A compelling case for contraception

Recently Melinda Gates made a compelling, passionate statement about how giving millions of women access to contraception was necessary to end poverty and disease for both present and future generations.

The Bill and Melinda Gates Foundation, of which Melinda Gates is co-founder, has made it a mission to ensure that millions of women in developing societies have access to safe birth control measures. Since 2012, Ms Gates has been leading a worldwide campaign to get 120 million more women access to birth control by 2020. The BMGF has donated over one billion dollars towards family planning.

Never before has this fight for a woman’s right to decide if, when, and how many children she wants to have been more important. The recent India wide study on how ten million women in the country are forced to resort to unsafe abortions every year underlines the critical need to make contraceptive options available.

The study, done by the IndiaSpend team, highlights that myths and misinformation about contraceptive methods are still widely prevalent despite India having the longest government-backed family planning campaign in the world. Millions of women still lack access to contraceptive options. They are left with no option but to take over-the-counter pills or undergo dangerous, unhygienic surgeries to end pregnancies.

A 2016 Lancet report highlights how distant the prospect of safe abortions remains for rural Indian women. This is the case even nearly five decades after abortion was legalized in India. In the absence of safe methods, sales of popular abortion pills remain abnormally high.

Widening the basket of contraceptive choices, as the government did earlier this year, is a much welcome, long overdue step. But to be truly effective, these choices have to reach the millions of women in our smaller towns and villages. That needs better delivery systems, better training of doctors, and a mass awareness campaign. All of which remains a giant, gaping hole in our FP program.

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Family planning in Dharavi

A vasectomy surgery is the end of “manhood”. A Copper-T can prick the body, rust inside the body, or ride up to the chest. Condoms give no “satisfaction”. Oral contraceptive pills can cause weight gain.

These are the the notions and misconceptions that SNEHA team working on the Family Planning programme has to deal with and dispel effectively. The Family Planning unit of SNEHA has been working hard in Rajiv Gandhi Nagar, Dharavi to dispel these misconceptions and notions since 2011 and have induced behavioral changes in many women and men in the area. As per SNEHA estimates, as much as 46% of the population has an unmet need for family planning.

For instance, Karishma, 30, (name changed) was reluctant to use any form of contraception, till she conceived again. She already had two children. She then approached a SNEHA community organiser who helped her get an abortion at Family Planning Association of India (FPAI) at nominal rates. The incident motivated her to get Copper-T fixed to avoid pregnancy for five years.

Social exclusion and lack of information limit access to services such as family planning which are crucial for reducing unwanted pregnancies, saving lives, reducing poverty and slowing population growth. A woman’s ability to control her fertility directly impacts the quality of her life and that of her children. Access to family planning can reduce the number of maternal deaths and child deaths.

“Instead of sermonising to the community to have less children, we have adopted a different approach. We tell them that having fewer children, it is easier to feed and educate them. We tell them that their families can be better and healthier,”said the programme coordinator, Family Planning, SNEHA.

SNEHA has adopted the Peer-educator model, whereby women from the community have been roped in to educate the other members and also provide contraceptive such as condoms, oral contraceptive pills and other services at the doorstep. SNEHA also gives the community information about safe abortion practices, post-partum family planning, spacing between two children and using methods of contraception by choice and mutual decision making. It has also strengthened the referral system to service providers such as municipal hospitals, and FPAI.

Some of our peer educators have made good choices and have fewer children. They help demonstrate the benefits of family planning in the community,”said Bapat.

There is also intervention by way of events and campaigns, group meetings, and home visits. Women who avail of SNEHA services and referrals to FPA agree to speak in group meetings that help in motivating other members of the community.

SNEHA also involves men in the project, a neglected target group of most family planning interventions. Men are important to target becuase usually they make all the decisions regarding family planning. To effectively deal with men in the area, SNEHA hired a male community organiser who conducts group meetings with men and is able to engage with men in the area well.

For instance, a SNEHA personnel were counselling a man who was in a live-in relationship with a woman. When the girlfriend recently got pregnant, SNEHA personnel helped her get an abortion and also helped the man understand the importance of using contraception to avoid such unwanted pregnancies.

“It is important not to judge such people and provide intervention whenever necessary,”said the programme co-ordinator.