Girls’ Clubs: The bridge from better health to finishing school

Keeping girls in school can sometimes be as simple as giving a girl a routine blood test, or as complex as rescuing a teenager from a violent home. In the impoverished urban settings where WomenStrong International works, we clearly see every day the direct link between health and education among the adolescent girls who are part of our Girls’ Clubs in Ghana, Haiti, India, and Kenya.

At Women’s Health to Wealth (WHW) in Kumasi, Ghana, a member of the WomenStrong Consortium, we run 34 Clubs in junior high schools where, in line with Ghana School Health Policy, School Health Education Program Coordinators liaise with the Ghana Health Service to educate adolescent girls on a variety of topics. Adolescent girls are taught about personal hygiene, dental health, nutrition, fitness, human sexuality, pregnancy prevention, and prevention of HIV and sexually transmitted infections (STIs). Girls also learn about the dangers of tobacco and drug use and about avoiding gender-based violence.

When WHW saw that neither Ghana’s Health Service nor Education Service were conducting health screenings, they began offering essential tests for visual, aural, and dental health, as well as testing for STIs and anemia. Hundreds of girls have been screened through the Clubs.

None of the girls had ever had a health screening before, and we received the full support of education and health staff at the district and local level, who understood the importance of basic health services for young girls but had been unable to offer them.

Testing revealed that more than half the girls between 14 and 16 years of age were moderately anemic.

The immediate impact of anemia is extreme fatigue and an inability to focus, both of which, obviously, impact a girl’s ability to study and learn. Longer term, if left untreated, anemia leads to difficult or dangerous pregnancies and low birthweight, sickly babies. Globally, anemia is the leading cause of maternal mortality. Most often, in poor settings, it is the result of not getting enough nutritious food to eat.

Not surprisingly, the screenings in Ghana found that one-third of the girls tested were malnourished, with a BMI of less than 18.5.

Girls receive the results of their screenings right away, and for those diagnosed as anemic, a 90-day course of treatment with iron-folate supplements is provided. After treatment, their blood is checked again. All girls in the Clubs are given folate supplements each school term.

In addition to treatment, we took on the root causes of anemia by offering nutrition education classes and the planting of kitchen gardens to help provide girls with one nutritious snack or meal each and every school day.

Girls needing additional care, such as the removal of a tooth or glasses, are given referral letters from WHW to school officials explaining what the girls need, so that the schools can work with parents to obtain medical care through doctors at district hospitals.

WHW’s own medical team working at the Girls’ Clubs includes a dentist and a dental assistant, an optometrist, an eye nurse and assistant, and two WHW staff members who conduct some tests and teach lessons in nutrition.

As a result of the health education and screenings done through WHW’s Girls’ Clubs, we have seen a 45% reduction in school absenteeism due to ill health. Teachers report that girls are more attentive and are eager participants in class activities. Fewer girls are reporting menstrual disorders, such as scanty blood flow and painful menses.

For high-school aged girls, WHW and WomenStrong offer adolescent reproductive health fora, held each year to address such topics as sexual reproduction, STIs, unsafe abortions, menstruation, mental health, and contraception.

About 85% of the forum participants are well into their late teens and are sexually active. As many as 18% have given birth to at least one child, in fact, while 37% have terminated at least one pregnancy. We have seen that reducing unwanted pregnancies means making more and better information available on contraception. The Adolescent Reproductive Fora are designed to fill this information gap, all within the context of the importance of staying in school.

Our meetings are held in safe spaces where girls hear from speakers from the health ministry, interspersed with skits and other tactics designed to create a relaxed environment where girls feel comfortable expressing their fears and asking their questions. Girls participating in the fora benefit from one-on-one counseling with adults who can answer their most pressing sexual health questions. In these individual sessions, counselors hear from frightened girls who are pregnant or carrying an STI, such as Candidiasis and Trichomoniasis. Treatment is provided on the spot.

The private sessions also have helped identify girls in abusive relationships. Over the last two years, WHW has rescued nearly a dozen girls from abuse, including girls facing violence at the hands of close relatives, and even one girl who was selling sex in a desperate effort to earn enough money to pay her high school fees.

WHW partners with Marie Stopes International, to provide sexually active girls with condoms or longer-term contraceptive options, as well as support if they find they are pregnant.

Not all those referred to Marie Stopes are in trouble; indeed, some are leaders. At the end of each year’s reproductive health forum, about 10 -15 girls volunteer to become trained Peer Educators. The Peer Educators are given hotlines to WHW’s Health Coordinator, as well as the Youth Coordinator at Marie Stopes, and are taught to give the phone numbers to any of their high school peers who may need help.

Above all, the collaboration between WomenStrong and WHW means that hundreds of girls are able to remove many of the health-related obstacles to finishing school, so that they have a real chance for a better life and a better, healthier future for their children.