Elizabeth’s five children are waiting for lunch. All she has is a handful of rice, some watery dal and vegetables – clearly not enough. She despairs.Enter Neelam, a social worker. She sympathizes but points out that Elizabeth should have spaced her babies and practiced birth control.
Watching them intently are 50-odd women, tightly packed together inside a tiny shanty in a colony in Dharavi, in Mumbai, Asia’s largest slum. Elizabeth’s story is a familiar one. And the community play gives them an entry point into issues they would otherwise never talk about openly.
The performances are basic, the actors untrained, but the message is a powerful one – Women can and should plan their babies. It’s a message that decades of government campaigns have failed to deliver effectively, because they have focused on permanent methods like sterilization. This leaves out women who want to delay babies.
A lack that the Society for Nutrition, Education and Health Action is trying to address in a first-of-its-kind, joint initiative with the Family Planning Association of India and the Mumbai municipality. ‘We are looking at reducing unplanned pregnancies. Our objective is to get to young women, introduce correct information, remove misconceptions, tell them about temporary spacing methods and give them autonomy over their fertility,’ says Garima Deveshwar Bahl, Program Director, SNEHA.
And it is showing results here at Rajiv Gandhi Nagar colony, home to first generation migrants from the states of Uttar Pradesh, Jharkhand and Bihar. A community of 3500 households, with poor access to basic amenities like water, sanitation, and health services. Most families here have 3 to 5 children.Women want to space their children or limit family size but don’t know how to.
“When we started out here use of family planning methods was just 12% and in a short period of one year with very low-cost solutions, it has gone up to 30%. Of this 13% are just new users’, says Bahl.
Peer educators like Neelam and Elizabeth who are from the community visit homes and inform women about the range of methods available, the so-called “cafeteria approach.” ‘In the beginning it was very difficult to reach out’, says Neelam. ‘We started by telling them about rising expenses and how it helps to space out children. Gradually they started thinking about it.’
“Mostly we pass on knowledge about condoms because it is easier for the men to use it,’ adds Elizabeth. ’We also tell women about pills and Copper-T so they know they can make a decision too. Use of injectable contraceptives has grown over the last few months.”
As Neelam and Elizabeth wrap up their play, out pour a flood of questions from the audience. “I agree with you but how do I convince my husband and mother-in-law?” asks a mother of two. Her query is an indicator of what remains a vital, but unaddressed part of the puzzle. Given the low decision-making powers these women have at home, it’s essential to make men part of this program. Something SNEHA says it plans to work on.
Every year, in India, over 100,000 women die during pregnancy and childbirth, a fallout of frequent and unplanned pregnancies. This low-cost community initiative is helping to change that dismal picture.
Family Planning matters because
*Each dollar spent on preventing unintended pregnancies will save governments $31 in healthcare,water, housing and waste disposal – UNFPA2011
*It increase chances of child survival
*It reduces maternal deaths due to frequent and unplanned pregnancies
Interview with Garima Deveshwar Bahl, Program Director, SNEHA –