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Society
A Couple's Contraceptive Revolution
by Swapna Majumdar
For the last 10 years,
Sunita and her husband, Shailendra Kumar Singh, have been working
together in Anantkamtaul village, district Muzaffarpur, Bihar, in
generating awareness about family planning. But it hasn't been easy. In
a state where cultural taboos confine women to the home and hearth,
Sunita has not only been able to break free of these shackles, she is
also engaging with issues as sensitive and prickly as family planning.
All this may never have been possible had it not been for
Janani, a
Bihar-based NGO working on family planning in Bihar and Jharkhand. The
uniqueness of Janani's programme in training and motivating rural health
workers to work with communities and advise them about family planning
services, is its insistence on couples only as motivators. By training
the wife, it has been able to get women to step out of their traditional
roles; and empowered them to be change agents.
Today, Sunita is a part of Janani's network of 32,000 rural health
providers who are making a difference. No longer is it just men coming
to ask for contraceptives, women too are seeking family planning
services. "This change has come because of the presence of my wife. It
has made a big difference in making women feel more comfortable," says
Shailendra Singh, Sunita's husband.
Bihar and Jharkhand make up 10 per cent of India's population - a
staggering 118 million. The fertility rate in Bihar is 4, the highest
for any state in India, and in Jharkhand it is 3.31, as against 2.68 in
the rest of the country. It is estimated that 11,200,000 people in the
two states want to contain their family size but do not know how to
access family planning services.
This is where Janani's strategy of making use of a husband-wife team has
helped. The team works to address misconceptions about family planning.
The roles and responsibilities of each partner is well defined. For
instance, while Sunita looks after the women, her husband is in charge
of advising the men.
But IUDs (intrauterine devices) and oral pills are not all the
motivators speak about. The couple offers advice to pregnant women about
nutrition and child spacing. More importantly, they stress on the
importance of the health of the woman. They explain that a woman should
not be the one to bear the burden of family planning and feel compelled
to undergo tubal ligation. They must educate men about the option of no
scalpel vasectomy (NSV), which is quicker than tubal ligation and
requires no surgery.
Even though winds of change are blowing in her village, Sunita feels her
work would have been far more effective if more women were educated.
During the last 10 years, Sunita says that she has been able to convince
many couples that it was the health of the child that is important, not
its sex. "I tell them girls are as good as boys and they should not keep
having children in the hope of a boy. I give them the example of the
widow in the village, who has only one child, a daughter. Although
married, the daughter looks after her. I contrast it with the case of
another family where the son has thrown out his widowed mother. What
good is the son if he doesn't look after his parents in their old age, I
ask them. This argument has motivated many couples," Sunita contends.
However, it is not merely the couples who need motivation. They reach
out to mothers-in-law as well for, more often than not, they have
considerable influence on the size of the family. This is where Sunita
scores. Not only is she able to gain access to the entire household
because she is a woman, she is also able to take advantage of being a
trained motivator and the wife of the rural medical practitioner (RMP).
But when she comes across some difficult 'cases' she has had to think
out of the box. As she did in the case of Sitavi Devi, the mother-in-law
of Geeta Devi, 25. Geeta already had four children including two sons
when she became pregnant for the fifth time. After giving birth to
premature twin daughters, Geeta was weak and anemic even four months
after giving birth.
Geeta didn't want any more children but she did not have the courage to
say so. Every time Sunita would talk about family planning, Geeta's
mother-in-law would say that the family needed more children to increase
its income. At present Geeta's husband, a rickshaw puller, is the only
bread winner in the family.
But Sunita did not give up after hearing this argument. She took the
support of Sitavi Devi's neighbors to reason with her. She motivated
Anamika Kumar, 16, a student living next door and their combined efforts
finally bore fruit. Although Sunita told them that a vasectomy for her
son would be quicker and painless compared to a tubal ligation for her
daughter-in-law, the mother-in-law agreed to Geeta getting sterilized.
"I did not insist on the vasectomy because at least she agreed to allow
her daughter-in-law to undergo a sterilization. This is also a big step
and the beginning of a change in her mindset," says Sunita.
Change is also visible in village Abirpur, in the adjoining district of
Vaishali, where the husband-wife team of Manoj Maharaj and Reena have
been able to rope in husbands to talk about family planning. In fact,
they managed to motivate local resident, Jyotish Kumar Sharma, to join
hands with them to spread the message about keeping families small and
healthy. He has even performed street plays propagating these messages
in the five other villages of the district.
It was Reena who played a pivotal role in counseling Sharma's wife,
Neerja, after she had a near fatal brush with death giving birth to
their third child, to undergo a tubectomy. Neerja revealed that once she
and her husband understood the importance of maternal and child health,
the decision was quick.
Getting husbands on board has helped the Janani teams to raise awareness
about family planning. While the wife motivates her counterparts to talk
to their husbands about NSVs, the husbands explain the entire procedure
and benefits in simple terms. Once the men agree, they are referred to
Janani's Surya clinics where these services are provided. So far, Manoj
and Reena have referred 50 cases. The beneficiaries are taken to the
clinic and dropped back home by the motivator, free of charge.
In rural Jharkhand,too, Janani motivators inspire men to opt for NSVs.
Local RMP and motivator Rajesh Kumar of village Murtu, district Ranchi,
is young and energetic. In fact, the newly-married Kumar has vowed that
he would undergo NSV after two children. "If I don't look after my
wife's health, who will? More importantly, if we are to motivate others,
we must lead by example," he says.
In these two states where primary health centres are few and far and
family planning a tabooed topic, Janani teams have opened the doors to
winds of change.
June 21, 2009
By arrangement with
WFS
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