Neha, 22, of Naun village in Dharampur block of Solan district in the hill state of Himachal Pradesh, got married three years ago. She became a mother soon after.
After marriage, her life has fallen into an established groove. Whether it is summer or winter, her day begins at the crack of dawn – she has to clean the home, cook for the family, send her husband off to work and look after the eight cows the family owns – all the while keeping a sharp eye on her lively one-year-old son. Neha looks frail but she works very hard to keep the household going even as her husband toils away at the local vegetable market to earn a modest income. They make up for the shortfall in expenses by selling some milk now and then.
Neha has many dreams for her son. She would like to see that he gets a good education and is well looked after. She also knows that the only way she can ensure this is by keeping her family small. But, until a few months ago, this shy young woman had no idea how to prevent an unwanted pregnancy.
Neha’s neighbour, Sunita, is barely 20 and is already in the third month of her second pregnancy. Married young, she found herself pregnant before she could even come to terms with her new life as a married woman. Sunita, too, had no idea about contraception. It was only after her daughter was born that a neighbour told her about the pill. She and her daily wager husband are clear they do not want more children but the only contraceptive option they know about is sterilisation, although the couple is still too young to go in for a permanent method of family planning.
Himachal Pradesh is recognised as one of north India’s most progressive states in terms of human development indices. Women here are better educated and more aware than their counterparts elsewhere in the region. Almost every woman wants a small family but not many know how to limit their family size.
What young women like Neha and Sunita need is access to proper information on the various contraceptive options available to young women like them, so that they can take informed decisions about this very important aspect of their lives. Interestingly, it is the anganwadi that is emerging as an important knowledge space for them.
The anganwadi, a child-care and mother-care centre set up by the Government of India as part of its Integrated Child Development Services (ICDS) programme, is run by a woman worker who is responsible for the basic health and nutrition needs of the women and children of her community. Today, anganwadi workers in Himachal do more than just ensure that the children under their care get proper supplementary nutrition – they also advise their mothers on contraception.
Harpal Kaur, a resident of Chirola village in Una district of Himachal Pradesh, is the friendly anganwadi worker (AWW) of her village who takes her job as a counsellor on contraceptive care seriously. And she is a perfect example, as well, since she herself has opted to limit her family. A mother of two daughters, one studying in Class IV and the other in Class I, as far as she is concerned her family is now complete and she wants to concentrate on giving her girls a good life by ensuring their proper education and nutrition.
She says, “Whenever we have our monthly meeting at the Chirola anganwadi I make it a point to discuss contraception. In my village, most couples opt for condoms although I have talked to the women about oral contraceptive pills as well. I also try and promote the intra-uterine device (IUD), which I think is a good spacing method that women here can really benefit from.”
Harpal is up-to-date with the latest information on the contraceptive choices currently available, thanks largely to the efforts of a local non-government organisation, Social Action Through Rural Uplift (SUTRA), which has been working to raise awareness on reproductive and maternal health in the region. In collaboration with the Population Foundation India (PFI), Sutra conducts capacity building trainings and workshops for local health workers. In addition, it has also formed ‘Save The Girl Child’ Committees – which include the AWWs – across five districts where great emphasis is laid on the proper use of contraceptive methods. Explains Leela, Project Coordinator, SUTRA, “Since the AWWs have a direct connect with the village women, we train and motivate them. Our focus really is to get them to motivate those women in the reproductive age who are not presently using any form of contraception.”
Says Subhash Mendhapurkar, Director, SUTRA, “For several years, the government’s family planning programme was either focused on promoting condom use or sterilisation. Both these methods are problematic. While women are unable to ensure that their men use condoms, sterilisation can only be a terminal, and not a spacing method. Contraceptives need to be user-friendly as well as user-controlled. For now, it’s the pill that fulfills both criteria, with the IUD following as a close second.”
According to Mendhapurkar, the government programme is finally in the process of shifting its strategy – from terminal methods like sterilisation to spacing methods like IUDs and pills. It is the AWWs who are taking this message into the community. They also provide information on the advantages and disadvantages of each method. Says Kalavati, the anganwadi worker of Rori Gram Panchayat in Dharampur, “Many women do not know that they cannot take pills for six months after delivery, as long as they are breastfeeding their babies. Also they need to know that they have to get themselves checked for any infections before getting an IUD inserted. We try to talk to them about these aspects.”
Kalavati shares with the women of her community any new information she gets from her periodic meetings with Sutra’s field workers. “It’s all about access to information and services. We guide women who are pregnant on the right contraception to adopt after delivery. During our immunisation days at the anganwadi, we also distribute condoms and pills to women with small children. The one thing I have noticed is that while women are apprehensive about using an IUD, they become more receptive to it if they are counselled properly,” she says.
Another crusader ensuring safe and accessible contraception in her area is 30-year-old Geetanjali Panwar, who has been working as an AWW in Nichla Baroh village in Dharampur block, for the last four years. Geetanjali says, “Every third of the month we distribute take-home rations and hold a village-level meeting where, along with information on various government schemes, we also discuss issues related to birth control. In this way, we have been successful in getting some women to come forward for IUDs, and we guide them to health sub-centres where they can get the procedure done safely.”
Geetanjali, who is the mother of a 10-year-old daughter, is an example for her community. She and her husband, Prem Chand, a tailor by profession, have decided to defer having more children for the time being through regular contraceptive use.
It is a well-known fact that anganwadi workers have a lot on their plate. They are formally responsible for no less than 23 tasks, including monitoring the growth of the toddlers under their care. But women like Harpal, Kalavati and Geetanjali have also found the time to deliver reproductive health care in a sensitive, unobtrusive manner. They understand that for many women leading tough lives in challenging circumstances, well-being is also about being in control of their bodies.