community engagement for saving daughtersaphrdi/2020/jan_1/be… · community engagement for saving...

Community Engagement for Saving DaughtersSaving Daughters

Dr. M. JayaramSenior Academic RegistrarIndian Institute of Public Health – HyderabadPublic Health Foundation of India

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The birth of a son enhances my status, whilethat of a girl lowers my head. Land is themother for Jats and looking after it is akin tocaring for your mother. If boys are there, theland will be looked after, but if there are onlyland will be looked after, but if there are onlygirls then the land will be sold. Boys are theowners of land, they are the tree of the housethat flowers and fruits.

Jat father quoted in Dagar (2007)

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Background

• The trend of decline in the Child Sex Ratio (CSR), defined asnumber of girls per 1000 of boys between 0-6 years of age,has been unabated since 1961.

• The sharply declining child sex ratio in India has reachedemergency proportions and urgent action must be taken toThe sharply declining child sex ratio in India has reachedemergency proportions and urgent action must be taken toalleviate this crisis.

• The deteriorating ratio from 976 girls to 1000 boys in 1961,to 927 girls in 2001, and to 918 girls in 2011, demonstratesthat the economic and social progress in the country has hadminimum bearing on the status of women and daughters inour society.

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6Source: https://www.theguardian.com/world/2018/jan/30/more-than-63-million-women-missing-in-india-statistics-show

7 Source: https://unwanted.interactivethings.io/#/introduction

The first girl is usually allowed to live. Also for girls born following a boy the biological ratio (on average 96.2 girls per 100 boys) is respected. But in families

with a firstborn daughter, a second girl has less chances of being born, a third girl even less.

8 Source: https://unwanted.interactivethings.io/#/introduction

In southern andeastern stateswomen have amore active rolein the economyespecially incountry’s farm

9Source: https://unwanted.interactivethings.io/#/introduction

country’s farmproduction.

In thesecommunitieswomen are lessdiscriminatedand daughtersare moreappreciated.

In AP State

According to census 2001 & 2011

Child Sex Ratio in AP

11Image Source: https://www.business-standard.com/article/news-ians/sharp-decline-in-child-sex-ratio-in-andhra-pradesh-113050300550_1.html

2001 : 961

2011 : 939

972 964

955 950

945 946 941

934 933

943

985992 993

987 980

986 981

977 975 972 978

993

940

960

980

1000

Sex

rati

oINDIA Andhra Pradesh

Trends in Sex ratio

930 934

927 933

880

900

920

1901 1911 1921 1931 1941 1951 1961 1971 1981 1991 2001 2011

Sex

rati

o

Year

2011

2001

Child sex ratio (0-6 years)

961

939

“Preference for “Preference for boys”

Sex ratio comparison with other states (2011)

Southern States show decline in child sex ratio at birth

Trends in sex ratio at birth in Andhra Pradesh

Key issue of concern - Trends in Child Sex Ratio & Sex Ratio

911

919

910

921

928

932

954

916

909900

920

940

960 Major Fall of 38 Points in CSR

The gap indicates towards high sex selective

Increasing trend in Sex

Ratio

Diff of 40 point911 910 909

888

840

860

880

900

1971 1981 1991 2001 2011

Sex Ratio Child Sex Ratio

PCPNDT ACT Implemented

in 1994 Due to Non Implementation of

Act, Fall of 21 Points

selective abortion

point

Issues & Concerns

• Sex selection - Practice of determining the sex of an unborn foetus and eliminating it if found to be female. sex selection is also referred to as pre-natal elimination of girls.

PCPNDT ACT

Pre Natal Diagnostic Techniques Act was passed in 1994, amended in 2003 as Preconception and Prenatal Diagnostic Techniques (Prohibition of Sex Selection) elimination of girls.

• Female foeticide - It is defined as aborting a female foetus after sex determination test.

(Prohibition of Sex Selection) Act It Prohibits sex selection before

or after conception

It Regulates use of pre-natal diagnostic techniques

It Prevents misuse of technology for sex determination

MutliMutli--Pronged Strategies Pronged Strategies

Strengthening Monitoring• Regular inspections• F-form analysis• Telephonic follow-up• Research studies

Strengthening Act implementation by innovations• Mukhbir Yojna• Decoy Operations• PCPNDT Bureau of Investigation• District PCPNDT

coordinatorscoordinators

Mobilizing community & Changing Mindset• Daughters are Precious• Rajshree Yojana• IEC Activities • Involving different Stakeholders – media, Civil society, activists

Using Technology• Impact Software• Active Tracker/

Silent Observer• 104/108 Helpline

What could be done?

• Rigorous implementation of Acts addressing discriminationagainst girls and women

• Effective enforcement of PCPNDT Act. Mapping andmonitoring of clinical, diagnostic facilities, medical audits andmonitoring of clinical, diagnostic facilities, medical audits andstrengthening the supervisory boards.

• Other laws and policies, such as the Dowry ProhibitionAct, Hindu Succession (Amendment) Act, 2005, Prevention ofChild Marriage Act

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What could be done?

A life cycle approach to empowerment of girls and women

• Design and implementation of interventions in all of girls andwomen’s development:

• Education, nutrition, health, skill development, workparticipation, maternity, access to micro finance andcredit, asset creation and ownership, support to mostdeprived groups, women’s security, empowerment and theirparticipation in governance and decision making

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What could be done?

Gender sensitive socialisation in institutions

• Gender sensitisation for girls and boys, young men andwomen, in and out of school and college.

• Gender sensitisation and large scale awareness generation ofgovernment officials.

• Professionally designed awareness raising campaigns on CSRat national, state and community levels through variousmediums of communication.

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What could be done?

Community Engagement

• Engagement of key stakeholders in the Community

• Including men and youth is vital

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What Is Community Engagement?

• Community engagement is central to any public healthintervention.

• Community engagement is the process by which communitybenefit organizations and individuals build a long termbenefit organizations and individuals build a long termrelationship with collective vision for the benefit of thecommunity

• It is primarily about the practice of moving communitiestowards a better change through empowerment

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What Is Community Engagement?

• The process of working collaboratively with and throughgroups of people affiliated by geographic proximity, specialinterest, or similar situations to address issues affecting thewellbeing of those people.

• It often involves partnerships and coalitions that help mobilizeresources and influence systems, change relationships amongpartners, and serve as catalysts for changingpolicies, programs, and practices (CDC, 1997, p. 9).

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Principles: Community Engagement

• Working closely with local leaders, civil societymembers, and existing structures is a core principleof community engagement

• Engagement strengthens citizens’ voices by involvingthem in the decisions that affect them.

• Community engagement can increase the impact ofhealth programs and contribute to long-termsustainability.

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Actions for community engagement

Community engagement covers a broad range of activities. Some activities undertaken by government practitioners include:

Reaching out to / informing the community of policy directions of the government

Consulting the community as part of a process to develop government policy, or build community awareness and government policy, or build community awareness and understanding

Involving the community through a range of mechanisms to ensure that issues and concerns are understood and considered as part of the decision-making process

Collaborating with the community by developing partnerships to formulate options and provide recommendations.

Shared leadership / empowering the community to make decisions and to implement and manage change.

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Community-Led Action• Work with Humility : Communities are complex entities, and it is

important to enter them with humility grounded in a spirit oflistening, learning, and power sharing

• Build trust, respect, and relationships first: Trust is the essential

foundation for enabling community-led work

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foundation for enabling community-led work

• Listen in an active, non-judgmental manner

• Build on existing community resources and strengths

• Build community capacities for mobilizing thecommunity, making inclusive decisions, and taking effectiveaction

Culture and Community Engagement

• “A complex integrated system of thought and behavior sharedby members of a group — a system whose whole patternallows us to understand the meanings that people attach tospecific facts and observations” Christie Kiefer (2007)

• To achieve successful collaboration with a community, allparties involved need to strive to understand the point ofview of “insiders,” whether they are members of aneighborhood, religious institution, healthpractice, community organization, or public health agency

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Example of Jhunjhunu (Rajasthan)

35Source: https://timesofindia.indiatimes.com/india/jhunjhunu-goes-from-worst-sex-ratio-to-the-best-in-rajasthan/articleshow/63152677.cms

Example of Jhunjhunu (Rajasthan)

• As per Census 2011, of the 33 districts in Rajasthan, the child sex ratio (CSR) — counted in the 0-6 age group — was the worst in Jhunjhunu

• In Jhunjhunu, 837 girls were born per 1,000 boys• In Jhunjhunu, 837 girls were born per 1,000 boys

• NFHS-4 data (2015-16) indicates that it has increased to 952 (rural) and 891(total)

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How did Rajasthan do it?

Some of the factors identified were

• The state government widened their awareness and outreach campaign

• Intense awareness drive by the state• Intense awareness drive by the stategovernment, strengthening institutional delivery and frequentmonitoring has slowly resulted in changing the attitude offamilies towards girl child

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Some of the factors identified were

• Continuous process and a collective effort by everyone --former district collectors, women welfare and healthdepartments, NGOs and others," Dinesh KumarYadav, Jhunjhunu's District CollectorYadav, Jhunjhunu's District Collector

• In order to encourage people to have a girl child, theadministration started several schemes, some involvingfinancial incentives, and even pushed for the celebration ofrituals like 'kuan-poojan' (worship of a well), which wereearlier performed only after birth of a son.

38 Source: https://www.business-standard.com/article/news-ians/save-our-girls-change-comes-from-below-for-rajasthan-s-women-ians-special-series-118032500173_1.html


• Fight certain misconceptions... that only a male child will support them during old age. We showed them how girls have been supporting their families as well

• Felicitation programme called 'Jhunjhunu Gaurav Samman' where schools would put up pictures of meritorious girl students. Rallies in schools would put up pictures of meritorious girl students. Rallies in honour of such meritorious girls.

• Women as Informers

• This Change would come only if we managed to engage with local people. We went on to select female brand ambassadors within the community who had already



• This Change was possible due to engagement with local community

• Female brand ambassadors within the community who had already broken the ceiling to create a self-identity



In addition,

• Strengthening of the PCPNDT Act

• Rajshree scheme, introduced by the state government in 2016, under which the family of a girl born in a government 2016, under which the family of a girl born in a government hospital gets Rs 50,000 in six installments till she is 18.

• Janani Suraksha Yojana, Beti Bachao Beti Padhao programme

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Examples: Mukhbir Yojana

• Mukhbir Yojna was launched in the Rajasthan state in 2012.

• Person providing confirmed information about theinvolvement of a doctor or a medical staff in sexdetermination will get reward.determination will get reward.

• On the basis of information, PCPNDT officials conducts decoyoperations

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The Republic of Korea – a success story

• In the 1980s and 1990s, the Republic of Korea had a highly imbalanced sex ratio at birth that reached almost 116 (KNSO, 2004). By 2007, the ratio had returned to 107.

• A combination of factors contributed to this shift.• A combination of factors contributed to this shift.

• Two decades of exceptional economic growth led tofundamental changes in Korean society with a shift away froma farm-based economy, increasing desire for smallfamilies, increasing urbanization, greater participation ofwomen in the workforce with better employmentopportunities, and parents having retirement savings for oldage

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The Republic of Korea – a success story

• All of these factors contributed to an increase in the status and value of women and their greater autonomy

• Several laws – such as allowing women rights andresponsibilities within their birth family even afterresponsibilities within their birth family even aftermarriage, and recognizing women-headed households –were seen to be beneficial, as was a Love Your Daughtermedia campaign

• Highly organized and controlled health system in the Republic of Korea was able to regulate sex determination tests more effectively than is the case in China or India (Kim, 2004)

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References

• https://apps.who.int/iris/bitstream/handle/10665/44577/9789241501460_eng.pdf?sequence=1

• https://wcd.nic.in/bbbp-schemes

• https://wcd.nic.in/sites/default/files/Executive%20Summary_HLC_0.pdf

• https://www.atsdr.cdc.gov/communityengagement/pce_what.html

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Eliminate all forms of discriminationagainst the girl child and the root causesof son preference, which result in harmfuland unethical practices regarding femaleand unethical practices regarding femaleinfanticide and prenatal sex selection.

United Nations (1994); paragraph 4.16

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reproductive rights embrace certain human rights that arealready recognized in national laws, international humanrights documents and other consensus documents. Theserights rest on the recognition of the basic right of allcouples and individuals to decide freely and responsibly thecouples and individuals to decide freely and responsibly thenumber, spacing and timing of their children and to havethe information and means to do so, and the right to attainthe highest standard of sexual and reproductive health. Italso includes their right to make decisions concerningreproduction free of discrimination, coercion andviolence, as expressed in human rights documents.

United Nations (1994); paragraph 7.360

• aimed at the prevention and treatment of diseases affecting women, as well as policies to provide access to a full range of high quality and affordable health care, including sexual and reproductive services.

CESCR (2000), General Comment 14, paragraph 21

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…deal with the health impact of unsafe abortion as a majorpublic-health concern and . . . reduce the recourse to abortionthrough expanded and improved family planning services.

UNFPA (1999); paragraph 63iUNFPA (1999); paragraph 63i

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in circumstances where abortion is not against the law, health systems should train and equip health service providers and should take other measures to ensure that such abortion is safe and accessible.

UNFPA (1999); paragraph 63iii

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detailed the roles and status of each member of a householdand lineage, under the unchallenged authority of the male headof the family. These authoritarian kinship relations weremirrored through the political hierarchy, culminating inobeisance to the king.obeisance to the king.

• Chung & Das Gupta (2007)

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