Impoverished adolescent girls and young women (ages 15-25 years) in low- and middle-income countries (LMICs) face inequitable gender norms that limit their educational opportunities, social support, and healthcare access. These inequities also place them at higher risk for maternal morbidity and mortality, psychological trauma, violence, and STIs/HIV. Consistent with these patterns, many young women in India marry early and face similar sexual and reproductive health and rights (SRHR) challenges. Adolescent services in India are unequally distributed leaving marginalized adolescents, including those not in school, without services or access. In 2013, India launched the ?Rashtriya Kishor Swasthya Karyakam? (National Adolescent Health Program) framework for improved adolescent health services and education to be provided in the healthcare system and community through adolescent health clubs and adolescent-friendly health clinics. However, implementation of the framework has been uneven, with poor fidelity in the adaptation of programs to make them youth-centered. In this proposal, I will adapt and pilot an integrated community and facility intervention to improve uptake of adolescent-friendly services for married and unmarried AGYW (ages 15-25) in a low-income area with a population of 600,000 in Mumbai, India. Formative research will characterize the SRHR landscape in the study area and adapt the intervention using the systematic ADAPT-ITT approach. The community component will adapt a health curriculum for the peer adolescent health clubs to incorporate participatory activities to build AGYW?s resources and agency, promote use of newly available adolescent services, and obtain participants? viewpoints and preferences. The facility component consists of adapted sensitization training on adolescent- friendly care for health providers and staff at both public and private clinics in the study area. This hybrid pilot study will assess both implementation outcomes and a pilot set of health/behavioral outcomes including clinic service uptake, contraceptive use, mental health, gender norms/agency, and health knowledge. My longstanding commitment to global health research with adolescent girls and young women has led me to pursue training opportunities to gain experience in international collaborative research projects. This K award builds on my doctoral and post-doctoral training in medical anthropology and adolescent SRHR, and the relationships I have developed with multidisciplinary mentors and organizations in the United States and Mumbai, India. This proposal extends my previous training and K12 work on youth-centered approaches to SRHR communication in the U.S. by providing training in adolescent health quality improvement, implementation science, and advanced quantitative methods in an international context. This K01 award also facilitates my development into an independent global health researcher focused on improving adolescent girls? health and well-being in low-income communities.
Adolescent girls and young women in low- and middle-income countries such as India, face unique challenges including early marriage, maternal morbidity and mortality, violence, psychological trauma, increased STI/HIV risk, and limited access to sexual and reproductive health (SRH) information or services. Implementation of India?s adolescent health framework has been uneven and limited in low-income communities. This proposal will use the ADAPT-ITT approach to systematically adapt an integrated community/facility intervention to improve uptake of adolescent-friendly services for married and unmarried adolescent girls and young women (ages 15-25 years), followed by a quasi-experimental hybrid pilot study that will use mixed methods to assess both implementation outcomes and health/behavioral outcomes including clinic service uptake, contraceptive use, mental health, gender norms/agency, and health knowledge in an urban low-income area in Mumbai, India.
