Where trust is the dividend

Pratibha Nishi Toppo, a health worker at the community centre in Bundu block of Jharkhand’s Ranchi district, had to deal with a 16-year-old adolescent who came thinking she had a menstrual problem but was found to be pregnant. After counselling, Pratibha asked the girl to bring her mother. The girl was hesitant but came back with her mother. The auxiliary nurse midwife then counselled mother and daughter, and referred the youngster for an abortion that would be safe and discreet. The girl and her mother, happy with the timely advice , came back to thank the nurse.

Based on his years of working at four health sub-centres of Sadar Chaibasa block, West Singhbhum district, Rajnesh Purty, a multipurpose healthcare worker narrates the challenges of working rural areas. Adolescents are not aware of health problems and unsure where to go. One day when Rajnesh was working at the Adolescent Reproductive Sexual Health Clinic, a young girl of 19 years visited the clinic. She was married and her husband was working in the city. The mother-in-law wanted a grandchild soon but the girl did not want to have a child for some time. Rajnesh took her to the doctor’s residence and he counselled her on family planning. She went home happier after opting for a family planning method.

In all the cases there was someone who listened, counselled and inspired trust. This is what the organisation EngenderHealth seeks to bring to all its work in India.

Providing family planning services and health facilities in rural India is more challenging than working in urban centres. But family planning is not just about numbers or smaller, manageable families. “Access to contraception saves lives and empowers women. When women are able to plan, they are more likely to survive childbirth and have healthier babies,” says Pamela Barnes, President and CEO of EngenderHealth, a global women’s health organisation.

Barnes has committed to support India’s goal to improve health and reduce maternal and child mortality by expanding access to contraceptive choices for 48 million citizens by 2020 — a goal set at the 2012 London Summit on family planning. EngenderHealth also plans to expand its footprint across the States it is already working in. In Gujarat and Rajasthan it will be expanding access to IUD (intra-uterine device) services. In Uttar Pradesh it will be providing technical support to the government for nutrition and partnering two other organisations for family planning services. In Bihar, in addition to nutrition and family planning services, it will be supporting the adolescent reproductive and sexual health project Tarunya. This has been running in Jharkhand since 2008.

Across the country, fertility rates are higher in rural areas, so are maternal mortality and infant mortality rates. While Rajasthan has a fertility rate of 2.5, in Bihar it is 3.4, which means a woman has three to four children.

Sanjeev Dham, deputy country representative of EngenderHealth India, says 60 per cent of women do not have spacing between children. The ideal would be 36 months for the woman’s body to recuperate from child birth, but often, it is just 18 to 24 months. So, ASHAs (accredited social health activists), auxiliary nurse midwives and doctors counsel women for post-partum IUD insertions.

To address the shortage of doctors and health professionals, the organisation is planning to involve AYUSH (ayurveda, yoga and naturopathy, unani, siddha and homoeopathy) doctors and to upgrade the skills of nurses and ASHAs for family planning services.

The writer is a senior freelance journalist based in Delhi

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