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  • CAPTION: Nirmala Shukla, wearing white, is another member of the panchayati raj system. She is also very active in Community COPE as a part of the information system, bringing its work to the public's attention and serving as a bridge to the press. Shruti Deogam, to her left in orange, is the pramud, the elected head of Ghatshila Block (meaning the highest rank in the panchayati raj system), and is also an important representative of the community to the outside in that she links the block to those higher up at the district level. She is the leader of the Community COPE exercise, and helps to bring in high-level officials to address issues being experienced at the block level. In this line of women (from right to left) we see the pramud (working at the block level), mukhya (village level), Vandana Maitry who is a ward member (village level), and a new Community COPE member. They are discussing what the work plan has addressed so far and what is still to be addressed. LOCATION: Pawra (village), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Bisu Murmu, Vandana Maitry, Parwati Murmu, Shruti Deogam, Nirmala Shukla and Shyam Bahadur Sonar.
    IMG44633.jpg
  • CAPTION: These are sahiyas attached to Ghatshila CHC who've been trained on adolescent reproductive and sexual health, and in how to communicate with adolescent girls on these issues. At the beginning of the sessions they conduct at the anganwadi center (literally: 'courtyard shelter' in Hindi), they start with a song about the importance of young women taking care of their health as they grow up and how important adolescents are in bringing change in their society in the long run. The song includes mention of how everyone has the power to take decisions on their own health, and to change both themselves and society as a whole (which includes the importance of completing Higher Secondary education). LOCATION: Pawra Anganwadi Centre (AWC), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Dipali Baskey, Rupali Shit, Bhasa Sharma, Anupma Soren and Sombari Tudu.
    IMG44917.jpg
  • CAPTION: Dr Ram and his colleagues are forming what they call a 'chain of information', so that even if families don’t allow their youth to seek out the services they need in person, friends can pass on the news about what the ARSH clinic can provide. He observes that another problem is that most families think only of educating their boys on what they need, and just think about marrying their girls off. So it’s important to ensure that girls don’t fall through the net. These four girls are part of the discussion group that’s been established in Ghatshila. They have asked Dr Ram to come to the community college where they are studying nearby and take sessions for all the adolescent girls there to ensure they will then access the services they need. They therefore serve as the link between the college and Dr Ram. LOCATION: Adolescent Reproductive and Sexual Health (ARSH) clinic, Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Tulika Shit, Sujata Shit, Rakhi Shit and Atosi Shit.
    IMG44870.jpg
  • CAPTION: This is the Adolescent Reproductive and Sexual Health (ARSH) clinic at Ghatshila Community Health Centre (CHC). Atosi Shit (right) is an adolescent client, and Sarita Kumari Panna (left) is an ARSH Counselor. Here, Kumari is giving information on hygienic practices during the menstrual cycle in order to guard against infection and possible infertility. The ARSH clinics have been designed to provide health-related services to young people aged between 10 and 19 at a time when they are going through a lot of changes, both physically and mentally. This can mean anything from getting a small wound dressed to getting an abortion. LOCATION: Adolescent Reproductive and Sexual Health (ARSH) clinic, Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Sarita Kumari Panna (left) and Atosi Shit (right).
    IMG44753.jpg
  • CAPTION: Dr Ram and his colleagues are forming what they call a 'chain of information', so that even if families don’t allow their youth to seek out the services they need in person, friends can pass on the news about what the ARSH clinic can provide. He observes that another problem is that most families think only of educating their boys on what they need, and just think about marrying their girls off. So it’s important to ensure that girls don’t fall through the net. These four girls are part of the discussion group that’s been established in Ghatshila. They have asked Dr Ram to come to the community college where they are studying nearby and take sessions for all the adolescent girls there to ensure they will then access the services they need. They therefore serve as the link between the college and Dr Ram. LOCATION: Adolescent Reproductive and Sexual Health (ARSH) clinic, Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Atosi Shit, Rakhi Shit, Sujata Shit and Tulika Shit.
    IMG44891.jpg
  • CAPTION: Community COPE members come to ask a householder about what her expectations of the health system are and what she feels ought to be done to get more people into the Government-run Community Health Centre (CHC). The men and women have teamed up here; mostly the men talk with the male heads of households. This lady has been living in this community for around 40 years since marriage. She has observed many changes in health service provision. She says that the panchayati raj system has brought significant health service changes for her, which she’s very happy about. She says that people hear from the newspapers and TV what they can access. The newly-elected female panchayati raj members, reserved 50% of the positions as part of women’s empowerment efforts, have been very active in changing how the government system works and serves people. LOCATION: Pawra (village), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Daya Nidhi Shit, Damodar Shit, Shruti Deogam, Punta Hansda and Parwati Murmu.
    IMG44705.jpg
  • CAPTION: Daya Nidhi Shit is a retired government worker who is very active in the community. He says he is especially keen on COPE because it is ensuring access to much in healthcare that was previously unavailable in this block. Here, he is raising the issue of non-availability of appropriate medicines for snake and dog bites. LOCATION: Pawra (village), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Damodar Shit.
    IMG44640.jpg
  • CAPTION: Sahiya Anupma Soren takes a monthly session with the 15-19-year olds. The discussion covers delaying the age of marriage, antenatal care, where the ARSH clinic is and what it does, the methods of family planning that the facility can help with, and what their respective pros and cons are. The Government requires these sessions to be conducted monthly. Sahiyas are given an incentive of ₹ 75 per session they lead. The girls are asked to come on a regular basis, as the knowledge imparted builds over time. LOCATION: Pawra Anganwadi Centre (AWC), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Anupma Soren, Pritilata Giope, Sarshati Hansda, Maya Namata and Kajal Namata.
    IMG44957.jpg
  • CAPTION: Sahiya Anupma Soren takes a monthly session with the 15-19-year olds. The discussion covers delaying the age of marriage, antenatal care, where the ARSH clinic is and what it does, the methods of family planning that the facility can help with, and what their respective pros and cons are. The Government requires these sessions to be conducted monthly. Sahiyas are given an incentive of ₹ 75 per session they lead. The girls are asked to come on a regular basis, as the knowledge imparted builds over time. LOCATION: Pawra Anganwadi Centre (AWC), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Anupma Soren, Pritilata Giope, Sarshati Hansda, Maya Namata and Kajal Namata.
    IMG44987.jpg
  • CAPTION: . LOCATION: Pawra (village), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Nirmala Shukla, Panchami Namta and Susmita Mardi.
    IMG44697.jpg
  • CAPTION: Dr Ram Chandra Soren is the Medical Officer-in-Charge in this area. Here, he is training Community COPE members on how efficiency can be improved. This involves consideration of how best to draw up a work plan, how to gather knowledge, how work can then be done, how follow-ups can be done, how analysis of what’s been done should happen, how information gathering should again happen, and so on. The cycle aims for quality improvement, and is continuous, not a one-time thing. Benchmarks are regularly set and reviewed. LOCATION: Pawra (village), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Dr Ram Chandra Soren.
    IMG44603.jpg
  • CAPTION: Community COPE is promoting institutional delivery, and is raising awareness that the Government has set aside money to facilitate this through the Janani Suraksha Yojana (JSY) scheme. This roughly translates as 'New Mother’, and provides ₹ 1,400 for the mother and newborn child. This lady has received this money directly to her bank account, yet it turns out she’s unaware of this. Here, Vandana Maitry is assuring her that the money is there and she can withdraw it. During the initial days after birth, it’s especially important that the baby should get adequate nutrition. The system was changed to ensure mothers would get the money and it wouldn’t fall into the wrong hands, but the problem is that husbands or heads of households can also appropriate it under the new system. LOCATION: Adolescent Reproductive and Sexual Health (ARSH) clinic, Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Sarita Kumari Panna (left) and Atosi Shit (right).
    IMG44747.jpg
  • CAPTION: Dr Ram Chandra Soren, the area’s Medical Officer-in-Charge, notes that adolescents tend to be reluctant to visit their CHCs, preferring private clinics and 'quacks', because they assume that they will not get what they need there, or that there will be insufficient privacy. He assures them that they can get what they need from the ARSH clinic with full privacy and confidentiality. Changing awareness about this has resulted in significant positive changes, such as a marked reduction in septic abortions. LOCATION: Adolescent Reproductive and Sexual Health (ARSH) clinic, Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Dr Ram Chandra Soren.
    IMG44861.jpg
  • CAPTION: Sahiya Anupma Soren quizzes the girls on such subjects as the legal age of marriage, their daily nutritional needs and the foods that can provide these, the sort of medical advice that’s available for them, etc. There are two groups in the room. One is made up of married adolescents, aged 15-19, which discusses delaying the age of marriage, the different methods of family planning that are available, and antenatal care; the other consists of 10 to 14-year olds, with some school-going girls and some school dropouts, and this group focuses in a big way on nutrition, menstrual hygiene, and developmental changes. LOCATION: Pawra Anganwadi Centre (AWC), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Anupma Soren (standing, left) and multiple others.
    IMG44923.jpg
  • CAPTION: Sahiya Anupma Soren takes a monthly session with the 15-19-year olds. The discussion covers delaying the age of marriage, antenatal care, where the ARSH clinic is and what it does, the methods of family planning that the facility can help with, and what their respective pros and cons are. The Government requires these sessions to be conducted monthly. Sahiyas are given an incentive of ₹ 75 per session they lead. The girls are asked to come on a regular basis, as the knowledge imparted builds over time. LOCATION: Pawra Anganwadi Centre (AWC), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Anupma Soren, Pritilata Giope, Sarshati Hansda, Maya Namata and Kajal Namata.
    IMG44982.jpg
  • CAPTION: This is a training of frontline workers (FLWs): auxiliary nurse midwives (ANMs) and lady health visitors (LHVs). The latter supervise ANMs. Across the state, there are more than 2,000 FLWs. The Government-approved plan states that these individuals must have five days of training on adolescent reproductive and sexual health matters. It is being conducted by Dr Jagannath Hembrom, a ‘Master Trainer’. His role is more as a facilitator than a teacher. There is a pool of 67 such master trainers in Jharkhand, and Dr Jagannath is recognized as one of the best of these.  LOCATION: Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Left: Dr Jagannath Hembrom; right: multiple people.
    IMG45046.jpg
  • CAPTION: Training of frontline workers (FLWs) is being rolled out in phases. Topics include developmental changes among adolescents and their consequences; nutritional requirements and how to meet them, plus what happens if they are not met; family planning; reproductive tract infections (RTIs) and sexually transmitted infections (STIs); menstrual hygiene; non-communicable diseases; and how to counsel on all of these things. Of these, counseling takes the major focus. LOCATION: Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Left: Dr Jagannath Hembrom; right: multiple people.
    IMG45066.jpg
  • CAPTION: Community COPE members come to ask a householder about what her expectations of the health system are and what she feels ought to be done to get more people into the Government-run Community Health Centre (CHC). She says she’s happy with what she’s been accessing, but reveals a lack of awareness of what she is actually entitled to. Shyam Bahadur Sonar is therefore suggesting that she should discuss her needs with knowledgeable community members. Kalicharan Namata (second from left) is one of the two adolescent representatives in Community COPE, and has an important role in bringing adolescent voices into the community dialogue. LOCATION: Pawra (village), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Shyam Bahadur Sonar (left) and Rupa Namata (right).
    IMG44723.jpg
  • CAPTION: The final group is listing out the various mental and social changes experienced by adolescents. One of these is the development of attraction to the opposite sex. It is impressed upon participants that this is something natural that happens to everyone, and that it should not be condemned as something 'bad'. Another is that girls start wanting to make themselves appear as beautiful as possible to others. Boys, meanwhile, might like to drive very fast in front of others, or smoke and take drugs. The group is considering the consequences of these things and how they may be addressed. After discussing these things, the groups join together and discuss what they have each found. This then leads to the enactment of role-plays. LOCATION: Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Kalpana Mahato, Savita Horo, Dr Jagannath Hembrom, Krishna Chakrabarty and Shobha Kumari Nirali.
    IMG45134.jpg
  • CAPTION: During the first day of the training, the participants are divided into three for group work. In this exercise, the groups have been asked to consider the various developmental changes that occur socially, physically, and mentally among adolescents, and what the consequences of these are. This group is listing out the consequences of the various physical changes that occur in the body. For example, breast development among girls leads them to bend forward slightly, which can cause them pain in the lower back and waist region. LOCATION: Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Ruby Kumari, Bela Sarkar, A Sharada and Dr Jagannath Hembrom.
    IMG45104.jpg
  • CAPTION: Shyam Bahadur Sonar has been engaged with the Community COPE initiative for the past six months. In the community, he is a cricket coach and talent scout, and he's also politically active. He has been a particularly active COPE member, providing a great deal of insight during the scoping phase. LOCATION: Pawra (village), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Shyam Bahadur Sonar.
    IMG44654.jpg
  • CAPTION: The lady on the right is a sahiya. She serves as a link between the health system and the community, working at the grassroots in villages. Every village has at least one sahiya. They help health service professionals understand what community needs are and what issues community members are facing. LOCATION: Adolescent Reproductive and Sexual Health (ARSH) clinic, Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Dr Ram Chandra Soren (left) and Rupali Shit (right).
    IMG44844.jpg
  • CAPTION: Sahiya Anupma Soren takes a monthly session with the 15-19-year olds. The discussion covers delaying the age of marriage, antenatal care, where the ARSH clinic is and what it does, the methods of family planning that the facility can help with, and what their respective pros and cons are. The Government requires these sessions to be conducted monthly. Sahiyas are given an incentive of ₹ 75 per session they lead. The girls are asked to come on a regular basis, as the knowledge imparted builds over time. LOCATION: Pawra Anganwadi Centre (AWC), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Anupma Soren, Pritilata Giope, Sarshati Hansda, Maya Namata, Kajal Namata and Sunita Murmu .
    IMG44965.jpg
  • CAPTION: The final group is listing out the various mental and social changes experienced by adolescents. One of these is the development of attraction to the opposite sex. It is impressed upon participants that this is something natural that happens to everyone, and that it should not be condemned as something 'bad'. Another is that girls start wanting to make themselves appear as beautiful as possible to others. Boys, meanwhile, might like to drive very fast in front of others, or smoke and take drugs. The group is considering the consequences of these things and how they may be addressed. After discussing these things, the groups join together and discuss what they have each found. This then leads to the enactment of role-plays. LOCATION: Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Standing: Dr Jagannath Hembrom; sitting (far side, from left to right): Kalpana Mahato, Savita Horo, Krishna Chakrabarty and Shobha Kumari Nirali.
    IMG45132.jpg
  • CAPTION: The final group is listing out the various mental and social changes experienced by adolescents. One of these is the development of attraction to the opposite sex. It is impressed upon participants that this is something natural that happens to everyone, and that it should not be condemned as something 'bad'. Another is that girls start wanting to make themselves appear as beautiful as possible to others. Boys, meanwhile, might like to drive very fast in front of others, or smoke and take drugs. The group is considering the consequences of these things and how they may be addressed. After discussing these things, the groups join together and discuss what they have each found. This then leads to the enactment of role-plays. LOCATION: Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Ratna Das Banerjee, Kalpana Mahato, Savita Horo and Krishna Chakrabarty.
    IMG45153.jpg
  • CAPTION: On the right is Damodar Shit, a retired teacher, and a new and instrumental member of Community COPE. He has been very helpful in the education domain, even before joining, working in schools and bridging the gap between schools and the health system. In the center is Daya Nidhi Shit, a retired government worker who is very active in the community. He says he is especially keen on COPE because it is ensuring access to much in healthcare that was previously unavailable in this block. Here, he is raising the issue of non-availability of appropriate medicines for snake and dog bites. On the right is Shiv Shankar Chandra, Community COPE's storekeeper. LOCATION: Pawra (village), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Daya Nidhi Shit, Damodar Shit and Shiv Shankar Chandra.
    IMG44652.jpg
  • CAPTION: During the first day of the training, the participants are divided into three for group work. In this exercise, the groups have been asked to consider the various developmental changes that occur socially, physically, and mentally among adolescents, and what the consequences of these are. This group is listing out the consequences of the various physical changes that occur in the body. For example, breast development among girls leads them to bend forward slightly, which can cause them pain in the lower back and waist region. LOCATION: Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Ruby Kumari, Bela Sarkar, A Sharada and Dr Jagannath Hembrom.
    IMG45090.jpg
  • CAPTION: Parwati Murmu is one of Community COPE's elected members. She is the mukhya (head of four to five villages) of the Pawra area, and is one of the most active Community COPE leaders. Before getting elected, she had 15 years’ experience in the panchayati raj system. The panchayati raj system dictates that 50% of those elected must be female; in this area, 60-70% are. She also used to be a very active anganwadi worker, and because she is very knowledgeable on relevant health matters she now helps a lot with mother and child health services. LOCATION: Pawra (village), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Bisu Murmu, Vandana Maitry and Parwati Murmu.
    IMG44554.jpg
  • CAPTION: Vandana Maitry, center, is again a very active member of Community COPE and a part of the panchayati raj system. She also works as a trainer of sahiyas at the block level. Accredited Social Health Activists (ASHAs) work at the grassroots level in the health system; they are called sahiyas in Jharkhand, which means 'people’s helping hand'. Vandana is particularly active in helping to keep hospital premises clean. She serves an educative role, working to ensure trashcan usage increases, spitting is prevented, and people use toilets properly, especially as many are reluctant not to use open spaces for defecation. LOCATION: Pawra (village), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Bisu Murmu, Vandana Maitry and Parwati Murmu.
    IMG44634.jpg
  • CAPTION: The media is interested in COPE because the Community is all about bringing positive change. This journalist is from GTN News, a local cable channel which broadcasts across several districts of Jharkhand. LOCATION: Pawra (village), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Left: unknown; right: Shruti Deogam.
    IMG44665.jpg
  • CAPTION: Community COPE members come to ask a householder about what her expectations of the health system are and what she feels ought to be done to get more people into the Government-run Community Health Centre (CHC). The men and women have teamed up here; mostly the men talk with the male heads of households. This lady has been living in this community for around 40 years since marriage. She has observed many changes in health service provision. She says that the panchayati raj system has brought significant health service changes for her, which she’s very happy about. She says that people hear from the newspapers and TV what they can access. The newly-elected female panchayati raj members, reserved 50% of the positions as part of women’s empowerment efforts, have been very active in changing how the government system works and serves people. LOCATION: Pawra (village), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Vandana Maitry, Kalicharan Namata, Shyam Bahadur Sonar and Rupa Namata.
    IMG44718.jpg
  • CAPTION: Adolescent client Sujata Shit is getting her blood pressure checked. She came to the ARSH clinic complaining of weakness and a spinning head. Most of the girls with anemia have low blood pressure. LOCATION: Adolescent Reproductive and Sexual Health (ARSH) clinic, Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Sarita Kumari Panna (left) and Sujata Shit (right).
    IMG44803.jpg
  • CAPTION: Adolescent Rakhi Shit is being taught about family planning methods. The counselor Sarita Kumari Panna is telling her about the different options available to her. This information is not considered something that should be given only after marriage; it is recognized that sexual activity could happen before as well, even though this is culturally unacceptable. Most of the girls here (and also the boys) are unaware that the condom is something that can be used to prevent STIs - including AIDS - and unwanted pregnancy. Owing to this ignorance, under-age pregnancies are quite common, and abortions - including unsafe illegal ones - are being sought. LOCATION: Adolescent Reproductive and Sexual Health (ARSH) clinic, Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Sarita Kumari Panna (left) and Rakhi Shit (right).
    IMG44789.jpg
  • CAPTION: ARSH Counselor Sarita Kumari Panna explains the use of iron and folic acid tablets to Atosi Shit. Most of the adolescent girls (perhaps 80-90%) in villages like this are anemic. There is large-scale absence of awareness of how to ensure their diets contain iron and folic acid, especially with the rising popularity of fast food while young people are away at school or college. Girls are especially unaware, after their menstrual cycles start, about when they ought to have particular types of nutrition. This often results in menstrual problems and anemia. LOCATION: Adolescent Reproductive and Sexual Health (ARSH) clinic, Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Sarita Kumari Panna (left) and Atosi Shit (right).
    IMG44811.jpg
  • CAPTION: Sahiya Anupma Soren quizzes the girls on such subjects as the legal age of marriage, their daily nutritional needs and the foods that can provide these, the sort of medical advice that’s available for them, etc. There are two groups in the room. One is made up of married adolescents, aged 15-19, which discusses delaying the age of marriage, the different methods of family planning that are available, and antenatal care; the other consists of 10 to 14-year olds, with some school-going girls and some school dropouts, and this group focuses in a big way on nutrition, menstrual hygiene, and developmental changes. LOCATION: Pawra Anganwadi Centre (AWC), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Anupma Soren (standing, left) and multiple others.
    IMG44921.jpg
  • CAPTION: Sahiya Anupma Soren takes a monthly session with the 15-19-year olds. The discussion covers delaying the age of marriage, antenatal care, where the ARSH clinic is and what it does, the methods of family planning that the facility can help with, and what their respective pros and cons are. The Government requires these sessions to be conducted monthly. Sahiyas are given an incentive of ₹ 75 per session they lead. The girls are asked to come on a regular basis, as the knowledge imparted builds over time. LOCATION: Pawra Anganwadi Centre (AWC), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Anupma Soren, Pritilata Giope, Sarshati Hansda, Maya Namata, Kajal Namata, Anjana Hembrom and Sunita Murmu.
    IMG44959.jpg
  • CAPTION: This is the group aged 10-14. The song the sahiya is leading is about the nutritional requirements of the adolescent age group, and how nutrition affects their mental, physical, and social development, as well as how important it is for future generations. They are singing in Santhal, the local tribal language. LOCATION: Pawra Anganwadi Centre (AWC), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Multiple people.
    IMG45034.jpg
  • CAPTION: This is the group aged 10-14. The song the sahiya is leading is about the nutritional requirements of the adolescent age group, and how nutrition affects their mental, physical, and social development, as well as how important it is for future generations. They are singing in Santhal, the local tribal language. LOCATION: Pawra Anganwadi Centre (AWC), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Multiple people.
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  • CAPTION: The training of frontline workers (FLWs) is very participatory, and it is not held exclusively in classrooms. There is a lot of group work, which the master trainer facilitates, as well as role-plays wherein case studies are acted out. Service providers are taught not only on how to counsel children, but also their parents. EngenderHealth is measuring the effectiveness of what it’s doing in different ways. One involves looking at how those they train perform using a performance to standard tool. Knowledge is tested, counseling is observed, and a check on what services are being given is carried out. If there are gaps, an effort is made to consider how these might be addressed. Another considers how many adolescents (male and female, across different ages) are accessing these services, and which services specifically. So far, it has been noted that male take-up has been slightly lower than female. LOCATION: Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Left: Dr Jagannath Hembrom; right: multiple people.
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  • CAPTION: The final group is listing out the various mental and social changes experienced by adolescents. One of these is the development of attraction to the opposite sex. It is impressed upon participants that this is something natural that happens to everyone, and that it should not be condemned as something 'bad'. Another is that girls start wanting to make themselves appear as beautiful as possible to others. Boys, meanwhile, might like to drive very fast in front of others, or smoke and take drugs. The group is considering the consequences of these things and how they may be addressed. After discussing these things, the groups join together and discuss what they have each found. This then leads to the enactment of role-plays. LOCATION: Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Standing: Dr Jagannath Hembrom; sitting: multiple people.
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  • CAPTION: Sahiya Anupma Soren quizzes the girls on such subjects as the legal age of marriage, their daily nutritional needs and the foods that can provide these, the sort of medical advice that’s available for them, etc. There are two groups in the room. One is made up of married adolescents, aged 15-19, which discusses delaying the age of marriage, the different methods of family planning that are available, and antenatal care; the other consists of 10 to 14-year olds, with some school-going girls and some school dropouts, and this group focuses in a big way on nutrition, menstrual hygiene, and developmental changes. LOCATION: Pawra Anganwadi Centre (AWC), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Anupma Soren (standing, left) and multiple others.
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  • CAPTION: Sahiya Anupma Soren takes a monthly session with the 15-19-year olds. The discussion covers delaying the age of marriage, antenatal care, where the ARSH clinic is and what it does, the methods of family planning that the facility can help with, and what their respective pros and cons are. The Government requires these sessions to be conducted monthly. Sahiyas are given an incentive of ₹ 75 per session they lead. The girls are asked to come on a regular basis, as the knowledge imparted builds over time. LOCATION: Pawra Anganwadi Centre (AWC), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Anupma Soren, Pritilata Giope, Sarshati Hansda, Maya Namata and Kajal Namata.
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  • CAPTION: Dr Jagannath Hembrom is the Medical Officer-in-Charge in Chaibasa in the Jharkhand district of West Singhbhum. The facility here is recognized as the best clinic in the state. In addition to FLWs, he also trains medical officers and outreach workers. He is particularly passionate about working with adolescents. He also serves as a referral point, where sahiyas are unable to answer adolescents' particular questions or meet their particular needs. Dr Jagannath has even been recognized for his training talents at the national level. LOCATION: Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Dr Jagannath Hembrom.
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  • CAPTION: Community COPE members come to ask a householder about what her expectations of the health system are and what she feels ought to be done to get more people into the Government-run Community Health Centre (CHC). She says she’s happy with what she’s been accessing, but reveals a lack of awareness of what she is actually entitled to. Shyam Bahadur Sonar is therefore suggesting that she should discuss her needs with knowledgeable community members. LOCATION: Pawra (village), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Vandana Maitry (left) and Rupa Namata (right).
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  • CAPTION: Adolescent client Tulika Shit has a lower respiratory tract infection. Many adolescents in this area have tuberculosis (TB) but don’t realize it. So Dr Ram Chandra Soren is checking whether her symptoms add up to this. ARSH clinics provide services that extend far beyond reproductive and sexual health. They are far more accessible to young people than the outpatient department (OPD) at the hospital is, ensuring they can get the services they need quickly. LOCATION: Adolescent Reproductive and Sexual Health (ARSH) clinic, Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Sarita Kumari Panna (left) and Sujata Shit (right).
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  • CAPTION: Sahiya Anupma Soren takes a monthly session with the 15-19-year olds. The discussion covers delaying the age of marriage, antenatal care, where the ARSH clinic is and what it does, the methods of family planning that the facility can help with, and what their respective pros and cons are. The Government requires these sessions to be conducted monthly. Sahiyas are given an incentive of ₹ 75 per session they lead. The girls are asked to come on a regular basis, as the knowledge imparted builds over time. LOCATION: Pawra Anganwadi Centre (AWC), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Anupma Soren, Pritilata Giope, Sarshati Hansda, Maya Namata and Kajal Namata.
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  • CAPTION: This group is considering sexual changes, such as the start of the menstrual cycle. Girls tend not to be aware that this is coming up, as parents and even the health system tend not to orient them on it. Then, when bleeding happens for the first time and it shows through a girl’s clothes, she may feel very embarrassed. So adolescents, schools, parents, and other family members all need to be sensitized. A similar example in the case of boys is night emissions after 'wet dreams'. The first time this happens, the boy may be very startled. In the rural Indian cultural context, boys are unlikely to want to talk about it with parents or healthcare professionals, nor are these people likely to want to talk about what's happening for them. Often, boys will consult 'quacks' or low-cost books available in local markets, and may get information that's far from the truth. Again, ways to tackle this must be considered. LOCATION: Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Sunita Patra, Jayashree Sawayan, Dr Jagannath Hembrom, Suhagini Kisku and Sefali Dandapat.
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  • CAPTION: Community COPE members discuss steps being taken by Dr Ram Chandra Soren, the Medical Officer-in-Charge, and the sahiyas to deal with the problem of snake and dog bites. Dr Ram has explained that medicines are on the way, so the members are now discussing how the Community COPE team can assist with ensuring people get the knowledge they need on obtaining the necessary medicines from the hospital. Most of the time, people go for magical solutions through faith healers. Many people have died from these bites (including from rabies) in this area. LOCATION: Pawra (village), Ghatshila (block), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Multiple people.
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  • CAPTION: Dr Ram Chandra Soren is the area’s Medical Officer-in-Charge. He oversees the ARSH clinic here. He says that they’ve seen a lot of changes since the clinic opened. At first there were around 20 clients; this has grown to approximately 250. Though he studied and started his career in Orissa, Dr Ram is originally from this community and this gives him a great level of acceptance among the community members, which makes it very easy for him to communicate with them. People also know that he’s approachable outside of the regular office hours. LOCATION: Adolescent Reproductive and Sexual Health (ARSH) clinic, Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: Dr Ram Chandra Soren.
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  • CAPTION: This group is considering sexual changes that adolescents go through. The idea that these things should even be discussed is often resisted by the trainees, and this often comes up in a big way during the first day of training. However, as the days unfold, they are encouraged to open up and relax, and generally a much more positive attitude to such discussion evolves by the end of the program. LOCATION: Ghatshila Community Health Centre (CHC), Purbi Singhbhum (district), Jharkhand (state), India. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Suhagini Kisku, Sefali Dandapat and Sarojini Mahato.
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