Nayreen Daruwalla and colleagues describe the Centre for Vulnerable Women and Children, which serves clients coping with crisis and violence in the urban setting of Dharavi, Mumbai.

BackgroundIn India, though breastfeeding is universally practiced, exclusive breastfeeding (EBF) rates in urban informal settlements are low; and health programs face several challenges in promoting EBF. In this study, ensconced in one program area of a non-government organization, we focused on “positive deviant”- mothers who were able to practice EBF for six months and attempted to delineate factors that shaped their EBF practices. Typically, qualitative research from Lower and Middle Income countries on EBF has focused on understanding why women do not practice EBF; the converse perspective taken in this study has been less explored.MethodsWe employed the positive deviance approach which contends that important programmatic learnings can be attained from persons who adopt positive behaviours. We conducted twenty-five diverse, purposively sampled case-studies of “positive deviant” mothers from two urban informal settlements in Mumbai; and analysed these using a framework approach. The results were summarised using a socioecological framework (consisting of individual, interpersonal, organizational and environment levels).ResultsWe found that mothers typically construed EBF as not giving breastmilk substitutes. Giving the infant minor supplements (water, honey) was not considered a violation of the EBF practice. The main themes that emerged as influencers of EBF included: at individual level, perceptions of having adequate milk; at interpersonal level, having role models who practiced EBF and having family support; at organizational level, advice from health workers (which was purported to play a secondary role); and at environmental level, financial constraints that limited access to supplements. One important finding was that women who practiced EBF could not always do it optimally; we encountered several instances of “poor EBF” practices, where mothers had breastfed infants inconsistently, allowing for long gaps between feeds, and had continued EBF even after six months.ConclusionsThere is an urgent need for health programs to clarify the meaning of EBF and counsel against “poor EBF” practices. Messages received by women from immediate family on EBF were powerful and families play an important role in the actualization of optimal EBF practices. Hence, it is imperative to counsel entire families on EBF rather than women alone.

The COVID-19 pandemic has magnified the multiple vulnerabilities of people living in urban informal settlements globally. To bring community voices from such settlements to the center of COVID-19 response strategies, we undertook a study in the urban informal settlements of Dharavi, Mumbai, from September 2020-April 2021. In this study, we have examined the awareness, attitudes, reported practices, and some broader experiences of the community in Dharavi with respect to COVID-19. We have used a mixed-methods approach, that included a cross-sectional survey of 468 people, and in-depth interviews and focus group discussions with 49 people living in this area. Data was collected via a mix of phone and face-to-face interviews. We have presented here the descriptive statistics from the survey and the key themes that emerged from our qualitative data. People reported high levels of knowledge about COVID-19, with television (90%), family and friends (56%), and social media (47%) being the main sources of information. The knowledge people had, however, was not free of misconceptions and fear; people were scared of being forcefully quarantined and dying alone during the early days of COVID-19. These fears had negative repercussions in the form of patient-related stigma and hesitancy in seeking healthcare. A year into the pandemic, however, people reported a shift in attitudes from ‘extreme fear to low fear’ (67% reported perceiving low/no COVID risk in October 2020), contributing to a general laxity in following COVID-appropriate behaviors. Currently, the community is immensely concerned about the revival of livelihoods, that have been adversely impacted due to the lockdown in 2020 as well as the continued ‘othering’ of Dharavi for being a COVID hotspot. These findings suggest that urban informal settlements like Dharavi need community-level messaging that counters misinformation and denial of the outbreak; local reinforcement of COVID-appropriate behaviours; and long-term social protection measures.

Objective: Anaemia is a health problem for adolescents in India. This paper examines the nuanced transformations triggered by a multi-pronged, community-based anaemia intervention with adolescents and their families, seeking meaningful insights for future nutrition and anaemia programmes. Design: Qualitative study rooted in critical theory. Setting: Three slum communities – Dharavi and Kandivali (in Mumbai) and Kalwa (in Thane) in Maharashtra, India. Methods: Data were collected through focus-group discussions and in-depth interviews with young people, parents and other stakeholders. Content analysis of drawings of a nutritious food plate by participants supplemented discussion and interview data. Thematic analysis was undertaken manually using a grounded theory approach. Findings: Nutrition education with adolescents and parents led to reduced junk food consumption although reinforcement of the information provided was necessary to sustain the change. Parental support was a crucial factor in ensuring anaemia treatment compliance but was affected by a lack of awareness regarding the consequences of anaemia and the nutritional requirements of anaemic adolescents. Other factors, including the pampering of boys, the neglect of girls and the heavy workload of mothers influenced treatment compliance. Awareness and agency among adolescents contributed to a supportive environment in terms of raised consciousness and better sanitation within families and the community. Conclusion: Findings highlight the need for a holistic approach to address anaemia among young people. While nutrition and health education are important to address treatment noncompliance, this approach should also focus on factors such as socioeconomic status, gender equity, health prioritisation, family involvement and engaging young people as agents of change to promote an enabling environment.

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In today's global society, business is increasingly conducted across borders, with English often used as the language of international communication. Being able to use English in the workplace has many benefits, including: helping your business succeed, building trust with colleagues and customers, building and improving international relationships, enhancing skills, earn good salaries and improve international relations through cultural understanding. Workplace cultures and organizations are changing as they adapt to globalization and rapid technological developments. Likewise, the nature and role of language in work and literacy requirements in the workplace are changing in the face of increasingly multicultural work environments and global networks of communication. Among these changes, recent research has highlighted the role of informal modes of interpersonal communication in the functioning of the modern workplace. Successful participation in such interactions should not only be seen as a matter of social inclusion but also as a verbal activity. This article reviews current research on the nature of language in the workplace, with particular attention to the contributions of ethnographic research and language socialization. It then discusses research on four aspects of language content in employment programs: employability skills, interpersonal communication, intercultural openness, and the importance of language and Pedagogy focuses on job interviews. These soft skills are just as important as your language skills in building lasting business relationships and can help you develop an awareness of cultural differences that can define how you communicate and how to interpret your words

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This qualitative study explores how comprehensive sexuality education located within a broader positive youth development approach informed transformations among young people from informal urban communities in India. A thematic analysis of data obtained from the young people, their parents, and frontline workers revealed that securing the cooperation of families was possible for the program because sexual and reproductive health education was not a stand-alone intervention, but a part of a larger approach seeking to build capacities of young people. The strategic introduction of sexual and reproductive health communication helped the participants to overcome inhibitions about the topic. Enhanced awareness of gender, pubertal changes, gender-based violence, and child sexual abuse was evidenced post participation. Improved agency was manifest through decision making, critical thinking, confidence, mobility, and articulation, especially among girls. Program interventions to enhance sexual and reproductive health awareness of parents and communities and to improve health services and facilities were bolstered through youth engagement. Such contribution by the young reinforced their knowledge and skills, strengthened agency, and cemented family and community support. A holistic program situated within the positive youth development approach thus seemed a pragmatic vehicle to promote comprehensive sexuality education for young people in vulnerable urban communities.