The Register That Does Not Add Up
In a high school in a tribal block of Koraput, 38% of Class 9–10 girls are absent on the same few days each month. A health check found 62% of girls and 40% of boys anaemic (haemoglobin below 12 g/dL for girls and 13 g/dL for boys). Fourteen girls from the school were married in the past year; three have dropped out. The sanitary-napkin vending machine is broken and the incinerator is missing. The weekly 'family life education' period was dropped from the timetable because some teachers say puberty is a private matter and parents may object. The school has ₹25,000 from a health programme and one trained counsellor who visits fortnightly. The headmaster wants a plan for the next academic year.
1. Rank the four issues - anaemia, menstrual-hygiene absence, early marriage and dropout, and the missing family-life education period - by urgency, and justify your ranking.
Read the worked answer
1. Early marriage and dropout - most urgent. Fourteen marriages in one year and three dropouts are irreversible: once a girl leaves school, her education, health and bargaining power are affected. It is also a legal issue, since marriage below 18 is prohibited. Action cannot wait for a survey.
2. Anaemia - urgent and widespread. 62% of girls and 40% of boys are anaemic; this lowers concentration, increases infection and worsens maternal risk later. It is measurable and treatable through iron-folic acid, deworming and diet.
3. Menstrual-hygiene absence - high. It is a direct cause of missed school days and is quickly fixable through a working vending machine, water, disposal and privacy.
4. Family-life education - enabling, not unimportant. Without it, the other three recur. It is ranked fourth only because it works through the other actions; it should start immediately as support.
The ranking is based on reversibility, scale and legal duty, not on which problem is easiest.
2. How would you respond to teachers and parents who say puberty education is against local culture?
Read the worked answer
Reframe, do not confront. Agree that puberty is private, then explain that the school is not teaching intimacy; it is teaching hygiene, nutrition, safety and the law. Use local words for menstruation and anaemia rather than clinical terms.
Bring in trusted adults: mothers' groups, ASHA workers and a woman teacher can co-design the sessions; separate groups for boys and girls; confidentiality rules; no personal questions.
Use evidence from the school: 38% absence on menstrual days, 62% anaemia, 14 marriages. Ask parents what they want for their daughters. Offer a preview session.
Anchor it in existing programmes: adolescent health and menstrual-hygiene schemes already exist; the school is not inventing a new morality. Keep content age-appropriate and skip explicit material that is not needed.
Escalate only if needed: the headmaster can explain the legal duty to prevent child marriage and the right to health information. The aim is consent, not a fight.
3. Design a monitoring plan and a budget for the ₹25,000 available.
Read the worked answer
Indicators: (i) anaemia - recheck haemoglobin of a sample after 3 months and record iron-folic acid coverage; (ii) attendance - compare absence on menstrual days before and after the machine is repaired; (iii) referrals - number of married or at-risk girls identified and supported to continue school; (iv) vending-machine uptime and napkin stock.
Budget (₹25,000): repair vending machine and install incinerator ₹8,000; napkins for a year ₹6,000; counsellor travel and follow-up ₹4,000; teacher and mother orientation ₹5,000; records and a privacy-friendly register ₹2,000.
Process: anonymous question box; consent from parents for haemoglobin testing; no public display of names; monthly review by the headmaster and counsellor. Risk: if the machine breaks again, the absence will return - so a maintenance contract and a named staff member are part of the plan.