Bangalore CAN Prevent.......

Enfold working with Karnataka State Govt to create Child Protection Units

2011-02-03T09:54:00.002+05:30

Enfold's DrShaibya Saldanha, after undergoing training in Philippines under the agies of UNICEF and IPSCAN, is working with CWC and Govt of Karnataka to set up Child Protection Units in 5 hospitals in Bangalore. It involves linking and training counsellors, medical practitioners, social workers, police and judiciary for the benefit of the sexually abused child. It will ensure that the child is not repeatedly harassed to give multiple statements to different agencies. A single center will ensure that the child is gives evidence/ statement and is examined just once. Counsellors will ensure support to the child and the family.

Training of personnel has already begun at Ramianh hospital, Bangalore. Once functional and working well, CCPU s wil be set up in other cities/ states too.

Hurrah for child safety!

Experience of Mentors in Peer Education Program

2010-08-27T15:14:00.003+05:30

Well the pep program finally launched and it was a really good introduction abt enfold and a totally fun and interactive class.

We had 67 attendees and had about 85 registered initially so i think that is a gr8 beginning. we now are a group of 7 working on this program.

Mentors created this warm, open, safe and witty space for the kids n although they didn't ask questions they readily and volubly answered and seemed really clued in. They enjoyed the role plays, related to them and i didn't freeze on stage ( yes i had to climb a stage to do the role plays the hall was as big as football field!! )

They say a job well begun is half done , keeping that thought this program will be a real super duper success. We all left feeling energised and glad to be part of a movement that will only bring good things .

I'm really glad to be a part of enfold, thank you once again for inviting me.

Enfold Starts Peer Education Program in a College in Bangalore!

2010-08-26T23:08:00.001+05:30

Peer Education Program

Adolescence is a period of transition – physically, emotionally and socially. As adolescents develop, peer groups help young people gain a sense of their own identity and become their primary social outlet. This, in turn, leads to the development and practice of social skills that will stay with them throughout their lives. Peer education takes advantage of the positive aspects of peer groups by helping young people learn from each other – something they do naturally anyway.

Peer education helps identifying one member of the peer group who receives special training in order to better facilitate a desired change within the group and adapted it in several key ways:

The young people form groups, elect their leaders, draft a working plan, establish rules, identify a range of activities they will undertake and select for themselves the young people that will be trained as peer educators (who receive training on both facilitation skills and sexual and reproductive health).

In this way the peer education process is facilitated and supported, but not directed as with most traditional youth programmes. Young people are not simply involved, but take the lead in all stages of design, implementation and monitoring.

Why Peer Education

Peer educators are not professionals, but they are trained to assist young people who need health information. Peer educators receive special training in decision-making, in imparting information and in making client referrals. In recognition of the work they do in motivating young people to obtain the information and services they need, peer educators/counselors are sometimes called "peer promoters."

Peer promoters usually work with participants in one-to-one or small group settings. But they often have other responsibilities. They make presentations in front of large groups, represent the organizations they work for on boards and councils, and consult with program managers. Peer projects are often part of larger programs that have added a youth-to-youth outreach component.

Q: What are the advantages and benefits of peer programs?

Peer programs build on evidence that young people already get a great deal of information from their peers.
Young people relate well to people similar to them in age, background, and interests.
Peer programs allow for the direct involvement of young people in their own programs.
Peer programs can be implemented economically.
Peer programs often reach not only the peer group but also the peer promoters' relatives and neighbours.
Peer promoters often gain long-term benefits from their experiences. These include an ongoing commitment to responsible reproductive health behaviour, leadership potential, useful employment experience, and personal development.

Enfold will train the peer educators and have monitoring sessions with them. Enfold will provide support to the peer educators for any obstacles they may encounter during the process

Why Enfold?

Enfold Proactive Health Trust, a registered trust in Bangalore since 2002, is the only organization in India that is working with school children, including primary school children, on issues of personal safety since 2002. So far we have interacted with over 25,000 students and adults, discussing issues of life skills, personal safety (including child abuse), sexuality and HIV prevention. A documentary film on Child sexual abuse in India features Enfold's work.

THE REQUIREMENT OF A NEW LEGISLATION TO ADDRESS SEXUAL OFFENCES AGAINST CHILDREN.

2010-05-21T07:42:00.005+05:30

India According to Many Studies Has Rising cases of Child sexual Abuse. Yet we seem to have been lacking in Legislation in this area. However In a meeting held in Jan by the National Commission for the Protection of Child Rights to discuss the Prevention of Offenses against Children Bill- 2009, It was felt that sexual offenses against children should be addresses separately. (Certain draft bills maybe found online for reading)

Therefore many consultative processes have begun in order to look and existing laws and recommend changes and draft new legislation where required.Enfold Proactive Health trust was part of one such Consultation. The Whole two day process was one of great learning.

It really is an important step forward as we sorely need legislation to protect our children. And I feel happy that enfold Was part of the process.

"Daddy are you Gay?"

2010-05-14T19:20:00.003+05:30

Working with school children in the National Capital Region has been an eyeopener! I have been conducting sessions on sexuality and personal safety in Bangalore since 2001 - and every year I felt that the younger and younger children were asking questions related to sexual practices. But I had not realised how rapidly children as young as 2nd and 3rd std students are being forced to 'grow up". Innocent childhood experiences are being contorted. A 3rd std boy on being hugged by his Dad asked- "Dad are you Gay?" His father, hoping to difuse the situation, replied " I am hugging you, I am happy, I am gay". The son admonished his father "Not that type of gay, but Gay!" The father was too shocked and embarrassed to answer.

3rd std students can read newspapers - and so are aware of all the words used there. Parents need to educate themselves and practice answering questions related to sexual practices authentically and in a matter- of -fact tone. Avoiding the question, punishing the child, or simply shutting them up will not solve the problem. The kid will turn to the internet or an older child for answers! Worse still, the child will stop asking questions and clarifying doubts with his/ her parents. It is better if the information comes from parents who can put things in perspective and state their values at the same time.

Enfold Trust conducts Demystifying Sexuality courses for lay people, parents, teachers and counsellors.

Enfold in Delhi and Gurgaon

2009-11-07T15:19:00.003+05:30

Hey we are now in Dehi and Gurgaon!
Enfold is conducting training sessions for facilitators who may be interested in working with school and college students on issues of personal safety and sexuality. We lay emphasis on prevention of child sexual abuse and we empower adolescents and youth to be assertive and responsibe.
The course, demystifying sexuality is also useful for lay people to understand their selves and help their children/ teenagers be safe and responsibe.

Please visit our website for more details about Enfold's work and to contact us.

My Recent Session on Parenting Adolescents

2009-09-17T21:46:00.003+05:30

It's been a long time since i have shared ....

I would like share my experience about how the session went...

Firstly, i was pleasantly surprised to see the no.of parents (120) who had come for the session.
Good to see you all Parents!!!

I entered the session hall thinking that a very few parents would come and i can actually finish the session sooner...
Myself and my Colleague were jointly conducting the session and that too in the regional language...

We started off with what are the different issues parents of adolescents face these days and all the parents really did contribute to our session.
they were really amazing...

We jotted all the points they have given us and went on to discuss both sides of the coin viz., the parents perspective as well as the adolescents.

W did some role plays to show what the young adult might be thinking... and what are the concerns of the parents...
most of the parents agreed with " oh! This is exactly how my daughter behaves".

So we had to take them through changes during puberty, why young adults behave the way they behave ...
and how to build communication channels and keeping them open always so that when ever the child wants he/she can approach the parent with out any difficulty or fear...

Parents also did participate in the role plays..

The discussion went on to how can one improve the child's self esteem and building trust in the child.

We had concentrated a lot on the feelings of the child validating the child's as well as parents....

We had to wind up our discussion due to shortage of time, but believe me the session went on very well.

Towards the end when tea and snacks were being served many parents spoke to me and were very keen on having this kind of Brain storming so that they also get a fresh view of seeing the issue and also the ways they can cope with and make parenting a very pleasurable experience...

I really hope schools and colleges take the initiative in arranging for these kind of sessions so that everyone present benefits from all the brainstorming...

That's it from me for now...

Will post something very soon...

What should a child do in case he/she is abused?

2009-08-27T20:08:00.002+05:30

What you need to do, when you find out that someone is sexually abusing you is SPEAK OUT. Reach out to your parents/teachers, friends immediately. Not talking about what you are going through will not make things easier for you. You need to also tell the person who is doing that to you, that you would tell your parents about this. A lot of times these could actually stop the abuse. However, if it still persists, please speak to your parents/teachers/friends immediately so that they can help you out.

Some questions and answers on HIV

2009-02-26T06:23:00.000+05:30

1. How can one be sure that one does not have HIV infection?
This is easily determined. Every person knows what they have done or are currently doing. If the activity or situation is such that one might acquire HIV infection then the person should test for HIV now and three months after the last high risk activity. If both tests are negative then the person does not have an HIV infection.

2. How can I be sure that a person is not HIV positive? How can I be sure that my partner or spouse does not have HIV?
You can never be sure that a person is HIV negative. You cannot force another person to go for the test and tell you if it is positive. In any case, the test will be negative for three months and during that time you could get the infection from your partner.

Suppose that the person is really HIV negative. The test is negative on 1st March and on 1st June. The person gets married on 1st June (in some countries it is mandatory to test for HIV before marriage). After one month the person has extra marital sex (with a person who, unknown to both, has HIV infection) and gets an HIV infection. The infection can get transmitted to the spouse. Both will test negative till September. Thereafter the couple will test positive.

Instead of relying on tests to detect the infection (by which time it is too late anyhow), it is better to create a relationship of mutual trust. If you know a person for a long time, if you have developed a close and trusting relationship, then that person will confide in you. He or she may say that he or she had been involved in activities through which he or she might have got HIV infection. HIV tests done now and three months after the high risk activity will settle the issue. Since there is trust and love between the two of you, he or she may come back and tell you their test report. This depends entirely on trust.

3. What is the extent of HIV infection in India?
Currently about 0.3 percent of our general population (which includes people like you and me) is HIV positive. In some areas, up to five percent of pregnant women are HIV positive. This means that if you attend a marriage, and there are 500 people there, then up to 2 could be HIV positive – unknown to you and probably unknown to themselves.

4. Can one be cured of HIV infection?
No. We do not have a cure for HIV infection yet. Being a virus (the link between living and non living things) it has the capacity to survive in a dormant state for years. We have drugs that interfere with the multiplication of the virus, but we do not have drugs that can kill or eradicate the virus. So all we can do with drugs is disease control. We can keep the quantity of the virus in our body to a very low level but we cannot get it out of our body.
The HIV mutates very fast. It becomes resistant to the drug being administered pretty rapidly. So we have to use three different types of drugs simultaneously to keep the virus under control. It is like taking three different antibiotics at the same time.

5. I read in a magazine that there is a cure for HIV.
We often read about claims from people that they have found a cure for HIV or that there is a cure for HIV in alternative medicine. None of these claims have been scientifically validated.

6. Is there a vaccine against HIV?
There is no vaccine available against HIV. Though the disease is twenty years old, we have not yet come up with a successful vaccine because this virus, unlike polio and small pox viruses, mutates rapidly. By the time a vaccine is developed, the virus has changed its outer sheath and the vaccine cannot work. Some vaccines are at a trial stage in laboratories, but none are available for use.

7. Why aren’t all sex workers tested for HIV?
Sex workers run a high risk of getting HIV infection because of multiple sex partners. They can test themselves if they wish to. This often happens if they have been counseled about HIV and its effects on the body.
It is important to realize that the sex workers do not approach people in their homes asking for sex. People choose to go to the sex worker and offer them money or gifts to have sex with them. So why should the sex workers test themselves? Nobody is forcing people to have sex with the sex worker.
The government cannot force sex workers to get the test done. Even if the test is done today, what is the guarantee that he/she won’t get the infection tomorrow? Should the test be done daily? In any case, the window period gives a false negative report. What about the customer? Shouldn’t the customer test himself or herself?

8. Life is not worth living after getting HIV infection.
Being HIV positive can be very depressing. But we met a HIV positive person who was full of life. Here is her story (names have been changed to protect her identity):
A young girl called Rani, the daughter of a government employee, was married to Ramesh. Ramesh fell sick a few months after marriage. He was diagnosed to have AIDS which he had acquired from a premarital relationship. He died two months later. By then Rani had acquired the infection from her husband. Her in-laws blamed her for making Ramesh sick and drove her out of the house after Ramesh’s death. Rani returned to her parents’ house. They encouraged her to study further as she had only studied upto the 10th standard. She also underwent counseling to understand her condition and the various treatment options. Rani did a counseling course and went to work for an organisation. There she met a man who was also HIV positive. They fell in love and got married. Rani and her husband now have a child. She took all the precautions required to reduce the chances of HIV transmission to her baby during pregnancy and after birth. Her baby was tested at 18 months of age and found to be HIV negative. She feels happy and is content with what she is doing. Her family members are willing to look after her child if she and her husband succumb to AIDS.
Should Rani have committed suicide? Rani definitely does not think so.

With treatment, a HIV positive person can live a healthy useful life far beyond 2 – 10 years. With treatment, good nutrition and a positive outlook, people have been known to be living with HIV for over 15 years.

9. Can one live with a HIV positive person in the same house?
Yes, definitely. Unlike a common cold, HIV is not transmitted by casual contact with an infected person. You can live in the same house, eat together, eat food cooked by a HIV positive person, shake hands and play together, share the toilet and sleep in the same room without getting HIV from that person. Intimate (sexual) contact has to be avoided.

10. Can mosquitoes spread HIV ? Unlike Malaria, HIV does not have a life cycle in a mosquito, so mosquito bites do not cause HIV. Only close bodily contact, that allows mixing of body fluids that have a high viral load like semen, vaginal fluid or blood can cause HIV transmission from person to person.

11. How can HIV be destroyed ?
HIV is a very fragile virus and can be easily destroyed outside the human body. Boiling or hot water, soap, bleaching powder, alcohol or chlorhexidine can be used to destroy the virus.

12. Can HIV positive children attend normal schools?
Yes they can. Sharing a bench or playing together does not transmit infection. HIV positive children know about their status and they know that their blood can infect others. They are trained to report to a responsible adult if they get hurt and start bleeding. Moreover, HIV transmission will not occur if blood from an HIV positive person falls on intact skin.

13. How is HIV different from AIDS?
AIDS stands for Acquired Immuno Deficiency Syndrome. This is the last stage of HIV infection, when the infected person begins to fall sick and looks obviously ill.

People who are infected with HIV are called HIV positive. They look perfectly normal in appearance and health for about two to ten years after being infected. By this time, their immune system has been overpowered by the virus and they fall prey to a large number of infections and tumors. This stage is called AIDS. Now the person is visibly sick and, without treatment, usually dies within one year.

14. When can one suspect that one has AIDS?
HIV infection does not produce any symptoms. On reaching the stage of AIDS, the person begins to feel weak, has significant weight loss, has low grade fevers lasting for over a month, persistent loose motions, rashes, coughs and swollen lymph nodes. All of these symptoms are long standing (over months), persistent and do not respond to routine medication.

15. Where is HIV found in the body of an infected person?
HIV primarily infects the white blood cells. Besides blood it enters many other tissues and body fluids like semen, saliva and even sweat. However the amount of virus present and the infectivity of the virus differ from fluid to fluid as shown below.

Concentration of the virus Potency of virus Infectivity
Blood Very High High High
Semen Very High High High
Vaginal fluids Very High High High
Breast Milk High Medium Medium
Tears extremely Low Very Low Negligible
Saliva extremely Low Very Low Negligible
Sweat Not demonstrated Nil
Urine extremely Low Very Low Negligible

16. Can HIV be transmitted by open-mouth kissing?
Open-mouth kissing is considered a very low-risk activity for the transmission of HIV. However, open-mouth kissing could allow HIV to pass from an infected person to a partner through cuts or sores in the mouth. Open-mouth kissing with an infected partner is not recommended.

17. Who is at risk of getting HIV infection?
1. A person who has had sex with many people is likely to come in contact with someone who is already infected with HIV.
2. A person who has only one sexual partner in his or her life, but the partner has had sex with other people.
3. A child born to an HIV positive mother.
4. A person who has had a blood transfusion of untested blood.
5. People sharing injection needles, tattoo needles and razors.
6. Medical and paramedical workers who come in contact with body fluids. Examples – doctors, nurses, lab technicians, sanitation staff.

18. How can I avoid HIV infection?
HIV infection can be reduced through safer sex practices, safe blood transfusions, and avoiding sharing needles and razors. Mother to child transmission can be reduced by testing all pregnant women for HIV and treating those positive with anti – HIV medication.

29. What are safer sex practices?
HIV transmission through sex can be avoided totally if a person never has sex. This is called abstinence. Since it is natural to want to have sex, the next best option is to have a single mutually faithful sexual partner. Two HIV negative people who have never had sex with anyone other than each other cannot get HIV by having sex with each other.
If a person has more than one sexual partner, there is an increased risk of getting HIV as any of the partners may be infected from their previous relationship. We cannot detect whether a person is HIV positive from their appearance. If one has multiple sex partners, the risk of HIV infection can be reduced (but not ruled out completely), by always using condoms during sex.

20. What is a condom? How does it reduce HIV transmission?
A condom is a contraceptive device made of latex which prevents direct contact between the penis and the vagina. The male condom is rolled onto the penis while the female condom is a plastic pouch which is inserted into the vagina. Condoms prevent direct contact between the body fluids of the two partners. The risk of HIV transmission falls. The condom may leak or burst or be incorrectly used allowing HIV transmission. Even as a contraceptive, the condom fails to prevent pregnancy in 10 to 15 percent of couples over a one year period.

Commonly asked questions about child sexual abuse

2009-02-26T06:17:00.001+05:30

Child sexual abuse (CSA) is very common both in India as well as worldwide. Adults can help in fighting this menace by learning about all aspects of CSA - how it happens, why it happens, why the child does not tell, what can be done if one finds out about it, how to support the child and what to do about the perpetrator.

Answers to some commonly asked questions about child sexual abuse (CSA).

Is Child sexual abuse common in India?
In 1993 -1994, Samvada, a Bangalore based NGO did a pioneering study in the history of CSA work in India by organizing a series of workshops for 348 girls (15 – 21 yrs old) from 11 schools and colleges in Karnataka.
They found that 47% of the respondents had been molested or had experienced sexual overtures, 15% when they were less than 10 yrs old. 15% had experienced serious sexual abuse, including rape. Of these 31% were less than 10 yrs old when abuse started.

The Ministry of Women and Child Development, Govt of India, Prayas and UNICEF, 2007 reported that out of 12,447 children (hailing from all strata of society), 53% reported sexual abuse. Out of 12,447 children, 21% reported severe sexual abuse.

Many reports (e.g.RAHI) prior to the recent report had indicated that child sexual abuse of girls was high in India. Now it appears that incidence of sexual abuse of boys is also on the rise. 52% of boys and 47% of girls have reported sexual abuse of one form or the other in this study. More boys than girls have reported severe form of sexual abuse.

Does this mean that 50% of our men (or women) are abusers?

No. This is because one abuser abuses many children. In a study in the USA, a convicted abuser had on average, abused 76 children. By exposing the abuser in the society, the abused child’s family can save many children from abuse. Hence it is very important to tell all the family members, friends and neighbours about this person. He/ she may be an influential person or a religious leader – but if he/she is a child abuser, he will not stop unless acted against. Though legal action is a way out, it may take a long time. Talking about this person among the family and neighborhood – “be careful with this person. I have heard that children are not safe with him/her” will keep children around him/her safe.

What is considered child sexual abuse?
Under the law, "child sexual abuse" is an umbrella term describing criminal and civil offenses in which an adult engages in sexual activity with a child or exploits a child for the purpose of sexual gratification.
Acts considered CSA may be:
Fondling – Touching genitals.
Violations of child’s privacy
Exposing children to adult sexuality
Behavior involving penetration.
Exploitation – giving or receiving money for using a child for sexual gratification.

An adult who engages in sexual activity with a child is performing a criminal and immoral act which can never be considered normal or socially acceptable behavior.

At what age does Child Sexual Abuse start?
One of the youngest victims of sexual abuse was a one and a half months old baby. However, in majority of cases, sexual abuse begins around 5 years of age, peaks at around 12 -14 years of age and then begins to decline (as per the Govt. report). It can, however, continue into adulthood.

Why do children keep quiet about CSA? How does CSA continue?
Children don’t talk about the abuse because they feel they won’t be believed, that they will be blamed for it or because they don’t want the family to break up. Often the abuser is a family member or is very close to the family. As the child has grown up loving and trusting that person, the person starts 'grooming' the child for sexual abuse by touching him/ her in an 'unsafe' way. The family remains unaware of this and the child feels confused.

If the family has brought up the child to think that anything to do with the reproductive tract is "dirty' or "shameful" the child will find it very difficult to report the grooming process. In the mean time the abuse continues and becomes more severe. The child now feels trapped and thinks 'I did not tell anyone when it first started. How can I tell now? Every one will blame me for not resisting or not telling earlier. Anyhow, I feel too ashamed to explain all this to my mother/ parent/ teacher. May be it will stop." The abuser, emboldened by the silence, goes ahead. He / she also uses bribes, threats, secrecy, promises, blackmail and emotional manipulation to keep the child from telling anyone.

A child’s brain is pitted not just against an adult brain of the abuser, but also against the silence and shame built around the current social perceptions of sexuality. The child can win only with the support of the family members, in a society that accepts and respects each individual's personhood and sexuality.
In some instances, the child informs the parents in a round about way or directly, and the child is either not fully understood or not believed or simply denied protection. CSA therefore continues.

If we don’t make a fuss about the abuse, won't the child forget it?
Children do not forget abuse. It remains with them and affects their behaviour and personality in many ways. In the present it can result in falling academic performance and a lack of interest in activities the child used to enjoy earlier
It may cause the child to become excessively sexualized in his or her behaviour, or it may cause the child to dislike themselves. The child may start keeping the body dirty and unattractive, wearing many clothes or baggy clothes to avoid attracting attention.
The adolescent may start behaving aggressively or become totally submissive. At times a very resilient child may appear to be ‘unaffected’. The psychological effects may however surface later in life.

Adult survivors of child sexual abuse may have difficulty in maintaining relationships, experience inability to trust close family and friends, develop harmful sexual behaviour or have marital problems.

Shouldn't we protest against only severe forms of CSA?
No. If we tolerate minor forms of abuse such as fondling, hugging, kissing children or exhibitionism then that becomes the norm. Let us have Zero tolerance for CSA.

Will 24 hour surveillance of the child prevent sexual abuse?
No. For one, it is not possible for a single adult to look after a child 24 hours a day. It is much better to empower the child. The child can be taught personal safety, personal space rules, and safe and unsafe touch, just as we teach our children about how to protect the body from heat, cold, fire and injury. Ask the child to come and tell you if anyone ever breaks the body rules.

Won't explaining about personal safety to the child unnecessarily frighten the child?
No. The child will not be frightened if we explain about personal safety as a choice and introduce the concept in a comfortable and non-threatening manner. We can tell the child that “you are the boss of your body. No one can touch you in a way you don’t like (this includes pinching and slapping and hitting etc)”.
Talk especially about the parts covered by the undergarments. How no one can touch them there except to keep them clean and healthy (mother, doctor). Talk about personal space – the space around our body that we consider to be our own. Talk about safe and unsafe touch. You may use a doll to explain to the child.
Children are told about strangers and robbers and kidnappers. Similarly tell them about their body rules and personal space. Do not frighten the child. Explain that most adults want to help and protect children. There are a few ‘bad’ people who want to hurt children. We need to protect ourselves from such people.

If society gets to know of the abuse, won't the child have more to lose than the abuser?
No. The silence of the abused and the people who know about it, is the main reason that sexual abuse continues. By exposing the abuser in a way which does not traumatise the child, helps the child to heal as well as stops other children from being abused. Every one wants to “Look Good” and have a “good” reputation. The criminal has his reputation to lose. The child is a victim, blameless and innocent and will heal faster from the trauma if he / she perceives that justice has been done.

Is Social ostracism of the abuser really a powerful option available to the family of the abused child?
Yes. Social ostracism often works better and faster than legal recourse. It also safeguards other children in the neighbourhood and in the extended family.

Do we have an obligation to protect not only our child, but other children in our community as well?
Yes. If our sister or neighbour knew that the person our child is associating with is an abuser, wouldn’t we expect her to warn us? Similarly should we not inform our relatives, friends and neighbours about an abuser we know of? We don’t need to prove his or her crime in a court of law. We believe our child. We wish to protect our nieces, nephews and the children in our community. We just need to let them know that they need to be aware and careful in the presence of a certain individual who has behaved in a reprehensible manner with a child. We can do this without exposing the identity of the child.

How can I detect a child victim of sexual abuse?
The majority of cases of CSA may go unrecognized unless we are aware and look for signs that may be suggestive of sexual abuse. How abused children can be detected through their behaviour is varied. The way the child presents can be demonstrated by the picture of an iceberg. What is obvious, or comes to the surface is only the tip of the problem.

The following is a pictorial representation of presentation of CSA, developed by Dr Shekhar Seshadri, Child Psychiatrist, NIMHANS, Bangalore, and a co-author of this workbook series. He is one of the first few psychiatrists in India to begin detailed work and research on child sexual abuse.

Obvious abuse:
1. Disclosure by the child
2. Detection (obvious) - pregnancy, child suffering from Sexually Transmitted infections , child having genital injuries

Suspicious of abuse:
_3. Sexualized behaviour, clear hints given by the child__
4. Clear symptoms like depression, post traumatic stress disorder
5. Sudden unexplained change in behaviour - school refusal, people avoidance_
6. Symptom patterns - sudden onset of bed wetting, aches, pains, general ill health
7. Children who do not report, hint or decompensate - because they are resilient,
have been threatened, manipulated etc.

Presentation of Child Sexual Abuse: By Dr Shekhar Seshadri, NIMHANS

When do I suspect child sexual abuse?

1. A change in the social behaviour of the child – a happy child becomes introverted, silent, refuses to participate in group activities. The child may become insecure and cling to a trusted adult, or become excessively fearful. Occasionally the child may become violent, easily enraged. The child tries to avoid coming in contact with a particular person.

2. A change in the personal grooming of the child – neglects personal appearance, deliberately tries to look unhygienic, shabby or unattractive. May begin to wear multiple layers of clothing, inappropriate for the weather.

3. Change in the academic performance, poor concentration, distracted, sleepy (since abuse may cause sleepless nights/ nightmares/ disturbed sleep), lack of interest.

4. Replaying the abuse with another child generally younger or same age as them. This is known as sexualized behaviour.

5. Change in eating habits: Child starts losing weight or may eat excessively, thus putting on weight.

How do children report sexual abuse? How can I encourage my child to report a disturbing incident?
A very small percentage of child victims of sexual abuse actually report it (12%). The reporting is often ambiguous because the young child may not have the vocabulary to explain what has happened or feels too shy to narrate the incident clearly.
You can encourage the child to disclose by accepting and understanding what the child is trying to convey. For example:

How can I probe the issue further if I have a doubt that my child is being abused?

Have a conversation with the child in private, in a casual setting.

1. Ask about the child’s feelings and emotional well being:

Do you feel happy; feel cheerful; feel jittery or restless; feel sad; feel like crying; feel afraid or scared; worry about things; feel, unhappy; feel nervous; feel bothered or upset?

2. Ask about how the child feels about him/herself:
How good or bad do you feel about:
yourself; your school work; your friendships; your body and your looks; the way others (peers and adults) treat you, the way others touch you?

3. You may ask leading questions about personal safety.

Has anyone ever embarrassed you and you did not talk about it with anyone?
Has anyone ever touched you in a way you didn’t like? Has any one – related or unrelated to you, known person or strangers, ever touched you in a way that made you feel uncomfortable / shy / yucky?

4. To make the child feel comfortable and reassured, state:
• I am asking you this because if this happens, you can always come and tell me
• Things that trouble you, need not be kept bottled up inside you.
• Yucky things are best let out.
• The person may tell you that it's all right, no need to tell any one, may try to bribe or even threaten you. But for your safety, it will be best to tell an adult you trust about it.
• You can tell me.
• When an adult or older person troubles (abuses) a child, it is never the child’s fault. The adult or older person is responsible for what they did.

How should I respond if a child confides about abuse?
The best way to respond to the child who has been abused:

• Tell the child you believe her / him.
• Praise the child’s courage in coming and telling you about it. Acknowledge the child’s feelings.
• Tell the child it was not her/ his fault. The adult was at fault. The adult is guilty of a crime – even if the child did not tell when the abuse first started, the child was not responsible for the abuse continuing.
• Tell the child that you would like to take the help of other adults (family members, institutions, staff members) to help the child, with the child’s permission.
• Do not make false promises like “I will send the abuser to jail. I will beat him /her up etc’
• Do not question or blame the child - “Why did you not shout for help?” “Why did you not tell me earlier?” “Why did you not fight?” Remember, it is a child and the abuser is a person known to the child – trusted and loved by the child.
• Do not ask the child to “Forgive” “forget” or “adjust”.

If you feel you are unable to support the child, you can always take the help of a competent, empathetic and trained counselor. In any case, you can always believe, accept and continue to care for the child. Taking the help of mental health professionals – Depending on an assessment of the child’s behaviour, symptoms and coping skills, mental health professionals need to be consulted. Severe symptoms, suspected or apparent self harm behaviour warrant a prompt consultation with a mental health professional with expertise in dealing with victims of child sexual abuse.

What possible strategies can be used to deal with the Abuser?
1. Counseling for the abuser, if repentant and willing
2. Community awareness – informing the abuser’s community about his / her actions. Community action
3. Para legal / quasi legal actions - a third person reporting abuse
4. Legal recourse
Certain basic principles need to be kept in mind while interacting with a child who has experienced sexual abuse:
1. Need for strict confidentiality
2. Best interests of the child.
3. Checks and balances in the reporting and decision making process. Do not hesitate to consult people who have experience in this field.

To sum up, I would like to quote Dr Shekhar Seshadri from his article on Good Practice in Child Sexual Abuse (CSA) Interventions (in AAINA,a mental health advocacy newletter July 2001):
"Child Sexual Abuse is a child issue, a sexuality issue, an abuse issue, a gender issue, a patriarchy issue and a power and domination issue. And good practice means one should be aware of all these dimensions and develop skills to intervene across these issues.

Author:
Dr Sangeeta Saksena, MD (OBG)
Enfold Proactive Health Trust
Facilitator: Life skills, Human Sexuality and Personal Safety programs for school and college students, parents and teachers.
Co author of “On Track” a workbook series on Life skills and Personal safety for school children

FAQ's about Periods

2009-01-10T08:21:00.001+05:30

Why does it pain during periods?

Just before the periods start, cells in the inner lining of the uterus die before being shed. This cell destruction produces chemicals called prostaglandins, and may cause pain. The muscular portion of uterus also contracts, so, depending on her sensitivity, a woman may find her lower back, abdomen or thighs hurting. This generally starts on the day of the periods and may continue for a day or two longer.

What is white discharge?

Our body is full of fluids. Eyes have a certain fluid, which they discharge. Ears discharge wax, nose discharges mucus etc. Similarly the vagina and the reproductive organs produce a discharge that is white in colour. This discharge is acidic in nature and it prevents infection. It stains the undergarments a yellowish, brown and this is normal.

Sometimes in case of infection there maybe a foul smell and itching, in which case you can go to a doctor to get it checked.

Can we take tablets to postpone periods? Is it unsafe for further procreation?

The tablets contain hormones and they ensure that you will not get your periods as long you keep taking them (provided the tablets are started 5-7 days before the expected date). They don’t damage you system, but do interfere with your normal cycle. They do not affect future childbearing.

Many girls take these tablets when travelling or to attend religious ceremonies. By taking extra care or by using tampons while traveling one can manage very well and there is no need to postpone periods. God made our bodies and periods are in no way ‘dirty’ or unholy. Breaking the natural rhythm of you body is best avoided. There is no reason to postpone periods.

Can we swim during periods?

Yes but you need to wear tampons to ensure that the menstrual blood does not come out during your swim.

What is hymen?

Hymen is a thin tissue (membrane) that partially covers the vaginal opening. The membrane has an opening in it to let out the menstrual blood. The size of the opening, and the elasticity and number of blood vessels in the hymen varies from person to person. The hymen may tear during vigorous exercise, gymnastics, horse riding, injury or sex. If the hymen opening is large and the hymen elastic, then sex may happen without tearing it. Therefore it is not always possible to ‘test’ for virginity by examining the hymen. It is not true that bleeding should happen during first sexual intercourse.

What is menstruation?

If the egg gets fertilized, it will need a place to grow. This place is the inner lining of the uterus, which becomes spongy and soft during ovulation. This lining has lots of blood and oxygen to nourish a potential baby. The outer edge is also muscular and will stretch as the child grows before contracting as it is delivered.

However, there is the chance that the egg-in the 24 hours that it lives-will not be fertilized. On this occasion, the inner lining (that had been altered to welcome the baby) is shed though the vagina in a process called menstruation. Most of it is made of blood, which trickles out over a period of 4-5 days.

When do girls get their periods?

Menstruation usually begins anywhere from 9 ½ to 16 years – 11 ½ is the mean. This often happens after the breasts have relatively grown, and a considerable amount of pubic hair is present. Pubic hair also first appears about 2 years before menstruation starts, and a mucous-like vaginal discharge is also normal at this time. The pubertal growth spurt has also occurred.

Can I change the timing of my periods?

There is no natural method of doing this. Periods depend on the hormonal balance in the body, and altering this is quite risky. Many claim that exercise increases the blood flow or pre-pones the periods, but this is entirely baseless.

What are sanitary napkins?

Menstrual fluid has mostly blood in it, so women use sanitary napkins to prevent it from staining their clothes. The pad is worn between the legs and covers the vaginal opening. It sticks to the underwear and can be tied to a thin elastic belt around the waist.

I do not get my periods regularly. Is something wrong?

For periods to come regularly, perfect synchronization of all the hormones is needed. This takes quite a while to develop, so for the first 1-2 years after periods start, it is normal for them not to be regular. A girl may bleed only once in 2, 3 or even 6 months.

As a girl grows older, the periods should begin to come regularly. Most have 28-day cycles, but these can be 21-35 day cycles too.

Blood loss is around 30-50 ml during periods. People usually use 10-15 pads per cycle. In the initial years, it is normal to have bleeding for 1-2 days alone. However, heavy bleeding for over 7 days on any occasion is abnormal, and a doctor must be consulted.

How does one reduce the pain during periods?

Doing yoga or being physically active reduces the pain during periods. One may also take a few painkillers, particularly those with mefenamic acid (Meftal spas), but only with food. Using three or four of the latter per month is neither ‘habit-forming’, nor does it cause any long-term damage.

How does a girl maintain genital hygiene?

It is very important to wash the pubic area with soap and water during a daily bath. The folds of skin – the labia minora and labia majora – must also be cleaned, as secretions tend to collect there. After passing fecal matter, always wipe from the front to the back, so as to prevent the vagina from being infected.

Some people think the hair should not be washed during menstruation. This is entirely baseless – a woman can wash her hair whenever she wants to.

What are tampons?

Tampon is a thin, narrow bundle of tightly packed cotton that can be inserted into the vagina to absorb menstrual blood. It has a string attached, so it can be removed easily. When a tampon needs changing, the string is usually soaked. Tampons should be changed when soaked or every 4-6 hrs, which ever is earlier. The advantage of using these items is that one can go swimming during menstruation. They are also small, and may be flushed in any toilet. The disadvantage is that, since tampon cannot be seen, there is a serious risk of forgetting it is there and removing it. Bacteria will be attracted to the blood, especially if the tampon isn’t changed in 6 hours. Toxic Shock Syndrome is a dangerous infection of the blood stream caused by a forgotten tampon.

Should one shave the pubic hair off?

Pubic hair is there to protect the sensitive genital area and trap the natural body odour, so shaving is off is rather pointless. The hair may get matted with blood during menstruation, but this only requires some thorough washing to handle. If you do wish to trim it, use a scissors, but be careful not to cut the skin.

Pubic hair doesn’t interfere with having sex, so one doesn’t have to shave it off before marriage. In fact since it traps one’s natural pheromones (chemicals in body secretions) it helps in sexual arousal.

Should there be food restrictions during menstruation?

Certainly not. If anything, Indian women need more iron-containing foods during their periods, as 80% of them are anemic. Menstrual blood in no way harms plants or foods – if that were the case, women would have been incapable of farming. In addition, there should not be any physical restrictions; exercising doesn’t increment blood flow.

What is the Safe Time to Have Sex and avoid Pregency?

2009-01-09T08:34:00.002+05:30

Let us assume that one has a 28 day menstrual cycle and period happened on say 1st May. Ovulation happens 14 days before the next period, so it can be 14th May but since the next period has not happened yet you can’t be sure of the ovulation date.
Also the ovum is alive for a 1- 1 ½ days so 14th is very unsafe i.e. there is very good chance of getting pregnant. Next period may not come on 28th May but 3-4 days early or late. If it comes 4 days early, then ovulation would have happened on 10th may and if late, then on 18th May.
Another important thing to be kept in mind is that the sperm can stay alive inside the uterus for about 3 days so if sex happened 3 days before ovulation it is not safe. So effectively the time from 7th May till 19th May is not safe for sex. The rule for a 28 day cycle is that 7 days from the day of starting periods is safe, and the last 7 days of the cycle (21st to 28th ) are safe. Middle 14 days or two weeks are not safe.
This is not a effective method of contraception to use as we are calculating based on an unknown fact (the next period).

OVULATION & MENSTRUATION

2009-01-08T17:28:00.000+05:30

At the start of puberty, pituitary gland in the brain gives signals to the ovaries to start releasing estrogen hormone. Estrogen produces physical and emotional changes in the person, changing the girl into an adult female.

The ovaries start maturing and releasing the ova (female reproductive cell). This occurs about once a month (one ovary releases one egg in one month, the other ovary releases an egg the following month). This process is called Ovulation.

Once the ovum has been released by the ovary it is picked up by the Fallopian tube. The ova stays alive in the fallopian tube for about 12 - 24 hrs. There after it dies and is absorbed by the body. If the sperms have been deposited in (or sometimes even at the opening of) the vagina, they swim up the uterus and into the fallopian tube to meet with the Ovum. This process is called Fertilization. The fallopian tube is joined to the uterus and helps move the fertilized Egg to the uterus. Here the egg will implant itself in the nourishing lining of the uterus called the Endometrium and develop into a baby in 9 months.

If fertilization does not take place, the soft endometrium is not required and is expelled from the body through the vaginal opening. This process is called menstruation or the period.

Menstruation lasts anywhere between 2 to 7 days. The blood that is expelled is absorbed on a pad or a tampon. Sometimes girls experience backaches and abdominal cramps during this time. All this is normal.

ERECTION, EJACULATION & WET DREAMS

2008-12-23T10:30:00.000+05:30

At the start of puberty, pituitary gland in the brain gives signals to the testicles to start releasing testosterone. Testosterone produces physical and emotional changes in the person, changing the boy into an adult male.

Under the influence of testosterone, the testicles start producing sperm – the male reproductive cell. Both the testicles are contained in a sac called the Scrotum- which helps in regulating temperature as sperm producing cells are very temperature sensitive. Sperms move from the testis into the Epididymus where they mature. Ejacualation is the process where the sperms are released from the body through the penis. Just before ejaculation the sperm move from the epididymus into the Vas deferens. Here they collect Semen - a whitish fluid that provides the sperm with nourishment. Semen is a combination of the fluid given by the Seminal vesicles, Prostate Gland and the Cowper's Gland.

Ejaculation can occur only when the penis is erect. When sexual feelings arise in the brain, it releases chemicals that increase blood flow into the Penis. The penis become hard, engorged and erect because of this rush of blood and this is called an erection. At the height of sexual pleasure the semen is released from the body through the Urethra- the same tube that is used for urination. There is a special mechanism that prevents urine from coming out during ejaculation. Once semen has been released, the blood flow returns to normal and the penis returns to its original state.

A man produces millions of sperm everyday. There are approximately 100 million sperms in 1ml of semen. Typically 2-5 ml of semen is released with each ejaculation.

During puberty a boy may experience erection and ejaculation during sleep. This is called a wet dream or night fall and is very normal.

Changes during Puberty / Adolescence

2008-12-23T09:34:00.000+05:30

We have a biological clock built in our brains that ‘switches’ on at around 8 -9 yrs to start the process of changing a child into an adult. The process takes anywhere up to 10 -15 yrs, physical maturity generally preceding mental and emotional maturity.
The process of physical maturation is called puberty while adolescence includes the psychological and emotional changes as well.
Physical changes during puberty
Girls mature about 2 years earlier than boys. Here is a short summary of the physical changes which occur.
Changes that occur in Girls

Height Increases rapidly. Starts at around 9 years and peaks at around 12-13 years. About 6cms are added on after the periods start.
Structure Pelvis widens for childbirth. Store more fat in the body.
Voice deepens and becomes less high pitched
Thyroid gland slight, temporary increase
Development of pubic hair starts at 10 years Can begin as early as 8 years.
Underarm hair develops last, sometimes after menstruation begins.
Blushing at slightest provocation during puberty.
Pimples start 1-2 years after onset of puberty and remain till late adolescence, subside on their own
Breast Development starts around 9- 10 years, develops by 14- 16 years.
Breast and areola are enlarged, nipple projects outwards.
Development of reproductive organs Lips of vulva thicken and enlarge. Mucus like vaginal discharge starts about 2 years before menses starts- often leaves yellowish stains on underwear.Menstruation usually start about 2 years after pubic hair starts appearing. Normally around 11-12 years, but range is 9-15 years.

Similarly boys also undergo some physical changes. Here is the summary of changes in boys

Changes that occur in Boys

Height Increases rapidly. Starts around 10-12years and peaks at around 14-15 years.
Structure Shoulders broaden. Develop more muscle in the body.
Voice first cracks, then deepens
Thyroid gland Slight, temporary increase
Development of pubic hair Starts around 10 years.
Underarm hair Last to develop.
Blushing at slightest provocation during puberty.
Pimples start 1-2 years after onset of puberty and remain till late adolescence, subside on their own
Breast Development Breast develops slightly during puberty. May be sensitive to touch
Development of reproductive organs Penis and testes start enlarging at around 10 years and continues till 15 years. Erection of the penis during a bath or on getting up from sleep is common from younger age, but ejaculation develops by 12-14 years.

As the body is changing there are also some Emotional & Psychological changes that both boys and girls go through. here is the list...

Forming one’s identity
Setting goals
Forming one’s values
Looking for independence
Desire to explore, take risks
Need for acceptance- especially by the peer group.
Wanting to fit in with peer group
Mood swings
Self –conscious
Curiosity about body and how it works
Feelings of sexual attraction

Are you a Victim of Child Sexual Abuse?

2008-12-16T10:23:00.000+05:30

Are you a victim of child sexual abuse? Do you think it all happened because of you? STOP! Don't think that way. Do you feel guilty if you fall sick ? Do you feel guilty, if you were waiting in your car on the traffic signal and someone comes and hits your vehicle from behind? NO ! you don't. Similarly, an abuse is never your fault. Sometimes you are too scared to resist. Sometimes you are too young to understand that you are being abused. You can't even differentiate between what is right and what is wrong. You think that may be its a bad dream that you are seeing. Its only much later you come to realize what happened with you. But, then, its very similar to someone hitting your car on traffic signal, you falling sick of a virus.. it is never your fault. Perpetrators of these crimes are like Virus of our society, they infect people around them and make them sick. What YOU need to understand is that it is this virus who is at fault and not YOU. Like we take medicine to fight a virus attack, we need to get ourselves informed, resist their act - this is the only medicine the society has against these virus.
Believe in yourself. You are unique, you are good and that no one can deny. Once you start believing in yourself, things will improve. Things will change for better. And probably you would save a fellow human being from infected by this virus.
So, don't be shy, don't be afraid. It is not YOUR fault.

On Track - a workbook series on Life Skills and Personal Safety is released on 19th Nov 2008 in Bangalore

2008-11-19T18:17:00.000+05:30

Dr Sangeeta Saksena and Dr Shoiba Saldanha, founder members of Enfold, have co authored this workbook series along with Dr Shekhar Seshadri, a well known child psychiatrist at NIMHANS. This workbook is for use by school children of std 3 through 9 and aims at improving a child's mental emotional and physical well being. It aims at prevention of child sexual abuse by building children's self esteem , communication skills and thus empowering them to resist and report abuse. The workbooks come with teacher's and parent's manuals and are published and marketed by Macmillan India. They are available at Macmillan showroom in Shrungar Complex on MG Road, Bangalore and at all Macmillan showrooms across India.

Are the workshops effective?

2008-09-26T18:51:00.000+05:30

Bangalore CAN Prevent initiative by SAP Global Delivert and Enfold Trust has been working to prevent child sexual abuse since Feb 2008. We aim to empower children to resist and report abuse - especially sexual abuse. This involves 4-5 interactive sessions with students - beginning with students as young as 5-6 yrs. This is done without making the child fearful of all adults or intoerant of any form of touch. So far we have reached over 7000 students.
Is the program effective? I would say yes - because at the end of the sessions many students come forward and report that they are experiencing abuse and what they should do about it. With a little support from us, the children have been able to report the abuse, ensuring their safety.
I invite you to come and attend a workshop in progress. If you feel interested, and are motivated to prevent child abuse, let us know.

2008-09-26T16:52:00.000+05:30

2008-09-26T16:51:00.000+05:30

Little Angels.... A Workshop is progress

2008-09-26T16:49:00.000+05:30

The People with a mission....

2008-09-26T16:08:00.000+05:30

Enfold is a fruit of the efforts of Dr Sangeeta, Dr Shaibya and Ms Meena. To know more about them please visit the enfold website . The link is :

http://enfoldindia.org/ourpeople.htm

Join Us.. Be a Volunteer

2008-09-26T15:59:00.000+05:30

Enfold offers various Training programs for you to become a part of this movement. One such course is "Certificate Course In Life Skills, Sexuality, Personal Safety " . The objective of the course is to :

To provide you with in-depth knowledge in life skills, sexuality and personal safety
To train you in conducting sessions for children and adults in life skills, sexuality and personal safety

To know more about the course please visit the website of Enfold Proactive Health Trust.

The link is http://enfoldindia.org/programs.htm

Bangalore CAN prevent Initiative

2008-09-26T15:50:00.000+05:30

SAP Global Delivery and Enfold has joined hands in speading awareness and empowering children against the menace of Child Sexual Abuse. The partnership started in the month of Feb 2008 has grown strength to strength. Till date the program has reached across children of age group 5-21 years, across various prestegious organisations/Schools/Colleges in Bangalore. Enfold volunteers conduct informative sessions, where the content is tailored to the age group being addressed.

WHAT IS ENFOLD?

2008-09-26T15:47:00.000+05:30

Enfold Proactive Health Trust is a registered trust in Bangalore, India since December 2002. In the U.S.A, Enfold Health is a registered non-profit organization.

Enfold was founded in November 2001 by Dr.Sangeetha Saksena and Dr.Shaibya Saldanha. As Gynecologists, they were dismayed at the occurence of preventable health problems in progressively young age groups. Seeing more sense in preventive and promotive health care, they started sessions on Human Sexuality and Life Skills.