Even as the urban belts of India debate the use of the female condom as an effective method for family planning and prevention of HIV/AIDS, in some rural areas of Uttar Pradesh, the condoms are helping women have better control over their reproductive rights.
In the nondescript town of Sampooran Nagar, in Lakhimpur Kheri district, situated on the Indo-Nepal border, female condoms have not only helped women save themselves from unwanted pregnancies, but also from Sexually Transmitted Infections (STIs) and HIV/AIDS. Sold through women members of Self-Help Groups (SHGs), the female condoms that are approved by the World Health Organisation are bought by women of lower class rural backgrounds. Interestingly, the contraceptive has won support from the menfolk, too.
Women keen to learn about the female condom converge at the Sewa Swasthya Kendra (health facilitation centre) - a local landmark of the Shinghai Khurd block, considering that most passersby know where it is. "Arre Sewa Kendra, woh toh usi gali mein hui (Oh yes, the centre... it is right there in that lane)," points out a helpful pedestrian.
Traversing through the lanes to reach the Sewa Kendra, run by the Navchetna Swayam Sahayta Samuh or Navchetna Self Help Group, is rewarding. Much seems to be happening within the building. Around 15 women, sit on a huge wooden bed, listening intently to Rama Devi, 38, who heads the Navchetna SHG and is also in charge of the Kendra.
Rama introduces them to the benefits of the contraceptive - control over reproductive rights, protection from STIs and HIV/AIDS - and tells them how a female condom is inserted.
Made from plastic polyurethane (the male counterpart is made from latex rubber), the female condom loosely lines the vagina and provides broader protection to women from STIs and HIV/AIDS. The female condom, which covers the cervix at its closed end, can be used during menstruation and pregnancy for one-time usage.
Rama's audience, both giggly and curious, asks questions and also learns how to negotiate the use of the female condom in case of a reluctant partner.
However, the need to be persuasive - highlighting the issues of health and family planning - does not seem to arise, judging from the demand for the female condom amongst the women in Sampooran Nagar, which has a population of around 10,000 and over 550 married couples till date. "Although female condoms are costlier than their male counterparts, we have been able to sell some 60 pieces in the last three months," Rama Devi reveals. Given the cost and apparent stigma attached to the female condoms, this certainly comes as a surprise.
The female condoms, which are imported from the UK, are sold at subsidised rates of Rs 2 per piece (US$1=Rs 40), whereas the regular male condom (Nirodh) is available at Rs 5 for three. "In the past year, over 1,000 female condoms have been sold in Sampoorna Nagar, with women trying to save money to buy them whenever their husbands, who work in cities, come home on holidays. Despite the fact that the female condoms are much bigger, sometimes uncomfortable and expensive, women are buying them because they feel they can protect themselves from HIV and unwanted pregnancies on their own without having to ask their men to cooperate," shares Rama Devi.
Lalli Devi, 30, agrees, "My husband is happy that I don't ask him to use a condom now as the female condom saves me from unwanted pregnancies."
"It is indeed a much better way to save yourselves from unwanted pregnancies and also, the 'shaher wali bimari' (a common acronym for HIV/AIDS)," adds Rama. Her circle of women nods in agreement.
"Initially, women came to the centre with complaints that the condoms are uncomfortable," recalls Ruchi, a field coordinator with Rahi Foundation, an NGO. But when support came from the men, they agreed to buy them. "Hamre purush log condom nahin lagana chahte. Unhen ismein burai lagti hai. Isiliye jab humne lagane ki baat kahi, toh unhone mana nahin kiya (Our menfolk do not like using condoms. So when we asked them about using one for ourselves, they readily agreed)," said Anita, in her twenties and one of the regulars at the centre. For the men, it was obvious that this condom would not inconvenience them.
Deviprasad, in his fifties, is a shopkeeper in the village who is all praise for the female condom. "Now, no one tells us how we need to plan our families. It's up to the women," he says.
While no survey has been done to gauge the impact of the female condom on the sexual health of women in Sampooran Nagar, there appears to be a positive change. According to Dr S.K. Mishra, head of the Public Health Centre (PHC) in Sampooran Nagar, the number of women coming with 'unwanted' and 'accidental' pregnancies has come down in the past one year. "It may be because of the use of the condom by the women," said Dr Mishra.
The Kendra is part of the several medical aid and female condom centres established in 80 blocks of Pallia and Nighasan in 2006 by the Rahi Foundation, using the SHGs formed by the state government as the support group.
The centres also offer women basic knowledge of hygiene and general health. Rahi Foundation had provided a medical kit called the 'suvidha kit', which consisted of Dettol (a popular brand of liquid antiseptic), bandages, Oral Rehyrdration Salt (ORS) sachets, iron and multi-vitamin tablets, and female condoms accompanied by a manual (Mahila Condom: Ek Dirdarshika). "Initially, we could not tell them that they should be using condoms or how they could get HIV/AIDS. But the kit helped break the ice," said Ruchi. Incidentally, SHGs were identified on the basis of their involvement in various government projects; while people who had a say in their community were recruited as trainers. For instance, Rama Devi is also referred to with respect as the 'badi bhabhi' (elder sister-in-law) in the area.
Even though the Rahi Foundation project came to an end in March 2007, the centre continues to sell the condoms. Sunil Singh of the foundation put it this way, "There is a constant need for working on the Reproductive and Child Health (RCH) needs of the women in this area."
Situated in the farthest district of the state, it is obvious that Lakhimpur Kheri gets very limited support from the government. Yet, the women of the area have ensured that a change for the better is slowly making its presence felt.