A Study to Assess Empowerment of Adolescent Girls in Terms of Knowledge-Based Life Skills Education About Child Survival and Safe Motherhood Practices

Abstract

Objective

This study has been designed with the intention to bring a substantial change in the mindsets or life skills of adolescent girls at secondary school level regarding their concept of child survival and safe motherhood practices in order to deal effectively with real-life situations.

Methodology

A cross-sectional analytical study was carried out with 538 adolescent girls regarding assessment of their knowledge on variables like correct nutrition, iron-deficiency anemia and its prevention, care during pregnancy, safe birth, skilled birth attendance, breast feeding and complementary feeding practices, child’s growth and development issues, immunization, management of common childhood illnesses. etc.

Conclusion

Analysis was done using Mc Nemar’s Chi-square test for paired data. Values obtained were highly significant for nutrition, iron-deficiency anemia and its prevention, care during pregnancy, and management of childhood illnesses variables, whereas study findings were found to be insignificant for rest of the variables. This study based on life skills approach and counseling worked well to promote and motivate adolescent girls for positive decision making. In this context, every adolescent girl should be encouraged to raise her unsolved issues in order to achieve safe motherhood plus growth and development of their children.

Introduction

The life skills approach is an interactive educational methodology that not only focuses on transmitting knowledge but also aims to shape attitudes and develop interpersonal skills. The main goal of the life skills approach is to enhance adolescent’s ability to take responsibility for making healthier choices, resisting negative pressures, and avoiding risk behavior.

The World Health Organization has defined life skills as, “the abilities for adaptive and positive behaviour that enable individuals to deal effectively with the demands and challenges of everyday life.” In other words, Life skills are abilities that facilitate the physical, mental, and emotional well-being of an individual.

Over the years, the educational program has focused on life skills development, which has contributed to the reproductive and sexual health of adolescents and young people around the world [1].

It is an accepted fact that young people have a right to life skills education, since it provides them with knowledge and enables them to acquire appropriate skills to protect themselves against abuse, exploitation, unintended pregnancies, sexually transmitted diseases, and HIV/AIDS, and to lead a better, safe as well as dignified life [2].

Vibrant with enthusiasm, resilient with energy, and filled with curiosity, adolescents are responsive and responsible given the positive contextual environment. They have the immense potential to change negative societal patterns of behavior and break cycles of stereotyped dispositions. With their creativity and energy, adolescents can change the present world in astonishing ways, making it a better place not only for themselves but also for all.

Aims and Objectives

This study has been designed with the intention to bring a substantial change in the mindsets or life skills of adolescent girls at secondary school level regarding their concepts of child survival and safe motherhood practices in order to deal effectively with real-life situations and the objectives of the study were

• To verify statistically whether any significant difference occurred in the adolescent girls’ knowledge level after getting life skills education based on life development interventions framework.

• To evaluate the indirect projections/impact obtained in terms of various future indicator’s reduction like Maternal mortality rates (MMR), Infant mortality rates (IMR), Under 5 mortality rates, etc., due to improvement in knowledge of adolescent girls regarding child survival and safe motherhood practices.

• To recommend developing a conceptual framework for life skills interventions at an appropriate age of an individual.

Methodology

Study design: Cross-sectional analytic study.

Study population: Adolescent girls of government senior secondary school who were willing to participate in the study were taken as target population from Bhopal and Hoshangabaad districts of Madhya Pradesh.

Study setting: Target population was tested with pre- and post-test questionnaires after giving knowledge-based life skills education on child survival and safe motherhood practices.

Period of study: 1 month.

Sample size: Sample size estimated by simple random sampling as 538.

Hypothesis:

H₀

There is no difference in the knowledge status of the target population after giving Information, Education, and Communication (IEC)- and Behavioral Change Communication (BCC)-based Life Skills training.

Variables under study: Correct nutrition, Iron- deficiency anemia and its prevention, care during pregnancy, safe birth, skilled birth attendance, breast feeding, complementary feeding, child’s growth and development issues, immunization, and management of common childhood illnesses.

Inclusion criteria: The above-mentioned target population was included in the study. Girls present throughout IEC/BCC sessions were included.

Exclusion criteria: Girls other than senior secondary classes were excluded from the study. Also girls absent in some of the sessions were excluded from the study.

Source of data: Filled Pre- and Post-test questionnaires collected from target population.

Research Instruments: Information, Education, and Communication (IEC)- and Behavioral Change Communication (BCC)-based Life Skills Approaches, and structured questionnaires.

Statistical tool: MS Excel software package.

Ethical considerations: Informed consent was taken.

Confidentiality of data was maintained.

Results

Five hundred and thirty-eight girls were pre-tested by a structured questionnaire regarding assessment of their knowledge status about the above-mentioned variables. Only 219 girls agreed for iron folic acid (IFA) interventional trial, and their pre- versus post-interventional hemoglobin statuses were checked. A knowledge-based training was given to these girls about relevant variables to enhance their knowledge by IEC and BCC methods. This group of girls was reassessed with a post-test questionnaire.

Analysis was done using Mc Nemar’s Chi-square test for paired data. Statistical values obtained were highly significant for nutrition, iron-deficiency anemia and its prevention, care during pregnancy, and management of childhood illnesses variables, whereas study findings were found to be insignificant for the rest of the variables (Tables 1, 2).

Table 1.

Distribution of study population in terms of numbers and percentages regarding their knowledge statuses about the variables in pre- and post-tests

S. no	Name of the variable	Results	Pre-test	Post-test
1.	Awareness about nutrition	Correct	300 (55.7 %)	390 (72.4 %)
		Incorrect	238 (44.2 %)	148 (27.5 %)
2.	Awareness about iron- deficiency anemia	Correct	241 (44.7 %)	390 (72.4 %)
		Incorrect	297 (55.2 %)	148 (27.5 %)
3.	Reduction in anemia	Normal	49/438	101/438
		Anemic	170/438	118/438
4.	Awareness about care during pregnancy	Correct	277 (51.4 %)	387 (71.9 %)
		Incorrect	261 (48.5 %)	151 (28.06 %)
5.	Awareness about safe delivery	Correct	237 (44.05 %)	327 (60.7 %)
		Incorrect	301 (55.94 %)	211 (39.21 %)
6.	Awareness about complementary feeding	Correct	214 (39.77 %)	332 (61.7 %)
		Incorrect	324 (60.22 %)	206 (38.2 %)
7.	Awareness about immunization and breast feeding	Correct	216 (40.14 %)	291 (54.08 %)
		Incorrect	322 (59.8 %)	247 (45.91 %)
8.	Management of childhood illnesses	Correct	287 (53.3 %)	427 (79.3 %)
		Incorrect	251 (46.6 %)	111 (20.6 %)
9.	Growth and development of child	Correct	241 (44.7 %)	342 (63.5 %)
		Incorrect	297 (55.20 %)	196 (36.43 %)

Table 2.

Chi-square values of variables under study as per distribution of scores of study population in assessment of knowledge statuses of pre- and post-tests

Variables	Mc Nemar’s test values (at df 1 = 10.83)	P value at 1df
Awareness about nutrition	36.30	<0.00
Awareness about iron- deficiency anemia	12.32	<0.00
Reduction in anemia	17.06	<0.00
Awareness about care during pregnancy	24.11	<0.00
Awareness about safe delivery	0.99	>0.05
Awareness about complementary feeding	0.074	>0.05
Awareness about immunization and breast feeding	1.46	>0.05
Management of childhood illnesses	45.16	<0.00
Growth and development of child	3.02	>0.05

Discussion

Adolescence is a period of experiencing, and expanding. Adolescents need help and guidance in decision making, problem solving, critical thinking, developing interpersonal skills, self-awareness, empathy, coping with stress, and managing emotions.

As certain inbuilt buffers of the society (both as support and control) are no longer available to the adolescents of today (for instance: extended family system, the smaller community that is personal and closed uniform culture—in the smaller circle of living, traditional ways of thinking.), there is an urgent need to provide today’s youth with a new set of ways and systems to deal with the demands of life.

The Family Life and Life Skills Education Programme is a good support system for adolescents at the community level.

Adolescent girls of today are mothers of tomorrow. Keeping this view in mind, policy makers should introduce life skills interventional framework in curriculum regarding child survival and safe motherhood so that it would be possible to empower adolescent girls at right time for future vital events of their lives.

One of the commonest problem statements in this regard is—poorly nourished body of mother is a major indirect cause of increased maternal as well as child morbidity and mortality. If growing girls are made aware of this truth in their early years, they will definitely become conscious about their dietary pattern and will start exploring more nutritious, healthy, and easily available food options [3–6].

This approach based on Information, Education and Communication (IEC)- and Behavioral Change Communication (BCC)-based strategy is found to be an effective tool to avert the high tolls of maternal mortality rates, infant mortality rates, under five mortality rates, etc. in future.

Including this aspect of life in routine curriculum will be a milestone in protecting reproductive health of females as well as lives of children.

Empowerment of females is also one of the Millennium Development Goals.

In this study, adolescent girls were explained about the importance of knowledge which may be useful for themselves, their family members, and friends. Rich knowledge information was shared with them in terms of present Indian context and recommended guidelines in a very easy-to-understand manner.

The impact of motivation was found to be positive in terms of knowledge-based empowerment in child-rearing practices including breast feeding, complementary feeding, immunization, infection prevention practices, and self-care through proper nutrition, etc. [3, 4].

Findings of present study match with the findings of similar studies of Gupta and A.K. Mathur (2009), and S.Bhattacharya and R.Bishwas (1997).

Also findings related to improvement in iron-deficiency anemia by consuming iron and folic acid and dewarming tablets match with other studies like Hemlata MS (2000), Begum S (2000), Talikati Koojal (1995), A Saibaba (2002), J. Rajaratnam (2000), and S.M.Choudhary (2008) [7, 8].

Similarly other findings are strongly suggestive of improvement in knowledge about nutritional status, safe motherhood, and prevention from childhood illnesses, etc., due to the impact of the knowledge-based empowerment (through aptitude practice in communication and education) [9–11].

However, insignificant results were obtained in terms of safe delivery process, breast feeding, immunization, proper growth, and development of child.

Conclusion

During the study, it was revealed that adolescent girls were keen to learn about the child-rearing practices and safe motherhood. This group of adolescents was very receptive and interactive on the issues addressed.

This study based on life skills approach and counseling worked well to promote and motivate adolescent girls for positive decision making.

In this context, every adolescent girl should be encouraged to raise her unsolved issues in order to achieve safe motherhood plus growth and development of their children. Hence, more and more such sessions should be conducted at mass level to generate public awareness, skill development, and positive behavioral changes.

These efforts will prove to be beneficial in the long term to avert adverse maternal mortality ratios, infant mortality rates, malnutrition problem, early-age marriage crisis, etc.

Many past interventional studies by using life skills approach in adolescent age groups have been proven to be an important landmark in bringing a required change in their life styles

Similarly, statistical proof obtained from this study adds impact on further use of such interventional methods like IEC plus BCC in adolescent age groups to attain desired improved health standards in order to avert morbidity and mortality patterns of current India

Dr. Abhay Kumar Choudhary

is the Chief Medical Superintendent at LN Medical College and Hospital, Bhopal. He is an excellent clinician and presently serving as President at the Indian academy of Pediatrics, Bhopal. He has dedicated his service to the cause of reducing prenatal infant mortality and has been elemental in pulse polio program running nationwide on behalf of the Indian central government. He has coauthored a book on “Neonatal Resuscitation in Labor room”. He is credited with publishing many articles in reputed medical journals so far.

Compliance with ethical requirements and Conflict of interest

Conducted study after getting permission from ethical institutional committee. There is no conflict of interest.