Bringing solidarity, justice and equity to the centre of the bioethics discourse: Overview of proceedings of the joint 14th World Congress of Bioethics and the 7th National Bioethics Conference, 2018

Forum for Medical Ethics Society (FMES), Mumbai; St. John's National Academy of Health Sciences (SJNAHS), Bengaluru; Society for Community Health Awareness Research and Action (SOCHARA,) Bengaluru and SAMA Resource Group for Women and Health, New Delhi co-hosted the joint 14th World Congress of Bioethics (WCB) and the 7th National Bioethics Conference (NBC) in Bengaluru. The theme of the Congress was, "Health for all in an unequal world: Obligations of Global Bioethics". The conference was held at an opportune time when we also commemorate 70 years of the Declaration of Human Rights of 1948 and 40 years of the Alma Ata Declaration of 1978. Both declarations affirmed Health as a fundamental Human Right. We have discussed earlier the significance of the congress theme in the year 2018.

Antenatal Care Service Utilization Among Adolescent Pregnant Women-Evidence From Swabhimaan Programme in India

Purpose: Pregnant adolescent girls (15–19 years) are more vulnerable to poor health and nutrition than adult pregnant women because of marginalization and lack of knowledge about the antenatal care (ANC) services. The present study aims to test this hypothesis and assess determinants of ANC service utilization among currently adolescent pregnant women.

Methods: Data were drawn from the baseline survey of SWABHIMAAN project, which had been conducted in three states of India: Bihar, Chhattisgarh, and Odisha. Out of a total 2,573 pregnant women (15–49 years) included in the sample, about 10% (N = 278) were adolescent girls (15–19 years) at the time of the survey, and the rest were adults. Sample was selected from the population using simple random sampling, and information was collected using pretested questionnaires.

Results: For all indicators of ANC service utilization, performance of adolescent pregnant women was better than adult pregnant women. However, significant variations were reported in the level of services received by adult pregnant women for different indicators. Religion, wealth, food insecurity, Village Health Sanitation and Nutrition Day meeting, Public Distribution System and Integrated Child Development Services entitlements, and knowledge of family planning methods had a significant effect on the ANC service utilization.

Conclusion: Adolescent pregnant women have shown better utilization of selected indicators than their adult counterparts. Utilization of full ANC services starting from first trimester itself for adolescent pregnant women is an urgent need in present context. Intervention program must pay attention to such adolescent married girls who are entering into the motherhood phase of their lives.

WASH practices and its association with nutritional status of adolescent girls in poverty pockets of eastern India

BACKGROUND

Water, Sanitation, and Hygiene (WASH) practices may affect the growth and nutritional status among adolescents. Therefore, this paper assesses WASH practices and its association with nutritional status among adolescent girls.

METHODS

As a part of an intervention programme, this study is based on baseline cross-sectional data. It was conducted between May 2016-April 2017 in three Indian states (Bihar, Odisha, and Chhattisgarh). From a sample of 6352 adolescent girls, information on WASH practices, accessibility to health services and anthropometric measurements (height, weight and mid upper arm circumference (MUAC)) was collected. Descriptive statistics were used to examine WASH practices, and nutritional status among adolescent girls. Determinants of open defecation and menstrual hygiene were assessed using logistic regression. Association between WASH and nutritional status of adolescent girls was determined using linear regression.

RESULTS

Findings showed 82% of the adolescent girls were practicing open defecation and 76% were not using sanitary napkins. Significant predictors of open defecation and non use of sanitary napkin during menstruation were non Hindu households, households with poorer wealth, non availability of water within household premise, non visit to Anganwadi Centre, and non attendance in Kishori group meetings. One-third of adolescent girls were stunted, 17% were thin and 20% had MUAC < 19 cm. Poor WASH practices like water facility outside the household premise, unimproved sanitation facility, non use of soap after defecation had significant association with poor nutritional status of adolescent girls.

CONCLUSIONS

Concerted convergent actions focusing on the provision of clean water within the household premise, measures to stop open defecation, promotion of hand washing, accessibility of sanitary napkins, poverty alleviation and behavior change are needed. Health, nutrition and livelihood programmes must be interspersed, and adolescents must be encouraged to take part in these programmes.

Effect of menstruation on girls and their schooling, and facilitators of menstrual hygiene management in schools: surveys in government schools in three states in India, 2015

Background

Lack of menstrual knowledge, poor access to sanitary products and a non-facilitating school environment can make it difficult for girls to attend school. In India, interventions have been developed to reduce the burden of menstruation for school girls by government and non-governmental organizations (NGOs). We sought to identify challenges related to menstruation, and facilitators of menstrual management in schools in three states in India.

Methods

Surveys were conducted among menstruating school girls in class 8-10 (above 12 years of age) of 43 government schools selected through stratified random sampling in three Indian states (Maharashtra, Chhattisgarh, Tamil Nadu) in 2015. For comparison, ten model schools supported by NGOs or UNICEF with a focussed menstrual hygiene education program were selected purposely in the same states to represent the better-case scenario. We examined awareness about menarche, items used for menstruation, and facilitators on girls’ experience of menstruation in regular schools and compared with model schools. Factors associated with school absence during menstruation were explored using multivariate analysis.

Findings

More girls (mean age 14.1 years) were informed about menstruation before menarche in model schools (56%, n = 492) than in regular schools (36%, n = 2072, P < 0.001). Girls reported menstruation affected school attendance (6% vs 11% in model vs regular schools respectively, P = 0.003) and concentration (40% vs 45%, P = 0.1) and was associated with pain (31% vs 38%, P = 0.004) and fear of stain or smell (11% vs 16%, P = 0.002). About 45% of girls reported using disposable pads in both model and regular schools, but only 55% and 29% of pad-users reported good disposal facilities, respectively (P < 0.001). In multivariate analysis, reported absenteeism during menstruation was significantly lower in Tamil Nadu (adjusted prevalence ratio (APR) 95% confidence interval (CI) = 0.24, 0.14-0.40) and Maharashtra (APR 0.56, CI = 0.40-0.77) compared to Chhattisgarh, and halved in model compared to regular schools (APR 0.50, CI = 0.34-0.73). Pain medication in school (APR 0.71, CI = 0.51-0.97) and use of disposable pads (APR 0.57, CI = 0.42-0.77) were associated with lower absenteeism and inadequate sanitary facilities with higher absenteeism during menstruation.

Conclusions

Menstrual hygiene education, accessible sanitary products, pain relief, and adequate sanitary facilities at school would improve the schooling-experience of adolescent girls in India.