bones and teeth strong.
_Durinq breast-feeding: Calcium is necessary for making breast milk.
During mid-life and old age: Calcium
wAak hnnoo
Calcium is
is needed
needed to
to orevAnt
prevent weak
bones (osteoporosis)
Foods rich in calcium:
Milk, curd, yoghurt, cheese, ground sesame
green leafy vegetables (particularly
drumstick leaves), beans, shellfish, lime (lime ash)'
To increase the amount of calcium in food:
z- Put a teaspoonful lime while kneading douoh
> Soak bones or egg shells in lemon juice for
■ a few hours, and then use the liquid in
soup or other food.
> Add a little lemon juice, ’
'
vinegar,
or tomato after cooking bones for soup.
> Soak maize (com) in limejuice and eat.'
Iodine Deficiency:
LISI coun,t^’ in certLain areas dlJ£1 to iodine deficient land people suffer from
iodine
°r may be men,a"y Sl°“ Th°
Ways to Work Toward Better Nutrition:
> Family kitchen garden
> Community gardens
> Rotation of crops
> 'mgation and counter ditches (prevent the soil from washing away)
> LXreeZ
s'
COmmUnity
bUV 'ar9e am°Un,s of f00d al lower prices.
>
Plajnt papaya guava, curry leaves, and drumstick trees.
> Use
— -i-natural fertilizers (Compost pile)
Better food storage facilities
> Working towards a balance distribution of land.
> Improved cooking methods practices
Public Distribution System (PDS):
at,tow
s° a=ensure their
ineffeePve. The poor people have np3
District level Training Module
9
Nutrition and Women's Health
prices are higher. The fact that few people make use of the PDS is then used as a
reason for further budget cuts.
3 a
Most poor families have not been given the benefits of Below Poverty Line (BPD
schemes and do not even have BPL cards. For example, in Dharavi a huge slum in
Mumbai, there are only 375 BPL cardholders. Since trade liberalisation poTcies Tnd ■
s ructural adjustment programmes were introduced in India in 1991 the supply of food
to igU^lakh f
DUb'IC DJstribution System (CPDS) has gone down from 207.36
cent Xnng ApXy
'"7 " “
25 6 per cent’ and 11 fe"furthw by 28
Useful Health Education Material
>
RoadS WTn’tHK T' CHETNA’ Lilavati Lalbhai’s Bungalow, Civil Camp
Rotab'Shahlba3. Ahmedabad, 380004, Gujarat, Language, Hindi, Gujarati English
> GuiarX ^nahsh0'6
‘
B°dy' SSt °f
booklets’ CHETNA, Languages, Hindi,
V-/
J
I C4 LI |
L— | | \_J I I O I I
>
>
‘ei-T MoaonU^ CHETNA. Languages, Gujarati, Hindi, English
Balanced Diet, Slides-33, CHETNA, Language, Gujarati
iuj?ratiAChHETNAanCed D'et)’ Vide°'
Education Through Puppets, Language
>
Nntrit0,]al Anaemia ’Video’ Training & Information on anemia, UNICEF Lodi
Estate, New Delhi, Language, Hindi, VHAI 40, Institutional area, New Delhi-110016
Useful Health Education Material
>
Aua'th: Educational Kit CHETNA, Lilvati Lalbhai’s Bungalow, Civil
C mp Road, Shahibag, Ahmedabad-380004, Gujarat. Languages-Hindi, English and
oujarati
>
Health and Nutrition Manual: CHETNA, Languages- Hindi, English, Gujarati
>
Better Health for Adolescent Rural Girls. Volume 1, Health and Nutrition Nutrition
Foundation for India.
Flash Cards:
>
Use of Iodized Salt: (Hindi), UNICEF and Salt Department of Udyog Ministry UNICEF
House, 73 Lodi Estate, New Delhi-110001
Slides:
>
>
>
Balanced Diet, CHETNA, Language-Gujarati
'
9
Bio Intensive Kitchen Garden (English), Centre for Development Communication 23 Jabbar
Buildings, Begumpet, Hyderabad-500016
Deficiency Diseases, VHAI, New Delhi Language-English, Hindi
Video Cassette
Healthy Food Devices UNICEF, New Delhi, Language-English,
> Controlling Nutritional Anaemia, UNICEF, New Delhi, Language- Hindi
District level Training Module
10
Nutrition and Women's Health
Activity 1 Game-Functions of Food Groups
Objectives
To understand the food groups and their functions
Material Required
Post card size cards (approximately 25), musical instrument (e.g. dholak), or metal plate
and spoon.
Method
> Write names of the various foods on cards (5 names from each food groups. You
can make the cards in triplicates so that all participants can get it)
The cards should spread on the floor in the form of a circle.
Ask the participants to stand in a circle around the cards
> As
a facilitator
you have
to and
clapsp0^ ' mUS'Ca'inS,rUment <9'9' dh0'ak) °r make
noise
voth the hetp
of plate
> energy1 giving'foT S°me “me
0U' name °f any °ne f00d 9rauP e
> The participants have to pick up one food card, which gives energy.
> ^Jfhl?thh°^their
t0 each °ther and ,et them discuss among themselves
net^essaiy TnfoSn
>
" nOt " neCeSSary the faa1ilal“
so^e^^500 Wh° P'Cked UP thS inCOrreCt
9™
t0 d° activi{y like' skipping or sing a
District level Training Module
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Nutrition and Women's Health
Activity 2 - Case study
(
This is Mithapur village where 300 families stay. It is a rich village of Gujarat State
Nathi is 30 years old women, married to Kamal, a farmer of the village. Nathi is
pregnant for the second time. She gives birth to a beautiful daughter. She is Nathi's
second daughter. Her name is Laxmi. No one celebrated her birth. Nathi was blamed for
the birth of second daughter. She was ill treated by her husband as well as other familv
members. Due to mental tension Nathi's breast milk output has reduced at a large
extent. At the end of the day, Laxmi remains hungry. She also cries a lot.
(
The desire for a son has made Nathi pregnant for the third time. She stopped breast
feeding Laxmi completely.
(
(
The third time, a son was born and his birth was celebrated. Being the son Ramesh
was an apple of everyone’s eyes. On the other hand, Laxmi lost her share in breast milk
along with other nutritious food. Her growth was slow and she looked undernourished.
Ramesh started attending the school whereas Nathi stayed at home to do the
household work, tend the cattle, fetch water and work in the field. Ramesh and his
father ate first and got lion’s share of food, while Laxmi, her sister Pushpa and Nathi
were the last to eat whatever was left.
Days passed by and Laxmi reached adolescent age. Her parents gave a large dowry to
get Pushpa married. They were tense because they now have to collect dowry for
Laxmi. Every day, they tortured Laxmi that because of her they have to work hard.
Laxmi feels suffocated due to such environment in the family. All the time she feels
neglected. She cannot eat well. She feels hesitant to ask for more food.
(
<
(
(
(
(
One day her father finds a 35-year old groom who was ready to marry Laxmi without
demanding any dowry. He is a divorcee. 15-year old Laxmi was forced to marry this
man. After marriage, Laxmi came to know that her husband is a drunkard who spends
lots of money in this habit.
(
Questions for discussion:
> List down the reasons for Laxmi's undemutrition.
> What needs to be done to change the situation?
> Do we have any programmes to improve nutritional status of women? What is their
impact on women’s nutritional status?
What will be the end of the story? Why?
District level Training Module
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Nutrition and Women's Health
Activity 3 Songs
For women
(Tune: Roses are red my love, violets are blue....)
Your look so healthy, my dear
What is the secret?
Eat leafy vegetables, sour fruits, with pulses and meat.
My family helps me do the work; we sit together and eat.
That is the secret, my dear, to stay healthy and happy.
For men...
(Tune: In the morning by the seaT.)
Men and women, shall share responsibility equally,
Responsibilities and resources.
Food and health care, home and water,
Equal work and equal wages.
For in-laws...
(Tune: Brown girl in the ring...)
A new bride in the house, tra la la lala
like your daughter in the house, tra... la la la la
she looks for your love and support.
Share with her food and work, tra la la la la
Equally, share with her food and work, tra la la la la la.
She will blossom with your love and support.
Mother to adolescent girl
(Tune: Jingle bells, jingle bells, jingle all the way...)
Leafy vegetables, sour fruits and pulses if you eat
with meat, fish and eggs also
healthy life shall you lead
food, rest, games and play are important any way,
with menstruation round the corner,
they will help you through those days.
Menstruation comes to us as a part of growing up,
Cleanliness and happiness will help you brighten up.
District level Training Module
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Nutrition and Women *s Health
Activity 4 Quiz
Objectives
. o evaluate the learning related to nutritional needs of women in a life cycle, food and
functions, eating low cost food, ways to improve nutritional status etc.
Material Required
Newsprint paper and marker pen or black board and chalk to write the marks obtained
by the each group, paper slips to write the questions, small basket or any available
container.
Preparation
■ ite one question on one slip. Some of the questions may be repeated. The examples
of questions are given below:
Give the names of food groups.
What are the reasons of under nutrition among women?
What are the causes of anaemia?
What are the symptoms of anaemia?
What is the prevention of anaemia?
Give five names of iron rich food.
Give five names of calcium rich foods.
Give five names of vitamin c rich food.
Give three names of vitamin A rich foods.
What nutrition related educational message would you give to pregnant woman?
What nutrition related educational message you will give to nursing women?
Method:
>
>
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>
Divide the participants in three teams. Ask them to choose a name for their teams.
The teams have to compete against each other for points form correct answers
The facilitator has to pick up a slip and read the question.
The member of the team who knows the answer has to raise her/his hand.
Ask the team member to give the answer. If the answer is correct, give 10 points. If
the answer is incorrect give minus 5 point, and give a chance to other group to give
correct answer. You may give partial points if the answer is partially correct
At the end of the game count the points and declare the winner team.
District level Training Module
14
JKomen fs Work and Health
Womexxs Work and Health
District Level Training Module
©
3 hours
Learning Objectives
At the end of the session the participants will learn about
♦ the linkages between work and their health
VariOUS illnA^Q^Q
—
i
various illnesses related to *1their
work
♦ various
;—_j measures to deal with these illnesses
♦ developing
. J a plan for improving health of women workers.
♦
Design
- Time Minutes
30
15
45
60
30
Topics
Methods
Women s work and its linkages with her
Mime, Discussion,
health
Illustration
Difference between organized and
Discussion
unorganized sector
Various illness due to work and
----- measures to deal with them
SomeusefuT exercise and remedieTto~
Discussion, Activity 1
-----ggtrelieffrom health problem
Planstoimprove health of women
workers
Material Required
- k
transferred on transparency3^
District Level training Module
Cha,k’ Enlar9ed illustration 1 or the illustration
Women *.v Work and Health
Note for the Trainer
Welcome the participants.
You may start by saying....
“Dear friends,
Today, let us discuss about our work and how it effects our health. Let us start with
making a list of work we do during the day.”
Ask the participants to perform mime depicting different kinds of work that they do
during the day. They would perform mime by turn. Ask other participants to
recognize it. Prepare a list. Categorize them into work in and outside the homes.
> Divide the participants in a small group and ask them to calculate the total time
spent in doing different tasks from morning till they go to sleep. The number of hours
women spend will depend on the region, occupation and nature of work. You may
lead the discussion as per your geographical situation.
>
■
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>
>
>
>
>
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In some places, Women work for about 16-18 hours in a day and men about
6-8 hours.
In some places, Women and men, both work for almost equal hours, but
women spend most time working in their homes (cooking, caring of children,
etc) which usually remains unrecognised.
Mostly men would spend time for individual pursuits and relaxation where as
women would hardly mention it.
Men would be doing more technical and implement oriented jobs whereas
women would be doing routine jobs.
(
Ask the participants to list how much and what do they eat in comparison to the work
they do.
Explain the linkage between Work, Undernutrition and Health. Use the illustration 1
enclosed herewith.
After this, ask them to tell the difference between the work done by women and men
outside the home. Categorize this into organized and unorganized sector and
explain the difference between organized and unorganized sector.
Based on the information given in 'Points to Remember’ discuss the health problems
of women due to work.
Along with the participants organize the demonstration of exercise given in Activity 1
and discuss few remedies given in section points to remember.
At the end of the session ask the women to brainstorm on different interventions for
some of the common health hazards they come across due to their work.
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District Level training Module
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Women fs Work and Health
t Points to be Remembered by Participants
' work at fields, at hor^e-prep'aring food^°eanPnqPswlen°St °f
working- Women
water, cleaning and caring for children and other J" ping' carry firewood and fetching
work outside to earn money to support their familie^Th ,Tiemt)er3- Many women also
people's homos, in factorios in make sSt sheH n h
7 W°rk 'n tho fiolds' in othor
In forests, on the road... the list Is endtess Women"?9 PaV0menls, ia railway stations,
reasons for the hlgh incidences for
*>men into a viaouXe
healSoverXto*
-i e- bi9
I" 'he
"^ng some materials Some
of 'he^XToS^^
shed set up by middlemen, andZ^
a
Oifference between orjanised and unorganised sector
J^I^niseTsector^^
No norms of payment
~
—
-------
^Organised Sector
-H------------------------
payment
^^^^veTTSrh^aittrcaFI
Accesstolea ^Tresf^Hdlre^th^Ti
No access to workmencompensation
I No facility^for child care
----------ffaci'lty can ^availidToF^hiid^I^
^opayrniFTfoT^IT^k—'---------------~Fixed rate for Overwork
--------
GNP (Gross National Product)
(Gross National Product)
District Level training Module
3
h» »
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■
A
Worne/i’s
and Health
Various occupations, associated illnesses and useful measures:
Please note that the work commonly observed in rural areas are listed here. There are
several other occupations in which women work and which have effect on her health.
Illnesses
Preventive Measures
Agricultural Farmers
Nausea, breathing
problems, itching, fungal
infections, contamination
of food, allergy,
tuberculosis, fatigue,
aches and pains________
• Salt workers_________
Sunstroke, ulcers in hands
and feet, boils, backache,
pneumonia and swelling in
liver. Use of certain
implements can also
cause problems.________
• Gum collector________
Fatigue, insect bites,
snakebites, sores and
bleeding through babool
thorns, injuries and
sunstroke.
• Ensure that farming implements are according to your size and
convenience.
Use herbal medicines for respiratory problems, infection and allergies.
Massage and hot water bath will relieve you from aches and pains.
• Adopt correct posture while working
• Use a pipe to collect water vapour from the salt pans. After cooling, this
water can be used for drinking
• Using gumboots, gloves, dark glasses, cap and better equipment.
• Wearing white, cotton clothes, which cover most of your body.
• Wipe your body with wet cloth on and off. Consume herbal decoctions that
are cooling.
• Use gloves, closed shoes, long handled sickle to collect gum.
• Wearing long sleeved clothes.
• Be careful while collecting gum.
\
• In case of injury, take tetanus injection and keep the wound clean and dry.
You may want to apply herbal pastes described in section points to
remember.
. i;V
• Eat foods that provide energy and herbs suggested to reduce fatigue.
__________________ Share workload among family members.__________________________
• Lifting and collecting heavy load____________________________________________________
Pains in joints, back and
• Lifting safely: Squatting while lifting things to pick weight from the ground.
chest, dizziness, stomach
• Keep your back, shoulders and neck as straight as possible?
ache, breathing problems,
• Avoid lifting weights during pregnancy and childbirth.
miscarriages, menstrual
• Carry objects close to your body.
problems and fallen womb. • Carry loads on your back rather than sides of body. You may divide the
load in two parts and carry on both sides or switch sides often.
• If you have a back problem, place a cotton pad under your back, while
sleeping.
• Do the exercises suggested in Activity 1
• Keep your back straight throughout the day. Do not slump forward.
• Do not bend over at the waist to reach out to things on the ground.
_________ • If your work requires bending forward, try to stretch and change positions.
• S ittin g a nd standing for Ion g hours______________________________________________________
Aches and pains in neck
• Take short walks during breaks and stretch yourself every hour.
and back, varicose veins,
• Do the exercises described Activity 1
swollen feet,___________
• Sexual Exploitation
Physical: injuries and
• Asses your options and talk about it.
infections in the body,
• Solicit support from women’s groups
pain, nausea, ulcers etc.
Emotional: Revulsion,
anger, disgust, anxiety,
nervousness, depression,
| and low-self esteem.
District Level training Module
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Women's Work and Health
A-
Psychosocial issues
The health implications listed here are just a small fraction of the wide ranqe of
occupational health problems faced by women in the unorganised sector The
'
^ereabo'uts 6*1''™"9
h15"1'6* my husband de™nda lo know about my
' sXd ’XdXt
XS every a’V ”nd bea,S me’ h' ,ates Wan''°™ney
kn°» *
re 1 haye
, earn and
’
■
When I feel terribly stressed. I think of suicide.
Effect of stress on women
> Sleeplessness
Loss of appetite
Constipation
> Depression
“Hysterical” outbursts
What needs to be done?
about these, even among themselves
>
consider mental health as health problem also
Sexual Exploitation at Work Place
> What is Sexual Exploitation^
> maXUm73praXrkOraC,i0nS0f —at nature.
Any place where working relations exist.
women can hlppeX'XXX'tXand oftenX'0"8-
SeXU°l -:'p!oi,al;on
women that does.
District Level training Module
5
Wo men's Work and Health
>
>
>
>
>
occupations like construction sites, domestic work. Recently it is observed that
sexual exploitation of women working as village leaders (sarpanches) or change-'1
agents has increased.
Rather than remaining silent about the assault, it is important to talk about it and act
promptly. Telling other women colleagues and confronting the harasser is the best
solution.
Emotional effects
Revulsion, anger, disgust, fear, shame, guilt, confusion, powerlessness.
Psychological damage
Anxiety and nervousness, depression, feelings of low self-esteem.
Physical reactions
Sleeplessness, headaches, nausea, high blood pressure, ulcers.
Whenever encountered by such a treatment, assess your options carefully. Silence
or quitting your place of work may not be the best solution. It allows the person to
“get away with it” quite free and gives him the opportunity to harass others.
t
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Different people may react to your complain differently. At times your own family
members might feel you are overreacting. But this should not deter you. Many a
times the remarks and suggestions are so vague, that when complained about, they
can backfire and the woman can be blamed for “thinking too much about you”. It is
very important to realise that sexual abuse is not based on intent but on what is the
effect, so do not hesitate, speak up.
> It is very important to handle situations related to sexual exploitation with utmost
confidentiality, but it is equally important to take actions. In some cases social
pressure might work, while in others a warning itself might be enough. At times
counselling and legal and medical help might also be necessary. Women’s groups
can be very helpful during such times.
>
A Few Herbal Remedies to get relief from the Health Problems
For nausea and vomiting:
Take a peacock feather. Separate the central blue colored semicircular part. Bum it
in a copper or any other vessel. Take the ash with honey or water 2-3 times in a day.
> Soak a teaspoonful of foeniculum (variali, saunf) in a clay vessel, through the night.
In the morning, mash the soaked foeniculum, add sugarcandy as per taste and drink
it on empty stomach. Can be prepared immediately using powdered foeniculum.
> Drink plenty of fresh buttermilk, lemon juice, curds(yogurt) and coconut water.
>
For sunstroke
> Wrap a white cotton cloth over your head and wear shoes/slippers while working in
the sun.
> Take frequent breaks and sit under the shade.
> Wear cotton clothes that fully cover your body.
District J.evel trainiti^ Module
6
Women's Work and Health
but?ermilk etc.10'12 9'aSSeS of water and also other fluids like lemon water,
> Boii’nX'1'" Cup Of O”iOr'juico boforo movi"a Out in the aun
Add roasted ^oraVoX^oTTaaaor
Drink it several times during the day9 Y SU9ar
m'X " ‘n 2 9laM'” orator.
m'nt ,oavos according Io taste.
For Skin Infection and Allergies
>
.
plen\ofOo not use soap.
neem leaves taken eccordTn^o^^neem^'mi^"8,yellOwish
(Water and
the affected part.
9
ed)' Use thls water for bathing and washing
and prepare
- KT-f
1
?
'
nner
bark
°
f
neem
trunk
and prepare a paste'Apply this paste on affected
it itches, apply coconut oil.
For respiratory/breathing problems
" Se^XisXX^<amlS)P0Wder with honey or water. Eat them in plenty
For aches and pains
lukeSm XT90" (Vi‘eX ne9Und°>' Tate »
'
or „ash the parts
its
Distrid Level training Module
1
I
Women ’.s Work and Health
Activity 1 Some Useful Exercises
Objective
I o teach exercise to the participants to get relief from the health problem arises from
work
Please Note:
As a trainer you could practice these exercises and teach them to the participants
To strengthen the respiratory system:
Pranayam is an excellent breathing exercise. Hold both nostrils lightly in a pinch.
Inhale from the left nostril and count the time. Exhale from the right nostril and count
the time. Inhale through the right nostril and exhale through the left. The exhalation
time should be double than inhalation time. This is one round. Do three such rounds
in morning and at night.
> Lie on your back; fold your knees on your chest. Hold in this position for 10-15
seconds as your breath deeply. Breathe out and gently rock your body, while
bringing your knees even closer to your chest. Repeat two or three times.
District Level training Module
8
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IVomen fs Work and Health
mn^nth°Ur b.aCkH
y°Ur arms stra'9ht °ut from y°ur sides- Bend your knees and then
move hem slowly to one side. At the same time, turn your head to the opposite side
jy "9 ° k?ep your shoulders flat on the ground. Stay in this position as you breathe 'in
District Level training Module
9
Women's Work and Health
Lie on your back with your knees folded. Flatten your lower back on to the floor. Slowly
tighten your lower abdominal and buttock muscles and holds as you count to 3. Keep
breathing as you hold and relax. Repeat two or three times.
When your work involves standing or sitting for long hours, do each of these
exercises when you feel stiff or pain.
Head: Roll your head in clock-wise
and then anti clockwise direction
(
Shoulders: Move them up and roll them
in circular motions and pull your shoulder blades
together behind your back.
Waist and upper body: With your back straight,
turn from the hip to face the side.
10
District Level training Module
«
Women ’.v Work and Health
For Stress and Emotional Problems:
tonieditatT abOIJt 1° minutes iri the mornin9 or at bedtime . There
and Chant SOme ma"tras
Z! to
'
and reach a tCght free state
"
P
-Ulsi beads.
and c°ncMrate
your breathing.
unnecessary thoughts and emotions away
ZXZ ZSX trelax your
SS tl^ aXrea,hS a"d
are different ways
oi!
S|MP
District Level training Module
11
Women’s Work and Health
Illustration 1
Linkages Between Work and Health
Low Socio economic status
Overwork
Inside home
Outside home
Child bearing
Poverty and price rise
Z' Undernutrition
Eating last and least
No control over food
Food taboos
S. Incorrect beliefs
And child rearing
Giving birth to a male child is essential
You may transfer this illustration on transparency to use during training
District Level training Module
12
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Violence and Women's Health
District Level Training Module
4 hours
Learning Objectives
At the end of the session the participants will learn about
> <gender violence faced by women
> types of violence
> linkages between violence and health
interventions in cases of violence
Design
Time in
minutes
45
30
30
60
15
30
30
Topic
Understanding types of violence on
women in the life cycle and gender
violence
Places where violence takes place
Methods
Life line exercise Activity 1
Activity 2-My safe space,
Role play
ActivityJ^What I like~arid
Effect of social norms on thinking
about our own body
what I dislike"________
Linkages between violence and
Discussion
health
How do you know when will men
Sharing of experiences '
become violent?
Why do women"stay wi'thTmarnM^
Brainstorming
has hurt her? Preparation to face
new difficulties when one decides to
leave the partner:
What is Rape? Howto avoid rape
Discussion, Activity 4-rolehow to prepare one self to go out ’
play, Activity 5-case study
alone?
Material Required
Flip charts, markers or black board and chalk. For AclMbH-small pieces of papers.
District level training module
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Note for the Trainer
Welcome the participants. You may start the session by saying....
"Dear friends,
Today we are going to discuss the topic on violence. It is a very important topic for all of
us to understand. Let us discuss this topic in detail."
'
>
Introduce Activity 1-Life- line. At the end of the exercise lead the discussion towards
type of violence on women in life cycle and gender violence.
> Introduce Activity 2 My safe place". This exercise will help you to discuss scarcity
of safe places for women. Inquire about different places where violence takes place.
Also encourage them to list down the persons.
> Ask them to perform a role- play on different situation. At the end of the role -play
while summarizing the discussion, focus on the type of violence depicted in the role
play and its effect on women's health.
Now you can lead the discussion towards effect of violence on women's health in
special condition like, pregnancy, childbirth etc. Please refer the session "Points to
Remember"
It will be interesting for women to discuss "when will they know that man is going to
become violent". Ask the women to share their experiences and make a list. You
may enrich the list by adding the points from the section 'Points to Remembered".
> Initiate a brainstorming session on "why a woman stays with a man who hurts her"
and “What are the new challenges a woman has to face if she decides to leave her
partner”.
You may now discuss sexual violence particularly - "Rape" in detail. Ask them to
define sexual violence. You may divide the participants in small groups and ask
them to define sexual violence. After they finish the discussion ask them to share the
same in the group. Compare the definition and brainstorm on the ideas generated in
the group.
> To sensitize the participants about the effect of social norms about our feeling of our
body introduce Activity- 3. "What I like and what I dislike". Also you may focus on
how we do not get our self prepared to discuss about topics related to sexuality and
sexual violence which does not allow us to be prepared to face it.
Discuss the topic of Rape. Focus on what is rape, how to avoid rape, what to do if
you are raped etc. Ask them to perform a role- play. You may give the guide- line
given in Activity 4 to build up their role-play. At the end of the role- play you may ask
the question given along with it. This will lead to discussion the complexity involved
to prove that a woman is raped. Summarize by focusing on points on what to be
done if some one is raped what to tell police? Points to be kept in view while
deciding to go for law. At the end of the topic discuss the case study given in
Activity 5. Ask questions and encourage the discussion. You may emphasize, how
'your1 own values affect your decision for the interventions.
District level training module
2
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Points to be Remembered by Participants
........ -
hisidious.
ccompanies women from their birth is in most cases invisible and
Type of Violence on Women in a life cycle
'
knowlhal,,he baby is a
> KT? ,Or,SOn',0 prohibit US9 of contraceptive^ method™"
care for girl infants.
pre9nanc>''
; emotional and
tment); differential access to food and medical
the Qenitals); sexual abuse
(impro^treatmrnQTy9fa^
and medical care, involving children in sex wrk
d'fferenllal access 10
at hpme apd ip iba
'
they XSXXXin
." Xpx
dX) aTXX°rShSeX Pn
>■ Old Aqe: Abuse of widows and elder women
*b«
abuse (treating
P ’a USe °f womeri with disabilities.
Other Forms of Violence:
There are many different ways that a mt
tries to gainhm
power over a woman. Physical
violence is one of them But all types of an
vioien^
■ —■la woman.
> SSlSfSg The man inSU"S thp ™™n, puts her do™, or makes her think
h^X^ema^he?^
District level training module
3
says that the abuse did not really happen, that it was not serious, or that it was the
woman’s fault. He may force her to work and then take the money she earns.
< Blaming her: The man passes on the blame of anything bad that happens to him or
the family, on the woman.
Controlling mobility: The man controls everything the woman does—who sh
,_:ets
and talks to and where she goes.
> Making threats: The man uses a look, action tone of voice, or makes threats that
make the woman feel afraid that he will hurt her.
Causes of Violence
Women have low status in the society. More often than not, they are used by men to
ventilate their frustrations and exert power.
Where and by Whom Violence Take Place
Where violence
takes place
By whom
Types of violence
Home
Husband, Father,
Brother, Other
relatives uncle,
brother-in-law etc.
Work Place
Landlord,contractor
, supervisor,
Male Colleague
Students,
Teachers,________
Students, warden
By any men
> Mental torture, wife beating, rape,
bride burning, compulsion of sex
work to earn money for the family.
> Women are pressurized to undergo
sex determination test, they face
discrimination & neglect
> Eve teasing(making fun),
molestation(trouble), rape________
Molestation, eve teasing, rape
School/ colleges
Hostel__________
Public places: Bus
stand, railway
station, while
travelling in this,
roadside, Cinema
Theatre, in
forest/farms.
Eve teasing, molestation, rape
Eve teasing, Molestation, rape
Eve Teasing, molestation
One out of five women, worldwide, is a victim of rape. Most of them know their
attackers. Young girls are the most frequent targets. Forty to 60 percent of all known
sexual assaults are committed against girl’s aged 15 years and younger.
District level training module
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Effect of Violence on Women's Health:
hX"X=: sssa KSand 'n°ntai i aai,h-101 us
XX ?S‘
excuse to control diet and activities of women. '
U
both
m°re' Pre9nancy becomes an
(sexual relationsTm^ng^loserelaUveT^or by affect'1
SUCh 9S rap® and incost
contraceptive use. !n a study in Mumbai InSfa 207 o?^^^3''3 abi'ity t0 ne9°tiate
abortion seekers occurred due to forced'sex 10 °/ fmm
servant, 6% from incest, and 4 % from other’rape!
pre9nancies of adolescent
7 3 ma'e d°meStic
^de^frave'on XmpXaX^^tenVbo^Thi?"133’5 abf°men or women are
Zhnrt eathr2f WOman- Sticks and sha? ON^S arl inXayHreSUtJ rUp,Ure °f the wo™b
abortion. This may result in rupture of womb or
aT?
h® Va9ina to iriduce
women and they face the anxiety and Xa“f tabdr atone
ParlnerS aband0"
^^h?mX?XeXhgeaVXhMdXd«9a?m'°n TdhreSU" of lhe frustration
the production of breast milk.
STb^n^eZe ™XaXX^
S thrOugh
through the effect
effect violence has
h on
is 'suspected-
contract sexually transmitted di
women are vulnerable to
protection. Women with STDs have a hioher risk oT53 hp7 arS unab,e to negotiate
possibly for her children as well.
s are usually fatal for the woman and
«mTrS,o ™eX to tamtotoe^Do^ XXommo"5' bralher-in-|aw e"= WU most
money
injuries, or homicide.
°on ^“^mands torgiST
y end in forced "suicide”, death from
District level training module
5
S'
Mental Health: This is a key intersection between violence and health, i e violence is
^eeT°-rrLOt JUSt affeCt women's health. but more specifically affect women’s mental
bea th. The most important issues in the relationship between violence and mental
ealth are depression and low self-esteem. Depression is most, but the effects can
include reduction of strength, lack of energy, insomnia and tiredness.
ge.nous pain and injuries: Broken bones, bums, black eyes, cuts, bruises, as well as
abuse haTtaken place
mUSC,e’ pairi that may continue tor many years after the
?eTJn a?SJ°f violence <such as domestic violence) create a paralyzing web of fear ill
ealth and destruction. Therefore, violence should be viewed as an issue of power for
women, or more fundamentally, as an issue of survival. Not just a woman’s health
ut a woman s survival is often at stake during encounters with violence.
When does Men Become Violent?
One must ask the following questions to assess when do men become violent?
>
oes he act jealous when you see other people, or accuse you of lying to him? If
you find you change your behavior to keep him from acting jealous then he is
controlling you.
> Does he try to keep you from meeting your friends and family, or from doing things
on your own? It does not matter what reason he uses. He is trying to keep you from
having their support. It will be easier for him to abuse you if you have nowhere else
to go.
> Does he insult you or make fun of you in front of other people? You may start to
believe what he says. This can make you feel as though you deserve to be treated
badly.
> What does he do when he gets angry? Does he break or throw things? Has he hurt
you or threatened to hurt you, physically? Has he ever hit another woman? All of
these things show that he has trouble controlling the way he acts.
> Does he feel insulted by people with authority, such as his teachers, bosses, or his
father? He may feel he has no power over them. This can make him try to gain
power over other weaker/ subordinate people in other areas of his life by using
violence.
Does he claim that alcohol, drugs, or stress is the reason he acts the way he does?
If he puts the blame on something else, he may say things will get better if he gets a
new job, moves to a new town, or stops using drugs or alcohol.
Does he blame you or someone else for the way he acts, or denies that he is doing
anything wrong? He is less likely to want to change himself if he thinks that the way
he acts is your fault.
In a community, violence can cause:
• The cycle of violence to continue to new generations.
• The continued false belief that men are stronger than wo men.
District level train ing module
6
Why Women Stay with Men Who Hurt Them:
Why do a battered women stay with men who hurt them? This is the first question most
people ask when they hear about a woman who is being abused? There are many
reasons why a woman might choose to stay in an abusive relationship. They include:
£-e^ar|d threats: The man may have told her, "I will kill you kill the children kill vour
Xeir aAdX^,Ob^eyi’nghe mav feel She iS dOln9 ev^thins she can to protect
-a" -
No protection: There may be nothing to slop him from coming after her and killing her.
Shame. She may feel that violence Is somehow her fault, or that she deserves It.
She may fee! it is her duty to
save the marriage, no matter
Social obstruction from society: In our b
society serving ties in a relationship is not viewed
positive. Usually the blame of a broken
■ i marnage/relationship goes to woman and she is
unable to live a normal life again.
SiSyS^nT^e^eLSs:;:^oX1^ XT r“p 10
guilt about leaving the children with no father.
But perhaps a better question to ask is,” why does not he leave?’' ir
' peT iXZSr 10
i
>
reSP°nSib'e f°r 'he hea“h and we" b*9 °< ^ery
she needs to be—- -
has IoVst control ov^heTand SVs^all^X'thinoT
t
Partner- The man
follow on his threat to kill her Sh^/must^make sTre ?h 9 / baCk He
even trV
does know about or where she is protected
fh hTJS s ayins In a safo P^ce that he
staying. He may force them to tell him or anyone XXe?XrTaZu1sWhere
iS
District level training module
7
)
Surviving on her own: She needs to find a way to support herself and if she has children
and her children too. If she can stay with friends or family, she should use that time to
get more education or learn job skills. To protect herself maybe she can share a place
to live with another woman, who was abused in the past.
r. eg lings: All the things she needs to do start a new life may feel like too much to face.
She may feel scared and lonely because she is not used to being alone in a strange
place. She may miss her partners—no matter what he did to her. When things seem
very difficult, she may not remember how bad it really was before she left. Allow time to
pass. Try to stay strong. Try to find other women in the same situation as you. Together
support each other.
For change to happen, people must stop thinking of violence against women as
something that 'is just the way things are’ or that is the woman’s fault. Here are some
ideas for understanding and helping stop violence in your community.
What is Raps?
Rape means to have sexual contact against a woman’s wish. Any time, if a man puts
his penis, finger, or any object into a woman’s vagina, anus, or mouth against the will of .
a woman, it is termed as rape. The consequences of rape are often severe and long
lasting. The shock may sometimes make the victim averse to sexual relations for life.
Rape, categorized in the Indian Penal Code under "offences against the human body”.
Rape is the only crime where the victim is immediately marked by social stigma. She is
treated as a social outcaste.
How to Avoid Rape:
There is no one correct or incorrect way to behave to avoid rape. What a woman does
depends on how well she knows the man, how afraid she is, and how much danger she
thinks she is in.
These Ideas May Help Any Woman to Avoid Rape:
Work with other women. You may be safer and stronger if you work collectively in
groups.
> Do not let anyone who makes you feel nervous or a stranger, enter in your home. Do
not let him know if you are there alone.
> Try not to walk alone, especially in the night. If you must go alone, hold your head up
and act as though you feel confident. Most rapists will look for a woman who looks
submissive and easy to attack.
> If you think you are being followed, try walking in another direction or go up to
another person, a house, or a store. Or turn around and ask him very loudly what he
wants.
>
District level training module
8
c
(
(
>
Carry scmBthing with you that will make a loud noise, like a whistle Also carrv
Som! h'n9 that y°U Can USe t0 defend y°urself- This could be a stick safety pins
somethmg you can spray in his eyes, or even some hot spicy powde'r like hot ’
pepper or chili powder—to blow in his eyes.
f you are attacked scream as loudly as you can use your whistle If this does not
SoXwaT(PartiCU'arly°n9entolS),0
him i•WouXbl
Avoiding Rape by Someone Known:
Be Aware if You:
>
>
>
have a lasting feeling that something is not right
reel afraid or you want to leave
Sik^X^
people will think° Inadd^
the person is making
maV be ^raid of what other
may not want to admit that he would do harm to her Bu??^ 7
CareS ab°Ut' she
feehngs and get out of a situation that feels uncomfortahl' L ?WayS best to trust W
happens.
eis ur|comtortable before anything bad
Trust your own feelings.
--------------------------------------- ------- ----------- Jt is better to offend someone if you are wrong than to be raped,
---
Be Prepared to Get Away-Tips for Women:
' do n'ot'know well'0"6 ™*h 3 PSrS°"
fee, uneomfodebte or who you
someywhere if yo™w‘°nofbeTbte togetbaotTSo"l th 10
" 'Sbelternot 109
Tell the person that his comments ortourh
h
he person's assistance.
change the way he is acting you should apt aw/ r °U u5lcomfortab,e- If he does not
> If he has power over you- (Landlord Villfoe I
h
h'm 33 S00ri as Possible.
leader or member, Sarpanch)
9 Leader,Landlord, Polioe, Panchayat
' Jhl “X6 totateld^aX’f'S
0
*°P
frighten. Let him know that you are noSht^ h u 0°k f°r someone who is easy to
(for example to fire you, refuse yTu medSl carl or d^
'ike,y tO treat
y meoical care, or deny your request) if you can
District level training module
9
(
get him to stop bothering you before he has done anything that makes him look
foolish.
> Talk to other women about him. You are probably not the only one he has bothered.
If you must continue to deal with him, try to bring along a friend with you so that you
are never alone with him. Warn other women to be careful.
If a Woman is raped:
> If a woman is able to resist her attacker, she v/ill usually be able to avoid a rape,
even if the rapist has a weapon. The more different ways a woman tries to keep from
being raped, the more like she is to be able to avoid the rape or to suffer fewer
injuries and mental health problems from rape.
> It is impossible to know before hand how a woman will react when someone is trying
to rape her. Some women are filled with rage and feel strength they did not know
they had. Others feel like they cannot move. If this should ever happen to you, know
that you will do what you can.
Some Ideas that May Help Woman baring a Sexual Assault:
D.Q
cry, plead, or give in. It usually does not help. In fact women who try this
often suffer more injuries than women who fight back do.
> Stay aware: Watch the rapist carefully. There may be times when he is not watching
you, or when he loses his control.
> Try-different things: Kick, yell, bargain, trick him—-do whatever you can think of to
make him realize you are not an easy victim. Try to make him realize that you are a
person, not an object.
If the rapist is a stranger, try to memorize what he looks like: How big is he? Does
he have scars or marks? What kind of clothes is he wearing? Try to remember them
so that you can tell the police and warm the other women in your community.
Use your best [udgement: Only you can decide how much to fight back. In some
rape situations, for example, during war, the rapist may have no reason to keep you
alive if you resist.
What Deas Woman do if She is raped?
Every woman’s experience of rape is different. But there are a few things she needs to
do to recover fast. She may ask following questions:
>
>
>
>
Who can she ask for help?
Does she want to report the police about the rape?
Where can she go for medical care?
Does she want to punish the rapist?
Women need someone to talk to when she feels sad, hurt, scared or angry, to go for
medical care. She needs to choose someone who cares about her, whom she trusts,
will not tell others, and who is strong and dependable. Sometimes a woman’s husband
or parents are themselves too upset to be able to give much support.
District level training module
10
•
I
If someone you know has been raped:
Reassure her that it is not her fault
h^thE^nLig’en0^7“'iZ'he,p her dec,ds what she ne^and—
Respec' her wishes for privacy and safety. Do not tell anyone else unless she wants
>
someone who Is^nX'llsSa^0
‘0 ‘he POfce’ 10 “™th
suPPo her, to see a lawyer, and to go court if
she wants to do those things
-s.
community eCI
l™'him
The Decision to Use the Law
danger to even, woman in the.
must be Made Carefully.
Following are some questions woman needs to answer
Can someone go wth you to talk to the police?
>
□o yo™“
>
about the rape?
> “"hXS is' caught and vrf
punished?
>
S
P
been raped,
' Can he Pollce keep others from learning
" y°U reP°rteid lhe
y0U Can prove lhal he raPsd you. how will he be
soonXl?hnekra;heeaZZteOS^Oshih10 ,he p°,iHy shp
« as
and carry the clothes that she was wearing'in™ bZ^seT'3'8 bef°re She 9°es'
prove that she was raped. Advise her to takP p frionn
u hin9s can he,P her to
female health worker (lady doctor) examine herjf possible
t0 haVS 3
some medicinesTodprevetntr|^e^
WOman for cuts or tears, and give her
sure that she writes down everything that she^nds^'^^'^^ diseases (STDs)- Make
police or to others in the comm^tharthe ^m/nwalri;^" he'P
*the
happened. If woman knows
what he looks like. She may have to ™ with the nni d<T
She needs to describe
be asked to get medical exam from a legal doctorS
7 tO
him' She
also
help to prove that a woman was ^6^"
W°rkS
the police- Th's is to
or in frontof a ju'Jgeln courTlHheTis amitl^ SfiM^ ’
°f the P°lice
rape cases before. The lawyer will tell the wornm^ f? aWyGr Wh° has worked with
for the triaL Always advice woman to taK Xon^wlSh he^^
h6,P
Prepare
District level training module
11
3?
-Qrking for chanqe: Rape affects everyone in a community. Women who have been
raped can suffer long-lasting problems because of the rape. But almost all women
whether they have been raped or not, learn to be afraid. They learn not to trust men
and they learn not to do things that attract attention.
I o create a world, in which rape does not occur, we need to work toward having:
< Communities where a person’s choices and behavior are not limited by whether the
person is a man or a woman.
> An equal chance for everyone to participate in the community
The chance for men and women to talk openly and honestly with each other about
what they each expect from a sexual relationship.
Useful Heclth Education Material
Video:
> Film clips on Violence, CHETNA, Lilavati Lalbhai’s Bungalow, Civil Camp Road
Shahibag, Ahmedabad-380004 Gujarat. Language Hindi
r- Mirch Masala:Yuva Narepark Municipal school,Parel(East) Mumbai-400012
Language-Hindi
z- Ek Potlu Bik nu : Dishti, 3 Aniket Duplex, Anandvatika, and Opp.S. M. road,
Ambavadi, Ahmedabad-380015. Language-Gujarati
> Bai Department of communication, Ishwani kendra, Post bagNo.3 Pune-411014
Language-Marathi
District level training module
12
4
c
c
c
Activity 1-Life Line
i
(
Objective:
To sensitize participants about the gender violence faced by women. To review the
visible and invisible instances of violence women that face.
Material Required
Small pieces of papers. Flip charts and sketch pens
Method
' h™?efPar!IC'Par:LS IO ,hink forfi''9 minutes and then let them list down different
types of violence that they are aware off They may list down differentXes of
domestio vioience and sexual violence. Few example of gender'oS may also
' dn0^athl n® participants t0 remember their life experiences and ask them to list
own the experiences of violence during their following ages.
5-10 years
10-20 years
20-25 years
25 and above
*
So^r^Ti^aXenTe0"6 *
*
Once they have completed the task, ask them to read
" experience th^groupXbeX
10 “ th9
;
simi.ar
iife—on
District level training module
13
3^
■c
Activity 2- My Safe Space
Objective
To sensitize the participants about the scarcity of safe spaces for women
Material:
Flip charts and sketch Pens
Method:
This is an individual exercise. Each participant will create her safe spaces on chart
paper. Each individual will define 'safe space', and draw an image of it. These 'safe
spaces' will then be shared in the larger group.
This exercise is part of internalization process. The participants will examine safety in
their context and identify areas in their lives where they do not feel safe. Encourage the
participant to share their experiences, which will help the group to realizing the scarcity
of 'safe spaces' in women's lives.
Activity 3 My Body:
Objective:
To sensitize the participants about how we are conditioned above our own body and
how much we are influenced by social norms.
Method
>
Ask the participants to think about different parts of their body. They should list down
parts of the body which they like and which they do not like. Ask them to think about
the reasons for there likes and dislikes.
> It is possible that participants will note down all different parts of the body but will not
discuss about the reproductive parts of the body. You may encourage an discussion
on the reasons for the same. You may summarize the discussion by highlighting
how social norm conditions us to think differently for our body parts.
A Summarize the discussion by focussing on how social norms limit us to discuss
about sexuality and be informed about the sexual violence.
District level training module
14
I?
Activity 4 Role Play on Rape
Objective
nsitize the participants about the complexity to deal with the problem of Rape
Method
Give following points to the participants to perform a role-play
V
>
She'^riesTtell hSfoTi
fT RajUka WaS raped
a rich man's
Qh! IT 7
h f
y members. who were not ready to believe her
She goes to woman's group and discusses about her problem
They go to he police. The police refuses to note the comp a.nt
The women’s group takes out a rally.
^mpiamt
Rajuka's family refuses to keep her in the house
Ask thAmaHS 9r°UP thinkS about filin9 a case in the court
Ask the participants to end the role-play as per their wish.
At the end of the role-play ask the following q
|uestions
What difficulties Rajuks faces to prove that she is raped? Why?
Activity 5 - Case Study who is responsible? Why?
Objective
To sensitize the participants on how ones
own value affects while deciding that a
woman is raped
Method
Read the following case study
empowerment. You feel
very stronglythat wlmSouWb^
life. You have two daughters Your s T/S
house and is very happ ^bringmX^her oS'son
d need t0 have control
her own
h0USe' She mana9es the
is intelligent. He is working in a well kno^ firm ?n Y0^15^’3 son is 30 years old, he
transferred to your city since last fi mon?hTv
•? ® °fhor city' He has been
noticed that fjis been mo^njJ arlnd wth bea. '
S°n 3 ,Ot You have
from other members of the community You cam/tn ?" '
try t0 find out about her
friends. Your daughters also teTyou thaTsheX a fast ZT’’
haS Several
boys and comes home late at night You mentioned thk ' Sh m°VeS around Wlth many
concerned None of you are .eased
your sXTXn ZciXg S
s “ Ke^uXd'h8:; SofXerhosmh:
story. She said that she does not have anv^nTan^
thing happens. She asked for you help
,hryour s°n has
h 9
-
y°U and told the same
6 does not what to do if such
Ask the question- Q. What reould you do In such a situation? Why?
District level training module
15
I
yVomen Mental Health
,!
1
Women's Mental Health
I
District Level Training Module
3 hours
Learning Objectives
At the end of the session the participants will |earn about
Causes of mental illnesses among women
Pr°btem5 arI,On9 —
■
•
^ns
support services to improve community's mental health.
Design:
Time in
minutes
30
30 ‘
30
60
I 30
Topics
Developing our own story
Who are mentallyT^althTwomerTand
reasons of mental illness among
women.
~C°mmonmierital health problems
among women and their causes
2uPPorFserviceFanFwayFtoTnpro^
community's mental health
Revision
-
Methods
Activity 1
Discussion
Discussion
Discussion, Activity 2 and
Activity 4~
Material Required
Flip charts, markers, black board and chalk
District Level Training Xfodale
1
Women's Mental Health
l
(
Note for the trainer
wScoSeVa^
"Dear Friends,
we talk about health, we usually think about our physical health, but our mental
hea/this epualiy important. Today, we will talk about mental health. We will focus on
mental health problems of women. It is observed that mental health problems like
depression (sadness, decreased activity) and other stress related diseases are more
amo^^ornen. They may arise from fears of different kinds or responsibilities
Semalharsssmenl^physicalMance. Let us learn
*
Introduce ^ptivity 1-Creating our own story. Ask the questions given along with it
This activity will help the participants to understand the problem of mental health and ‘
Xh S.p°r
S' Add P°ints on reasons t0 mental health illnesses from the
section Points to Remember’
remember^^01 menta'illnesses and its symptoms. Please refer points to
fT,y0U?h inf0rmal discussion try to bring out beliefs and the customs that community
follow to cure mental y ill people. Try to explain that it is important to provide support
to the woman at family and take her to medical doctor at appropriate time.
*
-u00 Can
thS partic'Pants about their ideas to solve the problems of mental
health illnesses^Discuss points related to howto cope up with own self, formation of
support group. Perform Activity 2 and 3. These activities can also be tried out at
mln?ei h VSLAt thS end briefly discuss about comprehensive government program of
menial neaitn.
You may end the session by asking them to perform a role play on depression. Ask
them to depict signs, ill treatment, society treats her and efforts of women's group to
provide her support. The details are given in Activity-4. This will help you know how
much they have learnt during session. Points to be remembered by the participants
’
District Level Training Module
2
i
yeomen fs Mental Health
Points to be Remembered by Participants
A mentally healthy woman
> Values herself as an individual
accepts her SZJoTera*9 '° h°W
* realistic,
her
>
^Sr tody3 hTrseT
>
eX‘endS herSe"
Takes pleasure m bemg a woman and an individual.
Reasons for mental stresses faced b
y women
Women go through various stresses in Indian society. They may be
Economic
>. Too little money
> No control on money and assets and livestock
Social
> Low Socia| status in family and society
Multiple social roles and expectations
> Early marriages
Physical/sexual stress
and violence (rape, sexual abuse, marital rape, etc.)
> Inadequate food
> Overload of work
Vx
Work
>
>
>
ExploiSion^963 ?nd earnin9 opportunities
exploitation at work - economic, physical sexual
Occupational health hazards
Y
'
Personal stresses
> Poor self-image
Frustrat'on due to unmet needs and desires
Deprivational stress due to loneliness
plC l'eep in "'ew before decidi"9 whe,he'-
has a mental health
health problemT™1'0" between normal responses to live's events and mental
>
[Most people sh°W some of the signs below at different times in th
• r
everyone faces problems at one time or another
> Siansrtf
In lheir lives, because
> Si9ns ot mentat riealtb prob.ems can vary from Community to community.
District Level Training Module
3
Women ’5 Mental Health
Common Mental Health Problems among women
depression (Extreme sadness or feeling nothing at all)
Signs
Feeling sad most of the time
> Difficulty in sleeping or sleeping too much
Difficulty in thinking clearly
> Loss of interest in pleasurable activities, eating or sex
> Physical problems, such as headaches or intestinal problems, that are psychological
and not pathological
> Slow speech and movement
> Lack of energy for daily activities
> Thinking about death or suicide
Anxiety (feeling nervous of worried)
Everyone feels nervous or worried from time to time. When these feelings are caused
by a specific situation, they usually disappear, soon afterwards. But if the anxiety
continues for a longer period or becomes more severe, of if it comes without any
reason, then it may be a mental health problem. That is when it interferes with routine
activities of day to day life for longer intervals.
Signs
> Feeling tense (having vague tension) and nervous without reason, apprehension
with anxious anticipation of danger (when there is no real threat or danger)
> Shaking hands
> Excessive sweating
> Feeling the heart pounding when there is no diagnosed health disease
> Difficulty in thinking clearly
> Frequent physical complaints that are not caused by physical illness and that
increase when a woman is upset.
> Forgetfulness
> Inability to concentrate
> Disturbed sleep
Mental Stress
When a person experiences stress, the body gets ready to react quickly and fight off the
stress. Some of the changes that occur are:
> The heart starts to beat faster
> The blood pressure goes up
> Digestion slows down
District Level Training Module
4
)
(
W7omen fs Mental Health
stress can also cause illness, like high blood pressure.
^^Jls^dearj^
V'
and ,oss of CQntro| wifh
Signs
th!
V°'CeS °r Sees unusual things that others do not hear or see
iovedones'are tryincuo JobhT da"y
<delUSiOnS)
eXamp'^ She
She™ longer ceres for herself, for example, she does not get dressed, clean herself
> She behaves in a strange way, like saying things that make no sense.
™attter”hat featment is given, a person with
a mental illness should
be treated with kindness, respect, and dignity.
Getting Care for Mental Illness
the person can also beVeaTed by^traine^ment^
11 is best if
S°me S'tUations
medicines are necessary, but it Xn never be the or!ly treatment
Interventions to Solve Women
's Mental Health Problem
Helping Ownself and Others
do what she likes,
songs, etc.
*
y
s®asaa~se--
, every one feel more
To build inner strength, prayer, meditation.
District Level Training Module
5
Women’s Mental Health
Starting a Support Group
> Two or three women, who want to start a group, need to come together
" for woCrshi^eet
P'aCe' SUCh 33 3 SCh°01' health post’ C0°Perative, or place
r
T1'"9 discussion' how the group will be led, how new members can
join, what kind of activity the group will undertake etc.
'5°U9ht the p®;son 2^° be9an the group will probably need to take the lead at the
first meetings. She should not make decisions for the group. Her job is to make sure
veryone has a chance to talk and to bring the discussion back to the main point if it
thTgroup0^
meetin9S' members may want to take turns leading
Comprehensive Mental Health Program of Government
Health1 Prog[-3^Cef f°r Pnmary Health Care in mental health and National Mental
I|pmPnltlcS°Phy °f community Mental Health Program consists of the following essential
“IciiiciiiS.
>
>
>
>
>
>
Inpatient services
Out patient services
Partial hospitalization
Emergency services
Diagnostic services
Education services031"6 SerV'CeS Includin9 fos,er home placement and home visiting
> Training research and evaluation
Useful Learning Material
Mental Health for Multipurpose Health Workers (National Institute of
Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
> Ih®,C°mplrte Guide t0 Your Emolions and Your Health, Emrika Padus, Rajendra
Publishing House Pvt. Ltd., Surface Road, Worli, Bombay-400018
District Level Training Module
6
Women's Mental Health
Activity-1 Creating Our Own Story
Objective
To help participants to share their experiences and analyze the causes for the same.
Method
from man, T'3'heallh Probte"l. The facilitator starts the
tell another part and so on onlToTt
s
PrOblBm Anolher member continues to
complete The story need to be rloe2|0n9a kS con,r bufed something and the story is
experiences of tS £^£^±2^ "'6 eXPe"e"Ce °r
Ke sure h9*
end.
^n'helppadlripantsVeg'in
‘
story comes to appropriate
h8Ve been ^velopecf. These questions
1.
2.
3.
4. Who helped to detel-T a newMance in her fcp hea'th PrOb'em 'TOman is facin9?
District Level Training Module
7
)
.
^2
H'omen ’.v Mental Health
Activity-2 Learn to Relax
Objective
i o enable relaxing among people who are suffering from stress
Method
i a quiet place where everyone can sit down (preferably lie down), the facilitator asks
the group to follow these instructions:
Close your eyes and imagine a safe, peaceful place where you would like to be. This
might be on a mountain, by a lake or ocean, or in a field.
> Keep thinking about this place as you breathe deeply. Let your body relax. You can
suggest each organ, starting from your right leg, to relax.
If it helps, think of a positive thought, such as "I am at peace", "I am safe".
> Keep breathing, focusing either on the safe place or the thought. Do this for about 20
minutes.
A woman can also practice this exercise at home whenever she has any difficulty in
sleeping, or feels tense and afraid. Breathing deeply helps calm nervous feelings.
r- If you start to feel uncomfortable or frightened at any time during this relaxation
exercise, open your eyes and breathe deeply.
Activity-3 Active Listening
Objective
To practice active listening.
Method
In this exercise, the group divides into pairs. One partner talks about a topic for about 510 minutes. The other partner listens, without interrupting or saying anything, except to
encourage the speaker to talk more. The listener shows that she is listening by her
attitude and by the way she moves her body. Then the partners switch roles.
When the partners are finished, they think about how well it worked. They ask each
other questions like:
Did you feel listened to? What difficulties did you face?
Then the facilitator begins a general discussion among everyone about the attitudes
that best demonstrate listening and concern. The facilitator can also emphasizes that
listening sometimes means talking: asking questions, sharing experiences, or saying
something that makes the other person feel understood. It may also mean admitting that
you have tried but still do not understand.
District Level Training Module
8
Women fs Mental Health
Activity-4 Role Play
Objective
> ^^S'HZe the. par1LciPants about the reality about how mentally ill women are
* treated in society and how to support mentally ill women
r' To assess how many participants learnt during the session of mental health
Method
You may introduce the role -play by giving the following situation This is Vilashour
±?e
Kha 'S “ yearS Old' She has four daughters Her husband is a Xunkard Her
mily members want a male child. Radha is going through depression Ask the
fhe XTk foToXTulstion:""'
rOle'P'ay' They
,ha story
**
1.
2.
3.
4.
What may be the reasons for Radha's depression?
What were the signs of depression?
Radha got support from any one?
If yes who supported her when and how?
District Level Training Module
9
Access to Government Services
'j
)
Access to Government Services Focusing on
Health Care
bistrict Level Training Module
3 hours
Learning Objectives
At the end of the session the participants will learn about
>
r
>
x
>
existing government services at the village level
role of village level government functionaries
existing health infrastructure
role of health functionaries
existing government health services at the grassroots.
Time in
Minutes
30
30
60
Topics
Methods
Existing government
services at grassroots and
who provides that
Role of various functionaries
Health infrastructure
Activity 1
30
Discussion______
Activity-2. Disci jssinn visit of
PHC(Primary Health Centre) and
sub centre.________
Role play, discussion
Reasons for poor access to
health service______
30
Discussion on role of
Discussion
Panchayat and community to
____ ensure govt, services.
It is impotant to organize a visit to PHC,
sub centre or First Referral Unit (FRU)
Material Required
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Note for Trainer
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Welcome the participants and explaining the topic to be discussed.
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You may start the session by saying....
“Dear Friends,
c
Everyday, we see different government functionaries come to our village like Gram
Sevak, Female Multi Purpose Worker, Male Multi Purpose Worker etc. They are
assigned different roles. Many times because we are not aware about their role and
services they deliver. We fail to take benefits of these services. Today we are going to
discuss about this topic. We will focus our discussion on existing health services."
> Ask the participants to think about different government functionaries that they
observe visiting their village. Give them 2 minutes and then introduce Activity-1.
Through this activity you will be able to appraise the participants with the roles of
different government functionaries.
Now focus your discussion on health care services. Introduce Activity-2. Through
this activity you will get a floor chart of health infrastructure. Refer points to
remember to update the chart. You may transfer the chart on the transparency and
show it to the participants.
> Divide the participants in three groups and ask them to perform role-plays based on
the situations given in Activity-3. Conclude the role-plays by focusing on reasons for
poor access to health care. You may classify them as state and societal reasons.
> At the end ask the participants what need to be done to improve the access to health
care and briefly discuss the role of Panchayat and community to ensure govt,
services at village level.
> If time permits take the participants to visit PHC and sub centre. During the visit
explain them different services to be delivered from these centres.
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Points to Remember
Role of Various Government Functionaries
'
Government
Functionaries
Forest/Agriculture
'Lagwad Kotwal’
Assistant
Cultivation
Officers &
Cultivation Officers
Roles
Whom to report in case of non
performance of duties
To encourage people to
undertake afforestation
and convince them of its
importance; to send their
application to higher
authorities_______
To convince people about
the importance of
afforestation: to implement
government programmes
and schemes regarding
the same.
Assistant Cultivation Officers
A complaint against Assistant Cultivation
Officer should be made to Cultivation
Officer.
A complaint against Cultivation Officer
should be made to the following officers
through the village committee
Assistant: Director
Sub-Director
(One officer per district)
Associate Director
(in some districts)
'T
_ Director (For entire state)
Education
Balwadi Teacher
(Pre-school)
To run the Balwadi for ten
months in a year, to
enhance children’s interest
in learning
Teacher
To teach and encourage
‘the students
Principal
To look after the
administration of the
school, to keep an eye on
the progress of students,
to supervise the working’of
teachers and to guide
them.
Contact the following officers through the
education committee.
Extension Officer
Block Education Officer
Sub Education Officer
EducationOfficer
The Principal (irT^se of on^te^teF---------school complaints should be made through
_the_village Education CommittPA)
The Principal (in case of one teach^F---------school complaints should be made through’
the village Education Committee)
The chief of the Center (one Center covers
10 schools)
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Education Extension Officer
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Block Education Officer
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Access to Government Services
Rural Development
Gram Sevak
(Village Development
Officer)
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To maintain Gram
Panchayat record from 1st
to 28th of the month to
conduct monthly meetings
and village meetings
(Gramsabhas)
And record their minutes; to
collect taxes and market
rent; to register births &
deaths as well as
marriages; to issue various
forms, to implement and
execute government
schemes, to look after the
supply of electricity, water
etc. to the village, to look
after water purification and
maintain general
cleanliness in the village.
Rural Police Department
Police Patil
To maintain law and order
in the village, in case of any
kind of disturbance in a
village s/he should report
immediately to the nearest
police station and Talati. In
case of murder, robbery
and theft in a village s/he
has to make further
Inquiries in the matter
Revenue Department
Talati
To collect land revenue, to
send annual report to the
Kotwal
administration; to inspect
the crops, both Kharif(Aug.
to Oct.) and Rabi (Nov. to
Dec.). These tasks have to
be completed by the end of
the year. To update the
record of land registration.
In case of natural
calamities, loss in
agricultural produce has to
be estimated and submitted
to the government.
Through the Panchayat Committee
•
Taluka Panchayat Officer (TPO)
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Block Development Officer (BDO)
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Village Panchayat Officer (VPO)
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Chief Executive Officer (CEO)
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Zonal Officer
Nayab Tahsildar
Tahsildar
T
Sub-divisional Officer
A
Additional collector
4
Collector
I
Commissioner
State Government
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Health Services
Primary Health Care in Indin:
principle of “fiacfog^llh Scheme. based on the
health care deliveryfn rural areas
P
P
“ iS 3 lhree-tier syste™ of
i
equitable distribution of hea1^resourcesPTo 3P631^
'S Universal coverage and
the following schemes are in operationT ,mP|ement this policy at the village level,
1. Village Health Guides Schemes
3 icDSnnt01 '0C;al Da'(Traditional Birth Attendant)
3. ICDS (Integrated Child Development Scheme)
1) Village Health Guides (VHG)
government function^5ThTscher^^s taun^M^ S°Cial service and is not a
Karnataka, Tamil Nadu, Arunachal Pra^Sh
In al1 states except Kerala,
alternative systems. VHG are usually wmen Th^VHC
Kfashmirhad
the community. They serve as links between tha rnVHG C°me from and are ch°sen by
infrastructure. They provide the first contact betwean
and the 9°verrimental
system. They should be able to
2) Local (TBA's) dais:
receives Rs. 10 when she conducts hZe d^ivaA Q?OrariUm- (She s°metimes
Delivery Kit (DDK) for conducting delivery It is planned^a (SUpp0Sed to use Disposable
(practicing under trained Dai) in each village. P
d
ra'n at east one or tw° dais
3) Anganwadi Worker:
Anganwadi worker^e^
scheme, there is an
from the community. She undergoes traininn in°' Th An9anwadl worker is selected
senses a„d pravide health
and
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In some states, there is a provision of Ayurvedic/Siddha dispensaries. In
Gujarat there are mibile Ayurvedic dispensaries. There are 629 Ayurvedic
dispensaries, and 34 homeopathic dispensaries. 4 mobile dispensaries
provide services to rural and urban areas. There are 37 district and Block
level hospital.
5ub-center leveI:
The sub-center is the peripheral outpost of the existing health delivery system in rural
areas. It is the first contact point for the people. They are being established on the basis
of one sub-center for every 5000 population in general and one for every 3000
population in hilly, tribal and backward areas.
Each sub-center is staffed by one male and one female multipurpose health worker.
The team at sub centre is supposed to prepare sub centre plan each in consultation
with local community leaders, panchayats and women organisations and with other
welfare programmes related/affecting health. They provide maternal health, child health,
family planning, health education and immunization related services.
The Primary Health Center
Structure: A primary health center (PHC) covers a population of 30,000 persons, in
plain areas and 20,000 tribal/hilly areas which include approximately 5000 to 6000
households. Each PHC has 6 sub-centers. A sub-center covers a population of 5000 or
about 800 to 1000 households. The details of the PHC staff is given in Table 1: PHC
staff.
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Table 1: PHC staff:
Name of Staff
No
Role
Medical Officer
2
Pharmacist
~~
Staff Nurse
MPW (F)
(Also called Village
Health Nurse)
1
1
1
or
2
Role is primarily in curative care. More important the
medical officers lead the PHC activities and its entire team
Dispenses drugs
-------------- —
.Assistant to the doctor in provision of curative care.
Child health and maternal health especially care in
pregnancy, family Planning, immunization and designated
MPW (M)
1
Health Educator
1
or
2
mSrTgXrosy0115 na‘iOnii' hea'tl1
nfTJ'-H plannin9’ immunization, tuberculosis control, control
of epidemics and carry out assigned duties with various
nat'ona! health programmes like TB, malaria, leprosy
control of blindness etc. He is also supposed to guide
ganchaygts in environmental sanitation activities
Health education to community especially women.------------ -
Lab Technician_____ 1
Driver
~
~~~ 1
Tiealth Assistant
('lady health
supervisor)
Health assistant
(male)
M alarla slides and detection, TB detectinn tnsts~---------------
1
1
Multi Purpose Work Supervisor
_____
Reasons for Poor Access to Primary Health Care by Women
Constraints of the Health Care Services:
t° avail heaith services if (he PHC is
iparfequa^^a^lft'ie^and^on-ava^ab^lily of d7uag?eDnXseoSnqivby
—1
Clfent
a'S0
services S" XXefXSZSh
toD6°0™p mP^
women as they are busy with their house hold wlrk
Sgs maynot bTsSable
between 8.00 a.m. and
COnvenient to
P^''0 tranSpOrtation to and
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Constraints at the family and society level:
Responsibilities of house hold work and Culture of Silence: Women are expected to
bear the whole burden of household work. They are not well informed about the
availability of the services through the government. Due to low self esteem and the
culture of silence in which they are socialized makes them endure extreme physical and
mental suffering. This further reduces their access to health care. Further more lack of
decision for spending money makes it difficult to access private health care services.
State Reasons
Long distances
Inconvenient timings
Non availability of health personnel
specially lady doctor
Supply of medicines/no proper medical
equipment, lack of quality care and poor
counseling/information about the sickness.
Lack of comprehensive health care for
women._____________________________
Lack of respect for women among the
health personnel. Lack of gender sensitivity.
Societal Reasons________________
Overburden of work, no time to attend
PHC____________________________
Low self-esteem (negligence of own
health problem.) _________________
Family does not give the importance to
women" health and is not ready to
spend money on them,
No money or mobility for accessing
other social health care facilities
Role of Panchayat and Community to Ensure Access to Health Care
> At the village level, various committees are formed, like education, health etc. It
should be ensured that men and women of all socio-economic levels; enthusiastic
workers from the village get due representation on these committees. They can look
into matters like whether teachers and students come to school regularly, whether
they have any difficulties, whether new classrooms are required etc. The villagers
should approach the Committee for any difficulty involving its particular subject.
> A regular system needs to be established for displaying the information through a
Blackboard outside the Gram Panchayat. Information about forthcoming government
development schemes and its beneficiaries can also be displayed. Women
Panchayat members should make special efforts to relate this information to other
women through word of mouth, through gatherings of women like Mahila Mandals,
Micro Credit groups etc.
> The largest and most open forum for the villagers to collectively express their views
and grievances on any subject concerning the village is the Gram Sabha. It can be
used for making decisions concerning the village including Gram Panchayat
schemes, the funds required for implementing various village level projects etc. The
presence of villagers in the Gram Sabha thus becomes of utmost importance.
Women especially should make a special effort to attend these Sabhas and report
all the problems they face.
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Access to Government Services
Activity-1 Game - Government Services
Objectives
Ipr^ireT thS partlcipants about existing government services and who delivers the
otdl VILztdo.
Material
1. Set if cards
Use a symbol and write names of government functionaries:
> Multipurpose Health Worker Male
> Multipurpose Health Worker Female (ANM)
J
>
>
>
>
Anganwadi worker
Teacher
Talati
Doctor
Gram sevak
2. Set of cards of institutes
Use a symbol or write names
> Primary Health Centre (PHC)
Sub centre
> Post office
> Revenue department
r Integrated Child Development Services (ICDS)
Rural Development Department
Method
Display the set 2 cards on the wall
"
'
oXrdw:;d P“ UP a Mrd frOm SeM
10 ,alk ab°ulOf these tacfionaries
' “;nPartiC'PantS ,0
‘hiS
it *
they
you should add the missing
> When the participants fist the roies, you need to «,te it do»n on the black board.
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Access to Government Services
Activity-2 Knowing Our Health Infrastructure:
Objective
To inform the participants about Primary Health Care (PHC) infrastructure.
Material
A set of cards with following write-up
>
>
>
>
>
>
>
>
>
>
>
>
>
>
>
>
>
>
PHC
Community Health Centre/FRU
Multi Purpose Health Worker Female (ANM)
Multi Purpose Health Worker (Male)
District Health Officer
Doctor
Health Educator(BEE)
Regional Deputy Director
Minister Health
Secretary Health
Department of Health and Family Welfare
State Directorate of Health
Nurse
Lab Technician
Compounder
Ward Boy
Health Assistant Male
Health Assistant Female
I
Ask three volunteers to come forward
Ask them to develop a floor chart of health infrastructure
Once they finish ask other participants whether they want to make any changes. If they
want ask them to do it. Reorganize the chart. Refer the chart given herewith. You can
also use this chart to show the structure to explain the participants. Transfer it on the
transparency.
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At the end you can arrange the correct organisation chart. You will get a chart like this
Heallh Intastruclre at State Levd
Mri’Ucr IIpaIUi
Secretary Heallh
State Dredaate d Health servees
and Med cal Education
Regans DepUy Directar Heallh
Dstrict Health Organisation
District Heallh Oficer
ConmuntyHeallh Centre J
—
1
Medd Queers 4
I
1----Nose Md wives 1
~r~
Oesserl
RiarmadsWkmpter 1
==l=?7
Lebaatay Technaan
I
Radio graphcr
ZZZZI
Other suppat staff
Ward boy, Dhobi, sweeper
Mali ChawWdar, Aya, peen
Rimary Health Centre
Med cal Offcer
A/IM
health Water Female |
Health Waler Male
Health Educator
Hedth Asastant Mate
Heallh Assstnt Femde
LeboatoyTechndan --
Qerk
Sub Centre
Mde Hitipupose H Female Mdtipupose
Worker
Hedth Waler
Health Water
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Activity-3 Poor Access to health Care
Objective:
To sensitize the participants about reasons of poor access to health care.
Situation-1
A family with mother-in-law, father in-law, son and daughter-in-law with 3 months old
daughter and 3 years old son.
[
The 3 months old daughter gets severe watery diarrhoea
Situation-2
A family with mother-in-law, father-in-law, son and daughter-in-law, who have three
daughters, daughter in-law has pregnancy of 7 months. She gets pain during the night.
Situation-3
A family with husband, wife, 2 sons and a daughter. The wife has cough since last 3
months.
The participants are free to increase any number of characters they want to include
perform the role-play.
At the end you as a facilitator has to cull out the reasons responsible for poor access to
health care.
District Level Training Module
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Panchayati Raj and Women's Health
Panchayti Raj and Women’s Health
District Level Training Module
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Learning Objectives
At the end of the session the participants will learn about
> what is Panchayati Raj Institution and its importance
> power structure of the Panchayat
> importance of Women's involvement in Panchayat
role of Panchayat for better health care especially for women
Design
Time in
minutes
30
Methods
60
What is Panchayat Raj, its structure at the
village, block and district level?
Importance of women s active involvement in
Panchayat
30
Panchayat and health care-----------
30
90
Role of Panchayat to improve health care in
general and women’s health in particular,
member Panchayat
an e|ected women ’
Question answer and
discussion
Role play Activity 1
Discussion
Small group discussion Activity
Field Visit
----------
Material Required
Flip Charts, markers, or black board and chalk
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Panchayati Raj and Women's Health
Note for the Trainer
Welcome the participants.
You may start the session by saying...
“Dear Friends,
' Are you aware that as women we have special seats reserved for us in the Panchayat?
oday let us discuss about Women's role in Panchayat and how we can improve our
own, our families' and communities' health through participation in the Panchayat."
> Ask the participants, What do they understand by Panchayati Raj? You may get
different types of answers. It may be
- Panchayati Raj is a body that works at the village level
- It is a committee elected by villagers.
- There is a Sarpanch who heads the Panchayat etc.
Note down their answers. Based on their responses, provide complete and correct
definition and concept of Panchayati Raj.
> 33 % seats are reserved for women in the Panchayat. Due to socio-cultural
constraints it may be possible that women are unable to participate actively in the
decision making process. To understand this reality give 3-4 such situations in small
groups. Ask the participants to perform role- plays. At the end of each role-play, ask
questions to the players and to the group. The details are given in Activity 1. After
having more clarity on the causes that inhibit the active participation of women in
Panchayat, discuss how women’s participation could be enhanced through
awareness & empowerment and \Miat is the role of men in this process.
> Introduce group discussion on role of Panchayat to ensure health care for the
community. Refer Activity 2. Based on the information given in the section, 'Points to
Remember1 discuss the different powers that the Panchayat has to improve the health
of their community.
> You can end the session by discussing role of Panchayat in specific aspects of
Women's health.
> Organise a visit to nearby Panchayat where women member is elected. Have a
dialogue with her about the functioning of Panchayat, its strengths and limitations.
Also encourage the women Panchayat member to share her positive and negative
experiences.
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Points to be remembered by the participants:
What is Panchayat?
> Panchayat is a local body at the village level which is elected by the villagers.
> It is a part of executive wing of government, which monitors all the development
programs at the local level.
> It is a three-tier system that works at village, block and district levels with people’s
participation.
Panchayat can also Influence policies at the state and national levels.
> Panchayati Raj is a concept of local governance by local bodies.
Structure of Panchayat
A Gramsabha is the foundation of Panchayati Raj institutions in the tribal/rural areas of
India. It refers to body consisting of all members of the village / group of villages, whose
names are registered in the electoral rolls of the Gram Panchayat.
The Panchayat Raj system in the country is generally a three-tier
arrangement. The first at the village or group of villages level, the
second at the block level and the third at the district level. The first
tier at the lower level is commonly known as Gram Panchayat. The
tier at the middle level is generally known as Panchayat Samiti
except in some states. In Gujarat, it is called Taluka Panchayat. The
third tier at the district level is known as Zilla Parishad or District
Panchayat.
Gram
Panchayat
Panchayat
Samiti
District
Panchayat
Salient Features of the Panchayati Raj Act
> The Gram Sabha is a local body comprising of all the adult members registered as
voters in the Panchayat area. There is a three-tier system of Panchayat at the village,
intermediate and district level. Smaller states with population below 20 lakhs will have
the option not to have an intermediate level Panchayat.
> Seats in Panchayat at all three levels shall be filled by direct election. In addition,
Chairpersons of village Panchayats can be made members of the Panchayats at
intermediate level and Chairpersons of Panchayats at the intermediate level can be
members of the Panchayat at the district level. Member of Parliament (MP), Member
of Legislative Assembly (MLA) and Member of Legislative Councils (MLCs) could also
be members of Panchayats at the intermediate or the district level.
r- In all the Panchayats, seats would be reserved for Scheduled castes and Scheduled
tabes in proportion to their population. One third of the total number of seats will be
District level Training Module
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Panchayati Raj and Women^s Health
reserved for women. One-third of the seats reserved for scheduled castes and
scheduled tribes will also be reserved for women.
> Posts of the Chairpersons of the Panchayat at all levels shall be reserved for
Scheduled Castes and Scheduled Tribes in proportion to their population in the State.
One-third of the posts of Chairpersons of Panchayats at all levels shall also be
reserved for women. It shall be open to the Legislature of the State to provide
reservation of seats and posts of Chairpersons in Panchayats for backward classes of
citizens.
> Every Panchayat shall have a uniform five year term and elections to constitute new
bodies shall be completed before the expiry of the term. In the event of dissolution,
elections will be compulsorily held within six months.
Women’s Involvement in Panchayot
> Seventy third amendment in the Constitution of India has ushered a new era in the
democratic process. This is one more step towards empowerment of women in
governance. This step will also encourage women to come forward and contribute
more positively towards the development process.
> However not all women elected are active members of Panchayats. They are often
“used” by brothers/fathers/husbands, sons and other relatives as “means” to achieve
their own ends. It is observed that often women have never attended a single meeting
of Panchayat of which she is a member.
> Therefore, our task as women’s groups and as non-govemment organizations
becomes very important in educating women as well as community and supports
them during their term of office holding as Panchayat members.
Powers of the Panchayat
The 73rd and 74th amendments to the Constitution have delegated 29 areas (or subject) to
be taken care of at the village level under the Panchayat Act.
> Preparing the development plan and co-ordinate implementation and monitoring such
as drinking water, Poverty Alleviation Programme, education including primary and
secondary, technical and vocational education, women and child development,
elimination of child labour and violence against women and children, family planning,
alcoholic drinks and tobacco.
> Participation, implementation and monitoring of Integrated Child Development
Schemes (ICDS), maternity and child care centers, contribution in mid day meals,
management of public health activities like control of communicable diseases, public
drinking supply water supply and sanitation, immunization and vaccination services,
health education, environment hygiene etc.
> Making recommendations to the State Government or district for village development.
Panchaya+i Raj and Health
Health is NOT merely a concern of medical doctors and hospital alone. It is also an issue
of social justice, which can be effectively handled by the Panchayat.
District level Training Module
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Panchayati Raj and Women fs Health
The Panchayat should monitor and ensure quality care at the local level by ensuring
proper functioning of Auxiliary Nurse Mid-wives (ANMs), Primary Health Centers (PHCs)
and community Health Centers (CHCs) or District Hospitals, along with immunization and
other health programs.
Panchayat themselves should also organize awareness program to ensure physical,
mental, and social health especially by eliminating gender differences
Role of Panchayat to Ensure Better Implementation and Monitoring of Health
Care Programs?
Forge Community Participation:
> Build linkages between the people and the service providers. This can be done by
utilizing forums like village health committees, village health fairs, etc.
Simplify and demystify knowledge and information
< Promote holistic health care including traditional healing practices. ■
> FnTZh n.d. maJntain a directory °f locally existing medical plants and healers/Dai
< Ensure hat herbs are not felled indiscriminately for commercial purpose
- Involve local groups such as Mahila Mandals in monitoring and implementation of
programs such as immunization drives, maternal health care etc.
Curative Medical Care
(RMPsV
Pr°viders (doctors’ vaidyas. Registered Medical Prachalan
K LZr
h workers’ etc ) are wel1 trained to provide quality care
" Purpose WoZerZZ1^fUn“tionaries <Auxiliary Nurse Midwife - ANM, Multi
purpose Worker -MPW, Malaria worker, sanitary inspector etc ) are posted in their
area and monitor their regularity and service provision
’
Ensure that emergency care is available in their area. Arrange for effective
communication systems, transport mechanisms, (under the S program Jund to
provide transport support to needy families is available for 5 years).
>
Influence the provision of lady doctor at CHC.
Maternal and Child Health:
f XSOa“SMS).
'
Urerada'iOn Of ,he Skl“5
3 ^“^Development of Women and Child in Rural Areas
9 p ? prepare dlsP°sable delivery kits. Encourage these groups to
educate women and men on nutrition, sex education to girls and boys effect of
violence on physical and mental health.
^no ooys, effect of
Ensure proper functioning of Public Distribution System (PDS) shops.
Control of Communicable Diseases:
treatXn X^TBeT °' 'rea,ment
,Or ,he
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Panchayati Raj and Womens Health
> At the time of epidemics such as diarrhoea, malaria, etc and calamities such as
flood, drought, Panchayat are the basic unit of activity at the local level along with
the PHC and other concerned departments.
Family Planning
>
Encourage interactive community dialogue, enabling them to analyze the impact
of growing population on natural resources, food education, housing, employment
etc.
Arrange to provide information and counseling on contraceptives.
> Ensure involvement of men to take responsibility for birth control.
Useful Health Education Material
> Raj Karenge Video, UNNATI, G-1/2CX) Azad Society, Ahmedabad-380015, Gujarat.
Language-Gujarati
> Chula Thi Chora Sudhi UNNATI, Ahmedabad, Language- Gujarati
6
District level Training Module
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Panchayati Raj and Women’s Health
Activity 1: Role Play
Objectives
To assess the socio-cultural constraints which hinders the elected Panchayat women to
participate actively in Panchayat matters.
Method
Invite few volunteers to come forward. Give them two situations given in this case study.
Ask them to read it and tell them to elaborate on it and perform a role play of it in the front
of the group. Give 10 minutes for the preparation for the performance of role-play. First
group will come forward and perform the role-play on the basis of the situation they have
received. After the role-play ask the questions to the players of the role play and the
group. After the performance of all the groups, find out and write down on the chart, the
common causes responsible for the poor participation of women Panchayat members
and who decides the priority issues for Panchayat.
Situation 1
Rami is elected Sarpanch of Malpur village. She wanted to meet the Panchayat members
regularly but her husband says that there is no need for her to go and conduct the
meeting. He says, ” you have been elected because of the compulsory quota for women
otherwise I would have been elected Sarpanch.” Her husband goes and conducts the
meeting with Panchayat members they decide to purchase a TV from the Panchayat
budget for entertainment and information of people in the village. Rami’s husband asks
her sign on the cheque.
Questions to be asked to the players of the role-play
How would you feel if you were Rami? Why?
If you were Rami s husband, do you think you did the correct thing? Why?
Questions to be asked to the group
> What will be the end of the story?
> If you were Rami, what would you do?
District level Training Module
7
r
Panchayati Raj and Women's Health
Situation 2
Sami is an elected member of the Panchayat. She attends all the meeting of the
Panchayat along with her son. All the members sit on the chairs. Sami sits on the floor.
She is also responsible for the distribution of water and tea to ail the members. At the end
of the meeting she signs on the minutes of the meeting.
Questions to be asked to the actors of the role play
> If you were Sami, how would do you feel? Why?
> Given an opportunity what will you do to change the situation?
> As a son of Sami what should be your ideal role?
Questions to be asked to the group?
> According to you what should be Sami's role?
Please Note: Make it clear to the participants that women being an elected member is not
enough. They need to equally participate in the decision making process.
District level Training Module
»
8
Panchayati Raj and JVo/nen fs Health
Activity 2 : Small Group Discussion
Objective
To discuss Panchayat's role in different aspects of health so as to improve the health
status to women in the community.
Method
Divide the participants in four groups. Ask them to discuss on the following topics:
Curative health care
Preventive health care
Maternal health care
Communicable diseases
Give them 15 minutes for the discussion. Ask them to note down their points on the flip
chart given to them. At the end of the discussion ask them to present their points in the
large group. Encourage other participants to enrich the information by adding their points.
Display their chart. At the end of all the presentations you may enrich the information by
adding the remaining points.
At the end of the session ask them to share any positive experiences of Panchayats that
they know in improving health of the community or women's health.
District level Training Module
)
9
(
Traditional Health and Healing Practices
Traditional Health and Healing Practices
District Level Training Module
4 hours
Learning Objectives
At the end of this training the participants will learn about
The health seeking behaviour of women in their area.
Locally available healing resources
f Useful THHP in life cycle.
Some common herbs useful in women’s health.
Design
Time in
mints
30
30
Topics
“
Health seeking behaviour of
__ women
Locally available health resources
30
30
2 hours
_
THHP and empowerment of
women and communities, the dai
tradition
UsefuTpractices in life cycle
T^^^oc^liTava^
herbs for healing
Methods
Role-play- Activity-1
Resource mappingActivity-2
Listing, Story
Discussion,
demonstration
Visit to botonical
garden/exhibition
prabhat pheri around
village/to the forest
Material Required
K “e' pens’ Chalk' blackb0^ chalk or rangoli powder, herbs or
District Level Training Module
I
Traditional Health and Healing Practices
Note for the trainer
Welcome the participants. Inform them about (he topic selected for discussion
Xs<eart^X'Zs0,'he r°le °f™HP " W°men'S heal,h and -P°— You
"Dear friends,
discuss about these practices, today.”
>
y
thS'vn enabling, environment ask the participants, what do they do when
y fall sick You may ask them to depict these through role-plays by giving various
situations. The situations are given in Activity-1. Through these role-plfys the group
mojnlh aboutvarious f.tePs mvolved in seeking health care. Ask the participants to
recall about various healing places/persons where women visit. Ask them to P
You can do
°eveloP a resource map based on this information,
to conduct JmLi| IV ya°ne hr°U9h 3 Sma" 9rOup discussion- The details on how
to conduct small group discussion is given in Activity -2.
Discuss the dai tradition with the help of story given in Booklet 3. You may first tell
read i°aloudhe partlC'pants by show,r|g the pictures. After that ask one of them to
>
You may ask them to list various practices during different stages of life and .provide
hem information on some of the useful TTHP in life cycle. The details are given in
he content. You may also procure samples of the herbs to show them like, garlic
tulsi (holy basil), adusi (Malbar nut) etc and share their use. The details of these ’
herbs are given in booklet 3 in a pictoral form.
> At the end take the participants for a walk; ask them to identify herbs they commonly
u e for promotor of health healing. This will help you to know how much they have
learnt during the training. You may want to collect a sample and preserve them Or
else collect detailed information and prepare a database. You may want to keep it at
PHC or sub centre. A performa for information to be collected is provided in Activity
District Level Training Module
2
Traditional Health and Healing Practices
Points to be remembered by the Participants
THHP and health seeking behavior of women
knowledgey’oHoi|^ood?andSnuK
practices to deal with their
related problems.
9Y
)
h°me remedies and have sound
!'S°
rely On these
9 3 lllnesses and pregnancy and childbirth
There are different streams of health care i
hey ftrhe Allopathy,
Ayurveda. Una™, Siddha. Homeopa,hy Hf^rT“U^3— .. jalth and Healing
I
Traditional Health and Healing Practices
I
rich cultural heritag^of THH^TradiSnafHeln^
Sn Lanka’that have a
means the knowledge, experience and infoma h
Healing Practices (THHP)
rural areas. All of us know about heSa to Sf * CSS °f Pe°ple in traditional
grandparents and parents. by seeing ^a^rdo^XS^'StZKs
THHP
group of people/606^311869 manner (ls not in the control of one person or a
> have a strong heritage of self-help
J mXuc" XSsbo'Zj^ 3?d
C°mmUnity suPP°rted
> even today they hive the lotent II tn h i
reliant in primary health care
PreVent d,SOrders-
S P °Ur villages and towns become self-
areas - plants, animal nfe and nmeraT650^™5 0131
> -odaX^n^
>
read'11' avaJab|e in our
s;°n bite heaiers'dais
rural areas, even
THHPs span many areas like nutrition firlt aidTar?60
aSS'St 'n chi,dbirth.
snake and insect bites and other animal bitesXiT® h Sk'n and eye problems.
disorders. Most of the recognised healers n
9Um Care and mental
Yet, women are the most nurnemi iC n • 0 heSS areas are men.
primarily in rural areas^^arl hea ers sTmT °f
C°Untless w^en,
community.
nealers. Some are also recognised by the
' S'torvnTT' °f COn™On ailme"ls 'ihe Oiarrhrea, worm infestations,
with THHPs
005 and Skln and denla' P^lems
-3 can be treated effectively
District Level Training Module
3
)
74
Traditional Health and Healing Practices
The Shastreeya stream
>
Shastreeya (classical) stream includes ayurveda, siddha, unani and yoga.
Practitioners of ayurveda are known as vaidyas/vaidus, practitioners of siddha
are called siddha vaidyas and practitioners of unani are called hakims.
> It is made up of highly developed systems, codified and organised with distinct
knowledge and theoretical foundations and sound methods that deal with all
aspects of medicine and surgery.
It contributes to the management of all diseases, including cardiovascular,
respiratory and immune system disorders, as well as the promotion of health and
prevention of disease.
> There are thousands of manuscripts in Sanskrit and other regional languages
that serve as a guide to students of shaastras.
> Each state decides the official traditional system in its area. The Government
runs departments, institutions, hospitals and dispensaries for providing these
services.
The Allopathic stream
The allopathic (modern) system is accessible, available and affordable for quick
relief and emergencies. People may want to use traditional systems to seek
promotive, preventive, natural and holistic health care (care that takes into account
mental and social factors, rather than just treating the symptoms of a disease).
In rural areas, allopathy as well as the traditional systems are difficult to access and
costly. In these cases, THHPs are the rational (sensible) choice of health care,
because it is at their doorstep and in their hands. However, in certain cases like
Sexually Transmitted Diseases, life threatening illnesses and emergencies,
allopathic medicine may be the only option.
THHPs and empowerment of women and communities
In our society, women have very little control over their bodies, their fertility and their
minds and knowledge. As a result, they are trapped in this system because their
self-esteem and confidence are so low that they are unable to make decisions and
take control over their own lives.
Promoting THHPs affirms the knowledge of healing existing with women and
reestablishes them as knowledgeable and thinking individuals, in control, and
capable of taking decisions.
Promotion of THHPs
Health Benefits
>
>
>
>
Health care is available, accessible and affordable by women
Women are able to treat common gynecological and other illnesses without delay
Helps demystify health care foractise.
Improves women's health and nutrition situation
District Level Training Module
4
)
Traditional Health and Healing Practices
Social Benefits
,
Recogpises women’s knowledge and skills
> Can be a reason for the community to come
together and sharing experiences
(cutting across class, caste and gender)
Challenges stereotypical health care roles
Strengthens self-reliance in the community
This Leads To
> Control over body, resources and health
ncreased in self-esteem and self-confidence
unity among women and communities
Increase in women’s status
> Increased decision making for health
Some Limitations of THHP
; ES;sSF"
'
I.Xw.Chan9e in lifes,y,e 10 ensure
~
which
Women healers
time immemorable (ancient times) But in the
he,r'nfluence or control) since
a subordinate status and their role as heal
patriar5hal slructure, women have
allopathic practitioners like doctors and a eT 'S
dom reco9nised. Apart from
is a range of local(ANMs), there
and their skills.
' L
see the different types of healers
Traditional Women Healers
>
Dai’s
> Elder women
> Bone-setters
District Level Training Module
5
-"7 t
c
Tradilional Health and Healing Practices
(
c
Women who adjust naval displacements (a condition which leads to
abdominal discomfort) through massage, pressure points and cupping
(putting a glass upside down on a light that is placed on the ailing part of the
body)
Women who cure through cupping
Women who treat migraines (severe headaches)
> Women who adjust the fallen womb
Women who do jhaadphoonk (medicine women) to cure both mental and
physical ailments
(
(
v
(
The dai tradition is one of the example of women centered health care during
pregnancy and childbirth. The dai is usually a middle aged woman, having
expereince of giving birth to several children of her own. She learns about
assisting in childbirth from an elder woman through observation and practice.
Some Dais may be a accomplished herbalist. Her knowledge also encompasses
other areas of women’s health like menstrual disorder, womb descent etc.
However, some dai’s may not know about the ways to avoid infection during
childbirth and recognising of some danger signs.
(
District Level Training Module
6
I
Traditional Health and Healing Practices
Some Useful THHP and herbs iin life cycle
THHP in different stages of life
Infancy and childhood
Babies are kept with mothers
Breast feeding continued for a Iona
time
Massage and fumigation
Immunity promoting herbs and
foods
Cloth toys
Adolcsccnco
"------Traditional games that support; and
strengthen the pelvis like phugadi
apatta-dhupatta etc.
Celebration of first menstruation
Adulthood (pregnancy and childbirth)
Fulfilling a woman's desire during
pregnancy.
a
Shreemant or Goad-bharai
ceremony in the seventh or eighth
month.
a
Giving cooling foods in the first
three months and energy and heat
producing herbs in the the last three
months.
Childbirth at home, by Dai’s.
Squatting posture for childbirth
_Ell£[gy_r!£h foods after childbirth
^g-gdulthoodan?oid^qe
Herbs that help problems of
menopause
More emphasis on spirituality
years)aShtiPUrti (celebration of 60
Herbs useful in different stages of life
Infancy and childhood
Turmeric
Vacha (Acorus Calamus)
Ginger (Gingiber Officinalis)
Adusi (Adhatoda vaslca)
Ajwain( Bishop’s weed seeds)
Neem (Azadiractha Indica)
— Vidang (Embelia ribes)
Adoiesence
Kunwar patha( Aloe vera)
Ajwain ( Bishop's weed seeds)
Bala(Sida cordifolia)
Shoe Flower (Hibiscus rosa)
Drumstick tree (Moringa olifera)
Neem (Azadiractha indica)
Adulthood
"
L
---------Neem (Azadiractha indica)
Kunwarpatha(Aloe vera)
Shatavari (Asparagus racomosus)
Ashwagandha(Withania somnifera)
Durwa(Cynodon dactylon)
Shoe flower(Hibiscus rosa)
Amla( Embilca officinalis)
Late adulthood~and~oidage
Guduchi (Tinospora cordifolia)
Gokhru (Tribulus terrestris)
Amla(Emblica officinalis)
Ashwagandha(Withania Somnifera)
Major contribution i
m upbringing of
Lsfand children
District Level 'Iraininf; Module
1
)
Tradilional Health and Healing Practices
Activity 1 - Role Play on THHP
Objective
To access the health seeking behavior of women for different women’s illness.
Method
Ask few volunteers to come forward and perform a role- play. Form 4 groups of 3^
participants each. Give the following situations.
>
>
Rama’s baby has severe diarrhoea, what can be done?
Ritu’s hand got burnt as hot oil spilled on it. What should be done?
Radha has smelly discharge and boils on her genitals
Karima is pregnant.
At the end of each role-play you may have a short discussion. Encourage the
participants to share their experiences too.
As a trainer, keep a record of where do they go first, when do they seek institutional
health care, for what reasons. Make a list of THHPs that are mentioned in the rolep ays. Develop an graphic chart based on this information. A sample is given here
for your reference.
Activity- 2- Resource Mapping-an illustrative Chart
Objective
To develop an illustrative chart depicting the TTHP resource in their local area.
Material Required
Blank paper, cloth, chalk, pencils etc. If you are planning to make the map on floor,
provide them with powder colours. They can also use leaves, stones etc to make the
chart more interesting and colourful.
Method
>
Make 3-4 small groups. Ask the participants to discuss among themselves about the
healing practices in their area, particularly where women feel better. Ask them to
develop an illustrative chart by using symbols, line drawing etc. Provide women with
chalk power/geru powder/paper/pen.
> Ensure that they include temples, peer, dargah, bhagat, oza, elderly woman, dai,
and other healers.
> Encourage the participants to observe each other’s maps. Develop a poster and
display if you are using pen and papers, paste them on a surface and ask all
participants to see the display.
> At the end ,in a large group discuss the reasons: why do we first go to dai? Why do
we first treat at home? And highlight the role of THHPs as described in the manual.
District Level Training Module
8
7 raditionul Health and Healing Practices
Acnvrry-3
Plant Information Sheet
Date
1. Local name:
2. Botonical name with family:
3. Description:
4. Where it is found:
5. Part used:
6. Quantity used:
7. Detailed preparation method:
8. Dosage:
9. Properties:
10. Symptoms:
11. Person who gave the info, with address:
12. Person who established the information sheet:
_J
Some tips for collecting information on plants-
>
PUrP°Se °f Col,ectin9 the '^formation
of information erS°n '*0 provides Nation. It is best if there is a give and take
> ?o,S Z Oar£SsPlaC^ea Pho,°9raph °r de“e,°p
You may take a twig or press it to develop a herbarium
>
sx*dosase’—
the mformattom0*,he name and °,her perao"al details of the healer, who provide
District Level Training Module
9
Malaria and Women fs Health
Malaria and Women's Health
District Level Training Module
2 hours
Learning Objectives
At the end of the session the participants will learn about
> spread of Malaria
> signs and symptoms of Malaria
> treatment and prevention of Malaria
Warning signs of Malaria epidemic
r- effect of Malaria on household routine
Design
Time in
Topic
minutes
~15
Local terms for Malaria
60
Signs and symptoms, spread, prevention and
treatment of Malaria
15
30
Warning signs of Malaria Epidemic
~
. household rSne" WOmen'S hea"h and °n dail>'
Methods
Discussion_____
Discussion,
Activity 1, and
2-Story telling
Discussion
Role Play
Material Required
District evel Training Module
1
Malaria and Women ’.v Health
Note for the trainer
Welcome the participants.
You may start the session by saying....
“Dear friends,
Malaria is a commonest fever in our country. There will be hardly any one of us who had
not contacted Malaria, once in a lifetime. Every year in our country many people have
Malaria and many die due to this fever. Let us learn about Malaria today so we can take
effective steps to prevent it.”
>
>
>
>
>
Ask the participants, whether they know about fever with shivering. What do they call
it? Make a list of the names they suggest. Once the list is developed, use the local
term instead of the Malaria. For example, Malaria is known as 'Tadhio Tav" (in
Gujarati). Use this local name of Malaria during the whole training in Gujarati.
Majority of people all over the country know about the symptoms of Malaria. Ask
them to list the signs and symptoms. Write them down on black board or flip charts.
If they miss-out any point you add it.
To explain the spread treatment and prevention of Malaria, introduce Activity 1, story telling. You may read it in advance and tell the story in an interesting way in
your own words. Ask the questions given along with the story. Make sure that they
have internalized all the points to be remembered.
Ask them to perform a role-play depicting a woman, who has contacted Malaria and
how the household routine gets disturbed. Howto introduce the role-play is given in
Activity -2
Play a game- Activity 3-"Find the correct answers" to evaluate the participants
learning.
Please Note: If there are other mosquito home diseases common in your area please
discuss them during this module
District evel Training Module
2
Malaria and Women’s Health
Points to be Remembered by the Participants
Malaria is specific type of fever, which is spread through the bite of female anopheles
mosquito. It carries malaria germs (malarial parasites) from a malaria patient to a
healthy person and infects her. These mosquitoes breed in clean, stagnant water.
Malaria is classified as a water related disease.
Signs of Malaria
>
>
>
>
Shivering followed by high fever
Headache
Fever comes down with perspiration
Fever usually comes in alternative days
Incase of Falciparum Malaria there will also be severe headache. The
person may start babbling or become unconscious.
Spread of Malaria
> Malaria spreads due to mosquito bite from a female anopheles mosquito
> When the mosquito bites the person suffering from Malaria, and later bites a healthy
person that person, may develop Malaria within 2-3 days.
> These mosquitoes breed in clean, stagnant water.
Treatment of Malaria
Ensure the following
r Let the health worker take the blood sample when the fever is rising This will help to
know whether the person is suffering from Malaria or not
" tab?etsalar'a Health Worker wil1 start the treatment. S/He will give chloroquine
> It is important to complete the course of 10 tablets of chloroquine
As the red blood cells are destroyed due to Malaria, a woman may become
anaemic. To treat anemia please take a course of iron folic acid tablets Eat qreen
eafy vegetables, citrus fruits like guava, amla (gooseberry), lemon etc and pulses
hke, green gram (mung) whole, Mungsoup, Tur (red gram) dal, Mungdal Udad
(black gram)dal, Ghana (bengal gram) dal etc.
You may want to take the herbal remedies suggested herewith to prevent
repeated
occurrence of Malaria.
Treatment of Malaria Under the National Malaria Control Program
The National malaria control programme has very clear guidelines for the PHC and the
sub-center teams regarding the follow up of cases of suspected malaria fever. Under
the programme any case of fever can be given presumptive treatment by qivinq
chloroqume tablets and blood is taken for examination on a glass slide (blood slide) to
est the presence of malaria parasite. The male multipurpose health worker is sunoosed
° send the slides with blood films of patients with fever to the Primary Health Cenfre
(PHC) twice a week. Here the trained laboratory technician is supposed to detect the
malanal parasite in the blood. If the blood slide is positive, which means if the malaria
District evel Training Module
3
Si
I
Malaria and Women’s Health
parasite is present in person’s blood than the person is given radical or active treatment
of chloroquine and primaquine. Treatment is according to the instructions of Medical
Officer at the PHO. Treatment can start immediately as the drugs are to be stocked
with the health worker. It is also available at all government institutions, subcentres,
PHCs, dispensaries and hospitals all over the country. The malaria inspector is a key
member of the team; he directs anti- mosquito measures.
The state government has also opened Fever Treatment Depots (FTDs) and Drug
Distribution Centers (DDCs) in villages which are run on voluntary basis by a voluntary
worker, teacher, social worker, etc. At FTDs chloroquine tablets are given to fever
cases and blood slides are taken for examination while at DDCs only chloroquine
tablets are given to the patient with fever. These tablets are also sold in shops.
Prevention of Malaria
>
>
>
>
>
>
>
>
Mosquitoes, which spread Malaria, breed in clean stagnant water. So cover the
water utensils, big water storage container and pits around your house
Get your house sprayed with anti Malaria spray. Do not wipe the spots of the spray
at least for three months.
Pour used oil in the stagnant water of the big pits
’
Breed gambuchi fish in the lake
If possible use mosquito net while sleeping. If financially viable use impregnated
bed-nets.
Fumigate your house with Neem leaves.
Grow a bush of damro or tulsi near your house
If possible apply neem oil on the uncovered body part before going to sleep.
To avoid repeated infection of Malaria and have a healthy life there are herbal
remedies, which are been used by people since years, it may be promoted:
Chiretta
Andrographis
Paniculata
Boil 60gms of Chiretta in two glasses of water and reduce it to half a
glass. Add 60 gms of Tulsi leave to the hot decoction, cover and let of
for an hour. Squeeze out the leaves into the decoction. Strain and
drink Dose: 1 cup thrice a day for 3-5 days
Tulsi, Holi
Basil
Mix 10 gms of Tulsi leaves juice with 5gms of powdered black pepper
to be given to the patient in the cold stage of fever. One may also add
jaggery of sugar. The decoction must be sipped slowly.
Guduchi
Tinospora
Cordifolia
Six tea spoons of the juice must be given three times a day.
Neem
Azadirachta
Indies
Neem bark is most useful, though the leaf has a role. 2 ounces of
neem bark bruised, 1 teaspoon cardamom and coriander and 20
ounces of water boil for 30 minutes. Grind 2-3 fresh neem leaves and
2-3 coms of black pepper with a few drops of water. Dose: 2 ounces to
be given before the fever rises.
4
District evel Training Module
-
Malaria and Women ’$ Health
When can a Community know about Malaria Epidemic (spread in community) in
their area?
Some warning signals to lookout for, otherwise many lives may be lost before action is
taken.
> Increase in number of fever cases during the transmission season of malaria-from
July (beginning of monsoon) to November
> Intermittent rainfall at intervals of 5 to 7 days in monsoon.
ncrease in number of breeding places either due to rains or badly managed
irrigation channels.
> News of malaria epidemic in neighbouring areas.
No insecticide spraying activity in the past six months or more
> High fevers with shivering followed by deaths.
Effect of Malaria on Women's Health
°r Cf?rOni? eP'sodes
malaria can lead to abortion and stillbirths These have
she iXdlyTuVr^3
in aloS
social context where her capacity to produce healthy, living children is in danger.
Useful Health Education Material
> Malaria Control in Villages, VHAI Tong Swasthya Bhawan 40 Institutional Area
Near Qutab Hotel, New Delhi-110016, Language-Hindi
'
lnSt,tUtlOnal Area’
.
Bha^n,
I09'™’
Hea"h and Famlly Welfara
388QC0hian^n ^a|laria:' Guja/;at Sahitya Prakash, P.B.No.70, Anand, District Kheda388001, Gujarat, Language-Hindi, Gujarati, English
District evel Training Module
5
Malaria and Women *s Health
Activity 1 Find the Correct Answers
Objectives
Malaria11316
learn'n9 related to si9ns. symptoms, treatment and prevention of
Material Required
Blank paper slips, pen, small basket or any container, ball (if the ball is not available
make a ball out of old cloth)
Preparation
Before introducing the game you have to do some preparation. Write correct and
incorrect symptoms in the paper slips. Write only one symptom on one slip. You can
write/draw the following symptoms
> Severe headache
> Fever with rigors
> Vomiting
> Body-ache
> Rash on the body
> Feel very hot
> Fever at the same
time
>
>
>
>
>
>
Fever recedes with
perspiration
Fever on alternate day
Running nose
Coughing
Toothache
Weakness
Fold the paper slips and keep them in a basket.
Method
Ask the participants to sit in a circle.
Keep the basket with the written slip in the centre of the circle. You stand facing the
opposite side. You have to clap for some time and then stop. When you are clapping
the women will exchange a ball from one woman to another.
When you stop clapping the woman who has the ball has to get up and take one slip
from the basket and read/ interpret the drawing. If she can not read you can help her to
She has to inform other women whether the sign of Malaria given on the slip is correct
or incorrect. Have a discussion on her answer. If the answer is wrong you can explain to
the group. You can ask the woman to do an activity like bark like a dog, jump like a frog
etc.
At the end of the game you may repeat the signs of Malaria to refresh their memory.
District evel Training Module
6
c
(
Malaria and Women’s Health
You can play this game for the prevention of Malaria. In that case make another set of
slip from the points given below and play the game again
Wash your hands with soap
Keep you nails cut
Do not sleep in Mosquito net
Cover the water pits
Eat leafy vegetables
Make a smoke of neem leaves
> Apply neem oil on the uncovered
body parts before going for sleep
> Pure used oil in the big water pits
> Ensure the anti Malarial spray in the
>
>
>
>
District evel Training Module
house regularly
Wipe of the spots of the spray
immediately after the spay
Every day have a bath with clean
water
Never let the water get logged near
the hand pump and stand post
Always keep the big water
containers open
Breed Gambuchi fish in the village
lake
Cover all available big water
storage containers
7
R-i
Malaria and Women's Health
Activity 2
Story-Malaria, a Concern of Rampur Village
JiSL™
''''I3?,6' TJ?ere are about 500-600 houses in the village. Every one in the
qhp9 ‘ves peacefully. Champaben is the Sarpanch of the village She is very active
difficMtS%Sh
?thS V'"a9e iS pr°9ressin9- Difficulties of the village are her own '
thS
hSh T.akSS SUre t0 S0'Ve the difficulties of her village. She made efforts so
long dlslanc"to^X^ghX°rS,eP' N°W
'TOmen d° n0'haVe
along with water, Malaria epidemic has affected the village. Majority of houses have
ne or wo persons suffering from fever with rigors, severe body-ache and head ache
tTp!t^eJfCh°meS dt0Wn Wlth persP'ration- Since the villagers are not getting the correct
treatment they continue to get repeated bouts of Malaria.
annrmp?en4ls wo^ied' She does not kn°w how to overcome this problem. She
approaches the village health worker and talks about the problem.
The health worker Samajubhai called a village meeting. Everyone young and old airls
and b„ys, men and women came to attend the meeting. Samajubhai explatoedtoal
Malaria spreads through mosquito bite. These mosquitoes breed in clean stagnant
wa er. He mentioned that Champaben got us water at our doorstep but we did not
nage it ProPerly. The collection of water has become a breeding ground for
mosquitoes and therefore the Malaria fever has came with it. He explained that we have
hJ' tUPHhe T Sr ^tS’thS Water containers need to be covered, stagnant water next to
stand post need to be drained away. He also explained that everyone has to
fumigate their houses with neem leaves, particularly after sunset. This will help to get rid
the mosquitoes from the house. He also promised that he will spray anti Malaria
liquid in the houses to kill the mosquitoes
every one to take Precautions to prevent Malaria immediately. Next day early
m the morning the villagers got together. They started covering the water pits In the bfg
S^m uebhAPiOnnt C Imh'k
drained of ^e water logged next to the standpost.
mjubhai got Gambuchi fish, and put it in the village pond. He along with his other
workers started spraying in the house. He also took the blood sample for the Malaria
sting and started the treatment of choloroquine. He repeatedly told all the villager to
complete the course of the treatment.
a
Champaben was very happy to see the enthusiasm of the villagers. With the constant
watch on the preventing aspects of Malaria, Samajuben could control Malaria in her
village.
Ask the following questions:
What was the reason of malaria epidemic in Rampur village?
What steps they took to solve the problem of Malaria?
What else could have been done?
District evel Training Module
8
;1 y
Malaria and Women’s Health
Activity 3-Role-Play
Malaria causes severe weakness. If the key person of the house get Malaria it affects all
the routine of the house. If a woman is pregnant and gets Malaria, she could have an
abortion or premature delivery or give birth to a dead child. There are various social
Xrfnrml1
!°
T'3 lf.
'"S'113" °f the hou39 9et Malaria. The participants can
tPhprfrnlp 3, r°le ‘P'97 lo depict thls- You mav g've the following points prior to performing
> S2Wmonths°f
is pregTianUoo
Me|S
M
"T® 'aSt 1° mOnthS' She 0ot malaria twice in
become weak- Sha feels tired and giddy. She
She can not perform all the household work.
Other members of the family do not appreciate this and behave badly
The woman one day get severe abdominal pain. She had miscarriage.
Please Note:
Ask the participants to develop the end keeping their socio cultural situation in view.
District evel Training Module
9
)
i ..
TB and Women's Health
TB and Women's Health
District Level Training Module
4hours
Learning Objectives
At the end of the session the participants will learn about
>
>
>
>
>
signs and symptoms of TB
effect of TB on women
spread of TB
prevention of TB?
treatment of TB
Design:
Time in
Minutes
60
30_____
30
45
30
45
Topic
Method
Signs and symptoms of TB
How TB spreads?
Treatment of TB
Prevention of TB, TB control
program________
Effect of TB on women
Developing slogans and songs
Discussion
Discussion
Discussion
Discussion
Activity-1, role play
Group work
Material Required
Flipcharts and markers or black board and chalk
District level training module
1
TB and Women’s Health
Note for the Trainer
Tuberculosis (TB) is a major health concern of our country. It is important that you
discuss the prevention and treatment aspects in detail. After discussing eve™ sub topic
revise it by asking questions. Welcome the participants.
You may start the session by saying
“Dear Friends,
In our village, there are men and women and children suffering from TB. Let us today
learn about TB so that we can prevent it. Let us think about signs and symptoms of TB
( Visualize a person you know suffering from TB."
>
Encourage the participants to describe the signs and symptoms that they might have
observed in an adult person suffering from TB. You may refer the signs and
symptoms given in the section 'Points to Remember1 and enrich the discussion
Explain the signs and symptoms of TB in young children too.
> Ask the participants whether they know about howTB spreads. Encourage them to
Share information available with them. If they have a correct information note the
information on a newsprint paper. Update the information and explain it to them.
> Discussion points related treatment of TB. It is important to discuss why people stop
the treatment too early or have irregular treatment.
> Provide details related to prevention of TB. Also discuss TB control program.
> It is important to understand how TB affects women's health and her daily life. Ask
the participants to perform a role-play. At the end of the role-play highlight the points
mentioned in Activity-1. Also discuss the points why women do not avail TB
treatment.
> You may end the session by making groups of three participants and develop
slogans, songs on TB highlighting signs, timely treatment and prevention of TB. Ask
them to share it in a large group.
District level training module
2
C\\
TH and tVamen ’.v Health
Points to Remember by Participants
What is TB?
TB is caused by bacteria. TB can occur in different parts of our body but lung TB is
XhSTh °n than t7 ?oer TB' Every year TB causes more deaths than any other
infectious diseases. The TB germ enters a woman's body through air when the
h rsT^d TB pat'ent COLJ9hs or sneezes near her. Healthy people can usually fight off
TB Abo Jt 1mt
8 Sma"
°f pe°ple who are infected actual|y get sfck wUh
TB. About 1 out of 10 persons mfected becomes sick with TB in his or her lifetime
Without treatment, the body starts to waste away, and the person usually dies within 5
How TB spreads?
the gSfnto
darlfplacesXre
ThX' oeV™"
no SJt
S0meOr,e Wh0 ls sick ™'h TB'
SUrV'Ve 'n ,he air
W survive in
TB spreads more:
>
> If the person is living in ta_rea_,Wt^ere the houses are not we|l ventilated and direct
sunlight does not reach inside the house.
In cinema houses where-------thereisi no sunlight and therefore the TB germs thrive and
survive.
> If people are working in cotton mills
or cement factory their lungs are more
susceptible to TB.
Vs
Please note:
With TB in other parts of the body than the lings
'*°
-
each year.^ut'oncea'pVson has beentaR8 Can
ab°U*10 more peoPle with TB
is probabiy no ionger e^oui^XlXelTX^
Signs of TB in Adult Human (TB in the lungs)
-
> Low grade fever especially during the evening
' froXXngs'6 'h8n 3 WeekS’ eSpeCiS* if lhe
brings up mucus (sputum)
> Blood in the sputum
> Weight loss
> Loss of appetite
District Iex'el training module
3
5.
TH and Women fs Health
Sputum Test
i o assess whether a person has TB, one has to have their sputum examined. To obtain
a sample of sputum - and not just saliva (spit) - a person must cough hard to bring up
the sputum from deep in her lungs. The sputum is then examined in a laboratory to
judge whether it contains TB germs or not. If it contains TB germs, the report says that it
is 'positive’.
A person who has signs and symptoms of lung TB should get her or his sputum tested,
preferable morning specimen of sputum. If the sputum is positive he/ she should start
taking antibiotics treatment immediately. Facility for sputum examination is available at
all the PHC. If the sputum is negative and still TB illness is suspected she go for X Ray
examination of chest. Such facilities are also available at govt, run Community Health
Centre/hospital and also at District TB Centre under TB control program.
Signs of TB in young Children
L ow grade fever
Anorexia (loss of appetite)
Loss of weight
Fatigue
Painless lymph node enlargement in the neck region (it may sometime burst)
Treatment of TB
> TB can almost always be cured if a person has TB for the first time and is treated
with appropriate kind of medicines in correct amount for the full length of the
treatment.
> The treatment has 2 parts. The intensive phase treatment for 2 months. Followed
the continuation phase treatment for 6 months. Further 2 to 6 months treatment is
known as short course chemotherapy. Under the National TB Control Program drug
regime guideline are provided. The sputum is examined at the end of 2 months
treatment, and if still found positive the case is referred to District TB Centre.
> If the person takes the treatment irregularly, the TB germs show resistance to
conventional first line drugs. This is called multi drug resistant case. They need
special type of more expensive second line drugs. It is therefore necessary that one
should always take full course and complete the treatment.
> If not treated correctly, a person sick with TB can infect about 10 more persons with
TB each year. If once a person has been taking medicines for about a month she/he
is not probably contagious.
> Eat well during treatment and continue to eat healthy foods after the treatment.
Birth Control Pills may become less effective during TB treatment.
Women being treated for TB should use another family planning method.
District level training module
4
■3»
TB and Women fs Health
Why do People Give up Treatment prematurely or take Irregular Treatment?
Personal Reasons
>
With strong allopathic medicines, people feel better in few weeks or months. They
easily get tempted to stop the medicine prematurely.
Financial and other social factors also make person give up treatment. This Is more
true in case of women/girls.
Side effects of the drugs such as nausea, loss of appetite, stomach irritation, etc,
occurs in some patients. Due to this, medicines are discontinued.
On taking Rifampiciline the colour of the urine becomes reddish, they stop the
medicine without even consulting the doctor.
Reasons Linked with Health Systems
Drug supply to the primary health center is not regular, due to poor management.
Doctors often under prescribe drugs. The dose/strength of the tablets and the
duration of treatment may be incorrect.
> Health workers and doctors do not motivate the patient to complete treatment.
>
Prevention:
Make sure your house is well ventilated. If there is no direct sunlight come from
Do nXn.HnOdr’ SP 9'?SS 1116 °n thS r°Of t0 'et SUnl'9ht Came in the house> sunSt to enters^,|minatl0n; esPeciaHy in Cinema halls where there is no scope of
sunlight to enter. Always spit in a covered sputter
H
from Government'PH? BCG ™media,el>'afler binh- Immunization is avaiiabie free
Do. s and Don’ts for People Suffering from Tuberculosis
Dos
> Continue and complete the whole
medicines prescribed for the full
course of period.
y Use handkerchief when coughing
or sneezing
Spit in spittoons containing house
hold germicides. In a spittoon cup
keep only household disinfectants
like phenyl containing either
cresol or phenyl and allow the cup
to stand for an hour. Dispose the
contents.
Do nots
> Do not stop medicines prematurely before
your physician advises to discontinue them,
even if you are feeling better.
> Do not discriminate against TB patients. If
the TB patient is sputum positive, do not
allow children to play with her/ him. But
after receiving treatment for almost about 2
months TB patient becomes sputum
negative, at this stage no form of isolation
is required. S/he can work with others.
> Spit in gauze/clean cloth piece/paper
handkerchief and later destroy it by burning
or spit in ordinary handkerchief or wash it
separately in a detergent.
District level training module
5
TB and Women's Health
(
TB Control Program:
TB was under control about 11 years ago but with the reoccurrence of AIDS it has aqain
flared up and medical people find difficult to control the epidemic. Many people have
become resistant to the medicine, which further complicates the issue.
The Government of India has a National TB Control Programme (NTP) and in some
districts the revised NTP, for the control of TB in our country.
Directly Observed Treatment-DOT
TB treatment is long and the effects of stopping treatment are serious, therefore extra
care should be taken to make sure that a person consumes all her medicine. A health
worker or community volunteer who is not an immediate family member should watch
the sick person take every dose and record what it is consumed. This is called 'Directly
observed treatment, short-course’, or DOTS. Because most of the TB patients do not
take regular medicines and/or do not complete treatment as prescribed by the doctor
under the Revised National Tuberculosis Control Program, Directly Observed Treatment
(DOTs) is introduced.
In this strategy for the first two months of intensive phase of treatment, patient comes to
clinic thrice a week (course of tablets is 3 times a week) and consumes medicine (all
tablets) in the presence of health worker. In case s/he fails the health worker visits his
home next day. In remaining period of 4 months continuation phase and treatment
patient visit clinic once a week - three doses per week - take one dose in presence of
health worker and remaining two in his own at home. The health worker ascertains the
position of 2 doses during his next visit. In rural areas health worker/Aganwadi Worker
are involved. NGOs can play a vital role in National TB Control Programme (NTP). They
can organise the people through action oriented health education. Motivate them to
avail services under NTP and make people more aware of the importance of their
health, regular taking of treatment and completion of treatment as per advice of the
doctor. They can also participate in NTP activities helping health worker in follow of TB
patient so as to reduce the irregularity on the part of patient and reduce the number of
defaulters.
Women and TB
It is a fact that TB affects both men and women, but fewer women are being treated
than men. Many women in our community live with TB without knowing that she is
suffering from TB.
Women usually eat last, least and leftovers. This leads to poor intake of nutrients. She
is usually undernourished and therefore more prone to infection.
In rural areas, she cooks food on a fire stove. She is exposed to more smoke every day
These women are more prone to TB infection.
Majority of women work in the unorganized sector. They are involved in the work like,
bidi rolling, dusting of cement bags, etc. These works enhance TB infection At these
work places she does not have facility to prevent herself from TB.
District level training module
6
TB and Women Health
Why Women Avoid the Treatment of TB
z- She fears that if she is diagnosed as a TB patient the husband will reject her as she
cannot perform household work for long hours.
> If she is working outside the home she fears that if she is diagnosed as TB patient
the employer will dismiss her from work.
She does not have control on money and therefore cannot decide to take the
complete treatment
She is not well informed about from where to seek treatment.
TB Treatment During Pregnancy
It was considered in past that TB of the lung is harmful for pregnant woman during
and the n®^°rn chlld' But now is n° longer true. A woman can continue
her pregnancy provided she takes the complete treatment. However certain anti TB
drugs should be avoided. However if she does not desire to continue pregnancy she
to hypchoose theraPeut'c abortion. A woman who has been cured from TB should avoid
to become pregnant for at least 2-3 years.
----------------------------------
TB is not a hereditary Disease
Useful Health Education Material
> LanPgigehGuS"h' S"deS' VHA'' 4°' lnS,itUtiOnal area‘ Naw Delhi-110016
r- Tuberculosis, Slides, VHAI. Language-English
r- Tuberculosis, Flip Book, VHAI, Language-English, Hindi
' MuSSoiXTu^^
MUniCiPa' SCh°°'’ Parel 'Eaal> Mumbai,
1strid level training module
7
TB and Women's Health
Activity-1 Role-Play
Points to be Emphasised on Effect of TB on Women:
lhe allnic on her
> oW™en d0 n°' have m°ney °r mobil,ly therefore she canno1
>
f he X gXXental ST 38 3 TB
WeZX"
hOT hUSba"d
"*
bB
’ She
mpmhJfh^6 9elS tired Td therefore finds difficult t0
at h°me. The family
members harass her, as she cannot cope with the household work.
V
• Because she cooks, the smoke of the 'chula’ enhances the disease
S ™ay resu|t in infertility. She may be ill-treated by the family members due to
iiu ci ii 111y.
l0Ht0f appetit,e- Usua"y in patriarchal society no one in the family takes
interest to feed her properly and therefore the disease increase.
Y
District level training module
8
c(\
)
/
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(■
Water, Sanitation and Health
WATER, SANITATION AND HEALTH
District Level Training Module
5 hours
Learning Objectives
At the end of the session the participants will learn about
Importance of water in our life.
How water gets contaminated.
Causes, symptoms and prevention of diarrhoea
> identification of water-borne diseases.
Methods of purifying water.
> Key points in keeping the environment clean.
design
Duration in
minutes
30
60
60
90
30
30
Topic
Importance of water in our life
sources of water.
Time and energy spent by
women and girls in fetching
water.________
Contamination of water.
Contamination of water at
various places
Diarrhoea (causes, symptoms,
types, treatment and prevention)
Other water borne diseases
(causes, symptoms, treatment
and prevention)
How to purify water
Low cost sanitation
Material required
wat^Flipcharts6'ma^penTand papeTYou^ll’
Methods
Discussions/activity 1
Discussion with illustration
cards
Discussions and
demonstration/activity 2
and 3_____ '
Discussions
Discussions^nd ’
'
demonstration/activity 4
Discussions with illustration
cards
ba3-transParent, bucket,
discussions on contamination of w^ter yOu mOv oho n°
illustrati°"S for
separately on the cardboard and use themZ Xf
^them and Stick each
related diseases.
h
f sess,ons- slides on water borne/water
District level Training Module
l
I I
(
Water, Sanitation and Health
Note to the Trainer
par‘rapants- Before introducing the topic, you may play a game to lighten
the atmosphere. You may pick any/ one icebreaker. You may then say,
"Dear friends,
Water is one of the key elements for our survival. We spend a lot of time and energy to
ensure and manage water. Today
and Sanitation ”
7 We are 9°in9 to learn about an important topic Water
>
Start the discussions by asking questions like, do you know that how much time
women and young girls spend in fetching water? Find out if they are aX about
>
different habits. In the end, ask participants to check each other’s nails Keep a nailcutter/scissor available; ask them to cut each other’s nails.
Use illustrations 1 to 4 given behind.
>
acZiSand'iXlnn1? T' b°me diSeaSeS- DiSCUSS diarrhoea first lntroduce
thVr d 3- H P Jy When necessarv- At the end, encourage participants to
share their experiences of traditional oral rehydration therapy that has proved
successful. P ease refer some of the traditional ORSs (rice water, barley water etc )
given in points to remember.
y
'
Give information on other water borne diseases. Quickly go through the spread
!ympt°mS' .treatmeat and Prevention. You may use slides on different diseases or
any other visual material available on this topic. Collect local useful remedies and
practices for treatment of different disease and encourage them. Please refer the list
of some remedies given in the module.
°f
water’ highlight indigenous ways of purifying water. Refer
points to remember. Collect as many ways as possible. Conduct activity 4.
Finally, discuss the importance of sanitation, include points related to local methods
of preparing soak pffs, pit latrines, etc. Use illustrations 5 to 9 given behind. Find out
existing methods of sanitation and encourage good practices.
Use illustrations 5 to 9 given behind
District level Training Module
2
f1
-S'
I
I
I
^Vater, Sanitation and Health
Points to be Remembered by the Participants
I
.... “
’
I
" and'fhe widdXS XS' "
'
yOur ''i,la9e.
Z™ of nSX bS tSZ(9irlS) X °n ,heir b<* This teads
" In areas where women have to walk severaSTto fetrh
°f miscarria9esnear a stand-post (a place were one twn nrZ?
/ f h water or wait for hours
by pipe-lines), hand-pumps or munic'ioal watZT6 aPS
PUt aftSr 9ettin9 the water
burden
P P
municipal water tap - young girls share the household
I
' S»"1a0ZanRX?andhXZon1009 diSlanCeS' 'hey als0 ,a“
gatung wot„
y°Un9 8irls and women
Iley are
I
.......
I
I
-pleasant to look at and taste.
> Sou’rXof ™te"nkin9 and dOmeSfc PUrp°Ses'
1. Rainwater
2. Surface water:
3.
Pond
River
Tank
Tap or pipeline
Ground Water: Well
Hand-pump
Springs
Contamination of Water
I
How water gets contaminated at different places:
1. Source of water:
,he area or
aSrpeople Zb ZX""T X " “,h dirty
place where drinking water’is fetched e’ U 605118
SSSpumZecoX dZXteZh
and bath al hand pump this will again d^Z area
bath 'n the same
draina9e S° 'he
' ‘“s
District level Training Module
3
fl
1<5O
I
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I
I
I
I
Water, Sanitation and Health
The patient and people in his/her close contact should take typhoid vaccine
(available at CHC).
Maintain personal hygiene.
If possible make use of latrines, if not defecate in a pit and cover it with mud.
> Wash hands with soap or ash and water after passing stool.
Avoid eating uncovered foods. Always keep the food covered and keep the
surroundings clean.
After an attack of typhoid, the germs exist in patient's stool and urine for three
months. Such a person should avoid cooking and serving food at public places like
hostel, hotels, etc.
>
■>
5) Worms
Lack of personal hygiene cause worms. There are different types of worms, which enter
our body through different routes. Worms are more common among children.
A) Round worms
Spread
> The eggs (ova) of roundworms exist in the stool of a person suffering form it. When
he/she passes stool in the open, the eggs or ova mix with mud.
> When children play in this mud, the eggs of round worms stick to the finger
especially under the nails. Eating with such hands takes the eggs to the person s
stomach.
> Many children have the habit of eating mud. If the child eats the mud contaminated
by eggs of round worms, they reach the stomach along with the mud. There, small
worms come out when the egg hatches. These worms lay eggs, which come out in
the faeces and get mixed with mud. Thus the cycle continues.
I
I
Symptoms
I
I
The roundworms come out through stool.
> Rarely the worm comes out through mouth or nose.
> If the child suffers from roundworms s/he may often have pain in the abdomen.
> S/he is unable to put on weight even though she has a good appetite.
>
Some children lose appetite
The
child becomes weak and has a distended abdomen
>
>
Treatment
> Mebendazole or piprazine is given in the form of tablet or syrup. The worms are
expelled in the stool.
> It is necessary to take a complete course of this drug otherwise the treatment will not
be effective.
I
Prevention
> Trim the nails regularly especially the nails of children
> If possible use latrines otherwise the child should be made to defecate in a pit and
the faeces covered by mud. Prepare another pit when it becomes full
District level Training Module
10
x 0^
I
Water, Sanitation and Health
>
and EX Sg.
>
>
Do not allow children to eat mud
SVbe eete^ raw XS
,
B) Thread Worm
““b6" th0r0u8hl* “,h S“P - ash and water after defecating
W Many times ®99s
C°Okin9
eSpeCii*,hos^
roundworms stick to vegetables
Spread
As a result, a M ontcNng^'Xerttd^ tha^area9 In wT”
°f anUS and 'ay e"S'
ur^X™3" °PeninS *° "9S ™S --'-n SIXZXX
> and
SZSSS*
"aiVhey—
threadworms come out.
d
th stomach. the eggs hatch
Symptoms
Itching in the anus is typical symptom of threadworms.
Treatment
' dCoX‘e C0UrSe °f med'Clne should be <^en under the guidance of a medical
Prevention
AHnHhSfSh°Uld bS Washed thoroughly with
soap or ash and water, after defecating
and before touching eatables.
Nails should be trimmed regularly.
>
C) Hook Worms
Spread
mix in the soil rnXSt soil "thelggs hlteMo ?' °f'' PerS°n sufferinS fo™ it. They
' When a person walks barefooted^ the so, *
'*'Ch ma,ure °ver s°me d»w
body through skin
are'001ed ‘^e soil or works with hands, larvae enter the
cough. White coyugh?negythjycjm'yto'throathand°a?eAS ^r91"' 'he PerSOn 9els
this way the cycle continues.
" '
99 are a9ain exPeHed through stool. In
Symptoms
anaemic. mS
bl°Od f°rm the ,ntestinal walls. As a result, the person becomes
District level Training Module
11
1
Water, Sanitation and Health
r- Symptoms of anaemia like fatigue, paleness in eyes, tongue, nails, breathlessness,
vertigo are observed.
Treatment
>
Complete treatment should be taken under the guidance of a health worker.
As the person becomes anaemic, green leafy vegetables, jaggery etc and a
complete course of iron tablets should be taken.
Prevention
> Latrines or sand pits should be used for defecating
Foot wear should be used always specially while working or walking in moist area.
b) Tape Worms
Tapeworms are flat and tape like. Usually only its pieces are expelled in stool.
Spread
Ova of tapeworms are expelled in the stool (faeces).
Pigs or cows consume the stool and fodder contaminated by it. The eggs hatch'in
pig’s stomach and small worms reach their flesh.
If this meat is not cooked properly, baby worms enter the human body and the
worms mature in the stomach.
> They lay eggs, which are again expelled in stools.
s.
In addition, a person, suffering from tapeworms reinfects her/himself, when they do
not clean hands properly after defecating.
> Through nails, eggs reach the stomach when food is consumed and eggs then hatch
to produce young worms.
> They enter the blood through intestinal wall and reach brain, eyes, lungs and
muscles.
>
Symptoms
> Pieces of the worm are expelled in stool
> If the infection has reached the brain it causes headache, some times
unconsciousness and it may cause death in some cases.
Treatment
> Complete treatment should be taken under medical supervision.
Prevention
Pork or beef should always be cooked for eating. Check pork of beef for small
whitish grey spots, which are eggs of tapeworms. So called “meaty pork” should not
be consumed.
> Hands should be thoroughly washed after going to the toilet
> All the family members must keep their nails trimmed.
> Use latrines where ever possible.
A,
>
District level Training Module
4
12
JL
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Water, Sanitation and Health
Remember
Atays Spoil's" cuT,Sr 'r°m
>
>
”a,er SOUrOe "ke hand-P™P. taps. etc.
Always wash vegetables and fruits before consumption
AlwaayysS Sp^oXvIrS
feedin9 3 child and after defecation.
Always keep drinking water covered.
Always use ladle to remove water from pot
S af dXXZ" eXCre,a- <lf ,hera are pp lalri"*< * o hole in ground,
Some indigenous ways of purifying water
proportion's
municipal offices. Generally the
measurement. After puK^the^SS^9:Wi"
te
There are various wavs to n, .rih fh
7 m'nUteS before usefrom water:
y the water at home, ways to remove physical impurities
1.
cotton cloZr plasS This Xemove SeTuS
2. Use of alum or "phitkaari” is also von/ r
* thr°U9h C,ean
he dUSt partlcles from the water
3.
platform and the other on the around imn h'9her
powder is mixed w,th a smaif amoun,
aXirTd'
contents at the end. (Refer illustration 1
outlets are put on a
‘°p p°l
,akeS Care °f ,he lh'ck inWe
of the container mt^aTo^'TcXb'andd1 lea? one rne,rs deeP- Remove the top
bottom of the container, if pSs^y?U“e- F“ * Co the
13
H
^<3
c
Water, Sanitation and Health
theses 15-20 cm deep, in the bottom of the container so that the stones around the
ap inlet are covered. Add a layer of fine sand 50cm deep. You can put flat rocks on
top of the sand to stop it from being stirred up in the water. Keep the filter covered
and full of water (up to 2-3 cm from the top). When after 2^ weeks the water starts
to flow s ow y the filter needs cleaning. Clean the filter by scraping off the top layer of
sand. After four or five cleanings you will need to add more sand. To do this you will
need to dram out the water until the water level is 10cm below the level of the sand.
Ways to remove bacteria from water or purify water:
1. Boil water in a big pot for at least ten minutes. Keep it covered and let it cool down
Pour it in clean pot and use for drinking. Boiling will kill the germs in water.
2. In many places the water is filtered and filled in a metal container with big mouth
Cover the container with thin clean cloth and keep it out in hot sun. This will provide
some heat to water and kill some germs, which can not resist sun heat for a long
Women’s groups can find out that other traditional ways of cleaning water in their
area and propagate them.
Sanitation
Sanitation is the way to keep our environment safe and clean so that we may not fall
sick. We have a responsibility to keep our environment clean for our own health and
that of our community.
> It is important to arrange for wastewater disposal.
< If people defecate (pass stools) in fields it can contaminate vegetables. Defecation
near homes can lead to diseases through flies.
It is important to organize for latrines, because women and girls going far awav are
attacked or molested.
> Sanitation will involve wastewater disposal, garbage disposal, latrine facilities and
things use of like smokeless chulas and/or biogas.
Useful Health Education Material
r Personal hygiene, Slides, Tamilnadu Integrated Nutrition project, communication
Cell, 570, Anna Salai, Madras-600018, Language-English
> Better care during diarrhoea, Slides, VHAI, 40 Institutional Area, New Delhi
Language- English
Diarrhoea and the special drink, Slides, Center for Development Communication,
“JABBAR Buildings”, Begumpet, Hyderabad-500016, Language- English
> Health and hygiene, Slides, Center for Development Communication, Hyderabad,
Language- English
A Mrugjal Nahin Jal, Video, case study of Utthan-Mahiti, Azad Society, Ahmedabad,
380004, Gujarat. Language-Gujarati
District level Training Module
14
fl
^ater, Sanitation and Health
>
S^!2d,as and ,en
Video, Centre for Development Communication
Hydrabad, Language- Hindi, English
'
camp
>
Samtatton and diseases transmission, Slides, UNICEF, 73, Lodi Estate, New
Delhi.Language: English
Language2TngSh
teChnol°9ies for sanitation, Slides, UNICEF-New Delhi,
and Samaj Sown ^1.^33'
Welfare Oepartment"^^^^^^: H°ndi
S;d'r
Un'’ °f Hea"h and Fam'ly
District level Training Module
15
'fl
w
Water, Sanitation and Health
Illustration 1
Contamination of water at the source
Note: Enlarge this illustration cut it and paste it on the cardboard or transfer on transparency for use
during training.
District level Training Module
16
H
C
(
Water, Sanitation and Health
Contamination of water on way to home
Illustration 2
Note: Enlarge this illustration
cut it and paste it on the cardboard or transfer on transparency for use
during training.
District level Training Module
17
I'
\ ir.i
(
.
Water, Sanitation and Health
~
Illustration 3
Contamination of water at the storage
Note: Enlarge this illustration cut it and paste it on the cardboard or transfer on transparency for use
during training.
District level Training Module
18
n
Heater, Sanitation and Health
Illustration 4
Contamination of water during use
r
“ng?X'hiS i"“S,ra“°n “ “ “lMste “
the cardboard or transfer
on transparency for use
District level Training Module
19
li'ater, Sanitation and Health
Illustration 5
Low cost sanitation facilities would include latrines, garbage disposal and
proper water supply and disposal systems
Note: Enlarge this illustration cut it and paste it on the cardboard or transfer on transparency for use
during training.
District level Training Module
20
Wuter, Sanitation and Health
Illustration 6
Wastewater if not disposed will become mosquito breeding places and water
borne diseases
dX1S'0'his“>11
on the cardboard or transfer on transparency for use
District level Training Module
21
<
Water, Sanitation and Health
Illustration 7
The best way to arrange for wastewater disposal is to build water drains to
backyard or community kitchen garden
Note: Enlarge this illustration cut it and paste it on the cardboard or transfer on transparency for use
during training.
District level Training Module
22
n
Water, Sanitation and Health
... ,
,
Illustration 8
If there is no kitchen garden, soak pits can be designed as given in the card
The pit is one foot wide, long and deep
dXlSeg,h'!
»«• « =n the cardboard or transfer on transparency for use
District level Training Module
23
J
P
lVaterf Sanitation and Health
Illustration 9
Low-cost latrines can be built per house or group of houses. You will require
help from experts to get measurements in water seal-latrines
Note: Enlarge this illustration cut it and paste it on the cardboard or transfer on transparency for use
during training.
District level Training Module
24
fv
c
Water, Sanitatian and Health
Activity 1 Case study: Who is responsible?
early, finishes household tasks and goes to school
her^ungeSher^ 9e‘S "P
2’fetch drlnteng wale? U^un^monsmnXTed fonhCame "“J6 and '"OTe d"l,CU"
Women of the village wa|ked seven^7en Kilometers^ nSn
consecutive Year,
above that, getting water for other use added annth fh9St ^rinkln9 watef- Over and
half-a-day was now required for fetXg water
k"°meterS per Visit At least
wXJX S* S^houslhXKV 0 work Ta
-d
water. One day, Jeevi’s mother got very ste^Jeeof ch,ldren and getting
have to take care of the house. They decided that her
On Person who would now
get enough money for getting food for the fam lv et alnnoT
'haVe t0 WOrk ful1 time to
And Jeevi, will have to become the ladv of thp hA
al°ne Jeevi s mother’s treatment
ability' to do it and support froTherfemfiy™5 neVer ab'e t0 9010 class four tlesPi<e her
After narrating the case study, ask the following question:
f Do yon think this Is a reality?
? How dSoryoSuP°cnopbl up^Sr*?? °7eev'‘'s Ptudy? Why?
options available?
m ° etchin9 water for your family? Are
there any
District level Training Module
25
fl
H afer, Sanitation and Health . ('
(
(
Activity- 2 Demonstration of Dehydration and Rehydration
I.
Objective:
To explain the concept of dehydration and rehydration.
Material required:
You will require a plastic bag with picture of a child on it, bucket, water and cup.
Method:
Ask a person to hold plastic bag above the bucket. Assume the bag is a child,
Ramu.
Ask another person to fill the bag with water, this means Ramu is healthy.
Ask a person to pierce a hole at the bottom of bag, means Ramu had diarrhoea.
Let the water flow in bucket.
When very little water remain in the bag, ask the participants what has happened.
Discuss symptoms of dehydration.
Ask one participant now to add water from the top.
Explain rehydration.
> Encourage participants to share what fluids are given locally during diarrhoea.
Activity-3 Preparation of ORS from ready made packet
Objective:
To learn how to prepare ORS.
Material required:
ORS packet, one liter of clean water in a clean vessel, spoon.
Method:
>
>
>
>
Ask a participant to read the instructions on the ORS packet.
Take the vessel of clean Water.
Open the ORS packet and mix the powder in it.
Stir it with spoon and let every one taste it.
District level Training Module
26
■^7
f 1
Water, Sanilaliaa. and Health
Activity- 4 How to purify the water?
Objective:
To demonstrate removal of physical impurities from the water.
Msteris.l required:
You will need a transparent glass of water with physical impurity and alum.
Method:
Let the water sit for 15 minutes.
rour limes.
Look at the water. The dirt will be
seen settled down in thick liquid, while water on
top will be clean.
e' Remove clean top water in
separate vessel. Do not shake vessel too much while
pouring out clean water.
District lerel Training Module
27
11 '
^<4
Reproductive & Child Health
Our growth
Reproductive and Child Health
District Level Training Module
Topics
Number of Hours
Our Growth (The Female A Male
Reproductive System)
Conception
Adolescent Health Development
Care During Pregnancy
Child Birth & Care After Child Birth
Abortion
Infertility
Contraception
Reproductive Tract Infections
HIWAIDS
Cancers: Cervical Cancer
Breast Cancer and
common tobacco related cancers
Total
2
2
4
4
3.30
2
2.30
3
3
4
2
2
33.30
District Level Traininf; Module
1
I I
Reproductive & Child Health
Our growth
Our Growth
The Female and Male Reproductive System
District Level Training Module
2 hours
Learning Objectives
At the end of the session the participants will learn about
r- external and internal changes occuring during adolescence age.
scientific information about female and male reproductive system
> process of menstruation.
r community’s conceptions regarding menstruation from a social perspective.
Design:
Time in
minutes
15
Growth of our body
Discussion
30
Scientific information about female
and male reproductive system
Activity-1, Body
Mapping and
Discussion_
Discussion with the
help of apron
Activity-2
~
Discussion, role play
I 30
I
Methods
3o
15
Process of Menstruation
Misconceptions about menstruation
Menstrual disorders and care during
menstruation
Discussion
Material Required:
Apron depicting the process of menstruation, flip charts, sketch pens, chalk, enlarged
illustration of male and female reproductive system or slides, transparencies of these
systems. You can also use a picture book.
Dislricl Level Training Module
2
I I
Reproductive & Child Health
Qurgrtlwlh
Note for Trainer
Welcome the participants. Since you are going to discuss the reproductive system and
that tonfe?f yDur voice is ssriDUS' Otherwise the women will
Sart a aa ina Ind ‘thf
env rnnmpn?tA d- h
SetrJoutsneSs of discussion may be lost. Create an enabling
.environment to discuss the topic.
You may stgrt the sejsien by ?gyjng
"Dear friends,
'
mSruatfon Tnin, ",la'"°bOUI a‘Oml"
'Wdudlvo SyslBm a„u
r wome^'sonfe common' beSa^Xn
'D eliC“,heSC from
Briefly d)scuss about menstrua) prob)ems
y en Actlvlty 2
At the end. dIScuss the points related to care during menstruation.
)
District Level Training Module
3
Reproductive & Child Health
Our growth
Points to be Remembered by the Participants
Growing from Child to Woman and Child to Man
ms we grow, our body grows bigger and stronger. Most girls attain puberty (when
secondary sexual characters develop and they become capable of sexual reproduction)
between 10-11 years of age. Various changes take place within and outside our body.
external Changes in fiirls
> Height increases
> Hair begins to grow in genital area and under the armpits. This hair covers and
protects the outer genital organs.
> The breasts enlarge.
The body becomes more curved, full and voice becomes soft.
> Pimples may appear on face
Internal Changes in Girls
The tissues and milk glands develop in the breasts. The milk glands produce milk
when the woman has a baby.
> The birth canal and womb gets enlarged.
> Egg cells mature and are released from the egg sac every month
/
Please refer illustration 1
External Changes in beys
• Height increases
• Hair grows under the armpit, around the genitals, on the body and face.
• Shoulders broaden, muscles develop
? Voice deepens
• Pimples appear on face
Interna! Changes in Boys
•
•
.
Penis and testicles (balls) grow in size.
Enlargement of penis and testicles, erection of penis
Sperms (egg cells in man) production strats
Plea&S refer illustration 2
District Level Training Module
4
11
c
Reproductive <£ Child Health
Our grawlh
The structure gf Female Repreductiv? System
" Se the body^ fema'e repr°dUClive SyStem are outside the body and some are
> The outside body parts includes, outer lips, inner lips, clitoris (the sensitive nart
where we get pleasure). There are two openings - "vagina, opSgThduX
sarsmnf3^5 *n(oludes. the birth canal, womb, egg sacs and egg tubes The eaa
' f«XX%P“»hXine mon^0”0" “ '0 n°UriSh
' t^Sbi^X"5 lhe 0U'er rePrOdUC,iVe °r9anS ,o ,he
make
^ans is called
Please refer illustration 3
The structure gf Mgle Reprgdugtiye System
=i.r.:s^
' SSSSS-SrSa!?
EteasejsferjllustratiQn 4
MsnstrudtlOh
' “X m=Xhe,XXS,.XbYo'™5 beTn 10 and 16 yMrs
reach to fnenarche by 18 years she needs tr2atm m®n^uation- lf a 9<rl does not
every girl. Usually by forty-five vears nf nn ea ment- Thls a9e may be different for
called menopause. The7me of menoSaSe'a^TZ^f 0^ haV'n9 PeriDd5' This is
r Every month one eoa is releaspH fmmfh
so varies from woman to woman.
Simultaneously, a thick layer of small bloocfv9 S3?' * r®aches the e99 tljbeSinner side of the womb Xis time if
3nd mUcUS ,ayer forms on the
conceive (become pregnant)
lf ,nterco^a takes place, a woman may
District Level Training Module
5
I
11
U9
■
(
Reproductive & Child Healfh
Our grwth
' conies out of me hT1"???Ihen lhe layer of b'00d and mucus breaks and
The b'eedl"fl
Please refer illustration 5
Care during tpensfruation
Diet
Cleanliness
>
,Cen'i’<) iS °Pen dUrin9 ™"slrua"°". any infection easily
Bathe daily to prevent infection. Wash the vaginal opening with soap and clean
in?he\XVd'0keo,t01nXk»Te?SI“rt1' b'°odJAfler use' " ah°uld be washed and dried
in sun ana Kept in clean place for use during next time.
Menstrual biscrders
SoTcifir cfuseirnn? JS 3 T™ m comPlaint' especially during adolescence. The
exercises have kno^TK
Hnn ttleri°r t°° miJch b,eeding °r irregular menstruation are other problems These mav
is
to
Qr some o,her probtero-11
Mental development and Emotional Changes:
iESlSEE’—sSSsw.
AdoLescenceJ-iealth ancLDeveLopnientJModule
Useful references and material:
development is qiven in
District Level Training Module
6
H
Reproductive & Child Ifealth
Qur growth
Books:
feT
dia (FPAI)’ Bajaj Bhawan' 1S‘Fl0Qr- Nar^an Point Mumbai-
glides:
> Child Birth Picture Book, CHETNA, Ahmedabad Lanouaoe Ennlkh
' Sooo"!
n K1' XaVlsr ln5ti,uteCommunlcaltan, Xaviert Callage. Mumbai-
i K%!°on
n ?Hn|„%n5S=HA™aLanguage-Gujarati. Hindi
" Ra^pX™™'?! OM M H°SP"al and ReSearch Cen,re' Sa'dar Mudaliyar Road.
District Level Training Module
7
Reproductive & Child Health
Our growth
Activity 1 Body Mapping
Objective:
10 assess the information level of the participants about female and male reproductive
i>y w it? i Ti.
Material required:
If you plan this exercise on paper, then you need A4 size papers and
marker pens for all the participants.
You can also do the exercise on the floor. In that case you need only
chalk. The exercise can also be done on tiled floor or mud floor on used
banners, cloth, etc.
Illustrations 3 and 4 (enlarged or in transparencies)
Method:
Ask each individual to draw the external and internal reproductive organs of female
and male body. Encourage them to draw whatever they can.
Ensure that you do not make any comment on their drawing nor you should laugh.
> Once they finish the drawing ask them to explain their drawing to you. It is our
experience that many time women do have fairly good knowledge of their own body.
r If the group is big you can give the exercise in a group of 4-5 women.
If you have ask them to draw on the floor, try to copy on paper for you own
reference,
After finishing the body mapping you should provide the correct scientific information by
showing the illustrations 3 and 4.
District Level Training Module
8
r
Reproductive & Chil(l HeqWi
Our growth
A?t!Y!Ty-2 Role Play
Objective
To sensitize the participants on some of the beliefs related to menstruation.
Method 1
Method 2
(Sheela shows her red stained clothes to her mother).
' '
mS
: oe1^’ 5e\Wl1a, bas ha'”>ened 10 me.
8o° andsdln XT*
D~ate
Resend
Grandmother: Why are you sitting in a corner?
Sheela
: Mother told me to sit here.
I - you a
’
Mother
Grandm°,he
and not,0
- -P-e
Mother
eyes andto'stop paying with^oys.
(Veil)' Wa'k Slowly with lowered
District Level Training Module
9
Reproductive *C Child //eidth
Our grunth
(
Grandmother: (to Sheela's father): Look son, now search for a boy and get this girl
After finishing this pole play ask the fdlgwing questions.
o- What do Sheela's mother and grandmother believe about menstruation? Is this
right?
r- Is menstruation dirty? What will you do to change these beliefs about menstruation?
> What will you do to bring about a change in the society?
Common misconceptions regarding Menstruation
■
■
■
•
The girl or women who are menstruating cannot
-enter the kitchen and temple
-consume milk and milk products.
Menstruation is dirty
The sin performed by women comes out in the form of blood
during menstruation
In some tribal areas women are asked to live in a special hut
located away from the home during menstruation.
!
District Level Training Module
10
i
Reproductive & Child Health
Our growth
Illustration 1
Stages of Growth- Growing from child tp woman
jSStaZMSS*"*•and
,he««.
Note; enlarge this illustration or transfer this lliustratt
ion on transparency and use during training
District Level Training Module
11
Reproductive & Child Health
Our growth
Illustration 2
Stages of Growth- Growing from child to man
)
)
I
)
External changes: Increase in height, broadening of shoulders, development of muscles, growth of hair
on face, body under the armpit and around genitals, deepening of voice.
Note: Enlarge this illustration or transfer this on transparency and use during training
District Level Training Module
12
Reproductive & Child He(i/t/t
Our gro wth
Illustration 3
Reproductive System of Woman
Note: Enlarge this illustration or transfer this
on transparency and use during training
District Level Training Module
13
Reproductive & Child Health
Our growth
Illustration 4
Reproductive System of Man
Note: Enlarge this illustration or transfer this on transparency and use during training
District Level Training Module
14
Reproductive & Child Health
Our growth
Illustration 5
Process of Menstruation
Note: Enlarge this illustration or transfer this
on transparency and use during training
Distna Level Training .Module
15
(
Reproductive A Child Health
Conception
CONCEPTION
District Level Training Module
2 hours
Learning Objectives
At the end of the session the participants will learn about
r-
how conception take place.
how the sex of the child is determined,
Design
Time in
minutes
'40
Method and material
Conception
40
40
Ge^der discrimination at
Sex determination of child
Discussion, illustration 1
Role play
Role-play, Activity-1,
illustration 2
Material Required
Enlarged illustration land 2
or transparency of illustration 1 and 2, rice and pulse (or
Activity-1
District Level trainin',; module
I
(
Reproductive & Child Health
Cauception
Note for Trainer
Welcome the Participants. You have already discussed about male and female
reproductive system and process of menstruation. To discuss the topics of
conception and sex determination also needs an enabling and serious
environment.
You may start the session by saying
"Dear Friends,
Many of us have children. As you are aware in our male dominating society, the
birth of son is celebrated, whereas birth of a girt is usually not announced. To
give birth to boys and girls is not in our control. It is decided at the time of
conception (meeting of the egg cell and sperm). Let us today learn about the
process of conception and sex determination of the child. "
r- Ask the participants to explain how a baby is conceived? Listen carefully. Keeping
their existing knowledge in view, with the help of the illustration 1 provide scientific
information on conception. Refer section 'Points to remember'.
< Ask the participants to perform a role -play depicting the social customs followed in
their area at the birth of son and daughters. Let few participants volunteer to perform
the role -play. At the end of the role- plays initiate the discussion on the gender
biases and its effect on mental and emotional health of woman.
< To explain the process of sex determination introduce. Activity 1. At the end of the
exercise ask the questions given along with it. With the use of enlarged illustration,
explain scientific process of sex determination. Try to sensitize the participants about
their crucial role to disseminate scientific information among people about sex
determination at the time of conception so that woman is not blamed.
r- Briefly discuss about amniosentesis test, its misuse and ban declared by Indian
government for its use for sex determination. Encourage the participants to share
information about woman who have gone through agony of sex determination.
District I.eve! training module
2
Reproductive Si Chil(! llcalth
Concepiiott
Points to be Remembered by the Participants:
How does conception take place?
> The^a^elHmvPk Ih'6^^!99
u™6 'n 3 month' This is called elation.
I he egg cell travels through the egg tube towards the womb
bperms are produced in the testicles.
During sexual intercourse, many sperms are released in the birth canal
' be^TeTl"-^ dVys of7he Sd™3' C''C'e',h9 Chan':eS
c0"cep“°" are m°-
' cated SStto Ch 'he ‘Ube and °r"'' °ne sperm unltes wilh 'he ew cell. This is
' aCnd
“““ 609
'™"> and lodges on (he blood
' wSna^p^s"0',3ke PlaM',he Womt’ shed5 lhe h'ood and mucus lining and a
Elease refer illustration 1
Sex determination
, The sex or the child ic aelcrmlhed al the time at uhloh of the mtte ceed a„d telnals
' cated chroniosc"^7™"’and lhe ™"'Veed
chromosome This pair of^chromosomo23 Pad Is the sox
women have different sex chromosomes Th^'065 the S6X °f the baby Men and
one in woman is known as XX AUhe limeLl f Prr ,n.man 15 known as ™ and the
egg cell meets Y chromosome oYsperm
1°°,h° X chro'”os«-»e of the
chromosome of woman meets the x Jh hG b by Wl be boy and if t,ie x
Please refer jlliistralinn 2
omosome of man, the baby will be girl.
Our Society and Sex Determination
A'XanX^tT^NId ha^
'S
desired-
forced to bear children until a boy^sbomltTSsV691'96^ behaviour and ls
Physical health. It is observed that if woman faS
S ^ental> emoflonal and
might remarry,
0 ^e^,ver male child her husband
Few years back the amnloscentesis test (testina the flnH in u
■ ■
is primarily meant to detect conoenimi HicLJi 9 " "U d the amn|otic sac), which
child prior to birth. If the Tasex of the
ask women to abort the child. The woman sometmiJ r * 0> ’e c ” d 19 fe,nale they
the child. The Indian Government has nut a lent h
hetself takes initiative to abort
determine the sex of the bab/
P
9 ban °n the use of this test, to
As responsible citizens we must realizp that
They must get equal rights, care and love We mult brmTT’
b°y afe eqUaL
disseminating information about sex determination
9 b°U awareness through
District Level training module
3
Rcpnnhulivc ct Chihl Health
('oncuptiim
Useful references and material:
Books:
r Universal Child Birth Picture Book, CHETNA, Lilavati Lalbhai's Bungalow, Civil
Camp Road, Shahibag, Ahmedabad, Gujarat. Language. English, Hindi, Gujarati
r- Let us Learn More About Our Body and Health, CHETNA, Ahmedabad
< Education in Human Sexuality, A source book for educators, Family Planning
Association of India (FPAI), Bajaj Bhawan, 1st Floor, Nariman Point Mumbai400021.
Slides:
Child Birth Picture Book, CHETNA, Ahmedabad. Language: English
Kahani Nahan Ki, Kahani Nau mahino Ki, Xavier Institute of Communication,
Xavier's College, Mumbai-400001 Language: Hindi
Cloth Apron CHETNA, Ahmedabad, Language-(Hindi, Gujarati)
Cloth Apron (Hindi), SAHAYOG, Almoda
Cloth Apron, KEM Hospital and Research Centre, Sardar Mudaiiyar Road Rasta
Peth,Pune-411011 Language-(Marathi)
h'lMliit l.t'vd fltlhlillL! IthHiulc
-I
------
Reproductive & Chil(l Health
Conception
Activity-1 A game of pice and pulses
Objective
To explain the process of sex determination
Material Required
Rice and pulses
Method
Ask the participants to stand in2 circles, outer and inner circles.
r Give only rice in both hands of some participants. To some participants give pulses
in one hand and rice in another hand. Ask them to close their fist.
r Ask the participants to walk In a circle until the bell rings. When the ringing of the bell
stops they must make a pair with the partner in the adjacent circle.
Ask them to open one fist of their partner and see whether the partner has rice of
pulse. The presence of rice and pulse will determined the sex of the child. Pulse is a
symbol of Y chromosome (man) and rice is a symbol of X chromosome (woman)
bothJhe Partners have similar grains then a girl is born, If one partner has rice and
the other has pulse then boy is born.
iilustratlon 2 thS 9ame eXPla'n thS pr0Cess of sex determination with help of
training00
en'ar9e the illustration or transfer it on transparency to use during
Ask following question?
eoU
thu Lma7 C°^ple prefers to abort the child if ‘hey come to know that
the sex of the child is female? If you know, share the information.
> Are you aware of the ban on the sex determination test in our country?
How will you disseminate information on sex determination of the child?
District Level trainin'; module
5
Reproductive A. Child Ueqll'h
Concepliuti
Illustration 1
Conception
Note: Enlarge this illustration or transfer this on transparency and use during training
District l evel Iruniini* module
6
Reproductive & Child Heiilth
Coucepdon
Illustration 2
Sex Determination of the Child
Note: Enlarge this illustration or transfer this
on transparency and use during training
District Level training module
7
Reproductive & Child Health
Adolescent Health and Development
ADOLESCENT HEALTH AND DEVELOPMENT
District Level Training Module
4 hours
Learning Objectives
At the end of the session, the participants will learn about
r- mental and emotional development of adolescents.
Iff y fnd effects of gender discrimination during adolescence
. videnTete'ado1—‘
-sueslike
' beliefeof adolescenls.eXUSlity “h9 ad°'es“"“ and ways to handle myths and
> ways of supporting adolescents in their own villages.
Design
Time in minutes
45
30
45
30
30
60
Topics
Methods
What is adolescence?
~
Ctianges during adolescents”'
Jmental and emotional)
Effects of myths and reality of
sex and sexuality during
adolescence
Gend^scriminatlorTduhr^
adolescents
MajoFhealth problems during
.adolescence
Ways and means of supporting
adolescents
Activity 1, Symbolic
presentation, discussions
Discussions, Activity 2.
Discussions, Activity f
Discussion, Activity^
^^ussions^HFsharing^f
information.
DiscussionsTActivitT^
J
Material Required
in activity 3 and S YoZmay XttlomhKepSu'61 COl5UrS- Set of pic,ure “rds shown
each picture separately and make a set
P
and St'Ck them On cardboard. Cut
District L evel Training Module
1
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1
1
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'■ e & Child Health
Adolescent Health and Development
Note to Trainer
Welcome the participants. You are going to discuss the topic adolescent health and
development. It is very necessary that as a trainer you hold a positive opinion of
adolescents. Talk to somebody who has worked with this age group. People might get
emotional during the training, be prepared to handle them.
Welcome the group by saying.
‘‘Dear Friends,
Today we all are going to get younger. We shall all try to relive our past and experience
the fun we had during our adolescence. Like any other age, there might have been also
some problems during our adolescence. We will also discuss those. Let us learn from
our own experiences and utilize them for the benefit of our sons and daughters today. ”
> Introduce Activity 1-Symbolic Representation: This activity will lead to a working
definition of adolescence and a list of their characteristics. Encourage participants to
relate self-experiences to the characteristics.
> Briefly refresh the physical changes mentioned in the chapter 'Our Growth'. Ask the
participants to think what are the other changes that happen during adolescence.
Introduce Activity 2 - Mapping characteristics of adolescents. Classify the changes
participants mention to, emotional and mental development categories. These are
also the developmental needs and realities of adolescents.
> Continue by leading the participants to discuss prevalent myths related to sexuality
during this age group. Ask them to share any myths that they are aware of. Discuss
these myths. Give one example, "Potency of men depend on size of his penis." Give
scientific information for each myth given in Points to Remember. At the end,
introduce Activity 3 - Let us make our own story.
> Carry on to explain effect of gender discrimination against girls. Introduce Activity 4 Group work, which will bring out the fact that gender roles control both girls and
boys. It will also highlight the effect of gender discrimination on physical, mental,
social and emotional development of girls.
If you have already talked about gender differences earlier, it will help here. If not you
will have to spend some time explaining how the community treats men and women
differently. It starts right from the birth and continues until death.
r Discuss concerns of adolescents and its effect on health. Focus on anemia, early
marriage, adolescent pregnancy, childbirth, abortion, violence, tobacco and other
addictions. Refer points to remember.
> Finally, with help of Activity 5, encourage participants to find their own ways of
helping adolescents at home, in village and in community at large.
district Level Training Module
2
Q.
Reproductive & Child Health
Adolescent Health and Develop^went
Points to be Remembered by the Participants
Definition of Adolescence
mensSm ammo S^aTldmTdreams''31 S'3nS °f se*ual maturation
maturation
appear ,o “ rc“e
ma,uri,y»»
I
raped physical, emotional and social
This period, can be divlded broad,y
Girls
Pre-puberty
Puberty
Post-puberty
Boys
10-12 years
13-14 years
15-18 years
12-14 years
15-16 years
17-20 years
are average ages
may start few years
rzr
> SSS?™- 098'A
module-Our Growth'
~ ™ socia,
finai s,a9e °f
'
'"'e '9e"e™lion
>
y earn 10 COnlral 'he express;’ " of7h “r!hey proc^
1 ine,r emotions.
^World Health Or
‘
~
"—
'
Switzerland. 1995
3
Reproductive &
1
Mental Changes
Emotional Changes6-
Asks more meaningful questions
Can understand a difficult situation if we
talk to them
Always asks for explanation, in earlier
ages instruction was enough,
Can be very creative
Self confidence increases
Questions areas of doubt
Has meaningful opinions on all things
Gets very emotional, suddenly laughs and
cries_________
Sexual desire begins
At times demands a lot of attention, at
_pther times wants to be left alone
Day dreams a lot_________
Wants to develop independent
relationships. Peer relations become very
important
Wants to get recognized as an individuaT
Wants to participate in adult activities and
decisions
Myths and reality about sexuality and its effect on
self-image of adolescents
Myths and beliefs related to sexuality (the
constitution of a person in relation to
adotescents*5
behaVi0Ur) P'ay
important role in
°f
”
SX' [X^X“SCen‘S'
*
' <ba
,hem
— sources
Ergyiding information about sexuality leads to their development
Myths and realities:
:
Well-developed girls [whose breasts are big] "have bad character."
Masturbation is very bad. One drop of semen is equal to one cup of blood
masturbates, she^immoraL^'
imP°,enl' "a S^oman
form at sate
**
district Level Training Module
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Reproductive JU Child Health
Adolescent Health and Development
A man needs to have a large size penis to have sexual pleasure and to give
sexual pleasure to woman.
J
h^Sfn/ery P'.eva'eht mylh and a great source of tension for boys. In reality only first
to two and a half inches of women's vagina have nerves, which gives sexual
oah
h G h ^°mlan' Therefore'the 'en9th of penis does not matfer how long the
Xn erect0
tO W°man' M°St PeniSeS arQ '°n9er than 2 ’ 2 1/2 inches
Girls
during first intercourse. So one cannot generalise thamh0^ 03039 Pa'n °r bleedin9
had sex before.
generalise that if the hymen is broken she has
Ha Vmg S6X With more than one ^oman/girl increases potency of man
Ifa man touches a girl 5 breasts or kisses on her lips, she gets pregnant.
g™ 10
a
meet her egg cell. ’
0n,er her womb through birth canal and
h
Gender Discrimination During Adolescence
inXtyat large*
,rBat
3nd bOyS
« ^me. in the village and
BU> 9'rlS SUffer ',,ore
from gender aZZZnZrX °s dT^Lpires"
image and forces boys to become s^ronoJ nhv«.> f
S’
leads to low se|fsuppose to be the sole bread earners oHhJh™ 3 y and mentally- They are
care and comfort to the homp ronri
he.house and gid ,s opposed to provide •
and deve,opmenTo7giXh“XoZr
'0
e^cauSn. he:,th
Major Health Concerns of Adolescents
> By-and-lerge, adolescents remain healthy during this age. They do not get sick very
pale) and other n^rittoaTS^TX:gTndSZSXiX™K
district Level Training Module
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Reproductive & Child Health
Adolescent Health and Development
distribution and intake often result in this and other kind of mal and under nutrition
leading to stunted growth and poor pelvic sizes.
> Among boys, tobacco, drug-use and alcohol are major risks along with accidents
and induced injuries.
> By the time the girl starts menstruating, she still has approximately 4% more to grow
in height and 12-18% more pelvic growth is still to come. The problems of early
pregnancy and motherhood therefore become a prime health risk to girls. It is very
well known fact that too early pregnancy increases the risk of maternal (mother's)
and chiid morbidity (incidence of illness or ill health) and mortality (death) as well as
the likelihood of having too many children too close together.
x Abortion rate during adolescence is also on the rise, in addition, at least half of
unmarried women seeking abortions are adolescent and a disturbing age of even
below 15. Most of these abortions are unsafe and illegal. The decision for abortion is
often taken late, during second trimester (4,5,6 months of pregnancy) abortion is
another health hazard.
x Young girls are also at higher risk of sexually transmitted diseases and HIV infection
since their body is still growing and there is higher risk of trauma/cuts/ aberrations.
Ways and Means of Supporting Adolescents
X Adolescence is an age where they need to explore their own identity their body and
environment.
y
Provide them information, support and guidance. Otherwise, they will resort to other
sources, which might not be correct. Encourage and satisfy their curiosity.
x Adolescents are capable human beings, not children anymore Treat them as
mature persons.
r They enjoy reasoning and logical arguments. Give them time and encouraqe
discussion rather than implore discipline and rules. Give respect to their views.
r Respect adolescents and develop them as healthy and independent individuals.
Useful References and Teaching Aids:
?hihihlnhfiCtUrJ h°?o?HETNA' Lilavati Lalbhai’s Bungalow, Civil Camp Road
Shahibag, Ahmedabad-380004. Gujarat.Language-Hindi, English, Gujarati, Marathi
Books:
AP5rsPecflve on Heaith and Development of Adolescents, CHETNA Lanquaoe- *
Hindi, English, Gujarati.
a y
X Education in Human Sexuality, a source book for Trainers, Family Planninq
/nnno\at|IOn °f lndia’ BaJaj Bhawan, 1st Floor, Nariman Point, Mumbai400021 .Language-English
x Adolescence, Voluntary Health Association of India, Tong Swasthya Bhawan 40
Institutional Area, Near Qutab Hotel, New Delhi-110016. Language-Hindi, English
Health and N
°f Rura' Adolescent Girls - Training Modules - Vol 1
r Im h D J M n' ^aramma Thomas, Mathai; Nutrition Foundation of India, B-37
Gulmohar Park, New Delhi-110049. Language-English
district Level Training Module
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Reproductive & Child Health
Adolescent Health and Development
Teaching Aids:
> A set of 4 flip charts, Life useful education,CHETNA Language-Gujarati, English
Hindi
Slides:
X
Nlahan Ki’ Xavier Institute of Communication, St.Xaviers College, Mumbai400001. Language-Hindi.
Video:
r Arman, Voluntary Health Association of India, Tong Swasthya Bhawan 40
Institutional Area, Near Qutab Hotel, New Delhi-110016. Language-Hindi
district Level Training Module
7
Reproductive & Child Health
Adolescent Health and Development
Activity 1 Symbolic Representation of Adolescence
Objective:
i o explain different characteristics of adolescence.
Material Required:
Flip charts and sketch pens.
Method:
r Divide the participants into small groups. One group should not consist of more than
six to eight persons.
<" Ask them to discuss qualities of adolescence. Based on the discussions, ask them to
decide a symbol for adolescence (you might have to explain it by giving example like
child being compared to a flower bud).
. r icourage them to find a close similarity of adolescence to another symbolic thing
living or non-living.
> Ask the to draw the symbol decide by the group in the paper given to them. If
necessary, let them write a few words on adolescence.
> Let one member share the picture with the group and explain.
Give them 15 minutes to do the group work. You might have to go around and help
some group at different times.
... et the groups present one after the other. While they are presenting, note the
different characteristics coming out of adolescents.
> At the end of all the presentations, write the characteristics of adolescence on flip
uhart and discuss with group relating it to our own experiences. Your list may look
like this:
Adolescents are:
Creative
Imaginative
Strong
Argues a lot
Do not listen to adults
Very courageous
Need support
Lonely
Good looking
Controlled
Ready to learn and change
Rebellions
district Level Training Module
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Reproductive & Child Health
Adolescent Health and Development
Activity 2 Mapping Characteristics of Adolescents
Objective:
To list the mental and emotional characteristics (changes) of adolescence.
Material required:
“22pens'26 di''id6d in 1W° Pie“S)' *hree bi9 ,lip charts’
a™l
Method:
' eSTona^g^
°n Wa"' OaCh has °"a
-enta, changes and
> Encourage them to seek thehelp o?
' ‘hat 'hey ,ind mos‘ rele''ant-
aRdeX^eX7f”^
Emotional changes during
three pari,clpants to share sp^e ot thTo^X^^^^^^^
,0
district Level Training Module
9
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Reproductive & Child Health
Adolescent Health and Development
Activity 3 Let Us Make Our Own Story
Objective:
To sensitize participants about needs for information and
□port of adolescents.
Material required:
Illustrate picture cards as given in the folder. You may photocopy them and stick on a
cardboard each separately to make a set. Some blank cards and colour pens.
Method:
x
>
>
<
Divide the participants in two large groups.
Give set of the five cards depicting the story of a boy to one group and the five cards
of story of girl to other group.
Ask the group to discuss pictures and make a complete story from it.
Encourage them to think creatively and add a few characters to make the story more
interesting.
Ask groups to draw the missing pictures of the story.
Let one person tell the story to the group using the entire set of their picture cards.
di^cusTo331^ 3
questions at the end of each story to the large group for
district Level Training Module
10
Reproductive & Child Health
Adolescent Health and Development
Set of Cards - Story of a Boy
Ram is very tense, he is fifteen years old. He thinks this is happening because he
fantasizes about girls. He feels very guilty about this.
Ram is very happy. He has realized there is
no reason for him to feel guilty.
district Level Training Module
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Reproductive & Child Health
Adolescent Health and Development
Small Cards
While Ram was talking about girls, his penis becomes hard. Suresh and friends laugh at
Ram’s elder brother Ramesh asks what happened? Ram is very shy to report.
Ramesh takes Ram to Somabhai...
district Level Training Module
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Reproductive & Child Health
Adolescent Health and Development
Set of Cards-Story of Girl
foXd
herself- She loves S^,h^ i"
-rtd and is looking
district Level Training Module
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1
Q\
Reproductive & Child Health
Adolescent Health and Development
Small Cards:
Seema is sick. Her mother talks to her.
Local nurse Anju comes to see Seema.
Mother, Anju and Seema are talking together
district Level Traininf; Module
14
Reproductive & Child Health
Adolescent Health and Development
Activity 4 Effects of Gender Discrimination Against Girls - Group
Work
r
Objective:
To sensitize participants about the etteots of gander discrimination against girts.
Material required:
Flip charts and coloured marker pens.
Method:
home and In the society*' Pr°blems lhey (men and "omen) faced as adolescents at
>
SXZTwhS
the ones you mentioned.
> Let them write down in the inner circle
If possible, try to draw
Stop going to school
Eats last or less
Cannot go out alone
Early marriage
Does not inherit
a “Use and ef,M
outer circtes.
n 9'r S face sPec<Fically, over and above
your tist might look tike this:
—results in- lack of future work
opportunity and mental
growth
-results in— slow growth,
weak body, less energy, less
opportunity
-results in- ^opportunity, less knowledge, less
'resu"sin-eTr;rss'^o-“d-too
-resu'ts ,n_ jess power, fess value, no voice in decision
Go to in-laws
Sexual exploitation
See injustice to her
District Level Training Module
___
15
Reproductive & Child Health
Adolescent Health and Development
Activity 5 Action for Providing Support and Guidance to A
Adolescents - Group Work
Objective:
To find areas/ways of supporting adolescents at the village level.
Material required:
Situations given here should be written on separate sheets of papers.
Method:
> GiveoneXie fo eai" J™" 9r°UPS'
'0 'iVe PartiCiPantS in a ^oup
Ask them to discuss the situation showed in the picture and decide what kind of
"6edS- ASk lh-
.
•he
Ask participants to enact a role play in response to the situation and present it
P
PantS t0 be Creative- Tel1 them they Can add
characters if they
> Move around and help a group if they are unable to move forward
> The entire work will take about 45 to 60 minutes after which they should return to the
- A^e 9r°T fand briefly explain the
and present the play
> Zr lisTmay Site thfe0 "S' d0'"'n P°in,S’
Actions_____________
Talk with our daughters at home
Forni a boys’ group and girts’ group in village
Talk with boys at home__________
Involve girts and boys in decisions of family
Invite girts to women’s groups meetings
Organise meetings for boys once a month
Arrange nurse to talk to boys and girls
---------------------- ------JTalk with teacher of the village to guide girls and boys-----------------.get some governmentjctu^^
youf1' |f1s and
.Honour clever glrt or boy of
Stop child marriage at any cost
---------- a--------Provide sex education to girts and boys
------Get information about contraception
Eliminate gender discrimination
"
------- --------------lake care of girts’ nutrition
in plays as s°“°"s
Who will do it
Self
Women’s group with other
men's group
Men in the house
Family
~
Women’s group_____
Women’s group with men’s
group
_
Women's group__________
Family, men and women
Panchayat_________
Panchayat
Every one_____ _
Nurse or other social worker
Women and men
Family, village and society
Family
district Level Training Module
16
(
Reproductive & Child Health
Adolescent Health and Development
Situations
V
In this family, parents have a lot of arguments with children (girl is 15 and boy is 13)
Soma is tensed because he wants to marry Rami, but he is still in grade nine.
>
>
>
bSuToSh« S?b:lbeMlJSe
°"
UnC'e OnM k'SSed
is"belowfe XnT eVen1°' He lhinkS workin9 on a
'aS'year Shehasa
heSlKtaMeaT;5'
°"
>
10 k-—
“sissy.” So he quickly Sfs a^o
started coughing blood.
h
eSay n°' the drivers wi" ca" him
rin 'n9' Since last some times he has also
,
pwtricf Level Training Module
17
\
Reproductive & Child Health
Care During Pregnancy
Care during Pregnancy
District Level Training Module
$
3 hours
Learning Objectives
At the end of the session the participants will learn about
>
>
>
>
>
>
causes of maternal mortality
development of fetus in womb
CHan9eS in pre9nant woman
risks during pr^nancy^69™™7 3 E (early’ essentia'. emergency care) approach
local referral points
Time in
Minutes
30
30
60
30
30
Topic
Reasons of high maternal
jportality and morbidity
Development ofTeTus and
-Changes during pregnancy
Care during pregnancy at
family level and essential
health care
Pregnane^ Eady detection of
complication
■L°cal Referral Systems
Methods
Discussion
Discussion
Role play, Discussion
Roie
Referral Mapping - Activity-4
Material Required
J
transferred on trraensparencrensar9ed llluStration 1'2-3- These illustrations can be
District Level Training Module
1
Reproductive &. Child Health
Care During Pregnancy
Note for the trainer
Welcome the participants. You may start the session by asking them to sing to sing a
traditional song related to pregnancy.
You may start session by saying"Dear friends,
We sing a song of pregnancy with lots of love and affection but do you know that every
day there are several thousands of women who die due to causes related to pregnancy
and child birth. Let us understand causes of death related to pregnancy and how to
prevent it."
> Ask the women to list down the causes of death during pregnancy and childbirth.
While they give the reasons, as a facilitator you may list them on the black board.
Categorize them under three categories, namely, medical reasons, social reasons
and reasons related to poor access to health care. Refer the section 'Points to
Remember'
> Explain the growth of the child in the womb with the help of the illustration 1,2,3.
> From their experiences ask them to list down the changes that occur during
pregnancy. Add information provided in the section "Points to Remember."
> To discuss the care during pregnancy, ask them to do a role-play showing how they
would look after a woman who is pregnant. Refer Activity-1. Collate points related to
care during pregnancy. Categorize them under, care at the family level and essential
health care for all women. Add the necessary points. Under the care at family level
focus on the diet, rest and mental health and emphasise that pregnancy is not a
disease yet it needs careful care at home and also by health care providers as it is
sometimes associated with risk.
> Ask them to enact a role- play on an emergency situation. Refer Activity 2. Ask the
questions at the end of the role-play and discuss the points given in 3 E approach
related to emergency care and early detection of complication. Introduce Activity-3 Body Mapping to refresh points relate to early detection of complications.
> At the end of the session ask the participant to prepare a map of referral health
services in their area. Ask them to develop a map based on this information. Refer
Activity-4 - Referral Mapping.
> Summarize the topics and conclude by the song sung at the beginning, but modified
with new learning.
District Level Training Module
2
Reproductive & Child Health
Care During Pregnancy
Points to be Remembered by the Participants
Maternal Mortality
Maternal mortality is defined as the death of women during pregnancy, childbirth or
within 42 days after childbirth or termination of pregnancy, from causes related or
aggravated due to pregnancy, childbirth or its management but not from accidental or
incidental causes. Maternal mortality rate of our country is very high. It is estimated
around 437 per 1,00,000 live births. Every year 1,00,000 to 1,25,000 women die due to
causes related to pregnancy and childbirth. The reasons of maternal mortality can be
categorized in medical causes, social causes and factors affecting poor access to
rieaiin cars.
Medical causes
Some major causes of maternal mortality are excessive bleeding during pregnancy
(hemorrhage), sepsis (a condition wherein a woman has high blood pressure swelling
has Hah blood n^
^’ A?aemia' Abortion’ toxemia <a condition therein a woman
and may haVe
obtruded labour (v^en
Social causes of Maternal Health:
Age at Child Birth:
Even though the legal age of marriage of girls is 18 years, child marriage and marriaoe
bXThe a^lVv^r
C°mm°n- Ma"y «iriS 9™
?°
« Sd
rate
9
16 y
whl,:h 15 a contributing factor for the high maternal mortality
Too Many and Too Close Pregnancies*.
rKiHh b.ten f°Un? that S°n Preference is one of the main reasons for repeated
i irths, greatly increases the risks of maternal mortality and morbidity.
Poor Nutrition and Anaemia*.
Sian'SirfnH90?007 andthe nutr't'°nal requirements of women increase
rPn
H y'A woman should eat enough so as to get the additional nutrients that
are
Anaem adUth 9 pregnancy and 'actation. Poor nutrition often leads to anaemia
Anaemia is the most common hematological (related to blood) disorder that mav occur
in ™9/re9nariCy’ The Incidence anaemia is pregnancy ranges widely from 60-70%
Due to gender discrimination, women get very less food which results in her nnnr
nutrition and health status. She continues to eat less as she is socialized to feed the
S
ea‘ laS‘ and
undernourished vromTnt '°e
dsk
District Level Training Module
3
Reproductive & Child Health
Care During Pregnancy
Poverty-.
Poverty is one of the major contributing factors for maternal mortality. Poverty results in
restriction of purchasing power. In conditions of limited resources a woman tends to
give the last priority to her own needs. She ignores her own health concerns and avoids
medical treatment many time due to lack of financial resources.
Access to Health Care
It is a fact that primary health care is not within the reach of several women. Poor
access to health care is a major concern in the area of maternal health. Some of the
contributing factors are:
Shortage of health personnel
Delivery by untrained dais (TBA’s)
Poor communication and transport facilities
Inconvenient location or long distances, long awaiting hours
Poor quality of treatment/lack of personnel attention/lack of medicines
Delay in recognition of emergency by family members or trained birth attendants
Delay in decision by family members to seek emergency obstretic care
Delay in reaching the health facility on time.
Delay in receiving treatment at referral hospital, after reaching the facility.
Fear of donating blood
Development of the Fetus
Details on conception are already given in earlier chapter on conception. As discussed
the egg and the sperm meet in the fallopian tubes. The embryo (fertilized egg cell) starts
moving towards the womb and the cells inside it keep dividing. After four days the
embryo implants itself on the inner lining of the womb. The outer layers of cells develop
a transparent bag - the amniotic sac, which is filled with fluid. The fetus grows safely in
this bag. Some cells start to develop the placenta (after birth), which takes three
months.
Dung these three months, the embryo obtains its nutrition from the inner lining of the
womb. After the third month the placenta is formed and starts functioning. The main
function of the placenta is to supply oxygen and nutrients from the woman to the fetus,
thus the fetus gets nutrition from the mother.
The cells inside the embryo continue to divide and multiply. Similar cells get together to
develop different parts of the body. By the third month almost all the organs of the body
are formed. But they are small and not in a position to function on their own. In the later
months, these organs grow and develop in to a mature baby. Refer illustration 1.
Changes in Woman's Body
> Common changes observed in a woman's body while the fetus grows, are increase
in the size of breast, darkening of the nipple and areola (circle around the nipple),
increase in the size of the abdomen, development of lines on the abdomen and the
occasional itching in the vagina.
District Level Training Module
4
Reproductive & Child Health
Care During Pregnancy
During the first three months, the womb remains within the pelvis. It is difficult to
confirm pregnancy by abdominal examination during this period.
> Among healthy women with adequate and appropriate food, rest and mental peace,
the womb increases about one and a half inches (measuring two fingers) every
month. The womb grows to reach above the naval region by the seventh month. By
the ninth month it reaches the triangular bone at the end of chest.
Please Note
x If the growth of abdomen is less than this, it should be considorod as a risk factor.
Inadequate growth either indicates that the fetus is not properly nourished or there is
some other obstruction in the development of fetus.
> If the growth rate is more, it indicates that either the amount of fluid in the amniotic
sac is more or there are twins. This again can be risky.
Care During Pregnancy
Care During Pregnancy at Family Level
Special care is needed during this period, both for her own as well as the baby's well
being.
7
r- The woman needs physical as well as emotional care during this period.
> She must get sufficient food and rest.
> Care should be taken that she does not feel stressful due to a number of factors
such as the family preference of a son, workload, and discrimination against food
and care
Injury particularly on her abdomen and also other type of physical as well as mental
violence, when she is pregnant, should be avoided.
> In the first three months the woman might experience the symptoms such as
nausea restlessness, tiredness, caused due to various changes in our body. This
settles down on its own after sometime.
> The woman must consume plenty of fluids during this period. Foods that are sour
and strength giving will provide relief from nausea and vomiting. The woman should
consume more of lime juice, soup of pulses, tomato soup, juice of amla sweetened
milk, buttermilk and fruit. Avoid intake of greasy foods. Take small frequent meals
< lake medical advice if unable to retain food or fluids, if urine becomes scanty and
dark or if vomiting persists about 3 months.
Home based herbal remedies for nausea and vomiting
r Soak some fennel seeds (Foeniculum vulgare) and sugar candy (in equal
proportion) overnight in water and drink it along with the soaked seeds in the
morning.
The woman should eat something dry as soon as she wakes up in the morning
Consume half a teaspoon of amla (gooseberry) jam on an empty stomach
"
,0f .wat®r Bo" a handful of beaten rice (puffed rice, kurmura, muri, lahi)
has sphIpH fb'
minutes remove from heat and keep it covered. When the rice
has settled at the bottom, remove the water from top, add some salt and sugar
District Level Training Module
5
|t£
Reproductive & Child Health
Care During Pregnancy
according to taste and drink a little at a time throughout the day. It should be freshly
prepared everyday and the woman should drink it whenever she feels nauseated.
> Extract juice from pomegranate, mix it with the roasted cardamom powder and drink.
> Burn and grind small cardamoms, mix it with honey and consume frequently.
Diet During Pregnancy
> The fetus draws its nutrients from the mother for nine months. For this reason, the
mother requires more nutrition during pregnancy, particularly iron and energy rich
foods, proteins and plenty of fresh air.
> Her diet should consist of the foods, which are locally available. The green leafy
vegetables contain plenty of iron and minerals. Hence, she must consume more of
the vegetables such as leaves of spinach, fenugreek, drumstick, bathua leaves,
cabbage, pumpkin, gram, etc., which are locally available. Besides, she must eat
leafy vegetable along with pulses and citric fruits. For example, if leafy vegetables
are cooked with pulses and buttermilk or lemon added, it becomes more nutritious.
Green leafy vegetables protect the body against illnesses, pulses maintain the growth
and roots, and ghee, jaggery, oil and oil seeds provide energy to the body,
> She also should include cereals such as bajri (pearl millet), rice, wheat, and all types
of pulses, legumes and groundnut in her diet.
> She should consume more of seasonal fruits, which are easily and locally available.
For example, plum, sugarcane, guava, mango, watermelon, muskmelon, amla,
berries, falsa (Grewia Asiatica), rayan (Mimusops Hexandra), shahtoor (fruits of
mulberry) etc.
> She should consume milk and milk products like buttermilk, curd, butter, ghee,
cheese, cottage cheese, in plenty, depending on availability and economic condition.
The Government of India has initiated the Integrated Child Development Scheme
(ICDS) to improve the nutritional status of women and children in the lower socio
economic group. Through the Anganwadi center, a woman can get nutritious food
during pregnancy and other related care. Women should enroll themselves at the
nearest Anganwadi centre as soon as they come to know about their pregnancy.
In a recent scheme, the Government of India provides Rs.500/- for nutritional
supplement to needy women upto two births. Contact the Sarpanch and avail this
facility.
Wayi
Obtain More Nutrition at Low-cost
> While washing the rice or pulses do not tab them vigorously. The rice will loose the
impohant minerals and vitarnins of the oUter surface.
> Do nt>{ throw away the left over water ftata cooked rice.
> Eat terminated
cj&rminated pulses.
pulses
(.
> First ^ash the vegetables thoroughly hhd cut into big piedeS and cook with the lid
on. Cobk the vegetables without remo'/lhg skin, as it contains more nutrients.
> Eat seasonal fruits and Vegetables.
> Eat more of raw vegetables
District Level Training Module
6
Reproductive & Child Health
Care During Pregnancy
> Avoid eating stale, rotten food and food kept open in the market. They are the
sources of illnesses.
> Drink clean and safe water.
Personal Hygiene
r f\ woman must bathe daily, keep her genitals clean, wear washed cotton clothes,
and should be provided with a clean and fresh environment. This will keep her
cheerful and healthy.
> She must clean her breasts. If her nipples are small and inverted, she should
massage and pull the nipples slowly upward everyday.
Avoid the Following
Consuming any medicine without consulting a doctor particularly during the first
three months. The medicine can adversely affect the growth of the fetus causing
> • damage to her body or at times it leads to abortion
> H^fn^rCOUrSe’ 33 db,rin9 the first three months of P^gnancy it may increase the
risks of miscarriage and could be uncomfortable for the woman during the later
stage of pregnancy and also, increase the chances of infection of the reproductive
iraci.
> Anxiety, anger, worries, depression and fear.
z- Grieving scenes such as severe illness, death, witnessing childbirth or similar
actions, might generate negative thoughts in her mind.
' p®.avy wor.k °r exertion, which might adversely affect the growth of the fetus
bating mud, brick, clay or raw rice.
r- Alcohol, smoking, eating clay, mud, brick, spices etc. and other such toxic
substances during pregnancy.
Useful Beliefs and Practices
> A woman's desires should be fulfilled during pregnancy.
" Preg"ancy ls joint|y celebrated and honored by both the parental as well as the ince^brat?nneSJhhar^appy (but usually on|y Qirl's parents bear the cost of the
celebration, which is unfair).
r- From the eighth month onwards the woman is given certain foods to enhance
eneJgy providing3"3
ja"ery and fenugreek seeds are nutritious and
^Oma? iS aSked t0 read sP'ritual b00ks and look at positive pictures
Avoiding intercourse during pregnancy.
Harmful Beliefs and Practices which may be harmful
Pregnancy does not require any kind of special care.
Avoid medicine or injection wherever possible
> ?n°Hn!S!'On °f T°r! f°Od dUrin9 Pregnancy may compress the head of the fetus
and which may also be bom emaciated.
uunneierus
r- Avoid eating brinjal and green leafy vegetables
as it would cause diarrhoea and the
child born will have a dark complexion.
District Level Training Module
7
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Reproductive & Child Health
Care During Pregnancy
>
During pregnancy avoid groundnut, milk, banana, curd and ghee which get
deposited on the fetus and obstruct childbirth.
Going out at night, during no moon and eclipse, as it would cause some defect
(physical or mental) in the fetus.
Eating clay, brick etc, is normal during pregnancy.
Not being able to see after dark is a normal phenomenon during pregnancy
> Not to wash hair or have head bath since the heat of head will go down in body
> Leading to miscarriage.
Healthcare
The three E Approach
In order to ensure that childbirth is safe; ensure that all women receive the following
> All women receive Essential care during pregnancy
'
> Complications are recognized Early
z- Those with complications receive Emergency care at the first referral centre.
1) Essential care to all women who ore pregnant
Most women in your communities are at risk of developing complications any time
unng pregnancy. Hence it is important that every woman receives the following five
components of essential care.
1. Early Registration of All Women Who Are Pregnant.
A woman needs to register herself during the first three months.
2. She should get a medical checkup done at least three times during pregnancy
The ANM/PHC doctor will be able to do this.
3. Prevent and treat anemia
> The woman needs to eat enoi
ugh food during pregnancy, particularly foods that are
rich in iron and growth along with sour fruits and vegetables. Detaiteare q
liven in
"Anemia during pregnancy".
b
' SXTnnn'1 should,t®ke at least 100 iron tablets during pregnancy. (The dose is 1
at sub XXd pur'"9 pre9nanc* and 2 if lha ™man is anemic). It is available
al oUU Utdl III t? ariQ r riU.
4. •Oho°Xl®
;
h°U^^k®^?0!eS.,0f tetanus tox°id durin9 pregnancy.
5. If ,the delivery' is conducted at village level the
Dai.’’’s, elderly women and all women
------who are pregnant, should know about the need for 5 cleans.
>
>
>
>
Clean hands
Clean surface
Clean razor blade
Clean cord-tie
Clean cord stump
Please Note
PXGZnment provides delivery kit t0 aN women during the seventh month of their
District Level Training Module
8
Reproductive & Child Health
Cure During Pregnancy
2) Early recognition of complications
If the complications that can lead to death are recognized at an early stage, many
maternal deaths can be prevented.
In addition to identification of complications, it is important that the woman must reach a
hospital with facilities of taking care of such complications. The communities must be
aware of such hospitals.
Referral
Following are the suggested referral places for different complications.
Bleeding, obstructed labour
Sepsis
Toxemia
Abortion
Anemia
First level Referral, District
level Hospital
Primary Health Centre (PHC)
Sub centre
3) Emergency Care of Common Complications
There are five common complications, which should be identified, and adequate
measures taken
1. Hemorrhage/ Excessive bleeding
It can be suspected when a pregnant woman starts bleeding from the vagina any time
after 28th weeks of pregnancy and before the birth of the child. There may be pain or
tenderness over the abdomen while bleeding. Immediately transfer the woman to the
first referral center.
2. Severe Anaemia
)
If a woman complains of lack of strength and shortness of breath, The VHW can
suspect severe anemia. There may be swelling on face and feet and her eyes, lips and
skin may look very pale.
The woman needs to refer to the Primary Health Center or the first referral unit.
She must ensure that the woman consumes 2 iron tablets in a day for at least 100 days.
In case the pregnancy is advanced, she may also need blood transfusion.
3. Reduced or absence of Fetal Movement
If there is any change in the frequency or the, movements of the child in the womb are
absent, the woman must be shifted to the first referral unit.
4. Headache, Blurring of Vision, Swelling
)
The ANM needs to check the blood pressure and weight of the woman through out the
pregnancy.
If the systolic blood pressure is 140mm of Hg or more 90mm of hg diastolic.
District Level Training Module
9
h2-
Reproductive & Child Health
Care During Pregnancy
If there is an increase of 3 kg in a single month. Any weight gain more than 2 ka oer
P=°r?th OrHm°re th^n °'5 k9 Per week is considered risky. These two put together are
uni;y predlctors of toxemia ln Pregnancy. The woman must be taken to the filst referral
The condition may worsen if the following symptoms are present:
Blurring of vision
Vomiting/headache
Severe pain in upper part of the abdomen
Convulsions
The women should be immediacy referred to the First Referra! unit or district hospital
5. Rupture of the womb
ma5?UeP?o9fX)'JoTenTenlobr Xo^
"i
Previ°us
-
by giving injections, misuse of injections ofUoxvtac nOL|f' (hasteniri9 of labour by quacks
abdomen, which is not synchronized sMth^?tra^man has sudden Pain in the
referred to the First Referral unit.
h “ntractlons of the womb, she should be
Useful Health Educatioh Material
LalbSsBu^ow" CivHcTmp^oad 1^^^
Language-Gujarati, Hindi
Ah^'^tT CHETNA' Lilavati
’ Shahlba9’ Ahmedabad-380004, Gujarat,
Flip book:
Ministry of Health and Family Welfare,
District Level Training Module
10
i
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1
I
)
Reproductive Child Health
('arc During l^c^iiutiiy
)
Activity-1 Role play
Objective
To sensitize the participants about the care during pregnancy.
Method
> Ask 3-4 participants to volunteer for a role-play.
> Tell them to prepare a role-play of 10-15 minutes on a situation in a house where the
woman is pregnant for the first time. They should share among themselves the role
peNtheir situat ^02^^ mo^er‘,n ,aw’ and
care provider (Dai, ANM etc.) as
rh^?mtt0 demonstrate how they would take care of a woman during pregnancy?
" groups
Sn m'nU 6S lme for PreParation and then perform the role play before the
r- Along with you, ask the participants to observe:
oarelhe Vari0US d0’S and don'ts related t0 diet and activities suggested
\Aa.aLare he various comPonents of antenatal care covered- Check-up T T etc?
X ^,CimnbertOf :he family and community are involved? (Husband, mother in
law, anm, Uai, doctor etc.
Whether emotional factors are considered or not?
-
> After they finish, ask the participants to share what they had observed
categorize their observations in two broad categories
Add fhP infn6 a,.fami'y lev®' and essential health care for all women who are pregnant
Add the information from the section "Points to Remember"
9
District Level Training Module
11
1'79
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Reproductive & Child Health
Care During l^egnaney
Activity 2 Role play
Objective
To sensitize the participants about emergency health care and factors affecting it.
Method
Based on the following points ask the participants to perform a role-play. Give them
freedom to alter the role-play keeping their socio cultural environment in view.
>
>
>
>
>
>
Shanta is a 25 year old woman. She is pregnant for the first time.
At 6 months of pregnancy she started having bleeding.
The family called the local Dai
She ask to take her to PHC
Due to difficulty in getting the transport they loose 2 hours.
When they reached the PHC, the doctor was not available. The ANM asked them to
reach the district hospital.
> They reach there.
r- The doctor explains the need for the blood and asks to donate the blood. The family
refuses.
Questions
1.
2.
• 3.
What could be the end of the role-play? Why?
What are the reasons for the delay in reaching the health facility for the treatment?
What are the ideal steps to take during such a condition?
District Level Training Module
12
Reproductive & Child Health
Care During Pregnancy
Activity-3 Body Game
Objective
To fadHtat. panidpanls understanding of compllCati0ns
Material Required:
during pregnancy.
Paper sheet, marker, and black board.
Method
> r
a.?n™™e &T0,
> Write the
> Discuss the identification signTa'S
> Ask them to repeat the symptom
°n 6ach fin9er
993 °f each sy™Ptom
Vis,rict^e/Train;ngAIodule
13
Vlt
Reprodactive Child Health
Care During Dregnnncy
Activity-4 Referral Mapping
Please Note: This is an exercise which participants will perform out side training hours
Objective:
SseofTmergency013
SyStemS available for a woman during delivery in
Material required
Flip charts and marker pens
Method
-
AbL
4
?ey may perform the activity in area wise groups
' pe™7be U “e"X
' anJ XedaZrP dePiC'in9
a"d
*heSB' Y°U may 9ivB ,hem lar9e sheBl of PaP^
< Display this in the training hall
' Xensa “
maP
be deVel°peCl and disPlayed at lhelr P^ayat, and
District Level Training Module
14
)
Reproductive & Child Health
Care During Pregnancy
»
Illustration 1
Growth of Fetus
Please Note: Enlarge this illustration or transfer it on transparency to
District Level Training Module
use during training
15
\")S
Reproductive & Child Health
Care During Pregnancy
Illustration 2
Growth of Fetus-Three Months
Please Note: Enlarge this illustration or transfer it on transparency to use during training
District Level Training Module
16
Reproductive & Child Health
Care During Pregnancy
Illustration 3
Growth of Fetus-Six Months
Please Note: Enlarge this illustration or transfer it on transparency to
District Level Training Module
use during training
17
)'
(
Reproductive & Child Health
Child Rirth and Care after Child Rirth
(
Child Birth and Care after Child Birth
District Level Training Module
3 hours and 30minutes
Learning Objectives
At the end of the session the participants will learn about
>
?
>
>
>
>
>
stages of labour
existing local practices and beliefs related to labour
measures for safe and aseptic child birth
risks during labour
practices and beliefs related to care after childbirth
car© after child birth
risks after child birth
Design
Time in
minutes
60
60
30
30
30
Methods
Local beliefs and practices related to
labour and care after child birth
Different stages of labour and
measures for aseptic child birth
Care of woman after child birth_____
Complication during labour and after
child birth________________
Infant Care, immunization and breast
feeding_____________
Own stories, role-play
Discussion with help of
illustrations
Practical, Activity 1
Role-play, story______
Activity 2, Discussion
Buzz group discussion,
Activity 3
Material Required
Flip Charts, Markers, delivery kit, enlarged illustrations- 1,2,3,4,5,6,7. You may transfer
these illustrations on transparencies.
District level Training Module
1
r,
ReI’r,,‘',,clivc & Child Heahh
< hild Rirlh and Cure after Child Birth
Note for the trainer
aTS^3"”’3"'5- ASk ,hem5i"9 a «
commonly sung for tahour and
you may jtgrt the session by saying....
"Dear friends,
nine months we ca^thfbaby Inside'us and a^e impOfrtant milestone
.
know the seriousness of this staoe and cnn^ri
baby is born, looking afte,r
7
our life. For >■
° S6e the baby- Many of us
F^hermore, once the
they share bring’out 'lhe toy"IssueTa’nd note th labo‘"f|a"d 45 da',s a,ler lal>our. As
shared.
s:
k
Don'ts during theseTtage? LeUhem Vh^rVlhe^5
and after chMbiriX
and labour.
st™*1
re that both P051^ and negative experiences are
°f lab°Ur and D°'S and
complications during labour
—‘0 d,scuss complications during childbirth
' 2Xthe
Dixtrirt level Training; Module
2
)
Reproductive A Child Health
Child Birth and Care after Child Birth
Points to Remembered by Participants
helpful beliefe Xted toIh^Kne^^
There are harmful and
Local beliefs and practices related to labour and care after childbirth.
Positive Practices
" qJ6 w°man 9'Ves birth in squatting position.
squattin^ciughing.'etc6 P'aCenta does not de|iver• which includes tickling the vulva,
- She is given special Joodsand heiL^fte^cSdSh0^01 f°r
W°man'
- A ight, carminative, fluid diet is suggested during the first 2-3 days.
Harmful Practices
: S “^SiSSISSSllS1 ■■
. s=:a»sssff "■ “■
>
-
'
f dheqhUa 6 rest IS 9iven t0 many worT>en
a baby girl ls born, her mother is discriminated and tortured.
Various Stages pf Labour
First Stage of Labour
time. The entire proces of abouH?^! r L T”* ab°Ut and Sit Or sfand for a lon9
labour comes the womL h!
completed m three stages. When the time for
District level Training Module
)
3
Reproductive & Child Health
Child Birth and Care after Child Birth
Do____________
:
r- Inform the Dai of ANM immediately
> Relax and keep moving. Rest when
you feel tired.
> Take the pains gradually as they
come. Do not apply force.
> Breathe deeply.
> Drink plenty of energy giving fluids
like jaggery, black pepper and
ginger decoction, tea, milk etc.
< Ask the Dai/other women to
massage your back, abdomen,
thighs, etc.
Do not
> Push or apply external pressure^on
the abdomen to hasten the labour
> Break the amniotic sac with nails or
blade.
> Give injection to speed up the
labour.
> Insert hands/other substances in
vagina.
The Second Stage of Labotir
feel the^ur Tto5 ass't’
contractions!befome
Do
---------------' Sitting in squatting position would
help the baby to come out fast due
to gravitational force.
< Bear down when there is a
contraction
r Support the perineum with a cloth
pad.
r Wrap the baby in a cloth and put it
to breast immediately.
r' Cut the cord after the pulsation
stop.
^Tas we^aVstoofe^the
*” "",e'the
Do not
> Pull the baby^ut with force
Cut the genitals of woman with a
blade to broaden the passage.
Push or apply external force on the
abdomen
Insert fingers to examine
The Five Cleans
District level Training Module
4
Reprodintivtl & Clnhi HcMfh
Child Birth and Care after Child Birth
1.
2.
3. Cut the cord with a clean blade.
4. Tie the stump with a clean thread.
5. Keep the stump clean. (Avoid putting anything on it and keep it dry.)
Thg-Third $tqge_of Labour
Do
--------------------------------x Wait for the placenta to come out.
Wrap the baby in a cloth and put it on
breast
" Ask the woman to push after the
placenta separates.
' See that the placenta is complete
r Bury it in the ground.
Do not
-- -------> Wait for more than30 minutesfor the
placenta to come out.
> Pull the placenta
Push the abdomen
> Remove placenta by hand
^are of the Woman After She Gives Birth
she has giving birth.' AUhe same time shTreqXs^l’ot6 fbec°me vulnefab|e after
■ milk and look after the newborn. She needs ade^lfe food
Diet: The woman should eat foods that
provided nutritious food from the AnOanwadi. She should eS it '°n' 3 WOman *
be,°re ,akm8 a ba,h *
tfe^The woman shoutd Pathe daity with warm water and wash the genitais as wait
District level Training Module
5
Reproductive Child Health
Child Rirth and Cure after Child Birth
Fumigation; In many places, there is a practice of using herbs and giving smoke in the
vaginal area. This reduces the chances of infection in the genitals.
Hgst: The woman should lie in bed at least for 10 days. This helps the womb to return
to its normal position.
Iron tablets: She should take 1 tablet daily after meals and complete the course of 100
tablets.
Breast-feeding: The child should be put to breast immediately after birth. This helps
the womb to contract and reduces the chances of heavy bleeding. Early sucking leads
to early flow of milk. The child should be given only breast milk upto four months of age.
After that, complementary foods should be introduced along with breast milk. Feed the
child breast milk for as long as possible.
While breastfeeding:
Eat plenty of foods that give energy (jaggery, ghee, sugar, cereals, etc.)
Drink plenty of fluids (10-12 glasses of water, buttermilk, milk, herbal decoctions
etc.)
Special herbs and foods promote breast milk (bajri, coconut, poppy seeds shatavari
etc.)
> Sleep adequately
> Relax and do not worry
>
Care, of the Infant
The first few days are crucial for the baby's survival. Give extra care to the baby.
Breast-feed the baby frequently as and when it demands.
Keep the baby warm
Keep the baby near the mother. This provides warmth and strengthens the
emotional bond (Family members should help with housework).
Keep the baby dry and clean.
> It is not necessary to bathe the baby for the first seven days. Wipe the baby clean
keep the stump dry.
Give the baby massage and fumigation (shek) depending on the season
> Immunize the child as per the national schedule. Complete the schedule Refer
Table-1.
Talk, sing songs and play with the baby.
Watch the baby carefully. Consult a health worker as soon as you see any
risk/changes in the baby.
District level Training Module
6
)
Reproductive & Child Health
Child Birth and Cure after Child Birth
Table 1: National Immunization Schedule
Vaccine
Name of
disease it
prevents
I etanus
TT*
Age
Route
Pregnant women
Intramuscular Injection (IM)
Intradermal injection
BCG
(tuberculo
sis)
OPV
Tuberculosis
At birth
contact
Polio
Birth
DPT
Diphtheria,
~~ 6 weeks
whooping cough 10 weeks
aJ?d Jetanus
14 weeks
Polio
As above
OPV
Measles
“DPT
OPV
DT
Measles
'
Diphtheria,
whooping cough
and tetanus
-PohjD___
Diphtheria,
Tetanus
or first
9 months
16-18 months
As above
5 years
10 years
tt t
B------------------- i 16 years
I tor Pregnant woman: One injection-------Second injecbonTt^hTinZal of onTmonth0" 35
Oral
IM
Oral
-—-Subcutaneous injection
IM
Oral
IM
IM
IM
SUSPeCtS She is pregnant
Complicotions during Labsur and /After Child Birth
ateXSS te b^ytisTmpS'!to
any ,ime duri"’ ,ab°ur a"d
stage, it may result in grave consequences E“I sS tae''3"5 a"d
aS al lh'5
The Following Condition? Are Risky
During Labour
the womb's mout/doe^not openj/iTriskyprogress even after 12 h°urs or pain or
SSSle theXb COmeS 0U‘ be'°re 'he head °f'-.us. the baby may
District level Training Module
7
)
^7
Reproductive & Child Health
Child Birth and Care after Child Birth
T. .
Hand Prolapse: If the hand comes out first, the foetus may be lying across the
abdomen, attempts to change the position may lead to suffocation or tearing of the
womb and heavy bleeding.
Baby is upside down: In such cases, the head might get entangled at the mouth of the
vagina.
Absence or reduction in fetal movements and heartbeats: This indicates suffocation
of the foetus and it may lead to death unless operated immediately.
Convulsions: The woman may have convulsions due to toxemia or other psychosomatic
disorder. This may lead to death of the foetus and the mother.
Excessive Bleedjpg: Excessive bleeding may occur due to a low-lying placenta, rupture
of the womb and some other causes. This could lead to death of the woman within
hours.
After Childbirth
Placenta does not come out: Usually, the placenta comes put within 15-30 minutes
after the baby is born. If there is a delay, the cord should be cut and women taken to the
hospital. Meanwhile, put the baby to mother's breast, tickle the vulva and ask the
women to squat and cough.
Excessive bleeding: Bleeding occurs when some times, the womb forgets to return to
its normal position or a piece of placenta sticks in the womb or the womb has ruptured
etc. The woman can die within two hours.
Convulsions. These occur due to eclampsia or emotional causes and risk to the mother
and the baby.
Infection- A change in amount, smell, colour of the discharge, accompanied by fever
and pain in the abdomen indicate infection in the genital area.
These symptoms should be recognized as early as possible and the woman shifted to
the district level hospital or First Referral Unit.
Useful Health Education Material
> Dai Training kit; CHETNA, Lilavati Lalbhai's Bungalow, Civil Camp Road, Shahibag
Ahmedabad 380004, Gujarat, Language, Hindi, Gujarati
> Flip book-Safe Motherhood, IEC Department, Ministry of Health and Family Welfare
Jaipur, Rajasthan, Language-Hindi
District level Training Modale
8
X
(
t
(
Reproductive A Child Health
Child Birth and Care after Child Birth
Activity-1: Clean Hand
Objective
To memorize five clean
Material
Flip chart and marker pens, disposable delivery kit.
Method
!?raw a hand on chart paper or on floor
-ds on the inte fln8er.
< In this way discuss the remaining four cleans
plwitheI? to rapeat and demonstrate the five cleans in oairs
> At the^nd riSk 09 them to draw a hand and dePicting thePfive'cleans
At the end demonstrate the use of delivery kit
Your illustration will look like this.
Five Clean
District level Truininn Mniliile
9
(8^
Reproductive A Child Health
Child Rirth aud Cure after Child Birth
Activity-2: Situations of Complications
Objective
r To inform the participants about what need to be done if complication related to child
birth arises
Method
Ask the participants to make 3-4 groups.
Ask them to develop role-plays on following situations. You may ask them to perform
all or selected one depending on time and interest of group.
X-
Mary is giving birth for the first time. She is having pains since 10 hours. The Dai
has looked in to her. She does not see any progress.
Rama is In labour since past five hours. The Dai look in to her and sees a hand
coming out.
Rukhl feels that her baby has stopped kicking.
Naulibai helped Soni to give birth. The placenta has not come out 20 minutes
have passed since the baby was born.
Shanti has given birth to a baby girl just now. She is bleeding profusely.
Nafisa gave birth to a boy baby two days back. She is having fever and there is a
secretion from her genitals.
You may develop situations for each at risk symptom.
Give 10 minutes for preparation and 5-10 minutes for presentation.
Ask the participants to observe carefully what they see in the role-plays.
r Discuss what they have seen and summarize the information after each role-play.
Activity-3: Buzz Group Discussion on Childcare:
Objective:
To inform participation on important aspects of childcare.
Method:
This exercise needs to be done spontaneously.
A$k the participants to make a group of 3 participants who are sitting next to each
other.
Ask them to think about childcare for 1 minute.
> Encourage each group to give one point
Ask a facilitator to list down the points
Add remaining points and summarize the discussion.
> Your discussion needs to focus on immunization and breast feeding
District level Training Module
10
)
Reproflui five & Child
Child Kirth and Care after Child Birth
Illustration 1
Stage? pf Ujbpyr- Stage 1
Note: E«arge ,his
„ trans|er
„ lransparerKy
District level 1 raining Module
ii
)
■
(
fteproilui tivi' Child H^ulfh
Child Hirlh uud Cure after Child litrth
Illustration 2
Note: Enlarge this illustration or transfer this on transparency and use during training
Dixlricf level Truinin^ Module
12
Ecprodu < // »•<' fV ( 7/ Ud Health
Child llirth and Care after Child Hir/h
Illustration 3
Stages ef Labour-Stage 3
Note: Enlarge this illustration or transfer this
on transparency and use during training
Disiricl level Training Module
13
Reproductive $ Child Health
Child Birth and Care a/ler Child Birth
Illustration 4
Complication during Labour
Note: Enlarge this Illustration or transfer this on transparency and use during training
District level Training Madule
J4
c
I
ReproAluctiv? & Cluld
Child Birih and Care after Child Birth
llustrafion 5
ConipljcqTioh during Labour
I
Note: Enlarge this illustration or transfer this
on transparency and use during training
District level Training Mudule
15
Reproductive & Child HenRh
Child Birth and Care after Child Birth
Illustration 6
Complication during Child Birth
I
Note. Enlarge this illustration or transfer this on transparency and use during training
District level Training Module
16
Krpnuhti div ((lUd tii’uifh
Child Birth mid Care after Child Birth
Illustration 7
Complication during Child Birth
Note: Enlarge this illustration or transfer this on
District level Training Module
^H"9 trainin9
17
10^4
Reproductive & Child Health
Abortion
Abortion
District Level Training Module
2 hours
Learning Objectives
At the end of the session the participants will learn about
>
>
>
>
>
why some women decide to have an abortion?
Medically Terminated Pregnancy-(MTP) Act in India
difference between safe and unsafe abortion
What is expected during safe abortion?
care after abortion
Design
Time in
minutes
30
Topic
Method and material
Reasons for abortion and difficulties
women face to decide for an abortion.
Sharing of Experiences
Case study. Activity 1
Role-play._____________
30
Difference between safe and unsafe
Discussion, case study
abortion
Activity 2_j3
15
What is MTP Act?
Discussion
15
What is expected during safe abortion
Sharing of experience
------------ -----------and Discussion
30
Care after abortion and danger signs after Role Play
_______ abortion.
You may organize a visit to Primary Health Care Centre (PHC) to show them
instruments of abortion.
Material Required
Flip charts, markers, Case study 1 and 2
District Level Training Module
)
1
Reproductive £ Child Health
Abortion
Note for the Trainer
Welcome the participants. Abortion is a sensitive topic. As a trainer you need to have
information on local practices related to abortion.
You may start the session by saying....
‘Dear Friends,
Today we are going to learn about an important topic, "Abortion". Let us discuss why do
some women go for abortion? •
>
>
>
>
>
>
>
Through this question, you may get different answers. Please refer points to
remember. Based on the replies of the participants you may build up the discussion
taking in to account various socio cultural aspects in view.
It is important to discuss how difficult it is for women to decide about getting an
abortion done. Narrate the case study given in Activity 1. Discuss questions given
along with it. Ask them to perform a role-play of a similar situation they are aware of
in their area.
Summarize the points on the places where women go for abortion? why?
After this ask them whether they are aware of the Indian MTP ACT. Most probably
they will not be aware of the details. Give the details in brief. Refer points to
remember.
You may now lead the discussion towards differences between safe and unsafe
abortion. Narrate the case study given in Activity 2 and conduct the discussion
based on the questions given. At the end summarize the discussion by giving them
information on difference between safe and unsafe abortion and how to ensure safe
abortion.
If some one has gone through the abortion process ask them to share the
experience.
End the session by discussing about care after abortion and what are the danger
signs where the woman need to seek medical help immediately.
District Level Training Module
2
Reproductive & Child Health
Abortion
Points to be remembered by the Participants
What is Abortion?
Abortion is expulsion/removal of products of conception of a foetus from the mother's
womb boloio It woiyhts loss than 500 grams (20-22"weeks of piognan^y) AbSon inay
,r°m ,he m“,h-
o, aboXXa
nor0CnnnHS nOt 3 method of contraception. It is important that each sexually active
Some Salient Aspects of MTP Act
SXpT" “““
from s
Person who can perform the abortion MTP
> A registered mediral practMoner canquaWv to o" rf
9mto COl°9y and obsletrics
performance of 25 cases of MTP in an appro “eiXton
aSSiS,ed in lhe
The act stipulates that -
the duration of pre^nSc^isupIo^ ^eks^Hnhed*0
10 PerfOrm MTP in
than 12 weeks but under 20 weeks opinion of two rnn .ura*!on of Pre9nancy is more
required, except in except,onai tife threatening ZmXce^
' d0C'°rS *
Consent of Woman
Consent from anV
other person. She^ndeddt onTero^^The actT^ ih
empowers her Please note that she haTto^ive cln^T 'bera"ZeS the woman and’
registered med.cal doctor for terminal of pregnancy
the woman is belowTsyears Sageo^alsolf^ew^3'7
unsound mind (lunatics/
9
3
tO
performin9 MTP if
S° f 01 woman ls above 18 years but of
District Level Training Module
3
Reproductive & Child Health
Abortion
Legal and Safe Abortion is performedre9is,ered med,ca' prac",ioner in -
>
>
with proper aseptic instruments
under clean hygienic conditions and environment
up to 12 weeks after the last month bleeding, opinion of one recognised doctor is
I eguii ea.
>
beyond 12 weeks but less than 20 weeks in consultation with two doctors and with
special equipment.
Illegal and Unsafe Abortion performed
>
by untrained person including medical doctor without authorization such persons
may be otherwise qualified but not authorized to perform abortion.
>
by trained Dais/untrained Dais/Quacks/Compounders/Nurses/Self etc
with rusted instruments (sickle etc.)
> under unclean environment
> by trained doctor but after 20 weeks
Why Women Seek Aoor+ion
> The woman is single (unmarried/widowed).
>
>
Some one has raped her and she has conceived as a result of the rape.
She is forced by some one to get the child aborted against her will. Especially a girl
foetus because of strong preference of sons in many societies in Indian context.
> The pregnancy is unplanned or the pregnancy is due to contraceptive failure
> She already has enough children and she does not want another child or because
this pregnancy is too close to the previous birth.
me6 j6,6'5 su^s*an*'a' r‘sk child being born with serious handicaps, physical or
>
There is a risk endangering the life of the mother or cause grave injury such as heart
diseases, psychiatric disorders, and severe hypertension in continuation of
pregnancy.
> The couple (woman) feels that they cannot afford to support another child (socio
economic reasons).
How to Tell If an Abortion Will be Safe?
It is not always easy to tell if an abortion will be safe. Abortion is the most common
surgical procedure in the world. When done by a qualified doctor early in pregnancy it is
10 times safer than having a baby, and 14 times safer than having your tonsils
removed. Abortions are safer in the first 12 weeks of pregnancy. Early abortion is safer
than late 2 trimester abortions. Follow the following guideline.
> Have you heard of women getting sick or dying from having an abortion here?
If so, go somewhere else. (This may be an institution not having adequate qualified
staff or equipment.)
District Level Training Module
4
)
)
)
Reproductive & Child Health
Abortion
Who will do the abortion and how were they trained? Doctors can do abortions.
However, that person need to be trained and has experience of conducting at least
25 abortions during her/his training and be authorized to do so or has experience in
obstetrics and gynaecology.
> Is the room whore tho abortion will be done clean and neat? If it is dirty and
mossy, probably tho abortion will bo also unsafe
> Is there a place for washing hands? A doctor who has no place to wash his or her
hands cannot do a clean, safe abortion.
A^hinnnXtrU^enttSJOOk
d°
IO°k UnUSed> dUSted Or ousted?
i 7'ed
by unscientific instrument cause injury and infection
ft V .
T6™3 Cleaned and made free of germs? |8 there stove available
to boil the instrument or a bottle of disinfectant in the room? Instruments
?nfecL S
'n Stron9 disinfGctant or boi'ed in water to kill germs that cause
ii iiwL/iiuri,
>
emeraenl
iff°T.
th.in.?.else soes wron9 during or after the
3/3 6 3 plan t0 9et y0U to a hosPital in case of
ci i ici yci icy.
What to Expect During a Safe Abortion?
' she'has SXl oVstd^'
,aS, m°n,hlr “-*9
' Mon o!pregnancy E’aX'’ me,hOa °f abOr,iOn- WhiCh Wi" dePend
^iber
lh8
after the abon.on, ,be S" Shddld bd °-r ddod
:
x:xrXnand ask -to - -
X The woman should be informed about danger signs after abortion
Danger Signs
If there is any of the following sig
ns after abortion it needs medical help immediately.
> Heavy bleeding from vagina
High fever
> Severe pain in the abdomen
> Fainting and confusion
r- Foul smelling discharge from vagina
District Level Training Module
5
.(
Reproductive & Child Health
Abortion
Care After Abortion
> Appropriate counselling before and after the abortion.
>
>
>
>
>
No penetrative sex for some time or use of tampons for the two weeks after the
abortion when the couple has sex again, use of an effective contraceptive method is
necessary.
Follow up check up in two to three weeks.
The woman will get her next period probably four to six weeks after the abortion. If
she does not get her period in six weeks, she needs to contact the doctor. The
woman can get pregnant immediately after an abortion, even before her next period
so she needs to use reliable contraceptive method if she has intercourse and does
not want another pregnancy.
Insertion of copper-T only after seven days.
Drink plenty of water
To reduce the pain and bleeding rub or massage the lower abdomen gently, and
> If there is a pain keep hot water bottle on the abdomen
[The information about how to tell if an abortion will be safe, what is to be expected
during a safe abortion, care after abortion and danger sign is taken from Where Women
have no doctor. Adaptation is done based on Indian scenario ]
Useful Education Material
> Life Useful Health Education for Adolescents: Set of 4 Flip charts, CHETNA, Lilavati
Lalbhai’s Bungalow, Civil Camp Road, Shahibag, Ahmedabad 380004, Gujarat.
. Languages-Hindi, Gujarati, English
> Abortion, Flip chart, VHAI, 40, Institutional Area, New Delhi 110 016
District Level Training Module
6
)
(
Reproductive & Child Health
Abortion
Activity 1 Case Study 1
Rami la's story
Rsmiia was the fifth among the seven daughters born to Rasi and Soma She was
her c assmate USheSen d 'S® St°0Cl
RamHa liked 3 b°y named Ramaj'’
was
RamajL Ramila WaS ™ -th a
forbade her to moveabout'and talMo^oyrShe^sT
chan9ed' Her Parents
them they went to Helds outside the village. She enjoyXng
did not know v.nmwM happeninginlifbo^y She used?''8
H0"*9
fee''n9 differenL she
a-d
~°aXSelSe- Nex*day ,hev™"‘neXX^e^man'""9
"e
mS:rl'e d^Td r
i’ * k^™19 She
^ling
her vagina. Ramila could not bear the pain She^ind X
by pushin9 a stick inside
her hand on Ramila's mouth Ramila startod hi h d ° SCream- Rasi immediately put
hack home. The Weeding did nol stop. Rami,a WaS Sngand dau‘’hto
After narrating the story, ask the following questions:
aTortioT,he ,aCtOrS '*ich made R“ldecide to go to the local woman for
>
>
Whose decision was it to abort the child? Why?
What will you do if you are in a situation of Ra^i?
o you think could be done to improve this situation?
District Level Training Module
7
Reproductive & Child Health
Abortion
Activity 2 Case Study on Unsafe Abortion
Ratan's Story
Ratan lived in Rangpur village. She was married to Laxman and they had three
daughters. The last child was eight months old. Long hours of work at the field and at
home, with a meager amount to eat had made Ratan very weak. She had very poor
breast milk output for her last child. It was 1 % month since her last menstrual period
and she was worried. Ratan did not want the child, as she was not in a position to
manage fourth child.
She talked to Kala who was her friend. She advised Ratan to go for abortion. She also
suggested, to go to hospital at nearby town. Ratan talked to Laxman. He wanted the
child. He wanted the male child. Ratan had no money to go to the city. She was afraid
too, as her husband was not ready for abortion. She went to a local known allopathic
doctor, who gave her an injection. On that day, Ratan started bleeding profusely.
After narrating this story ask the following questions:
> Will you call this a safe or unsafe abortion? Why?
> Howto ensure safe abortion?
> What will be your action if you are at Ratan's position? Why?
Activity 3 Case Study On Safe Abortion
Rajul is 35 years old women. She is 3 standard pass. Her husband is a farmer. She has
two children. She and her husband have decided not to have a third child. Since last
three years Rajul is using copper T to avoid pregnancy. She is comfortable using it
One day Rajul realized that her period has delayed. She waited for 15 days. Rajul
realized that she might be pregnant. She talked to her husband. Both of them decided
to go and meet the doctor at the Primary Health Centre. The doctor confirmed the
pregnancy and informs both of them. Rajul and her husband went back. They discussed
about what to do. Both of them were not ready to have the third child. Rajul decided to
go for abortion. She got it done at PHC. Same day she returned back home. Her
husband undergoes sterilization operation. Both are happy and healthy.
After narrating this story ask the following Questions:
> Do you think this is possible? Why?
> What helped Rajul to decide to go for abortion?
> What would you have done in place of Rajul?
District Level Training Module
8
Reproductive & Child Health
Infertility
Infertility
bistrict Level Training Module
2 hours and 30 minutes
Learning Objectives
At the end of the session the participants will learn about
How infertility affects a woman's life?
What is infertility?
causes of infertility
> charting of cervical
--------- 1 mucus.
>
Design
Time in
Minutes
30
15
45
60
Topic
Howjnfertjhty affects women's life?
What is infertility?
"
Causes of Infertility
What to do for infertility?
Charting of cervical mucus
Method and material
Role play
Discussion
Lecture
Activity 1, illustrations,
—----------------------------------------
Material Required
e99 ^ite and a
may lrans,er the illustrati
°"
syrup, raw
District Level Training Module
I
Reproductive & Child Health
Infertility
Note for the Trainer
Welcome the participants.
You may start the session by saying"Dear friends,
Some time due to some reason the couple may not be able to give birth to child. We all
know that if the couple does not have a child the woman is usually blamed. Her family
members and community harass and torture her. You are aware of this condition. Let us
today learn about reasons of infertility and what need to be done."
>
Ask the participants to perform a role-play. Refer Activity 1 to integrate in different
socio cultural and health infrastructure related reasons for women's problem due to
infertility.
> After this you can give the scientific information on causes of infertility.
> Discuss different points of what to do for infertility. To explain the charting of cervical
mucus discuss Activity 2 - "Howto chart the cervical mucus."
> With the help of illustrations 1 and 2 show them the positions of man and woman
during the sex which helps woman to become pregnant.
District Level Training Module
2
r
Reproductive & Child Health
Infertility
Points to be Remembered by the Participants
Infertility and Women's Life
In our patriarchal society woman is always blamed for not having a child The
community and tho family Isolato hor. Soma of the difficulties woman facos are:
rf cNIdhHh
pa'"c;pate in lhe reli9i°us
especially the ceremony
of Childbirth Also she is not welcome on the celebrations like marriage.
> one is not allowed to see and play with someone else’s child
Steh^nn°Lfreely l0Ci?lize in the communi‘y- Her mobility gets restricted.
> Without getting a check up done, the community declares the woman infertile and
h.^S er The/a’™l»;'»hKh is ready for the medical test, forces woman to get
nnm ®xamlned and does not insist on the man to be examined. It is important to
Th?hh h * 'h eaS'er ° 9et the medlcal check UP done of man than woman
The husband remarries and asks the woman to leave the house
> UfZXT30 haV°
throiJ9h’ various religious rituals, to get pregnant which
affects her emotional and mental health.
’
> She also has to go through the rituals of black magic and faith healers.
What is Infertility?
A couple who cannot have a child after having intercourse a few times a month for a
whole year, without using a family planning method can be termed as infertile.
romh nT5 thT £r°blem 'S nOt the man's or the woman's alone but a
combination of the two. Sometimes both partners seem to be healthy but
no doctor or test can find out what is the problem.
Distribution of Causes of Infertility
20%no reason
10% in bot
40%in women
30%in rr^en
District Level Training Module
3
Reproductive & Child Health
Infertility
Infertility in a Man
The main causes of infertility in a man are:
•
Not enough production of sperm.
Sperm may not be able to swim to the woman's tubes or to fertilize the eggs.
Mumps infection in childhood. He may still ejaculate, but the liquid that comes out
has no sperm in it.
• Illness like TB and STDs can also leads to infertility
• He has a swelling of the veins in his scrotum (varicocele)
• He may have problems during sex because:
- His penis does not get hard
- His penis gets hard but does not stay hard for sometime during intercourse
- He ejaculates too quickly, before his penis is in the woman's vagina.
Infertility in a Woman
•
•
The main causes of infertility in a woman are:
> A couple may also have a fertility problem if they have had 3 or more miscarriages
(lost pregnancies).
>
>
>
>
>
>
>
>
Habits such as drinking too much alcohol, smoking or chewing tobacco, and using
drugs can all affect a man's or a woman's fertility.
Woman does not produce an egg (no ovulation). If her monthly bleeding is less than
25 days apart, or more than 35 days apart, she may have a problem with ovulation.
Sometimes a woman does not produce eggs if she loses weight very quickly, or if
she is over weight.
She has lumps in her womb. Lumps can prevent conception or make it difficult to
carry the pregnancy to full term.
Conditions such as diabetes, tuberculosis, can also lead to infertility.
She has scarring in her tubes or inside her womb. Scarring in the tube can prevent
the egg from moving through the tube, or the sperm from swimming to the egg
the fertilized egg from attaching to the wall of the womb.
Scarring can be caused by:
> An infection from an untreated STD that goes up into the womb or tubes (pelvic
inflammatory disease or PID).
>
Unsafe abortion or problems in childbirth that caused damage or infection in the
womb.
> Unclean conditions when an IUD is put in that caused an infection.
> Problems from an operation of the vagina, womb, tubes or ovaries.
What to do for Infertility?
> A couple needs to have sex during the fertile time. Healthy woman releases one egg
every month. The time she release the egg is called her fertile time - the only time
during the month when she can get pregnant. For most women their fertile time
starts about 10 days after the first day of the monthly bleeding and lasts for 6 days.
District Level Training Module
4
Reproductive & Child Health
Infertility
>. The body has several signs that tell woman what is her fertile time. The easiest
signs to check are the changes in the mucus (slimy secretion) in birth canal. During
fertile time, the mucus looks clear, and wet, like raw egg white, and can be stretched
between fingers; this is a fertile time.
> Later in monthly cycle, you may see sticky or dry mucus. This kind of mucus
prevents the man’s sperm from getting into the womb.
> Position of man and woman also helps to increases the chances of getting
pregnancy.
The best positions during sex are
- The woman lies on her back with the man on top.
- Both man and woman lying on sides
Please note:
After having sex, woman should lie flat on her back for about 20 minutes
minutes. This will help
the sperm swim into womb and find the egg.
>
If any partner is suffering from STD, get it treated. Even if only one person is
suffering from STD it is important to get the treatment for both of them.
Eat good, healthy food. If you do not have regular monthly bleeding and you are very
thin or fat, try to gain or lose weight.
Avoid smoking or chewing tobacco, using drugs, or drinking alcohol
Avoid caffeine in drinks like coffee, black tea, and cola drinks.
If woman does not get pregnant after one year it is important to consult the doctor. '
A couple can always adopt a child if they do not have their own child or they may
consider other people's/friends children as their own or involve themselves in
creative and meaningful activities.
• Useful Health Education Material
> Flip chart on infertility, Dai Training Kit: CHETNA, Lilavati Lalbhai's Bungalow Civil
Camp Road, Shahibag, Ahmedabad-380004, Gujarat. Language-Hindi, Gujarati
District Level Training Module
)
)
■
5
Reproductive & Child Health
Infertility
Activity 1 Role-play - Women's Problem Due to Infertility
Objective
To sensitize the participants about the social constraints woman faces due to not having
Method
You need following characters to perform the role-play
> Woman who has not given birth to a child and her husband
> Women from the community
> Mother in law
> Father in law
> Bhuva
> Religious leader
> Health worker
> PHC Doctor
Let the participants select their roles,
Inform that they have to depict a role-play on infertility.
High light following points
> . How family members behave with the woman
> Behavior of husband
> Intervention of religious leader and Bhuva
> Lack of facility of infertility at PHC level, behavior of health worker and medical
doctor
At the end of the role -play to summarize ask the following questions to the participants
who performed the role-play.
> Feeling of woman during the role- play?
> Feeling of other members felt during the role -play? You may ask them individually.
These two questions will help you to get information on emotional and mental state of
woman who is harassed and the power other members draw by harassing her.
Ask the following question to the participants who were observing the role-play.
> What are some of the difficulties that a woman faces and how it changes her life?
District Level Training Module
6
.(
Reproductive & Child Health
Infertility
Activity 2 Charting of Cervical Mucus
Objective: To teach the participants on how to examine the cervical mucus and how to
chart it.
Material required:
Curd; sugar syrup, raw egg white
A monthly calendar with clearly illustrated dates
Method
Observing and Charting the Cervical Mucus.
thpPmahath® parti(cipants that thev have to Check the cervical mucus for a month and
them based on its consistency they have to develop a chart. Every day during the bath
fter cleaning the hand with soap they have to insert one or two finger inside the vagina
andtCfh^hCerVKX anc! 9et the mucus- This mucus has to be examined between the finger
and the thumb as shown in the diagram.
9
Explain them that they have to look for
Dryness and wetness
Colour, texture
Slipperiness and stretchiness
District Level Training Module
7
(
Reproductive & Child Health
Infertility
Test the Veginol Secretion end Mucus Between Your Finger end Thumb.
Type of Mucus
Symbol for charting on
_____ calendar
Dry(no mucus) nothing comes on the finger
Non stretchy, crumbly or like cream on the fingersfnot
fertile)
---------- lJses cufd to explain this consistency
Stretches a little but breaks(slightly Fertile)
JJse a sugar syrup to explain this consistency
Wet, very stretchy, slippery(extremely fertile)
_____ Use a raw egg white to explain this consistency
To chart these consistency use the calendar. They can develop a symbol for all the four
conditions and draw those symbols. By charting they will come to know their fertile
chances oTXeX "h10
10 Perf°rm interc°uree- « leases the
District Level Training Module
8
Reproductive & Child Health
Infertility
Position of Man and Woman during Sex
Illustration 1
Note: Enlarge this illustration or transfer this illustratioi
n on transparency and use during training
District Level Training Module
9
')
Reproductive & Child Health
Infertility
Position of Man and Woman during Sex
Illustration 2
Note. Enlarge this illustration or transfer this illustration on transparency and use during training
District Level Training Module
10
Reproductive & Child Hetdlh
Conlrucepdan
CONTRACEPTION
District Uey?| Trpining Mcdule
3 hours.
Learning Objectives
At the end of the session the participants will learn about
' coMr’aiXT 90''ernmen, SUpPOrtet) temPo^ry and permanent methods of
> use of different contraceptives.
r side effects of different contraceptives.
f now to choose the best contraceptive for self.
Design
Time in
minutes
60
60
60
Method/materials
What is contraception, different methods of
contraception and how to use them
Effectiveness and side effects of different ^
contraceptives
MfEEEarigrit choice of"contraceptive
Activity 1, 2 and 3 and
discussions
Discussions
_Activity 4 and discussions
Material required
a penis or a banana for Acfivity 2 °l)exSe'mode! of ut3"0 Crn‘)om for Acl'vil* ’■ model o’
’nstroment. copies of s^ giv’n
^'XsSnJ'
District Level Traitiiti^ Module
I
Reproductive A Child H^h
Contraception
Note to Trainer
Contraception can become an issue of controversy for some people As a trainer
^ITnendly wa°yWn te6""95
thG SeS5'Qn-lnvite Part'ciPants
You may Start the session by saying...
“Dear sisters,
All of know about various contraceptives. You may have seen them and use them too
,hsm in 3 scienmk
lfy<=u
> Distribute samples of pills, condom and copper T among the participants Let the
participants have a close look of the contraceptives. Ask questions given in Activity
> Discuss difference between temporary and permanent methods of contraception
Discuss the use of each method in detail. With help of Activity 2 and 3 demonstrate
use of condom and insertion of iud.
> With the use of illustration 1 explain Improper use of condom.
r With the help of illustration 2 and 3 discuss male and female sterilization.
z' Discuss effectiveness, safety and side effects of each method. Encourage
experience sharing while discussing side effects. Highlight the individual differences
In acceptance of appropriate choice of contraceptive. Emphasize factors of safety
. and effectiveness along with personal choice.
r Discuss factors affecting choice of appropriate method. Introduce Activity 4 and
encourage sharing of experiences.
District Level Training Module
2
Reproductive & Child Health
Contrucepfion
Points to Remember by Participants
^usu? ConfXepnlit?06 th Hrevent °r postpone pregnancy while enjoying sex life
as usual. Contraceptive method is a tool to achieve this.
now^exisHharZn^i0 pare"thoodJs a matter of choice, not chance. Effective means
' F?th J hnoh J b y°U tD deCldB When il is the r‘9ht ‘ime for you to have a child
' colder
“".X"16 me'hOd 'he!' choose-dePe"*!> “Po"
'
' ™smoaod rj^Vea^'8 o, a9e-The ideai age ,or
" hXVaVthp bp ftmeHth0dsf °f contraceptlon. Individual preferences vary and only
'
Info’rmar ar T?'
even^hrough
' and7„£!^
al^EXaZs'oS‘s Se
‘hB
contraception. Condom. Oral Pills
-he pregnancy.
Temporary methods
Condom
world.
is the most widely known and used barrier device by males around the
' pe“sn.d0',’iS Shea'h OT C0Vedn9 made 01 ,hin
10 »t over the man's erect
centres "pdma^heaUh clnkesan^' sub ceE.h0Spita,S1 community health
sexually transmitted disea^
th“re^f^rlduTesTensIt-^56
both men and worTlen from
^ces
matter of practice for them sXtvT " Or embarrasses ^em. But it is a
making a choice.
°re lmPortant to consider while
District I. eve! Training Module
3
^8
Reproductive if Child Health
Caulruceptiun
Remember
Do not use grease, oils, lotions or petroleum jelly to make condoms slippery. These
make condoms break.
Do not blow in to the condom to open it.
Do not open the condom to check if it is broken, they are already checked.
Use a new condom at each time one have sex.
r Use a condom once only (single use).
Store condoms in a cool and dry place.
r Learn to wear condom properly, Loose fitting or angled wearing can lead to leakage
or breaking of condom. Please refer illustration 1.
If condom breaks during intercourse, one need to contact doctor or nurse as soon as
possible. They will give oral pills to woman (emergency contraceptive pills). Take
them immediately.
bo not Use Condom If
'r the package is broken
> the condom is brittle or dried out
> the colour is uneven or changed
Som? Myths About CondQm
Condoms Reduce Pleasure
If the condom is worn properly and there is sufficient lubrication there should be little
difference in the level of pleasure for either partner.
Condoms are Not Reliable
Condoms are a reliable method of birth control—as effective as the pill when properly
used. They are the only option to control Sexually Transmitted Diseases. The new,
lubricated Nirodh Deluxe is very effective. Many of the commercial brands are of good
quality too. Handling condom carefully, wearing it properly, never wearing more than
once reduce the chances of breaking.
Condoms aren't Sexy
Condoms are sexy. Condoms have only one real purpose and that is of use during sex.
Thus they become a symbol of potential sexual activity. Sexy is a completely subjective
term, which is defined through the association with a particular object or person. If
positive associations can be allowed to accumulate around condoms, they too, can be
seen as sexy. If the user is sexy, the condom is sexy.
Using condom Interrupts Sex
First of all. people often use condoms improperly by waiting until just before penetration
Io put on lhe condom, Condoms should be put on as soon as the man has an orecllon
and tho intent to have aex Is clear. This Is because sperm and IIIV cun ull icudy be
piesent on lhe tip of the penis in a tiny drop of pre-ejaculate. Tims, putting on the
District Level Training Module
4
)
Reproductive A Child Health
Contniception
hn??h°JvA °He °!
fl/St ‘hiT y°U Sh0U'd d° dUring Sex’ lon9 before the moment is so
not that you don t want any interruption.
Lain too shy to buy a condom
V6ry d'ff'Cuit task t0 buy condoms. It is a public declaration of a very private
niarle fWe
7 °vercome this shyness with practice. There are harder and easier
m!eh J?k96 condomt?' however' Government hospitals give them out for free without
much talking or questioning about It. It may help you to be courageous if you think of
why you are buying them. Condoms protect from disease and pregnancy7 Would rt not
embarrassing to get pregnant/get some one pregnant by accident? Would vou
Condoms are more a man’s things
£;sa
™ra C ie,n,stry There are absolutely no
dangerous side effects for eithpr a man
». w ca„ te
Intrauterine Devices (IUDs)
from implanting itself on the^ls^ the XuT^0
" W in oT'oX "the'
Prevents the fertilized egg
is a iXed de' ThB m°St C°mnlOnly "Sed
wire and has a string attached to it
P
V'Ce COvered with C0PPer
perfomTa proper^heck^p to^ule^u^1"31 PferiOd by 3 d°Ctor' The doctor need td
inside the S.rtS"anaf^gh th^omb"/mo^^??^95 °f
'UD h9np
the string of the IUD and ask the woman to feeHt S y
°rS CUt Smal1 Portion of
know the touch feeling for the string This is^mLrSn?09 h6r QySS' Th'S he,p her to
the IUD regularly eve^r day.
9'
s ls Important as woman is advised to check
How.to_check_wbether th
e copper'T' is iflLplace.or not?
finder inside the vagina to checHheTtrina
soap and insert the index or middle
day. If the woman does not feel the strino^h
pr°pess needs to be...........
doneiedi
every
^
DiMrin l evel Truininn Module
5
Kcpnuhu tire
( hil(l llwlfh
( uulrucepliun
> IUDs are made of copper and plastic, and are inserted in the uterus of the woman.
The presence of such a foreign element causes a disturbance in the uterine cavity,
making it impossible for the fertilized egg to Implant itself in the uterus.
> IUDs are inserted at all government hospitaIs/famtily planning clinics/health centres,
and through private doctors. The woman need to have following information
- How long it is going to be effective for.
- Where and when should she get IUDs removed?
> When the time period of IUD is over she need to do any of the above mentioned
places and get it removed.
> When woman IUD inserted, she needs to ask the doctor to give a paper, which has
information on what type of IUD has been inserted. The date of removal can be
written on it. The woman can preserve this paper and take it along with her. When
she go for a checkup or IUD removal she can present this paper.
Woman needs to make sure that she is not pregnant before getting an IUD Inserted. It is
best to insert an IUD soon after a proper menstrual period (not just a little spotting or
bleeding which can even occur if woman is pregnant).
Woman should not insert IUD if she never had a child or a history of cancer of
reproductive argans.
Refer to doctor if woman has:
P-Periods (Missed or irregular)
A-Abdomen pain severe
I -Infections, Foul smelling or discoloured vaginal discharge,
repeated urinary tract infections.
N-Not feeling well
S-String is missing
Oral Contraceptive Pills
> The oral contraceptive pills usually come in a 28-day supply package, containing
one or both of the following artificial hormones - estrogen and progesterone. When
the pills are taken, these hormones get absorbed into the blood stream and prevent
the formation of the egg in the ovaries.
> Pills are easily available at government hospitals/clinlcs and family planning centres,
it is usually Mala-D and Maia-N, distributed free. You can also buy from a regular
chemist shop.
Di\lricl I eve! Truinin^ Module
6
72- \
Reproductive & CliiR( Heflilh
Contraception
" Intense ornoV10^
da'ly’regardless of whether C0UPle have
It can be discontinued whenever pregnancy Is wanted
DPROGKTEN^NIPLLS
hK-NKPEAR^FKRn/pft±^
lhe mMt comm°" ones are
' PRIM°VLAR' 0VRA'-< CHOICE, TRIQUILAR ANO
'
Th“XS
a|^':i;|eXaStoUt±1SlB ,akln9 Oral
, If
“ 7-xas? on
“
Or ,mme(^,a^ely for a check-up. She may be
pregnant.
Refer to Doctor if woman has:
A-Abdominal pain
C-Chest pain
H-Headache
E-Eye problems
S-Severe leg pain
XPpiXSS XlnX ^±271,S*. -x'ely, depression,
choose lhB freerfDm
Important Point? to ^member
•
If woman smokes the pills are not suitable to her.
pressure or b-iea0s7?eeed?nVabZ^X„h„X?
, has high blood
method,
9 3 Ch"d Should avoid P|lls and use other contraceptive
District Level Trnininx Module
7
7 2'2-'
Reproductive & Child Heqhh
ConUacqition
Permanent Methods
Male Sterilisation
Vasectomy is a surgical method of sterilization for men. It is a simple quick surgical
procedure that is carried out in a doctor’s clinic, under local anesthesia. It takes only
10’15 minutes to be completed.
Vasectomy prevents the sperm from entering the seminal fluid, and the sperm are
re-absorbed into the body.
Man’s sperm are made in his testicles, while the seminal fluid is secreted by his
prostate gland and seminal vesicles -the secretions from these glands make the
major part of semen. During a vasectomy, the tube that carries the sperm from the
testicles is blocked with a clip, or cut and tied. This will stop sperm from entering the
seminal fluid.
Vasectomy is a minor and simple surgery, and man can leave the clinic within an
hour of the operation. But for a day or two, there may be some swelling or discomfort
in the genital region. Some men also have bleeding, bruising or infection at the site
of the surgery.
Vasectomy has a success rate of almost 100%. Only in a very few cases does it fail
and pregnancy occurs. This happens if the tubes have not been blocked/cut
properly, and some sperm make their way down the tube and Into the seminal fluid.
It is also not immediately effective the first 20 ejaculations after vasectomy may
contain sperms. The couple must use another contraceptive method for the first 20
ejaculations or the first three months which ever comes first.
Remember
There is no real basis for the apprehension that many men and women have, that a
vasectomy will adversely affect men's libido and their sexual performance. Since the
operation does not involve or interfere with the functioning of the testes and release of
male hormones, it does affect the secretion or ejaculation of seminal fluid and ability of
man for sex. Therefore, it has no negative influence on a man's libido or sexual
performance.
However, such apprehensions and tension could affect men's potency. So, it is
suggested that both the man and the woman, or at least the man talk to the doctor and
others, and be completely convinced that the surgery is not going to affect their sexual
life, before undergoing a vasectomy.
Precsutlpn? fP be Taken pftef P Vasect5my:
> Rest for about 48 hours (2 days)
> Avoid too much exercise for e week
> Wait for about a week before resuming sexual intercourse. Do so only after all signs
of discomfort have gone.
District Level Training Module
8
Reproductive A Child Health
Contraception
" aHhV^Tn^^JV0110^ b7 h!gh f!Ver’ excesslve or continued bleeding or swelling
at the site of the surgery, a doctor should be consulted immediately
Be sure to use an alternative method of birth control for at least 2-3 months after the
’in
rh fOLe»hla/!Ln9 tO have se* wlth0l't ar|y contraceptive protection it is Important to
Ma" C°"
a Zero,hSp«rS?n^
— <«ted to got
Female Sterilization
SSBjSES“■ ~
Laparascopy and Tubectomy .
9
most common female sterilization are (i)
Lapgrqssopy:
—in
of pSS^oSX^ ditCh.ar
This procedure is usuall ? carried ouTSnder S 5'1° ™™tes in experienced hands,
(sedation) and only by well-trained person^? ThZneS
3 W'th premeditatlon
W bet™ the ^ontan'e Mly
X
Pain in th^ In
the irLCiSi°n that may be relieved by Pain relievers.
operation and/or the anesthesia causes ?his
S
,he
Tybeptotny
X™mad'e5‘Jnder l0Ca' aneS"'esia' A 5’’°
are then pulled up and tied or cur The Incision^thenshit10^6 fa’lopian tubes- These
w liXXtSgl°fo)aat 'XawX1, °r hare ramP'etB bed rBal- in—nrt yourself
Preoautto^ f0 be TakeJ)
'
steri|,2(Jtto:
certai",hat
d° -
District i.eve! Training Module
9
c
H^productive <£ Child H^dth (
Contruceptio
' Xnaiy^^ouidbXe
S “b'
PaP Smear' bk><>d
noted so as to prevent compiications
a"°
KeT
Precautions to be Token After Sterilization:
laparescXr3'XXrest shS brsuffiSab°''' “ Week: but a"er a
bU‘ d° "*"«
' ES
objects Hke
' ssiMSttSrSSir5 and increasinfl °r
Effectiveness of Sterilization
~S?sESHSS=S!F
Cdh stenihtatidH be Reversed?
i'el joining of thetes'k is I'XT l!,eri“zalion by « P™«« called re-canalization.
any mOre children
slenl'zal'°" “"'y after you are certa.n you do not wish to have
Useful Health Education Material
CamoRoa?'^!??
BaOk- CHETNA. Lilav*i Laibhai’s Bungalow Civil
Maraw Telugu
9'Ahmedabad 380°04' Guiaral. Language-Hindi, Gujarati.
> Dai Training Kit, CHETNA Ahmedabad
r EnglishfUl HBaltl1 Educalian- "ip ch3rts- CHETNA. Languages-Gujarati. Hindi.
District Level Training Module
10
Reproductive & Child Ueatlli
Contraception
Activity 1- Random Questioning
Objective
To familiarize participants with contracepti
ves and prepare them for discussion.
Material Required:
illustration on the transparency^us^duTg7ammT
You may transfer these
Method:
_
below and encourage Informal d^scuslions^9
3Sk them the quest'Dns given
< Encourage sharing of experiences.
Questions:
> What is that?
When did you first came to know about it?
'
S?UCbed " or ,roted a! il? Why?
'r Wh?toMyou’to use the roXepbve? ™? 'n "ha‘ l:'rcumslar'‘®s?
Who helped you to decide?
Were there other contraceptives available?
r h om where can we get that? How much does it cost?
Were you afraid to use it for the first time?
Dimnd Level Training Module
I I
I<cproductive
Child Health
( onlruceptlon
Activity 2 bernpnstrqtipn of Condom Use
Objective
To educate participants about proper use of condom.
Mgtsrigl Required
Pack of condom, a model of penis or banana.
Method:
’
Carefully °Pen the Package so that condom does not tear Do
not unroll condom before putting it on,
r I6" PanHICipant!,that 'f pen'S is not circumcised, pull foreskin back. Squeeze the tip if
pull foreskin back. Squeeze the tip if
the condom and put it on the end of the hard penis
Continuer
’
squeezing
tip while unrolling the condom till it covers the entire penis
>
Once
condom
. (comes), hold X'condom^pol?SS
r
r Discuss and demonstrate them the improper use of condom with help of Illustration
> Throw away or bury the condom.
Emphasize Following Points:
makVcohdomibSak1.8' l0t'°nS °r petroleum jelly t0 make condoms slippery. These
> Do not open the condom to check if it is broken, they are already checked.
Use a new condom each time you have sex.
> Use a condom once only (single use).
> Store condoms in a cool and dry place.
> Learn to wear condom properly. Loose fitting or angled wearing can lead to leakage
or breaking of condom.
if condom breaks during intercourse, contact you doctor or nurse and
take oral pills as early as possible according to their advice.
District Level Training Module
12
(
- C
Reproductive A Cfiild Heqtfli
Cuntruceptian
4?tiyity 3 bempnstrgtien of IUD Insertion
Objective
To educated participants about IUDs and its functions.
Material Required;
Sample of IUDs, flexible model of uterus and IUD insertion instrument.
Method:
> JXel ° SJSXSSS SSud ta in5Me lhB
IS
District Level Training Module
13
.95.^
Reproductive
Child Health
Contraception
You may Use activity A or B depending on t.i.i
which suits better to group. Using both might
also be a good idea, where some groups deal
'.''■’I one case and other group the other.
A. Making the right choice
Objective!
To sensitize participants about the factors influencing choice of contraceptives.
Material Required;
Copi&s of the of the story given below,, as the number of participants or you may write it
in big letter on a flip chart and put it on.
Method:
> Divide the participants in small groups.
> Give the story of Govind and Godavari
' -h
'SS&Fsl,ua,lons and
*
> Ask the small groups to make a presentation.
r Encourage the other participants to argue about their choice.
A You may summarize by emphasizing on need for information, counseling and how
one s values reflects on choice of contraception.
Story of &ovirid and Godavari
Govind and Godavari have three children. Govind Is a casual laborer In the near by
r
dHh9 smalil.j°b5uand Godavari works as agriculture labour on the landlord's land
Born of them realize that having more children is not good for them. The village nurse is
i QQd®van
for Ectomy pr Govind for vasectomy for a long time now.
But Godavn is not sure If she wants to do it. She thinks her children are too young
Many children die before ten years in her village. Besides she is afraid of the operation
Govind might also not agree to this, because this will mean loss of wages for both of
tern or at least two days and what if she ends up sick? So many women get sick after
the operation. Govind on the other hand, does not want children but is afraid of going for
the operation. What if his sex desire die after that and so many men cannot do hard
work after that. Besides his children are too young.
The village nurse explained about the use of contraception to both of them. Govind
suggested Godavari to take pills. Godavari started taking pills. But in between forgets
and then she gets tensed about pregnancy, all this leaves her very uneasy. She asked
District Level Training Module
Reproductive A Child lledlfh
('imtruception
Govind to avoid sex to avoid pregnancy. Govlnd is very angry with that He wants
® ve”safe.SgSS feafraid.in5ert"
L BVBn 'hB*SB"Ur5B535,5“
All this makes Govind very angry. He thinks If Godavari will not co-operate he will end
pe™i!)°
WOI”°n (WI’,C|'did nor”o,itI’° i” ‘I'o 'own. whnn Godnvoii won
? Do you think Govind is right in his thinking? Why?
\A/CLy0U th,nk Godavari ,s ri9ht ln her thinking? Why?
< W at contraceptive would you suggest them to use? Why?
B. Who decides?
Objective:
To sonstee participants about the factors that influence choice of contraception.
Material required;
Copies of the case study according to the number of participants. Sip chart and marker
Method:
i
m°re ih5" - -
> Let themTs’XX^ions’S S' S^nd BrQieCi ,he e"'Jgroup.
qUeS',OnS a*,he e"d °f
case study and present it to large
' aXy iPnecessary0001'"9 OU' °' 'he presenlafca a"d Hartze them in the end.
Story of Rani
brother-^law'his wifea^^
iives with her husband, her
has two sons and one daughter. So everyone in the
Ran' brother-in-law
at least one son. Rani’s husband dop^ nnt ha
mi y ^ee's Rani should also have
they can only take care of two children Ranl^hushand,On ab°Ut bLlt Rani fee'5 "lat
2Xyp^bes.
HXeHe„^al50 deep dow^S^
District Level Training Module
15
)
^3°
Reproductive & Child Health
Cunlrwaepli'jti
Activity 5 Evaluation Quiz
Objective:
To revise the learned material and to find out the participants' grasp.
Mgtsrigl required:
Samples of different contraceptives, some music, chairs, chits of paper with questions
on them.
Method
r Arrange chairs in a line where every chair near to each other is facing in opposite
direction. There should be one chair less than the number of participants.
r Invite the participants to stand in a single circle around the chairs.
x Keep all the contraceptives in the one bag.
Ask a volunteer to turn away from circle and play the music while the participants
move in circle around the chair. (It is better if you do the volunteering so that all
participants could participate.)
x Stop the music in between, the participants are suppose to occupy chairs.
r The participant who is left without the chair is supposed to pull out one contraceptive
from the bag.
< The trainer can ask any question related to that contraception from the questions
■ given below. Others can help her to finish or complete the answer.
r If the person does not answer properly, she will get a punishment like singing a
song, writing the answer five times after the game, etc.
The questions on the chits can be:
1. Is this a temporary or a permanent method of contraception? What is the
difference between temporary and permanent methods of contraception^
What are they?
2. Who can use condom? Explain how.
3. Explain the way to use oral pills.
4. Give names of some IUDs and explain how IUD works.
5. Why is vasectomy called vasectomy?
6. Which are the permanent methods of contraception for women9 Explain how
they work.
7. From where can we get contraception?
8. Which do you think is the best method to use? Why?
9. What are the side effects or negative sides of this contraception?
District Level Training Module
16
to
Reproductive & Child H^ahh
Cottlruceptioit
Illustration 1
I
E„arge Ws ,l l s,rallon Qr lransfer Ms on transrare^ M use
District Level Training Module
17
.97 7
Reproductive^ ChildHeqhi
Ctintrucepiim
Female Sterilization
Illustration 2
1
Note: Enlarge this illustration or transfer this on transparency and use during training
District Level Training Module
18
Reproductive & Child U^Jttfh
Conlraeeption
Illustration 3
Male Sterilization
)
Note: Enlarge this illustration or transfer this
on transparency and use during training
Dalricl Level Training Modale
19
)
)
■'(
)
Reproductive & Child Health
Reproductive Trad Infcdion
Reproductive Tract Infection
bistrict Level Training Module
3 hours
Learning Objectives
At the end of the session the participants will learn about
>
>
>
What is RTIs/STDs?
symptoms of RTIs/STDs
myths about RTIs/STDs
“etenZof' ^Tof1 W’m°n,0’k
Design
Time in
minutes
60
30
30
30
30
Topic
Methodsl
Socio cultural aspects restricting woman
to seek medical help
Activity-1
Story telling and
discussion
Drfferenc^etween RTI and STDs--------Discussion
Symptoms of RTIs/STDs
-------Discussion
Myths abourRTI^TSTD---------------- ---Discussion and sharing
of experiences
----- Prevention of RTIs/STDs
I Discussion
___
Material Required
Flip charts and marker p.
ens or black board and chalk
District Level Training Manual
•1
c
(.
Reproductive & Child Health
Reproductive Tract Infection
Note for trainers
Welcome participants to the session. This is an important discussion in terms of
relationship with self and with partners.
You may start session by saying....
"Dear Friends,
Today we are going to discuss some of our health concerns about which we do not
normally discuss openly. Tell me which are the common health ailments of women
which create maximum stress and tension to them."
> With the above-mentioned question you will get a list of local names for various
Reproductive Tract Infections (RTI). Define what is the meaning of RTIs and STDs
and the difference between them. Refer Points to remember.
> Introduce Activity 1. This activity will help you to list down various socio-cultural and
economic factors affecting women to restrict for seeking health care for RTI and
STDs.
> Now discuss symptoms, spread and prevention of RTIs and STDs. It is important to
discuss the effects of such illnesses not only on physical aspect of women’s health
but also her social and mental health.
> Various myths are prevalent about STDs spread and cure. Ask the participant to list
some of the myths they are aware of. You may add few from the section points to
.remember.
> You may end the session by discussion the prevention of RTI and STDs. You may
discuss demonstration of use of condom. Refer the module contraception.
District Level Training Manual
2
Reproductive & Child Health
Reproductive Tract Infection
Points to be Remembered by the Participants
> Reproductive Tract Infections (RTIs)) are infections in the genital/reproductive tract
duo to n vnnoty of organisms like bacteria, virus and protozoa. Somo Infections aio
tra,n®T"tted and som® occur due to changes in the environment in the
genital tract. These can affect men as well as women.
> There are three types of RTIs*
1.
‘
Sexually
Transmitted Infections or Diseases (STIs or STDs): These infections
s^uaFrantart°qeOm,|niJt1ICa^'e diseases that are transmitted mainly through
sexual contact-sexual intercourse. Various types of infective organisms such
as viruses, bacteria, etc cause them.
2. fre^fusTd h l|nof!Ctl°nS: ofte" theV are considered as minor infections. They
are caused due to overgrowth of organisms normally present in the
amonXme"93"5' They
responsible ,or
levels of morbidity
3. parocedurasnsfoohOnS:
in,ections are usuail>' associated with medical
procedures such as vaginal examination, abortion IUD insertion etc when
,
-
ai
, vagina and cervix) and
> There are different kinds of STDs, refer table 1 and 2 for details:
Table 1: The most common RTIs/STDs
Illness
YeastCandida
Trichomona
s
Non
specific
bacterial
infection
T Symptoms
and how they can affect individuals
Allopathic treatment
Tablets to be inserted
in the vagina is given
by doctor
White Jumpy secretion
like milk curd, bright red
skin in genitals, severe
itching, burning while
passing urine, smell like
mould
Grey or yellow bubbly
secretion, bad smell,
red and itchy genital
area, burning in urine
Oral tablets is given to
both the partners and
tablet to be inserted in
vagina is also given
More secretion, yellow
or white colored
Tablets to be inserted
in vagina is given
Herbal Treatment
---------After relieving your^Tm^^Tampon made ’
from neem leaf paste wrapped in a clean cotton
cloth. Let it remain in the vagina for night and
remove it in the morning. Do this for 10-15 days
a month.______
7
The herbs mentioned above
-------------------Grind together 5gms root of Shatavari (Asparagus
racemosus). 10 gms of cumin seeds and 15 gms
of crystal sugar, Take a cup of this paste, every
£normr>a_on_empty stomach for a month.
I
District Level Training Manual
3
Reproductive & Child Health
Reproductive Tract Infection
Table 2: Other STDs which has sever effects on woman and child
Disease
Symptoms
AIDS
Long-lasting infections,
diarrhea, night sweats,
fever, weight loss,
swollen glands,
coughing, shortness of
breath
Chlamydia
Itching or burning
during urination,
vaginal discharge,
wheatish discharge
from penis, pelvic pain,
or no symptoms at all
Sores on penis or
vagina, vaginal
discharge, fever,
tiredness, itching and
pains
Genital
Herpes
Effects on
Your Health
Immune
system
damage
leading to
cancer,
pneumonia,
brain damage,
death_______
Pelvic
inflammatory
disease,
sterility
Effects on
Fetus/Baby_____
Foetus can get
virus from mother
during pregnancy
or delivery;
immune system
damage leading to
death in a few
years___________
Baby can catch
during vaginal
birth, causing ear
and eye infections,
pneumonia
First attack
very painful,
recurrent flareups, less
painful
Baby can catch
during vaginal
birth causing
severe skin
infections, nervous
system damage,
blindness, mental
retardation, death
Baby can catch
during vaginal
birth, causing
serious eye
infection,
blindness_______
Foetus can catch
before birth,
Gonorrhea
Vaginal discharge,
burning during
urination; most women
have no symptoms
Pelvic
inflammatory
disease,
infertility,
arthritis
Syphilis
Sore on penis or
vagina, mouth, anus or
elsewhere; low fever,
sore throat, other sores
or rashes
If untreated,
can cause
damage to
heart, blood
vessels and
nervous
system,
blindness,
insanity and
death________
Warts grow in
size and
number, may
increase risk of
cervical cancer
Genital
Warts
Genital itching, irritation
or bleeding; warts may
appear as small,
cauliflower-shaped
clusters; may get
worse during
pregnancy
District Level Training Manual
damaging bones,
liver, lungs, blood
vessels; infected
fetuses can die
before or after
birth
Baby can catch
virus during birth,
causing wart
growth inside the
voice box and
blocking windpipe
Treatment
No effective
treatment
Can be cured
with
antibiotics
Symptoms
can be
treated; no
cure for the
disease; flareups may
occur 4 to 7
times per year
Can be cured
with drugs;
babies are
treated with
eye drops
after birth
Can be cured
with drugs;
once foetus is
damaged,
there is no
cure
Can be
treated with
drugs applied
directly to
warts, or with
surgery to
remove them
4
Keprodiuiive A C hih! Health
Reproductive Tract Infection
Some of Common Symptoms and Signs of the Widely Prevalent STDs in India
General symptoms in both men and women
r- Burnmg/pain during urination or defecation, increased frequency of urination
x Sing e or multiple blister and open sore on the genitals may or may not bo painful
Swollen and painful glands in the groin
y
P
> Itching or tingling sensation in the genital areas
Non itchy rashes on the body
> Warts in the genital area
> Sores in the mouth
> Nodules under the skin
> Flu like symptoms, headache, lethargy, vomiting, fever etc
Symptoms among women
Painful sexual intercourse
Unusual vaginal discharge (yellow
green, curd like, frothy, pus like, foul smelling,
blood tinged)
Blisters or sores in the genital area
> Lower abdominal pain
Burning or itching in and around vagina
Some STDs may not produce any signs
and symptoms in women. They may look
healthy but they can spread the infection
Symptoms in Men
K drip or discharge from the penis
Treatment and Prevention
given if e^octorthelnh
^SsTOs™'’1
' STyDUc&Xe
,h: Chart' 90 ,0
°n Syrnpl0",s can b!!
- —by
partner along wrlh^ou I
have
!
Pa,?er ,S also traaled- Taka
who you think might have STD in that ymptoms but have had sex with someone
> Most of the STDs^nTe^^ed andcure3: IX unXt^
t
worse, causing permanent damage or death
Untreated’ STDs ke
keep
eP dettmo
getting
- Eating certain food or application of certain oils on
genital organs cannot cure STDs.
Always go to qualified doctor for the treatment
Kd e“pTsoT«hlTO n:^
*°m y0U haUe
A"y0™
even if You have beenTeaX o^ rnX
‘0
Pr°mpt treatment Remember:
different one, if you have sex wth a
’ y°U C3n get the same STD again, or a
you have any sign of STD.
Person who has a STD. Avoid having sex when
District Lex el Training Manual
5 .
Reproductive & Child Health
Reproductive Tract Infection
>
If you are an unmarried teenager and have STD, talk about it to your parents or any
adult on whom you have total trust and faith. If you are confident to approach the
doctor directly go to the STD clinic and get the necessary treatment.
Myths about STDs
Due to taboo attached to STD there are a variety myths attached to STDs
Some of them are:
>
STDs can be cured by having a sex with virgin or with young girls.
>
>
>
STD spreads due to masturbation
Person catches STD due to evil spirit, and curse of god.
Person who has done sin in past gets STDs.
Women RTIs/STDs and HIV/AIDS
There are various conditions and socio-cultural and economic reasons, which makes
women more vulnerable to RTIs/STDs and HIV/AIDS.
Socio-political reasons:
1. The most basic factor making women vulnerable is the social status of women. Due
to social and sexual subordination, women find it difficult to negotiate and prevent
men from practicing unsafe sex at home. Thus lack of control over sexuality, in
addition to the culture specific submissiveness increase the chances of HIV infection
in women.
2.. Early marriage expose women to RTIs/STDs and HIV/AIDS at an early age.
3. At present, male condoms on which women do not have a control are the only
means to prevent RTIs/STDs and HIV/AIDS.
4. Lack of basic amenities like water and sanitation also increases the occurrence of
such problems.
5. Communication about STD is extremely difficult, as it is necessary to discuss sexual
practice. It is therefore important that health especially the sex education is made
mandatory for the school education. It is important that sex education is given in a
non-judgmental manner and with a frank and open manner.
6. Inadequate information, lack of mobility and poor health services increases the
chance of RTIs/STDs and HIV/AIDS by manifolds.
7. Inadequate law aggravates her HIV status. For example, rape law and PITA
(Prevention of Immoral Traffic Act) are inadequate and more often the violators go
unpunished due to the lapses in the Act.
8. Women become sick with AIDS more quickly than men do. Poor nutrition and
childbearing may make women less able to fight disease.
9. Women are usually the caretakers for the family members who are sick with AIDS,
even if they are sick themselves and run more risk of infections.
District Level Training Manual
6
I
Reproductive & Child Health
Reproductive Tract Infection
Economic reasons:
1. This situation reflects at persons at work site also. The supervisory staff or the male
workers sexually exploit women. This also increases the chance of RTIs/STDs and
HIV/AIDS.
2. Povorty, unomploymont and lack of oducafion might forco thorn to accopt sox work
increasing chances of RTIs/STDs and HIV/AIDS through forced unsafe practices. ’
Biological reasons:
1. ml^LUre cfrv’x ’n ad°lescents and less mucus production in the genital tract of post
P.wornen may cause injury during sexual intercourse increasing their
susceptibility to RTIs/STDs and HIV/AIDS.
2. Since female birth passage is not visible, any lesion that may occur is not easily
2?S?'Zed and. tre^®d' Also blrth Passage has larger surface area to absorb
causative agents of RTIs/STDs and HIV/AIDS
3. Xanns9vea±C1X™h.H|V
e?S“y *han men do- A ma" Puls his
»’<>
Sv into Z
k L lys
a lon9 1'me- "there is Hlv strnen « ran pass
cuts or " ores
V
9h hSr ''a°ina °r cervix’ especially if there are any
4. ra«ShCa" 981 m°re t"°Od lrans,usi»"s 'han men because of problems during
Access to health care:
1' X^'shon sooolv'n'rlt0"™"0" amon9 lhe commun'|y aboul availabilily of
reas^fXXSSZKC
2' heaJhTam^eVrrf i'iS “I
women to access health
faCi",y Pre''enlS women 10 ‘fa’61 'hB P^ary
non‘a''allablll|y of lady doctor also prevent
Useful Health Education Material:
EX
'W°men'S Hea',h:
CHE™A Lan^geSi, Gujarati.
District Level Training Manual
7
Reproductive & Child Health
Reproductive Tract Infection
Activity 1 Case Study
Revati's ultimately gets the treatment!
Revat! is 35 years old. She is very upset last few days. She has severe pain in lower
hpr h h a"d.SOme sme,|y d'scharge from her vagina. She is afraid to have sex with
hZd
a4h; dacaus® she feels that her husband will consider her dirty or that she has
d J * w|th others. The other day, Revati's husband, Ramu asked her for sex, and she
with her hntlh06?^ 'I
real'zed that Revati has some Pr°blem. He tried to talk it out
h her, but she did not share. After few days Revati could bear the pain and
discomfort. Her sense of guilt and shame for what happened to her made her very
depressed. One day Ramu found her crying. He asked her to share her problem. Revati
finally explained her problem. She said that some evil spirit has put a spell on her.
Ramu did not pay any attention. Revati's condition was worsening. She refused to have
a sex with Ramu, as the intercourse was painful.
Ramu was confused. He decides to talk to his friend. His friend explains that it may be
some infection. He also said that many times such complaint is due to sexual
re a lonship. He advised him to visit the doctor. Ramu got doubt whether Revati had
relations with others? However he decided to visit the nurse.
When Revati and Ramu reaches the nurse's house she is not available He decides to
go to the Primary Health Centre. The doctor at PHC was a male doctor. Revati refused
to get herself checked. Ramu explained to her the importance to check up The doctor
cal s the nurse who gave her moral support. The doctor checked Revati and told her
s, ® has infec,ion in her vagina. She discusses with Ramu if he has any symptoms
of RTI. The doctor prescribed medicine to both and advised them safe sex.
Both completed their treatment and are now very happy.
Tell this story to participants and ask the following questions
>
>
Why Revati was hesitant to talk about her problem?
What would you do if you were Revati? Why? What constraints you will face to put
your thoughts in action?
What would you have done if you were Ramu? Why? What constraints you will face
in doing those things?
At the end of the question answer sessions consolidate the discussion by focussing on
socio-cultural and economic factors restrict women to seek treatment of RTI/STD.
District Level Training Manual
8
)
I
Reproductive A Child Health
HIV/AIDS
HIV/AIDS
District Level Training Module
4 hours
Learning Objectives
>
>
>
>
>
e?M
the Participants will learn about
What is HIV/AIDS?
attitude of people to HIV/AIDS
mode of transmission of HIV/AIDS
Who are at more risk?
facts and myths about HIV/AIDS
> socio cultural aspects linked with HIV/AIDS
> prevention of HIV/AIDS
Design
Time in
minutes
15
_What is HIV AIDS? And its symptoms
60
Attitude of people about HIV/AIDS, and
their thoughts and feelings about
epidemic of HIV/AIDS.
30
How does it spread?
15
30
30
30
30
Who are more at risk?
Myths and facts about sex, sexuality and
HIV/AIDS.
7
Socio cultural aspects linked withTliv
AIDS
How to negotiate with partners?
Prevention of HIV/AIDS
Training method and Material
Discussion
Activity 1 and Activity 2
Activity 3
Discussion
Activity 4
Activity 5
Activity 6____
Discussion, demonstration of use
I of condom
District I.evel Training Module
1 .
^6 3
Reproductive & Child Health
HIV/AIDS
Material Required
>
Flip charts, Markers,
Copies of Worksheet 1 for activity 1,
>
L7tog"apLProPreAetM!?21h0,JSh,S”
,he
O"e 'abeted
"feelings" and
>
Cardt (Y°U may CUt °UtS the index cards from the Photocopied Index
wJh the hlin nr?hh^e* worksheet) wth “mmon beliefs and facts written on them
With the help of the list given develop the cards for Activity 4
> Silouhette (Cut out figures of the family members) Activity 5
> Vegetables for Activity 6
> Condom and model of penis or banana
Refer chapter contraception for the
demonstration of condom
e
District Level Trainiiif; Module
2
Reproductive A Child Health
H1V7AIDS
Note for the Trainer
Welcome the participants.
Talking about HIV infection will create some amount of embarrassment and stress
among participants. Please realize that during your sessions, your ow aXdes
JZrtant an’W°man re,atl°nShi^ faithaspect and partnerTomZication are
You may start session by saying
“Dear friends,
We are going to talk about something very important in terms
Let us today discuss the scientific informatn
-----------ion about the same."
not. Upgrada'™™ ab0Ut ‘he diSea5e
>
person“oT^^ ™ aSS"
lhe pa'liCipan,s 10 k"°»
epidemic of HiZoSMXe AcW,^"95 and 'h°u9h,s °,peopte
altttude of
? sp-d '2
'd^mation^n^iff^en^od^saoApreaadaoaf'HIV/AaDS16 ‘"‘“a™ bythe
Pr°community.
V'din9
relatedPtortH!v/AaDShanUoduffActlvTy-T'6 ab°U1 ‘he ''ad°US myths and ,acls
>
popidaUon “ ‘he
,
SohnT °f
H'V and AIDS 10 Senaral P°P^'ion and high-risk
diSCUSS ,he in,porta"“ °f'»« and negotiability in partner
surface these points?nl°odueceeAc°vilv°6'al aSpeClS of ',lan and w,>man- To bring to
' deironstrabol^o/howho use thSeCMndonmOnpteasZn,i,?n mT"08' °r3anize a
carry out this demonstration.
rSfer Module on contraception to
Distrid Level Training Module
3
Reproductive & Child Health
HIWAIDS
Points to be Remembered by the Participants
What is HIV/AIDS
> The disease, Acquired Immunodeficiency Syndrome (AIDS), is caused by infection
wth Human Immunodeficiency Virus (HIV), which enters in the body's white blood
cells and destroys them. It weakens the body to such an extent that tuberculosis;
cancer, pneumonia and other infections occur and kill the person. AIDS is the final
stage of disease when HIV infected person becomes very ill and dies.
r- In India the HIV/AIDS epidemic is now more than a decade old. In such a short
period it has emerged as a serious public health concern of the country The
oHhe coun^'"3006 data^early indicates that ^IVis prevalent in almost all parts
> About 75% of the infections in the world occur from the sexual route (both
heterosexual and homosexual), about 8% through blood transfusion, another 8%
through injected drug user.
One in every 4 cases reported, is a woman.
About 89% of the reported cases are occurring in sexually active and
economically productive age group of 15-49 years.
Transmission of HIV
HIV is transmitted in four common ways. They are-
through unprotected penetrative vaginal or anal sex
> Through sharing any instruments that can pierce the skin, for example needles and
. blades that have been in contact with the blood of an HIV infected person.
r From an HIV infected pregnant woman to her baby during pregnancy during
delivery and through breast feeding the baby after birth.
> Through transfusion of HIV infected blood
HIV cannot be transmitted through:
>
Normal human contact, touching, kissing or hugging.
>
Playing together or sharing food.
> Sharing toilets and latrines or bed
Caring for someone with HIV/AIDS particularly if you make sure not to touch their
blood.
> Insect bites.
>
’
Who Can Get HIV/AIDS?
> Every one is at risk of HIV/AIDS. There are certain categories of individuals and
groups who constitute the ' high risk' group as they due to their life styles are
especially vulnerable to HIV infection. They are:
1. Sex workers: They constitute a particularly high risk group as they have multiple
sex partners and at many a times due to economic constraints social factors they
are not in a position to negotiate the use of a condom with their clients.
District Level Training Module
4
Reproductive Sc Child Health
HIV/AIDS
4. Introduction of HIV/AIDS knowledge among industrial labourers and migrant
labourers.
5. Regular training and sensitization of health professionals and functionaries on
different aspects of HIV/AIDS including the gender aspects.
6. Addressing the issue of HIV/AIDS as a development concern and integrate it with
various development programs
7. Special awareness programs for the at risk groups, like sex workers blood donors
etc.
• Efforts towards control of STDs
• Promotion of condom use
• Effective administrative and legal management of use of blood transfusion
• Strict vigilance on drug abuse
Women and HIV/AIDS
Please refer chapter Reproductive Tract Infection
The behavior of different people, including medical professionals, towards men and
women with HIV infection is different. Some of the examples are as follows:
He has HIV________
The doctor breaks the news
She has HIV____________
The doctor breaks the news
You havo tested positive for HIV. This is a
terminal illness. Be careful about your health.
You have tested positive for HIV. This Is a
terminal illness. Make sure that you do not
conceive. It will transmit to your child and you
will be the one to blame for the misery that the
child will suffer, in case you are pregnant, you
must abort the child as early as possible.
The family learns that she is HIV positive
The family learns that he is HIV positive
You have brought us shame. It is better that we
keep the family’s honour by dissociating
ourselves from you. Please leave the house.
The wife leaves with the husband.
The community learns that he is HIV
positive
We did not know that we were sheltering a
whore in the house. Leave the house before
the sun rises tomorrow. We do not want to see
you here. As far as we are concerned, you are
dead. Leave the children here. She leaves
alone.________________
The community learns that she is HIV
positive
It is unfortunate that this happened to him.
After all, men will be men. They do stray
sometimes, but such misfortune does not strike
everybody. It is his "karam" (destiny). In any
case, a bull is not a bull without its scars.
Considering the behaviour she has indulged in,
she has gotten off lightly by just being thrown
out. In our times, she would have been
branded so as to be a lesson for other girts to
keep away from bad activities.
Source: She can cope. A paper on gender and
HIV/AIDS by Madhu Bala Nath. 1997
District Level Training Module
6
Rcprodudivc & Child Health
Hll'/AIDS
2. Miflrant labourers : They also constitute a high risk group as they travel from
and’Sing Testas O''TOrk a"a he,,Ce
UP havin9 mul,ip'e sex par,ners
3. —U5k62S: Lhe truCk drivers/c|eaners also are a high risk group as they are driving
on the highways for days together and they tend to visit sex Workers very often
“ 0,m 3,1 the
Many of them also actively engage in
homosexual behaviour (men having sex with men).
y y
4.
SeX
Me?
they also constitute a high risk group as they
equently engage in anal sex which has a greater risk of HIV infection as there
are more chances of abrasion and lesion in this kind of activity
5.
6.
Prevention of HIV/AIDS
In’cS^SA" indi’'aUal5 "Ped be
inipor,anl way 10 prevent HIV Weptio"-Th—
>
" use o/condom0"1
refer Fact Sheet -2 for details on
penelral've
' dX^b^oXteeted6
31 a"' 'S
m°S! °b™US
> NeiXTo™'h a"
« /°u
3'n9le partner.
X Be away from activities related to drug abuse
Ge? ke^ted^or'alfsTOs^RTlsh160*(5yrin0eS)
People suffering from STDs and RTI are i-------more prone to HIV/AIDS. Get
treated all STDs and RTIs. Both the partners need the tieatm^nt'
What Needs to be Done for Prevention of HlV/AIbS in Society?
1.
XtS SCh°dlS’
—
2. Production and promotion of need based health
education material for different
target groups.
3. Introduction of HIV/AIDS
awareness program at school curriculum
District Lex el Training Module
5
Reproductive & Child Health
HIV/AIDS
Chart i- Factors Increasing the Risk of HIV/AIDS In Women
Existing Socio-cultural Practices
Lower Status of Women
No Decision Making Power
In Family
At Work Places
Sex Behavior
No Negotiation
Power
Sexual
Exploitnlion
Women are more
vulnerable to HIV
infection
Unemployment, poverty,
forces women to work as sex
workers
Inaccessible, inadequate and
expensive health care services
Identification, Diagnosis and
Testing of HIV/AIDS are a complex
issue.
Source: folder developed by CHETNA
HIV/AIDS AND WOMEN
Useful Health Education Material
LaZSeSgTh'
>
VHA'40 lnS,ilu"onal Area’
Delhi 1100016,
STdXidZT6" y°U and me' F'iP B°Ok' VHAI>
English
STD/HIV/AIDS what everybody should know. Booklet. Language; Enghsh. Hindi
HIV infection-Prevention and Health Education, Slides, VHAI Language-English
script
District Level Training Module
7
I
Reproductive & Child Health
HIV/AIDS
Activity 1 Exploring Attitudes
Objective
towards1 HIV andeAID^0^0^^ t0 tra'neeS to exPlore and clarify their own attitudes
Material
Copies of Worksheet 1
Method
Divide the trainees group in smaller discussion groups of 3-5 members First have each
member fill in the worksheet for himself/herself (allow 10 minutes). Then ask each group
to elect a leader who can record the group's ideas after all members share and discuss
their responses and report them back to the class. Each group member will need a copy
of the statements listed in worksheet 1. It is important that the trainers does not seek to
correct or criticize views that he or she disagrees with at this stage, but allows free
expression of them. The trainer then discusses the following issues with the group by
going over the points given below: (allow 20 minutes).
Points of Discussion
Why are these called controversial statements?
Have you heard of such statements being made by people? Which ones are most
frequently used?
Did you feel comfortable discussing your views with your partners?
> Were you surprised when your partner disagreed with you?
> Did you change any of your views after listening to your colleagues?
>
District Level Training Module
8
Reproductive & Child Health
HIV/AIDS
Worksheet 1
Controversial Statements
In the boxes fill in an (A) for agree and (D) for disagree based on your opinions about
each statement:
□ Women with HIV infection should not have children.
□ People with AIDS should not be allowed to continue work
0 AIDS is mainly a problem of people with immoral behavior
□ Men who have sex with men indulge in abnormal sexual behavior
□ People with HIV Infection should be isolaled to prevent further transmission
U It is a collective responsibility to care for people with HIV infection
□ I would feel uncomfortable inviting someone with HIV infection Into my house.
L Surgeons should screen all patients for HIV infection before surgery
U I ™u,d fee, uncomfortable discussing sexuality with a person of the opposite
□ Intravenous drug users should compulsorily be tested for HIV.
It is all right for men to have sex before marriage.
□ School children should not be educated about safer sex.
□ Women should never have extra marital sexual relations.
□ All professional blood donors should be jailed.
□ It is difficult for male counsellors to talk to women
clients about condom use.
Please note: Xerox this worksheet
as per the need to introduce the activity
»;
District Level Training Module
9 .
Reproductive & Child Heali.
HIV/AID^
Activity 2
Thoughts and Feelings: Personal Impact of HIV/4IDS
Objectives:
> SSSSSv° r
sessions.
'
7
community and prepare them for the succeeding
o,
Materials needed
Sketch pens
Maskingf’tTpes3'3^
"lhou9hts"and lhe °lh8r
lasted with "feelings"
Method
>
■THOUGHTS" aandheFeEEffis"bi9
°n 'hem) 00 lh8 b°ard’ labeled with
>
> Discuss/process their responses emphasizing those which
are held very important
especially among people of our culture.
> Summarize the discussion by reiterating how individuals
the eoidemic and h™X V
3 9 hOW indlv,duaJs get affected and react to
P.;®T'5^h°wJhese reactl°ns can influence their social and economic life.
> The facilitator -----leads> a discussion on the following:
> :
'
Are there any common responses?
> What are these?
> What does it mean?
> Encourage anybody who wants to share
some more his/her thoughts about the
activity.
> End the session
by pointingJ out outstanding/significant "thoughts’' and "feelinos”
,, ,,
expressed by the participants and relate it with their insights of the epidemic
9
> Leave the tom sheets posted on the wall inside the training room.
District Level Training Module
10
Reproductive & Child Health
HIV/AIDS
Activity 3 Wild Fire
Objective
To sensitize the participants about how extensively HIV/ AIDS can spread
Method
> cS, S
,^eand Shake handS “,h each
ltlree <™es.
HMAIDS,St t'Ve '*°m V°U t0UCh °n shou,der- Announce lhat they were infected by
' nve poreone d’roc°yParliC'Pan,S *O COmO 'n circle
h=>d shook hands with these
after touchin°a She
'hey Shake hands
- Ask the feeling of participants standing outside the circle.
District Level Training Module
11.
)
)
)
Reproductive & Child Health
HIV/AIDS
Activity 4 Sexuality, HIV/AIDS Myths and Misconceptions
Objectives
> To clarify misconceptions about sex and sexuality.
r- To understand how myths develop.
Materials
Set of index cards (You may cut outs the index cards from the photocopied Index card
sheet given here withsheet) with common beliefs and facts written on them. With the
help of the list given develop the cards.
Process A:
The cards are distributed to each participant. In turn, each participant reads her card
aloud and says whether the statement is a myth or a fact. Alternately the group can be
requested to volunteer opinions about each statement read.
The facilitator provides the explanation why the belief is a fact or fallacy.
Process B:
An alternative approach is to make it like a game. First break the group into teams of
about 10. The teams compete against each other for points from correct answers.
The index cards would be all jumbled in a basket. Either the facilitator or a member of
each team would draw out their question. The facilitator would read it for all to hear.
One team would be allowed to confer and come up with the answer. If the team
answers correctly, they would be awarded 100 points for getting the myth/fact part
correct and 400 points for being able to explain why (total points for a correct answer:
500)
District Level Training Module
12
- r
■■
(
'
Reproductive & Child Health
IHV/AtDS
%
Index and fact Cards
Statement
(For (ho Indox cards)
1. Girls and boys can have
sexually
transmitted
diseases without showing
any symptoms.
Notos to tho Fnciiitator
'
FACT; While^some STDs ‘may^have'qJitTT^Hi^biT
symptoms, others may not. Gonorrhea, for exam^e ?yS°
dismays no symptoms in women and often is undetectable in
may have'^STp311110 bS eXamine‘:l
3 doc,or ’
“'Ink y°u
2. A girl can get pregnant if
she has sex only once or a
few times
3. Once you have had
MYTH: A person can get gonorrhea
as many times as she or
gonorrhea and have been
he has unprotected sex with an infected person. It is important
cured, you can’t get it again.
h^meXX'f55^^
th6refore,_ that anyone who is
sure that his
4. Condoms help prevent the
spread
Of
sexually
control,
transrnitteddiseases.
5. The size of the penis is
oquivnlont to masculinity or
virility.
..... - ....... ..
6. A girt
preg^t
even if a boy doesn’t is still possible that thTp^seminarfluids wV 9irl'S Va9iria' 11
ejaculate or ’’come” inside therefore a girt can get pregnant
d
C°ntain Sperm'
her.
Sexually
transmitted
diseases can be cured if the
infected man has sex with a with a virgin or anyone else,, one will only pass on the infection
*
virgin,_______
8. Menstruation is unclean.
conception |
9. The female determines the
sex of a baby.
W.
Nocturnal
make boys weak.
. genetic material is only XX 9
emissions
12.
r
Homosexuality
abnormal.
I Se^a|:intercourse7sea^XUc9t?y nomlTh63"1? maStUrbatlOn~°i;'
not make you weak.
11. Masturbation is normal.
V chromosome. Female
’ ^arm^ess thing. It does
^femateV
is
™%ae^TeyXSS :h"ea"= A~' “
District Level Training Module
13
cM
Reproductive & Child Health
HIV/AIDS
experience some level of attraction to others of the same sex.
It is common and should be considered normal.
13. Circumcision increases MYTH: Circumcision is a procedure by which the loose fold of
the sexual power of a man.
the foreskin of the penis is cut off. After the operation,
intercourse, if it was painful for the male before, becomes
painless. It is also easier to keep the penis clean. However
there is no change in the sexual pleasure or powers of the
man.________
14. A drop of semen is equal MYTH: Semen has no relationship to blood and its loss causes
to 20 drops of blood. Hence no weakness to the body. Semen is meant to be released from
the loss of semen weakens the body.
the body and should be
avoided._________ _
15. The vast majority of MYTH: Both men and women can be and are homosexuals.
homosexuals are men.
Male homosexuals are more visible simply because society
allows men in general to be more open about sex and desire.
16. Most of the women with MYTH: Most women with HIV are-housewives. The rate of HIV
HIV are prostitutes.
infection in ante-natal clinics in Delhi increased by 100% in
1994 and 400% in 1995. 70-80% of all women is infected by
their husbands.______________________
17. Most men who enjoy sex TRUE: Over 90% of male clients who regularly visit male
sex
with men are married and workers do not consider themselves to be homosexual or even
have children.
bi-sexual. The fact that they have a wife and, more importantly,
a son confirms their ’’normalcy". Likewise if the client takes the
role of active partner during anal sex he may consider the male
sex worker to actual BE a woman. They follow the logic that a
woman takes the receptive role in sex, thus anyone who takes
the receptive role is a woman.
____
18. You cannot get infected TRUE: L—————————————————
with HIV form a mosquito.
1. HIV is the HUMAN Immuno-deficiency Virus. HIV lives
within human white blood cells. It cannot survive outside of
its host. Thus, as soon as the white blood cells die, HIV
dies.
2. While blood cells and HIV are destroyed in the highly acidic
environment of the Mosquito's stomach.
3. Mosquitoes suck in blood for food. They do not inject blood.
There is no way that they can inject HIV back into another
person. A syringe is used to inject medicine; in the process
it could inject droplets of infected blood. Any tiny droplet of
blood left on the outside of the mosquito's stinger would be
unable to infect. Such a small amount would probably dry
very quickly. When blood dried and HIV is exposed to air,
the virus dies within a few seconds. Thus even "infected"
blood would become harmless. If, somehow, the blood
does not dry, it is unlikely that the blood could enter the
body. When the mosquito inserts his stinger, the tension of
the skin around the stinger would squeeze the blood back
off the stinger, and the blood would remain outside the
body.
District Level Training Module
14
Reproductive & Child Health
HIV/AIDS
r
19. A man can only become
infected with HIV from an
infected woman, not if he has
sex with an infected man or
hijra._______
20. If you have a STD,
having sex with a hijra will
cure it,_______
21. The chances of infection
are 1 in 5 lakhs through a
needle stick from a syringe
used1 on an HIV infected
person._____
22. 85% of people in India
xax,sed wi,h H,v
4. Mosquitoes do inject their saliva into their victims. Malaria
is carried in the saliva and spreads in this way. HIV cannot
exist in the mosquito's saliva and, thus, cannot be spread in
this way.
5. Once reassuring statistical proof that the mosquitoes do not
spread HIV, is that demographics of HIV infection the
majority of HIV infections happen through sex, it is largely
those people within the most sexually active age range who
are infected and die of AIDS. Most AIDS deaths occur
between the age of 25 and 45. Malaria, on the other hand,
affects all people. Very young and very old people are
vulnerable to Malaria. Mosquitoes are not interested in the
age of their victims. Thus, if mosquitoes could also transmit
HIV, HIV prevalence would be as common among the very
old as it is among young adults.
FALSE. The gender of the sexual partner is absolutely
irrelevant. HIV transmission can happen whenever the virus
from an infected person is able to access the white blood cells
or an uninfected person. Both Vaginal and Anal sex are highly
dangerous.
3
FALSE: Only proper medical treatment can cure a STD.
TRUE. HIV must enter your body in an unknown number for
you o get infected. This is also one of the reasons it is almost
impossible to get infected from barber’s razor. There has been
no known transmission in this way.
I^UE: Although lndia Portrays itself as a "moral country" that
t
J 3(111 extra marital sex, the
ahstics for HIV transmission and STD prevalency do not back
mat up. The government estimates that more than 17 lakh
people have been infected with HIV in this way and 4 crore
-yp.'T5n6ek treatmerit at government STD clinics each year.
23. Anal sex has a higher
anrtTh Bot\anal and ^gina! sex are unsafe. Both the vagina
chance of HIV transmission wh^h th/6 m are 'ined With a mucus membrane through
than vaginal sex.
virus can pass directly into the blood stream But
anal sex has a higher chance of transmission because the
chances of minor abrasions or tearing is higher.__________
24. 1 out of every 4 people in
RUE. 4 crore Indians seek treatment at government STD
the WORLD who have a clinics each year and this is just the tip of the iceberg. Many
STD is Indian.
people choose to seek treatment from private clinics, quacks,
not seek treatment at all. It is estimated that only 30% of
women with STDs seek medical treatment,
25. 1 out of every 10 people TRUE. The same behaviours which can lead to a STD can
with a STD has HIV.
transmission if your partner is infected.
r ex'stence of a STD increases the chances of
1 transmission if exposed to HIV upto 10 fold.
District Level Training Module
15
)
I
Reproductive & Child Health
HIV/AIDS
•i
26. 50% of all HIV infections
happen between the age of
15 and 25.
TRU E: Young people are experimenting with sex and drug use
but they may not understand the risks of experimentation. Thus
early education about reproductive health, sex, sexuality and
HIV/AIDS is essential to the safety of our young people.
FALSE: Condoms are the only form of birth control which also
also
offers protection from the sexual transmission of HIV. Use of
_Copper-T actually increases the rate of transmission.
TRUE. The only risk behaviour the majority of women who are
infected will have practiced is having sex with their husbands their "marital duty". Many people believe that people who are
infected with HIV deserve to die. What about these women?
FALSE: Although rapid weight loss can be an indication of a
weakening immune system and, thus, the presence of HIV,
there are many reasons for unexplained weight loss. The only
way you can be sure whether you have the virus is to take an
HIV test.
27. Using a Copper-T for
birth control also protects
you from HIV.
28. 7 or 8 out of every 10
women who will be infected
with HIV will be infected by
their husbands._________
29. One way of knowing you
are HIV positive is if you
loose more than 10% of your
body weight over a period of
less than one month for no
apparent reason.___________
30. Frequent scratching in FALSE
the genital region is a
symptom of AIDS.__________
31. Direct stimulation of the TRUE: Not only is this one source of sexual pleasure during
prostate gland during anal anal sex, but the same nerve which carries pleasurable
sex can result in orgasm
sensations from the penis (or clitoris) reaches the anus.
32. 23% of unmarried males TRUE: But only 6% of unmarried females have had sex by that
have had sexual contact by age. 15% of secondary school girls were found to have been
the age of 19.
victims of sexual abuse (not necessarily including penetration).
Many boys report that their first sexual experience is with an
older man. The first time they had sex with a woman almost
half had sex with an older married neighbour.
TRUE: Only 27% of sexually active college students had used
condoms. This is related to the statistic that 50% of the daily
clientele of 1,200 males in a Bombay STD clinic were between
the ages of 15 and 25.________________________ __
FALSE: There is no connection between the digestive tract
and the reproductive tract.
33. A quarter of the clientele
of the central red light district
in Bombay are below the age
of 21.___________________
34. It is possible for a woman
to get pregnant through anal
sex._____________ _______
35.
Having
sex
with FALSE: Homosexuality is a very personal issue. One's self
someone of the same sex identity is completely a personal choice which has very little to
means
you
are
a do with sexual behaviours. A male sex worker may have 10
homosexual.
male clients a day, but only be turned on by women. He may
not consider himself a homosexual. On the other hand a virgin
may feel his attraction to other men very strongly and know he
is a homosexual. In India it is most common for men who enjpy
sex with other men to not identify with the term homosexual.
Human sexual response does not neatly fit into a set of
prescribed terms. Each person falls some where along a
spectrum of sexual attraction. It is estimated that only 10% of
the population is solely attracted to people of the opposite sex.
It is estimated that another 10% is solely attracted to people of
District Level Training Module
16
Reproductive & Child Health
HIWAIDS
R^!ame r.u A" the other 80°/o fal1 somewhere in between
Because of the powerful pressures of society expectations of
parents and peers, most of the 80% (and many oUhe ToS
36. The vagina is the primary
sexual organ of a woman.
£rM)
to
»P^mina4nyh°LXL1
nMtf f:
Va9ina 'S Primar'|y a reproductive organ Because
°fjs funcfon as the birthing channel, the vagina has a ver^
low concentration of nerves In fart thn
Sna^n aZemb^'^XmaiesaTdfemXthaJe S
3n? nrenita S ructure for the first 6 weeks of life). Fewer than
37. STDs can only be
transmitted via the genitals
>•
i
District Level Training Module
17
(
A
Reproductive & Child Health
HIV/AIDS
Activity 5 Demographic Silouhette Activity
Objective
J
epidemic at famil^lXel and byT^ension aUhe SmmSn^y lev^036^60063 °f H'V
Material
V
Silouhette (Cut out figures of the family members)
Procedure
hSh^eltowdXhgTPi'eS aCCOrdi'19 '0fam"y memberS maWnS SUre ,hey a"
SH0Uh9,le °ardS ,0 repreSen*members an
When a I have made up their imaginary families, using the silouhette cards ask them to
explain the roles the members play in terms of meeting the economic social health and
other needs of the family. Let this be a lively sharing of ideas about how members
contribute to a family’s quality of life.
'"einueib
When all have shared ask them to turn the silouhette cards over to expose the other
m?
wk
the.CardS ™"revea' a red dot indicating the presence of the virus
Now ask the partapants to reflect on and discuss how this new information wfll affea
the family roles discussed earlier and the well being of the family as a whole
Time permitting invite comments on how a number of such cases would affect the
quality of life and economy of the community.
(
Source: Lyra Srinivasan and ACDIL, Goa.
District Level Training Module
18
•I.
I
Reproductive & Child Health
HIV7AIDS
Activity 6 Negotiation for the Use
of Condom:
Objective
To sensitise the participants about the process of negotiation.
Material required:
Vegetables
Method
Eple Play. 1 The Market
arwme woman had to change their originat offers Deta comproS0"1
Role P lay 2: The Family:
facilitator acts as^hJs^Tnd^nd'me oart0*'31'0? ab0111 *he use of “h*™ The
of the negotiating techniques used diing tKS
' or TheXtei ■"'° U“ S0,,,e
A3K the participants what are seme of the techniques used in negotiation.
)
District Level Training Module
19
Reproductive & Child Health
Cervical Cancer
Cancers
Cervical Cancer
District Level Training Module
2 hours
Learning Objectives
At the end of the session the participants will learn about:
What is cancer?
Symptoms of cervical cancer
Risk factors of cervical treatment.
Treatment and protection from cervical cancers.
Design
PTime in
minutes
30
30
30
30
Topics
^General information on cancer
Causes of cervical cancer and who
are at risk, and warning signs.
Treatment of cervical cancer
Social factors leading to delayed
diagnosis
Training methods and
Material
Discussion
Discussion
Discussion and
demonstration, Activity 1
Role Play
Material Required
Model of uterus, Pap test kit, Flip charts, Markers
District Level Training Module
1
Reproductive & Child Health
Cervical Cancer
(
Note for the Trainer
Welcome the participants.
You may start the discussion by saying
"Dear friends,
i
Cancer is a non communicable disease which is increasing in our country. It is therefore
/mportant to know about the same. Today we will learn about cancer especially cervical
and breast cancer which are the most common among Indian women."
> Start the discussion by asking a question whether they are aware about any cancer.
Encourage them to talk about whatever they are aware of. Once you know their
knowledge base, add critical information on what is cancer and causes of cancer
You may encourage them to share experience of any individual which they are
aware of who has suffered from cancer.
> Now lead the discussion to cervical cancer. Give them information on indirect
causes of cervical cancer, who are at risk and the warning signs.
x Regular screening and treatment of cervical cancer is the important topic of
discussion. Especially focus needs to lay on Pap test. With the help of the Pap test
kit, and the uterus model demonstrate the procedure of Pap test. Please refer
Activity -1. Focus that Pap test is quick and painless procedure and is also
inexpensive.
> -You may end the session by encouraging participants to perform a role play focusing
the economic and socio cultural aspects linked to or leading to delayed diagnosis.
District Level Training Module
2
c
Reproductive & Child Health
Cervical Cancer
Points to be Remembered by the Participants
What is Cancer?
tear ofour’body'Jlhecel“XXT"3 9r0W10the
tumor).
0
°rmal cells 13 local,zed-H is known as a tumor (benign
.““"l9
abnXTy
to nearby tissues. They harm the other cefs°anri
and lymph. Such a lump is called lump of dancer
Th^
V™
a lump' wh'ch als0 sPread
° °ther °r9anS thr°U9h blood
npLiiSi?9emphqnanrl'7Pd ''^-g-isnotalways benign and the lump at many
medicines or radiationlnd the ^SceTonXing °Ved by SUr9ery °r treatment with
cancer spreads, however, cure it is more d ffie? i? =. h' may be fairly 9ood- Onca
Cancers of cervix and breast is m
eventually it becomes impossible,
common among both men and women^rlTanceToTr a^ °ther CanCerS
is
and mouth and throat.
r of uri9' colon, esophagus, stomach
Causes of Cancer
P™edlt^“ O'
>
is
The foiling things may make a person more
Smoking or chewing tobacco
Incorrect use oThormones hepat'tlS B Or 9enital wads
>
Chronic infection
gmri„x^-x^-Tpera*ure
Prolonged trauma/irritation
Some cancers to a some extent i
may be hereditary eg. Breast cancer
Healthy living
J can prevent many cancers.
worketo
fotect yourself from
------- at~th^---------------------------------------------------
Cancer of cervix
cervix starts in cZXix and in^SSTs
the
District Level Training Module
)
3 .
)
)
)
)
a™09 'ndian WOmen- Cancer
■
Reproductive & Child Health
Cervical Cancer
Common signs for the cancer of cervix
>
Abnormal bleeding from vagina, irregular menstruation from vagina, the colour may
be brown or dark brown in colour or.water discharge tinged with blood including
Dieeaing after sex.
y
> Bleeding from vagina after menopause
> A pinkish or bad smelling discharge, or a bad smell from vagina
>
leg^ow^bXS.SiSnS maV inC'Ude Pain '*6n PaSSin9 Urine' °r pain in ,he
Some facts of cancer of cervix
women161"
>
>
>
>
f°r 7/00160 °lder than 35 years' compared to than it is for younger
Cured easily if it is detected early
Painless in its early stages
Slow growing. It usually takes about several years to become advanced
Often not detected until it has spread, it is more difficult to cure in advanced stage.
Risk factors for cancer of the cervix
Women are more likely to get cancer of the cervix if theybecame sexually active within only a few years of starting their monthly bleeding and
has given birth in younger age
- has had Sexually Transmitted Disease in the past
- does not keep cleanliness of their private parts
-• have had viral infections such as genital warts
- have had many pregnancies
Reducing Deaths Due to Cancer of Cervix
Many deaths from cancer of the cervix could be prevented. Early detection of cancer of
the cervix is usually possible using Pap Test. This is a simple painless test, using a few
cells taken from a women's cervix, which are then put on a slide and looked a under a
microscope for abnormalities.
It is suggested that -
Preferably after 35 years of age, every 3 years Pap test needs to be performed. In
places where it is not possible, women should try to get a Pap test done every 5 years.
Pap test is not expensive. It can be easily done at public and private
Warning Signs
There are usually no outward signs of cancer of the cervix until it has spread and is
more difficult to treat.
Abnormal bleeding from the vagina, including bleeding after sex, or an abnormal
discharge or bad smell from the vagina can all be signs of a serious problem, including
advanced cancer of the cervix.
District Level Training Module
4
^2^
(
Reproductive & Child Health
Cervical Cancer
Finding and treating cancer of the cervix
The Pap test
The most common test is the Pap test. It is quick and simple procedure For this test
doctor needs to scrape some cells from the cervix (this is not painful) durinq a pelvic'
> Pap test is not done during menstrual period
> nnPnntSt Sh°UlC! nOt
done
48 hours of insertion of vaginal tablet
Do not use savlon or any other cream
> Pap test should not be repeated earlier than six months
35.
d n °a3t °VOry 5 yoar9’ O9Pocially all sexually active women over
Visual inspection
solution (^cedcadd^^i^^s fainted'onTh^cerv03'106^ thS CerV'X Uses a vine9ar
The cervix is examined sometime^?h thL h
tUmS abnormal tiss^ white,
see. If a woman has abnormal tissue she mav ne
1603 that makes il easier to
treatment.
“normal tissue, she may need other confirmatory tests or
Other tests used to find cancer
>
iS ,aken fr°m 'he Ce™ and senl t0 a
'
ma9"te
to
«
Social Factors effecting Early Diagnosis of Cancer of Cervix
i'XZ^Z^
health activist that due to cut ure o sZX L experienced bV ^e clinicians and the
not contact the doctor on time Simth^h0 '^T3 Va9,na' dischar9e and does
ignored. This leads to delayed ^aCosis H is nX
t0 CanCer °f Cervix also 9et
the to cancer specialist at tS stage o! the lease
USUa',y the W°men reaches ‘
iXXZiiheT™'(Xno/XZSymP,°mS Of
over all development of women is Iquallv imole^6'?^Iy' Al°n9
information
women might not diagnose cancer on til
' observed that even informed
independence and lack of mXy
seif-esteem, economic
District Level Training Module
5
(
' C
(.
Reproductive & Child Health
Cervical Cancer
Activity 1 Demonstration on Pap test
Objective
(
To demonstrate Pap test so as to inform them about its simplicity and encourage them
to get it done regularly.
(
Material Required
(
(
Pap test Kit and model of uterus
’
(
Gloves
Speculum
Torch
Spatula
Glass Slide
Fixative
i
<
Method
nnod inX9 MhS' nSert
sPeculum In va9|na and pull it gently downwards. Then get a
for 3d60?ocnl
°f
°f
tOrCh' Tum the Spatula in the ful1 ^6
nLnT h
h . ?ear from the CerVIX- 11IS imPor,ant t0 explain that all these items
need to bo appropriately sterilized.
on ^smearTnd al?ow VdT^
'mmediatel>' pul some
Please focus on following points:
This is a painless procedure
Do not fill shy.
It is a quick procedure.
Note: This activity is to be done by a properly trained health care provider. The pap test
kit must be available at the PHC
District Level Training Module
*
6
Reproductive and Child Health
Breast Cancer & Ora! Cancer
Cancers
Breast Cancer and Common Tobacco Related Cancers
district Level Training Module
2 hours 30 mints
Learning Objectives
At the end of the session the participants will learn about:
)
"l
>
r>
'
what is breast cancer?
causes of breast cancer
who all are more at risk?
treatment and protection and early diagnosis from breast cancer?
besign
)
)
)
Time in
fninutes
30
)
js___
)
15
30
)
')
)
15
30
15
Methods
General information on breast’
cancer
Causes of breasTcancer
Who all are moreatTisk?
Protection against breast’cancer?”
jreast self examination
Treatment of breast cancer
Access to health care for breast
cancer
Oral Cancer
)
)
)
Discussion
Discussion
Discussion
Discussion - Activity 1
Discussion_____
Activity 2- Case study
Discussion
Material Required
traneXc^''6'PenS' lra"Sfe',he
°f ^ast self-examination on
)
)
)
)
)
)
District Level Training Module
1
Reproductive and Child Health
Hreast Cancer & Ora! Cancer
Note for the Trainers
thTS TnCe^S In';reasin9 In our country especially in the urban areas. It is important
rioht'timA3^- he 'r?formatlon ori the t0Pic- s° as t0 be able to take correct decision at the
activi es Wa wJi hh'S V te^hn,cal topic 11 is not Possible to use different participatory
activities. We will have to rely on the lecture method.]
y
You may start the session by saying-
"Dear friends,
We already know what is cancer and cervical cancer. Today we will discuss about
breast cancer. Are you aware about the symptoms of breast cancer?"
>
You could wait for their answers. Note down their answers. They may be incorrect
also. You may give the correct answers and enrich the information.
> Discuss who are more at risk of breast cancer. It is important to focus that women
wth risk factors may not always develop breast cancer. If you do not discuss this it
may lead to unnecessary fear among women.
> Once the participants have clarity on the above mentioned topics lead the discussion
towards the treatment of breast cancer. Very briefly give them the information and
discuss its side effects.
> For early detection from breast cancer focus on breast self-examination. You may
"
nJZe 3 demonstrati°n or explain it though the pictures given herewith.
End the session by discussing the social factors affecting poor access to health
Car!'J°U Can discuss this by introducing the case study given in Activity 1. You may
read the case study and ask questions given along with it. You may ask them to
perform a role-play. Through this exercise you can focus factors affecting late
diagnosis of cancer. Also tie up the discussion how it affects access to other
diseases.
> At the end of the session briefly discuss about common tobacco related cancer
especially oral cancer and lung cancer. You may start the discussion by asking
them to describe the symptoms of oral or lung cancer based on their knowledge.
District Level Training Module
2
i
c
Reproductive and Child Health
Rruast ('ancer cf Ora! Cancer
(
(
Points to be Remembered by the Participants
What is Breast Cancer?
Breast cancer is increasing all over the world. It is increasing in our country too
especially in the urban areas. The common manifestations of breast cancer are
I lard, painloss lump, which somotimos may bo soft.
x Change in size or shape of breast.
in.colour or feel of the skin of the breast or nipple(dimpled or puckered)
x Red secretion from nipple, at times it may be yellow.
Some of the common wrong beliefs are that breast cancer is caused by:
is,caused by:
Injury to the breast
> Injury to the breast caused by infant's head
> Breast-feeding for a long time
Wearing a tight bra
Having large breasts
Using scented soap
Having more children
Sin of a previous life
Risk Factors
are more than 50 years old.
has had cancer in one breast
>
consnu°^
stressful life
Special Note:
cancl^0
faCt°rS mentioned above ma
y not always develop breast
> Women not having any risk factor can get breast cancer in fom n
having breast cancer only 30% have risk factors.
n9 women
Protection against Breast Cancer
Lifestyle
Change in a life style will be helpful i.
m many ways. It may protect woman from breast
cancer.
Eat a variety of fiber rich seasonal foods
District Level Training Module
3
^7°
Reproductive and Child Health
Breast Cancer & Ora! Cancer
>
>
Choose a diet that is low in fat
Maintain your body weight with, regular exercise and a balanced diet
Avoid tobacco and alcohol
Be alert and keep mentally peaceful with yoga and meditation
Early Diagnosis
Women need to do regular breast self-examination from the time they reach 20 years.
After the age of 50 years, it is recommended to have a mammography (x-ray of the
breast) regularly in case of high risk women.
If lump is located in the breast, the doctor may recommends to go for further test. Many
. tests are available to diagnose a breast lump: mammography, sonography (getting an
image of the breast using sound waves) and biopsy (a surgeon removes all or part of a
lump with a needle or a knife and has it tested for cancer in a laboratory). Usually
mammography is suggested first other investigations may be required depending on the
extent of disease based on clinical examination.
(
Treatment
There are different ways of treating breast cancer, which are decided depending on
age, health and the extent of disease. Many times, a doctor suggests more than one
therapy.
>
>
>
>
surgery
radiation
chemotherapy (treatment through drugs)
hormonal therapy (Sometimes the female hormone estrogen helps the growth of
cancer. Hormonal therapy by anti estrogen like tamoxifan prevents this effect.)
<
Side effects of chemotheropy.
During the treatment of breast cancer, healthy cells are also destroyed with the cancer
cells. It is impossible to destroy only cancer cells. This causes certain side effects like
aneamia, loss of weight, weakness excessive hair loss, indigestion, etc. It is natural that
persons taking similar treatment may experience different side effects. Also, different
treatments have different side effects. Please note that majorities of these side effects
are usually temporary and they disappear after the treatment is completed.
Common Tobacco Related Cancers
Tobacco consumption, chowing and smoking, is increasing in India. Tobacco can lead
to head and neck cancers, lung cancer and esophagus (food pipe) cancer. More than
50% of all the cancers in men are tobacco related cancers. The death rate of these
cancers is high in India.
Chewing tobacco, raw and Gutka leads to fibrosis in mouth leading to inability to open
the mouth. It can also lead to white and red patches in mouth.
District Level Training Module
4
C^l
)
Reproductive and Child Health
Breast ('ancer <V Otxj/ Cancer
Common symptoms of the oral cancer are
)
)
)
>
>
>
>
>
>
Pain in throat
Non healing ulcer
Difficulty in speaking
Difficulty and painful swallowing
Change of Voice
Swelling or tumour in neck
The diagnosis is obtained with biopsy of the ulcer or swelling in neck. The treatment
includes surgery, radiation and chemotherapy.
Common symptoms of lung cancer are
>
>
>
>
>
Dry cough
Loss of appetite
Weight loss
Blood in sputum
Pain in chest
Prevention
> Avoid habit of chewing and smoking tobacco
> Avoid passive smoking
If someone is smoking and chewing tobacco in that case it is assume that stoooina
the use of tobacco; chewing or smoking reduces the risk of develoSno the cancer
ver the years After stopping the use of tobacco, the consumptio^of vit A rich
food may help in reducing the risk of tobacco related cancer"
Useful Learning Material
District Level Training Module
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Reproductive and Child Health
Rreust Cancer & Ora! Cancer
Activity 1
How to Perform Breast Self-examination
Regular self -examination of breast will help to locate and detect lump in breast early
Observation of Breast
A mirror is necessary to look at the breast. You need a mirror of at least a size 45 cm x
45 cm.
Stand in front of a mirror. Let your arms hang by the side of your body. Observe your
. breasts from the front and from both the sides.
Has there been any change in size and
shape?
Is there any redness or puckery skin on the
breast?
Is there any discharge from the nipple?
Now lift your hands above your head.
If there is a lump, the skin may be
puckered. It may look like the peel of
an orange.
Bring your hands to the level of your
nose, as shown in the figure, and
make a gesture like 'namaste'.
Squeeze your palms together.
During both these positions, observe changes in the breast and armpit.
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Reproductive and Child Health
Breast Cancer & Ora! Cancer
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Examination by Hands
It is important to examine both the breasts
with your hand. Use the right hand to examine
the left breast, and the left hand to examine
the right breast. Hold the thumb and fingers
together. Keep the fingers straight so that the
hand remains flat. Feel for any hard or thick
lump in your breast.
Start examining the breast from the outer
most area. Feel around the breast in a
circular rnovement.
Make a small circle all the way around your
oreast.
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Reproductive and Child Health
Breast Cancer & Ora! Career
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Bend your wrist to check your armpit.
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Once you complete checking the outer
circle, shift your hand slightly towards the
nipple and go around the breast again.
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Keep moving towards the nipple. Do not
forget to check the nipple. As shown in the
figure, press your hand against the nipple
and check for hardness.
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Reproductive and Child Health
Breast Cancer & Ora! Cancer
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Press the nipple between your thumb
and finger and look for discharge.
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You can examine the breast while lying
down. Before going to sleep, lie down on
a hard surface. Keep your right hand
below your head and use your left hand to
examine the right breast as explained
above.
Then change hands and examine the left
breast.
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Remember
> Always examine both the breasts.
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contact wfth^breasf D^noTm^hlndfromJhe b'^^
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every part of the breast.
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y°Ur hand in constant
hS breasl- Glve eclual pressure on
> Bend your wrist to feel under the armpit.
ever conduct breast self-examination while wearing your clothes.
Please Note:
of overhead projector Youmy^refenTcon? afnd Hshow 1110 Part'cipants with the help
breast self examination wearing cloths it is extreme^™00?31100' *f y0U demonstrate
that in reality they have to perform it without clothina^hf °rta.n.ttha‘you exP,ain ta them
before taking bath.
°UI clotr"n9- The best time for that is just
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9.
Reproductive and ('hdd Health
Hrca\t ( '(int er A- Ora! Cancer
Activity 1 Case Study
Hope After Breast Cancer
Ratan - 50 years old woman who had Breast Cancer, Graduate.
a ba,h 1 nofced a
«
When | returned home I got busy with my house hold work and I forgot about the lump
‘ be die to brea^f^ H
ab°Ut H t0 my mother' She also felt that it might
discussed it ^th rn X T!
he breast-feeding stopped, the tumor did not go I
h'scussed lt with my husband who said he does not understand such matters I went for
He camp tn Ithat the tumor was that of cancer. I told my husband about it
throunh J d°C °r 1° dlSCUSS about the trea‘ment. I needed to be operated I went
through surgery and chemotherapy.
^nes^t^n^lXTy?^reaSt WaS rem°Ved- For years 1 7/35 “nscious and had a
constant fear of the deformation and if I felt someone's eye on my breasts I thouaht that
they had noticed that I had only one breast. My dressing style has changed I could not
wear low necks or sieeveless tops. I found myself wearing foose long sklS an“baggy
rnp invo?^ 3 manta CrlS'S' 1 t0°k diVOrCe from my husband- Fortunately, I did find
hrPpS
h °T-man 3nd my fearS are 90ne forever- For a woman going through
ones noX^e^Vh6 h
t0 961 the Utm°St SUpport from their near and
ones, notnmg heals better or faster.
Ind^h iam confld®nt and feel Whole again. thanks to the support of my family, friends
nd this one man. I would like to end this testimony by sharing with you a funny
have one brea^r
ShS
Mummy’
1 9r0W Up w" 1 also
Ask Following Questions
>
Why did Rataa ignore the lump in breast?
reasons for delayed diagnosis of breast cancer in case of Ratan7?
> What kind of constraints Ratan faced due to breast cancer?
> If you were in the place of Ratan would you have behaved differently? Why?
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rpZdSthpNrT: Y°u may read this case study and ask the given questions. Or let them
read the case study and perform a role-play.
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Centre for Health Education, Training and Nutrition Awareness
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Lilavatiben Lalbhai’s Bungalow, Civil Camp Road, Shahibaug, Ahmedabad-380 004,
Gujarat, India. Gram:CHETNESS Phone: 2868856, 2866695, 2865636
Fax:+91-079-2866513 and 6420242 Email: chetna@adinet.ernet.in
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