A Common Future: Gender Justice and Reproductive Rights



A special series supported by PFI





The Population Foundation of India (PFI) has for the last 40 years been doing work that conforms to its vision of “promoting, fostering and inspiring sustainable and balanced human development with a focus on population stabilisation through an enabling environment for an ascending quality of life with equity and justice”. Over the years it has evolved, as its mission, the promotion and formulation of gender sensitive and rights based population and development policies, strategies and programmes. This special series, ‘A Common Future: Gender Justice and Reproductive Rights’, captures work on the ground which reflect struggles and interventions for gender justice and reproductive rights.

India:
Not Numbers But People: Turning Family Planning Around
By Aditi Bishnoi

Over the last few years, the government has been working towards nationally repositioning family planning within the framework of maternal and child health and women’s empowerment, instead of seeing it as tool for population control as it had once done. This, of course, is a complex process, requiring a raft of strategies that range from preventing child marriage and engaging young couples on contraceptive use to community counselling, the projection of key messages as well as improving quality of service delivery. Experts speak about how this is being done.

* "If one really analyses the reasons behind the poor acceptance of a method like Intra Uterine Device (IUD), two things come up – first, insufficient service delivery and, second, poor follow up and weak counselling."


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India:
The Two-Child Norm, A Sword Hanging Over Women
By Swapna Majumdar

According to NFHS 3 (2005-06), most Indian states, including some high fertility states in the north, have reached replacement level fertility. In other words, a majority of couples do not wish to have more than two children. And yet, some state governments continue to push the two-child norm in a bid to control fertility, instead of focusing on increasing access to healthcare and family planning services. This violation of women’s reproductive rights is inherent in denying those with more than two children the benefits of over 20 government schemes related to maternal and child health, either overtly or covertly. The imposition of the exclusion criteria has also had a telling impact on women’s participation local politics. In Odisha, where the two-child norm has been in place since 1994, the scale of disqualifications in panchayats, where it is applicable, has been high.

* Health activists contend there are direct linkages between the two-child norm and women being forced into having abortions.


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India:
For The Young Brides Of Barwani, Some Hope
By Smita Deodhar

Kanchan Vaksale is well known in her little village of Ghatti in Madhya Pradesh. This 40-year-old has a packed schedule, urging pregnant women in the community to go in for hospital deliveries and completing the full immunisation schedules for their newborn babies. She also counsels adolescents, individually and in groups, about the physical and mental changes that occur during the teenage years, and conducts ‘joda’ (couple) meetings on contraception. Vaksale is part of a group of 900 Accredited Social Health Activists (ASHAs) across 514 villages in Barwani district who are unwitting revolutionaries in a conservative society where it was once unthinkable for a woman to discuss sex and family planning publicly. Today, within two years, contraceptive acceptance for the age group up to 19 years in Barwani has risen from 3 per cent to 13 per cent.

* “Trying to convince people – especially elders – and demolishing myths about contraception is a daily challenge. People do raise objections.”


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India:
Preparing Young Men For Responsible Contraception
By Aditi Bishnoi

'If a girl is educated and gets appropriate training, she will look after her health…she will raise a healthy family and bring up children with good values.’ While this statement is undeniably true, imagine if young women in India had the equal support of young men in creating a family and future. The reality of course is that in most traditional Indian families, couples are unable to hold frank discussions on that commonly avoided but critical issue called family planning. Do they want children? If so, when best to start a family? How many children should they have? What are the contraceptive methods available and best suited to them? Some young men, however, are now beginning to realise the importance of equality within marriage and shared contraceptive responsibility. Meet Atul Kumar, the resident of a slum in South Delhi. This young, father-of-one is concerned about his wife’s well being and doesn’t want to add another member to his family for the next few years. He understands that a minimum gap of three years between children will not only keep his wife healthy but enable him to give his family a better, more fulfilling life. Atul is part of a growing tribe in his neighbourhood, all thanks to an innovative intervention that reaches out to boys and young men with key messages related to reproductive health and family planning in order to change attitudes.

* “Young men are interested in their own bodies, they want to know more, but there aren’t enough resources of information, which will tell them what they need to know in an honest, frank, unembarrassed way.”


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India:
A Birthing Map That Can Save Women’s Lives In Slums
By Sarada Lahangir

Odisha’s state capital of Bhubaneswar has 426 slums and is home to thousands of people living in abject poverty. Lack of awareness and access to basic reproductive health care has made their lives even more difficult. It is in such an unlikely setting that an intervention like Health of the Urban Poor (HUP) Project, is helping to improve the delivery of comprehensive maternal and child health care, and assisting women like Minati Pradhan, 30, to have safe deliveries. Six months ago, Minati – in her eight month of pregnancy – suddenly started having labour pains at midnight. The nearest hospital is located 10 kilometres from their home, and her husband’s search for an autorickshaw to take her there proved futile. What came to their rescue that difficult night was the birth micro planning map given to Minati by a health activist. The couple called a local dai (midwife) - whose phone number was printed on the map. In addition, the map provided information like the numbers of autorickshaw drivers and ambulances in the area as well as details of when and where to get prenatal check-ups done. This invaluable information helped Manati deliver safely and become a proud mother for the second time.

* An estimated 30 per cent of India’s population, or about 300 million, are living in towns and cities today. Of these, more than 90 million reside in urban slums without even the most basic facilities like toilets.


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India:
Forced Hysterectomies, Unscrupulous Doctors
By Swapna Majumdar

When Rajamma of Kannaram village in Andhra's Medak district went to the doctor complaining of pain in her lower abdomen, she was wheeled in for a hysterectomy. All she was told was that this would help relieve her pain. Rajamma was just 20. In the last two years, across India, over 30,000 women were reported to have undergone hysterectomies - the majority of them unnecessary. Activists contend that unsuspecting poor rural women are being advised to opt for the surgical removal of their uterus, a procedure in order to avail of the health insurance money provided under the Rashtriya Swasthya Bima Yojna (RSBY), a premier government scheme that provides health coverage to underprivileged families. At the same time, a doctor can charge a hefty Rs 12,500 for each hysterectomy. In Bihar's Samastipur district, 14,851 BPL women were admitted to 16 private hospitals in the past one year to "avail of benefits", while in Chhattisgarh, last year private nursing homes billed the state Rs 2 crore for conducting hysterectomies of 1,800 women over a period of eight months.

* "Instead of following the normal protocols while examining women with complaints of abdominal pain, bleeding or vaginal discharge, doctors performed or advised hysterectomies."


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India:
Planning Families, Planning Progress
By Anuradha Sahni

Matlab, a riverine sub-district in Bangladesh, about 50 kilometres from capital Dhakha, has attracted the attention of the world for some time now because of the data it provided on an important trend highlighted in a recent series of articles in the prestigious medical journal, 'The Lancet'. Citing controlled trials done here, 'The Lancet' demonstrated that increasing access to family planning services not only reduces fertility but improves women's physical well-being and economic status. Today, evidence of this kind, both at national and international levels, has confirmed that access to reproductive health and family planning services is a major factor for human and national progress, whether it is measured by the number of mothers who survive childbirth, the number of children in school or in the significant increases in family income.

* "Improved control of fertility and health of women and children will give women more opportunity to acquire skills and raise lifetime earnings and asset creation."


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India:
For Maternal Health, Play This Game Of Snakes and Ladders
By Azera Parveen Rahman

The women of Ramnagar slum in Agra, the city of the Taj Mahal, are helping to transform the well-being of their neighbourhood through innovative change strategies. Members of a local group, the Mahila Aroygya Samiti (MAS), which in turn is part of the Health of the Urban Poor (HUP) programme that works in eight states and five cities, keep a tab on mothers and children who need care with the help of bindis - which would otherwise have only adorned their foreheads! To help convey good maternal health practices to the women of their community, there is even a special snakes and ladder game in which every good practice – like eating green vegetables - leads a pregnant women to climb up the ladder; while a bad one – like feeding solids to infants before they are six months old - pushes them into the snake’s mouth! In this way, the message of good maternal/child health and better sanitation is reaching the community.

* “During our regular visits, whenever we come across a pregnant woman, we put a small red bindi on the map; an infant means a big red bindi. As time progresses, we keep ensuring that the woman and the child is immunised, and keep putting white dots on the bindis.”


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India:
Their Health In Their Hands: Delivering On Primary Health In Rural Karnataka
By Aditi Bishnoi

Many consider India’s primary health care system a basket case. Dr H. Sudarshan, who has spent over three decades working on various ways to strengthen public health delivery in India, begs to differ. He believes that with better management the existing system can be made to deliver on the ground, save millions of lives and ensure that 80 per cent of the population doesn’t have to avail of expensive private treatment. His Karuna Trust is today setting benchmarks for public health delivery through the public-private-partnership model in eight states, changing health outcomes for many – including a woman like 18-year-old Sunitha, the wife of tenant farmer with a history of amenorrhoea, who suddenly developed complications while in labour. Not only did she get good nursing care at her local primary health centre, an ambulance attached to it transported her in time to the Government Hospital in Gulbarga, where she delivered a healthy baby girl!

* Dr Sudarshan prescription is simple: “Improve PHC management. Keep the centre open 24x7, ensure that the doctor, nurses and healthcare workers report to duty daily, provide adequate stocks of essential drugs and complement all this by running competent referral units.”


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India:
Targeted Sterlisations Violate Women's Reproductive Rights
By Swapna Majumdar

Sample this statistic: Of the 225 million women worldwide that go in for sterilisation, 40 per cent live in India. Whether it is Madhya Pradesh or Uttar Pradesh, Assam or Rajasthan, roughly 80 per cent of Indian women use sterilisation as their contraceptive method. Shockingly, more than half the women who get sterilised – and according to National Family Health Survey (NFHS) data, three-quarters of contraceptive users have undergone female sterilisation – have had their operation before they reach 26 years of age. It’s evident that state governments are invariably following a ‘target approach’ to family planning even today. Unfortunately, in their overdrive to meet these targets, vital issues of safety, quality, and hygiene are overlooked, including well-established guidelines for female sterilisation.

* By offering incentives and disincentives to encourage small family norms, there is a gross violation of human rights, particularly women's reproductive rights.


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India:
Contraception As If Women Mattered
By Aditi Bishnoi

Mehmooda Khatoon. She is 26 but looks as if she has already spent a lifetime of struggle. Up at 5 am she sends off her husband, an autorickshaw driver, to work by 6 am after which she wakes up her three children. The eldest, a boy, has to be dressed for school even as the younger two – a four-year-old daughter and a toddler – vie for her attention. Mornings melt away in chaos but Mehmooda not only attends to the trio patiently she ensures that all the household chores are done. Although Mehmooda seems to be in control of her life, she has a few regrets, particularly over the fact that she became a mother very young. Her situation underlines a phenomenon known as “unmet need” for family planning. Unmet need is the percentage of women who want to avoid a pregnancy but are not using any kind of contraception. In a state like Himachal Pradesh, it is 14 per cent, while in Bihar it is as high as 37 per cent. Addressing this lag requires a shift in family planning strategies from the present focus on sterilisations to reversible methods like intrauterine contraceptive devices (IUCDs).

* “At 26, I am a mother of four. If I had known about contraception I could have ensured adequate spacing between my children. It would have given me an opportunity to take care of them and myself properly.”


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India:
Giving Birth Threatens Life In Tribal Odisha
By Sarada Lahangir

When Santosini Sisa, 40, a resident of Phulpadar village in Odisha’s Koraput district, who was eight months pregnant, had to be transported to a health facility because of a medical emergency, her husband had to literally tie her to a pole and carry her across a river because the only boat plying those waters had broken down. Today, she believes that it is only because of a miracle that she and her baby were saved. The Odisha government claims that it is working hard to improve health services in the state, but institutional deliveries in here stand at a poor 47 per cent, with the situation in the tribal Kalahandi-Bolangir-Koraput (KBK) belt much worse. According to the National Family Health Survey (NFHS-III), a conflict-hit district like Malkangiri district had only 7.1 per cent institutional deliveries.

* “In spite of many women dying from postpartum haemorrhage, no significant steps have been taken to set up blood storage units in the 24-hour primary health centres.”


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India:
Anganwadi Workers Talk Contraception With Hill Women
By Anuradha Sahni

Harpal Kaur, a resident of Chirola village in Una district of Himachal Pradesh, is a mother of two daughters, in Class Four and Class One, respectively. 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. It's the regular and proper use of contraception that is enabling Harpal to control her family size. Of course, Harpal is no ordinary village woman; she is Chirola's friendly anganwadi worker who takes her job very seriously. Of her many responsibilities, she believes that motivating women to adopt family planning methods is what can truly help them to lead a healthy, happy life. Which is why during her monthly anganwadi meeting, counselling women on the use of different contraception methods available is her top priority. Today, Himachali women want small families, but many are simply unaware of ways to limit their family size. It is anganwadi workers like Harpal who are the key to bridging this vital information gap.

* "We tell women that if they have had two kids by the time they are 25 then instead of opting for sterilisation they should go in for an intra-uterine contraceptive device or use condoms or pills."


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India:
In Himachal, Speaking Out On The Missing Girl Child
By Aditi Bishnoi

The tableau of the missing girl child is still unfolding in Himachal Pradesh. Despite being north India’s most progressive state in terms of human development indices – Himachal is facing a grave crisis. According to the child sex ratio data (2011 census), there are only 906 females per 1000 males in the age group 0 to 6 years. That’s even lower than the dismal national average of 914. A local civil society organisation, Sutra, recognising the problem, is working to harness the power of the panchayat, the lowest tier of government, to combat sex selective procedures in the area. Unfortunately, not too many panchayats are looking at the bigger picture as they are focused on implementing schemes rather than delivering on governance. Reproductive health and the declining sex ratio are not seen as priority concerns. Hoping to turn things around are the Kanya Bachao Samitis (Save the Girl Child Committees) formed in 300 panchayats across the five districts in the state.

* ‘Couples are going in for sex detection to ensure a male child, particularly when the first child is a girl. While many may not opt for an ultrasound test during the second pregnancy, if the second child too happens to be a girl, then a test will most definitely be done the third time round.’


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India:
In Amritsar, It's 'V' For Vasectomies
By Benita Sen

In India, the onus of planning the family has almost always fallen on the woman. Whether it's ensuring the use of condoms or adopting a more permanent method like sterilisation, men rarely come forward. Only a confident, responsible man can go through a little inconvenience to shoulder the responsibility of safe sex, rather than passing it on to his partner. The National Population Policy 2000 describes men as the "under-served population" as far as reproductive services go. But Punjab is partially reversing the trend by vigorously advocating No Scalpel Vasectomy (NSV), a unique approach to male contraception. Today, men from the vibrant town of Amritsar are taking their family planning responsibility seriously - 45 per cent of birth control surgeries in the district are being performed on men. Sometimes, it's the simple solutions that work best.

* Amritsar-based Dr Baljit Kaur is a rare woman expert of the NSV technique and one of few doctors, who can be credited with popularising this method across the state.


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India:
Hope Floats: Assam's Boat Clinics Help Women Plan Families
By Azera Parveen Rahman

A visit to the doctor may seem like a simple enough activity to many, but for the expectant mothers of Laika island in Assam’s Tinsukia district, it used to be a daunting task. After all, travelling in a rocking boat over the temperamental River Brahmaputra and then treading through the dense Dibru Saikhowa forest reserve to reach a health centre was no mean feat. Not surprising then that these women would avoid regular prenatal and antenatal check ups and often end up giving birth at home. Then, in 2005, came the boat clinics, an initiative of the Centre for North East Studies (C-NES). They helped to turn things around for the vulnerable women of these ‘saporis’, or river islands, bringing healthcare and family planning services to their doorstep. Today, women like mother-of-four, Phaguni Payeng, 25, of Karmi Chuk sapori, have finally been able to adopt family planning methods and improve their health thanks to 16 boat clinics, complete with doctors, nurses and a lab, that have been servicing the 2,500 islands on the Brahmaputra.

* "At a health camp in Dhemaji (lower Assam), the health team was elated to know that the child of the first woman who was under their prenatal supervision was named 'Doctor'! "


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India:
In Chhattisgarh, Tribal Women Demand Their Reproductive Rights
By Anumeha Yadav

Deep inside the Mainpat and Khirkhiri hills, the Pahari Korvas, one of five Primitive Tribal Groups (PTGs) of Chhattisgarh, are still waiting for their right to decide their family size. Women like Phool Sundari, Sabutri Bai and others, who have given birth to more than six children, continue to become mothers even though they do not want to, simply because they have no access to basic family planning services like contraceptives or sterilisation. The reason is a three-decade-old order of the Madhya Pradesh government - Chhattisgarh was carved from that state in 2000 - that restricted PTGs with small populations from being targeted during sterilisation drives, a stipulation the Chhattisgarh government continues to follow. This anachronistic approach to saving tribal populations from 'extinction' has not only put women and children at risk - maternal and infant mortality rates here are high - but has added to the economic burden of these poor families living at the edge of deteriorating Sal forests.

* "I do not want more children but the 'mitanin' (village health worker) says she cannot take me or anyone from my community to the clinic for an operation."


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India:
Give Them Support And Child Brides Will Fight Back
By Aditi Bishnoi

The incidence of child marriages nationally is coming down. But the pace of change is excruciatingly slow. Fortunately, there are also signs today that India’s ‘balika vadhus’, or child brides, are ready to put up a stiff fight against the injustice they have been subjected to in the name of ‘parampara’ (tradition) and ‘prathishta’ (honour). Girls like Rajasthan’s Laxmi Sargara, 18, who stood in front of cameras earlier this year with a court order that annulled her child marriage are providing an insight into the transforming mindset of millions of adolescent girls in India. Lending a hand in creating this change are organisations like the National Commission for the Protection of Child Rights (NCPCR), which has created a force of ‘Bal Bandhus’ (child rights’ defenders) in nine districts across the five insurgency hit states of Andhra Pradesh, Assam, Bihar, Chhattisgarh and Maharashtra.

* “There is always a grandparent in the family who is dying and who wants to see the child married. There are always parents who have ‘given their word’ and leave their daughters with no choice.”


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India:
Scene Changers: Why Some Districts Do Better
By Anuradha Sahni

We talk to district magistrates and deputy commissioners of some of the states that were recently conferred the JRD Tata Memorial awards for being "best performing districts", to find out what really made the difference in terms of how governance is changing people's lives at the grassroots. The award-winning districts were varied, ranging from Varanasi in Uttar Pradesh to Thoubal in Manipur, and Jagpur in Odisha to Firozpur in Punjab. What was the common factor for change in each one of these districts was the new visibility of women in the public space and out-of-the-box governance.

* "We found that women in the community were far more receptive about adopting change and fighting for their rights, than the men."


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Global:
Professor Amartya Sen Looks At Women And Other People
By Pamela Philipose

How do families deprive women of their rights and agency? How does women’s inequality impact on national development and well-being? Why has Bangladesh, with half India’s GDP, been able to out-perform India on many social indices? How are women central to population dynamics? In his JRD Tata Memorial Oration, delivered in Delhi recently, Nobel Laureate Amartya Sen undertook a magisterial survey of women’s place in contemporary India, bringing into the frame Bangladesh and Asia in general. While doing so he raised some intriguing and thought provoking questions on a variety of themes, including the eternal riddle of India’s declining sex ratio.

* “Any social change that brings voice, not just to women in general but young women in particular, has tremendous impact on fertility decisions.”


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