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  • Access to information on reproductive and sexual rights can empower women
  • An awareness camp makes a big difference
  • Counselling helps in behaviour change
  • Matter of health and dignity
  • Making a Health Centre Functional
  • Main Kuch Bhi Kar Sakti Hoon
  • PFI support helps get a landmark decision on women’s reproductive rights
  • Making Primary Health Centre Functional
  • Towards gender equality
  • Timely care and trained staff can save lives
  • Access to information on reproductive and sexual rights can empower women

    Kangra district, Himachal Pradesh

    Jyoti Devi is a 34-year-old woman with two children. She has studied up to Class 10 and belongs to a scheduled caste family. She lives in Patta Badiya village of Dharampur block, Kangra district, Himachal Pradesh.

    She and her husband were not using any contraceptives as they did not have proper information about the methods. She says they used to feel ashamed about discussing this with anyone. They were also hesitant to buy pills or condoms from the health centre as they did not know how to use them. Jyoti Devi’s mother-in-law, who is the president of the Mahila Mandal (women’s group) in the village, introduced her to the Kanya Bachao Samiti (Save the Girl Committee) in June 2013. She became a member and has also taken part in training camps for members.

    Jyoti says, “I would have never been able to understand my own body or participate in the training camps, had I not become a member of the Samiti. It was only after participating in these that I got information about the different non-terminal methods of family planning and also understood the difference between the terminal and non-terminal methods.”

    She is happy that she is able to openly discuss family planning options with her husband. She says, “We both felt that as our family is complete we should adopt some method of family planning. My husband told me to adopt any method that I feel comfortable with and which suits me".

    Jyoti states, “Associating with the Kanya Bachao Samiti has improved my life remarkably. I got a chance to visit the gram panchayat office and attend meetings. I have now understood which method of family planning will be good for me and also started taking decisions on improving my health. I have let go of the shame and hesitation associated with discussing family planning methods and have started speaking on them openly. Now, I also disseminate information about these methods among other women.”

    An awareness camp makes a big difference

    Barpeta district, Assam

    Ajmal Hoque, 27, is a graduate from lower Assam’s Kasimpur island village in Barpeta district. He says circumstances have forced him to take up agriculture rather than seek a “decent earning” doing a government job.

    An awareness camp on Child Marriage and Family Planning was organised last year in Kasimpur, a two-and-half hour journey across the Brahmaputra by boat from Barpeta. The normally reserved Hoque showed a keen interest in the discussions and had many questions for the team. After the session, he took one of the team members to his house nearby to meet his sister-in-law, Minuti Khatun.

    Minuti was in her mid-twenties but looked much older. She had been married to his elder brother when she was just 12 years old. A couple of years later, she became pregnant, but lost the child at birth. The following year, she delivered a baby girl, who drowned in the Brahmaputra at the age of one and a half years. By 22, Minuti had had three more children.

    Within a span of eight years, she had delivered five children, three of them when she herself was a child. She never got a chance to go to school. Societal norms had cost her dearly. She had lost her childhood, added to which was the despair of having lost her children in quick succession. Repeated childbirth when her body was still not ready for motherhood had taken its toll. Since the birth of her last child, Minuti had been on temporary family planning methods. She and her husband were not willing to go in for a permanent method, afraid of what would happen if they were to lose their surviving children.

    A progressive minded Ajmal said that like Minuti, many women from the area suffer an early set back getting married when still very young. They are anaemic, weak and suffer from many diseases at an early age, he said. He added, “There is no scope for informative discussion like the one we had today. If we had such talks, discussions and opportunities more often, and contraceptives were easily available, many of our women would be much healthier. I am thankful that I have been able to learn so much today. I shall try and pass on whatever I have learnt to anyone else who would seek my advice.”

    As for Minuti, she said she would discuss with her husband about using Copper-T (contraceptive device).

    Counselling helps in behaviour change

    Tiloi, Uttar Pradesh

    (Names have been changed to protect the identity of the people)

    Sunita got married to Rajesh in 2014 at the age of 19. She now lives with her husband, her parents-in-law, her husband’s elder brother, his wife and their four children in Uttarpara village of Tiloi, Uttar Pradesh. Sunita was allowed to study only till Class 5 by her parents.

    A field facilitator from Save A Mother (SAM) visited her house and counselled her and her sister-in-law about maternal and child health. Her sister-in-law’s four children were born in quick succession within five years. During the discussion, the facilitator explained the following:

    1. A girl should not be married before the age of 18 years.
    2. The first pregnancy should be after three years of marriage as the women get married young.
    3. The pregnancies should be adequately spaced for the health of the woman and the children.

    Sunita said, “My sister-in-law is very weak and anaemic after the pregnancies. We had heard about female and male sterilisation, but feared side effects.”

    The facilitator informed them about various family planning methods available such as condoms, oral pills and the IUCD. She also told them in detail about the benefits of each method. With the counselling given, Sunita and her sister-in-law have got their husbands to use the condom. They purchase the condoms from the ASHA.

    Sunita says, “I have decided to give birth to my first child after three years of marriage and we are using the condom for delaying the first pregnancy. I used to think that one should have a baby soon after marriage. But the counselling has changed my mind. I think delaying it by a few years and spacing pregnancies prevent maternal and child deaths and improve  health.”

    Making a Health Centre Functional

    Bellary district, Karnataka

    Eleven-year old Lakshmi lives with her parents and five siblings in Kadekolla village in Bellary district of Karnataka. Her father is a daily wage labourer and the only bread-winner of the family, which survives on an annual income of less than Rs. 20,000.

    Lakshmi, her elder sister and a younger brother were all born blind. Being poor and uneducated, the family was unable to provide proper medical attention. All they could do was visit several temples, hoping for a miracle. The village Lakshmi lives in has a sub-centre, Bheemasamudra that comes under Hudem PHC. The PHC was taken over and managed by Karuna Trust and supported by PFI. A Vision centre was established as part of the primary healthcare services at the centre.

    At a screening camp conducted at the PHC, Lakshmi was examined and referred for diagnosis and treatment to the medical college in Bellary. She was found to have congenital cataract. Her left eye was operated upon. She can now see and her life has changed dramatically. From a lonely, sad girl, she has turned into a confident, bubbling child. She now wants to study, play with other children and do something worthwhile in life. She has been advised surgery for the other eye too.

    Karuna Trust now plans to get her siblings examined too, and get Lakshmi into school. Lakshmi got a chance to lead a normal life, only because her village had a functioning sub centre which provided basic health care.

    Matter of health and dignity

    Agra, Uttar Pradesh

    Strong messaging on sanitation and hygiene encourages people to set up and use toilets. CURE, the nodal agency implementing PFI’s Health of the Urban Poor program in 22 slums of Agra, has been using strong messaging on sanitation and hygiene to promote the use of toilets. The messages focus on using toilets to reduce waterborne diseases and highlight the benefits of handwashing and a clean environment. They also focus on the dignity and safety of women. These methods are leading households into constructing toilets, availing of the Community Credit Fund set up by CURE which provides partial funding, ie Rs. 3,500 of the Rs. 6,500 needed for a toilet construction.

    The messaging prompted two pregnant women, Urmilla and Kulia of the Bada Ukkhara slum of Agra, to have a toilet constructed in their house even though the move was not supported by their in-laws.

    Urmilla and Kalia, who are sisters-in-law, had to get up before dawn and walk a kilometre to an open field for defecation. Their children did likewise. When they came to know about the health hazards of open defecation, they were keen to use a toilet. They learnt through the link worker that CURE was assisting the residents to construct household toilets. When the Cluster Coordinator, Neeru Sharma, visited the slum they expressed their desire for a toilet for their household. However, the following day when Neeru visited them to complete the formalities, she found that their family members were reluctant to meet her. Neeru’s enquiries revealed that the in-laws were against the construction of the household toilet.

    She tried to convince them, informing them about the threats of open defecation, the advantages of a household toilet and also about the subsidy being provided by CURE, but the in-laws refused to change their mind. The father-in-law stated that his generation had been practicing open defecation and had not had any problems. So he did not see the need for a toilet for their household.

    After a couple of days, Urmilla called up Neeru and requested her to come over to her house. On reaching there, the sisters-in-law told her that they were ready to complete the formalities for the household toilet even though they had not been able to convince their in-laws. For “a household toilet is our need and a matter of our dignity”, they said. They were ready to meet their share of the expense through their individual savings.

    Today, Urmilla and Kulia are happy that they do not have to get up before dawn and rush to the field. The toilet offers them dignity, privacy, and personal safety. Other household members have also started using it and realize the benefits that it provides.

    Main Kuch Bhi Kar Sakti Hoon

    "Educating a daughter is as important as educating a son. A daughter is equally responsible,” says Real Hero, Usha Devi our Real Hero

    Usha Devi (45 years) a resident of Nadiyawan village in Phulwari block, Patna was married off at an early age and thus deprived of an education. Soon after marriage, over a period of three years, she conceived three consecutive times and this  significantly weakened her body. Around this time, her husband met with an accident at work resulting in Usha Devi having to take up the responsibility for the entire family.

    While she was managing her home and work, Usha Devi heard about the NGO Nidan and its activities. She joined the Sneha Club and was inspired by the serial, especially the discussion on the importance of family planning, age at marriage and girls’ education. As someone who had already been through a succession of close pregnancies she decided to initiate discussions on the subject in her community, particularly with groups of adolescents and mothers-in-law.

    Along with creating awareness on these issues, Usha Devi is also ensuring that her children study well and become responsible citizens.

    “We must feel confident about discussing and using methods of contraception with partners. Family planning should be the top priority among couples,” says Real Hero Nirma Devi

    Nirma Devi of Batasi village in Barachatti district, Gaya is a regular viewer of ‘Main Kuch Bhi Kar Sakti Hoon’. She has a son and a daughter. From the time, NGO Samagra Seva Kendra formed Sneha clubs Nirma Devi has been participating in all the meetings and taking an active part in the outreach activities.

    Watching MKBKSH, she realised the significance of at least a three year spacing between two pregnancies. She also learnt about the various family planning methods available by watching the serial. This gave her enough confidence to discuss available contraceptive methods with her husband. She has been using copper-T after consulting with the local ASHA and ANM.

    Now, Nirma Devi plans to motivate other women in her neighbourhood, those who are not members of the Sneha club. She says, “I want women to be confident while discussing the use of contraceptives with their partners or the health worker. She also counsels couples who are interested in planning their pregnancy.

    “I knew my two daughters would fulfill all our dreams so I decided to convince my mother in law, there is indeed no need for a son!” states our Real Hero Surbhi Devi

    Surbhi Devi from Maheshpur block in Bhagalpur is a regular attendee at the ‘Main Kuch Bhi Kar Sakti Hoon’ ( MKBKSH) group meetings organized by NGO SEWA for women in 20-34 year age group. She has been encouraging women to attend these meetings. She has two daughters, as a result of which, her mother-in-law and husband were insisting on having a third child as they wanted a son.

    Surbhi Devi had made up her mind that she did not want any more children and it was time to convince her husband and mother in law on the issue. She started bringing her mother-in-law to the MKBKSH meetings so that she understood the importance of family planning and the value of the girl child. She also took her husband for a few meetings.

    The mother-in-law and husband are convinced now that they should not have third child in expectation of a son. She has been able to discuss with her husband the best contraceptive choice for themselves and have opted for Copper – T.

    They are now role models in their community, who promote the value of a girl child and gender equality. They both counsel other couples and encourage them to use contraceptives and plan their families. Surbhi Devi’s mother-in-law has also been active in Sneha clubs and speaks with her peers against gender preference and treating daughters as equals.

    PFI support helps get a landmark decision on women’s reproductive rights

    Delhi

    Thirty-five-year-old Hallo Bi was arrested on November 21, 2012 for the alleged murder of a man named Usman. She was lodged in Indore District Jail, Madhya Pradesh and is awaiting trial. During the court proceedings, Hallo Bi testified that her husband, Aamin, had sold her into prostitution to Usman. She also revealed that Aamin regularly invited men to their home and allowed them to rape her. While in prison, Hallo Bi discovered she was pregnant as a result of the repeated rapes.

    A medical test on December 5, 2012 confirmed that Hallo Bi was about six weeks pregnant. She made it clear that she wanted to terminate her pregnancy but the prison superintendent did nothing to help her. On December 18, 2012 seeing no alternative, she attempted suicide. She survived and again requested the jail staff to allow her to terminate her pregnancy. Without prison guidelines to guide them, the jail staff forced Hallo Bi to make an application to the court of the Chief Judicial Magistrate (CJM) requesting the same. The magistrate dismissed Hallo Bi’s request for an abortion.

    Programme Intervention

    On the basis of a newspaper report on two Indore District Jail inmates being denied their request for abortion, PFI partner, the Socio-Legal Information Centre (SLIC), arranged for an Indore-based advocate from the Human Rights Law Network (HRLN) to visit the jail, speak to the women, and offer legal representation. However, advocate Shanno Shagufta Khan was able to speak to only Hallo Bi. She offered to represent her at the CJM hearing, but Hallo Bi told her that an advocate had already been assigned. Due to SLIC’s interest in the case, Advocate Khan attended the CJM hearing. At the hearing, Hallo Bi realised that she had been misinformed, and that in fact, she did not have legal representation. After the CJM dismissed her request for access to an abortion, Hallo Bi asked Advocate Khan to be her legal representative.

    In January 2013, SLIC and Advocate Khan filed writ petition Hallo Bi @ Halim vs. Government of Madhya Pradesh and Ors.,W.P.(C) No. 408 of 2013 in the High Court of Madhya Pradesh in Indore. The petition argued that under the Medical Termination of Pregnancy Act 1971 (MTP Act), a decision to terminate a pregnancy is between a woman and her doctor(s). Moreover, no court has the authority to determine whether an eligible woman can or cannot terminate her pregnancy under the MTP Act. The petition asked the Court for an order recognizing Hallo Bi’s right to a safe, legal abortion and allowing her the same. The petition also asked the Court to issue guiding principles on the MTP Act’s implementation when a woman is imprisoned.

    Outcome

    The court heard the petition on January 11, 2013 and arranged for gynaecologists to examine Hallo Bi. The case was called again on January 15, when Hallo Bi testified in an open court that she had been forced into sex work and became pregnant as a result. She reaffirmed that she wanted to terminate her pregnancy and the Court ordered a final medical opinion to determine whether she could obtain an abortion under the MTP Act.

    The High Court granted Hallo Bi permission to receive an abortion and to get medical assistance and after care. The court also ordered Hallo Bi’s doctors to submit a monthly status reports on her health.

    The high court reaffirmed the importance and breadth of reproductive rights, including the right to abortion, guaranteed to all Indian women under Article 21 of the Indian Constitution saying:

    “There is no doubt that a woman’s right to make reproductive choices is also a dimension of ‘personal liberty’ as understood under Article 21 of the Constitution of India. It is important to recognise that reproductive choices can be exercised to procreate as well as to abstain from procreating. The crucial consideration is that a woman’s right to privacy, dignity and bodily integrity should be respected. This means that there should be no restriction whatsoever on the exercise of reproductive choices such as a woman’s right to refuse participation in sexual activity or alternatively the insistence on use of contraceptive methods. Furthermore, women are also free to choose birth-control methods such as undergoing sterilisation procedures. Taken to their logical conclusion, reproductive rights include a woman’s entitlement to carry a pregnancy to its full term, to give birth and to subsequently raise children.”

    The Court further stated that:

    “We cannot force a victim of violent rape / forced sex to give birth to a child of a rapist. The anguish and the humiliation which the petitioner is suffering daily, will certainly cause a grave injury to her mental health.”

    The Court’s order not only helped Hallo Bi access medical abortion, but was a landmark decision for women’s reproductive rights in India. The case sets a positive precedent for women who are in a similar position, as well as a clear statement that a decision to have an abortion is between a woman and her doctor.

    The High Court’s order reiterates a rape victim’s right to a legal, safe abortion under the MTP Act. This is particularly important in India, where approximately 6.7 million illegal abortions are conducted every year and a woman dies of abortion related causes every two hours.

    Making Primary Health Centre Functional

    Gaya district, Bihar

    Gambhri is a remote village of Jaipur Panchayat located in Fatehpur block of Gaya district in Bihar. It takes an hour in an SUV to cover the 15 km stretch of dirt track with deep potholes to reach it. The village is not electrified and no public transport plies there.

    April 24, 2013 was a big day for the community here. The services at its additional PHC were inaugurated in front of a crowd of about 70-80 people. Devilal Yadav, an active member of the community and a member of the Village Planning and Monitoring Committee, narrates the long and difficult process of getting the facility functional.

    The building of the additional PHC was constructed about 30 years ago, but the facility had never been functional. Over the years, it had become a place to house cattle and was totally run down. Women from Gambhri and surrounding areas had to undertake the difficult journey to Fatehpur PHC to have an institutional delivery, which they rarely ever did. Villagers recount five to six maternal deaths taking place in the village and its neighbouring areas every month. In addition, being an area with agricultural fields, there were often other emergencies like snake bites.”

    Devilal Yadav had realized the importance of having a health facility in the village that could serve villages that were even far away. “Even before the CBPM project had started, from 2009 onwards, I had been sending petitions to different authorities,“ he says. “But this had not yielded any results. This had saddened and demoralized us all. However, when the community Based Planning and Monitoring programme started in my village in 2011, the training and facilitation by the block NGO motivated me and others to renew our efforts.” He puts it as “the CBPM programme helped show the road and fill gas in our hearts to carry on the work.” With the help of facilitators from the block NGO, Devilal filed three different petitions under the Right to Information Act — on the status of the PHC building, the number of staff posted there and the ownership of the land on which the building stood. In August 2012, he met the District Magistrate and the Block Development Officer and placed a charter of five demands, one of which was to make the centre functional. The DM then gave orders to make the centre functional.

    Devilal then had to negotiate with district and block health authorities to see where funds for the renovation and equipping of the centre could be accessed. He managed to get about Rs 1,40,000 from various heads of the health budget. These funds were used to renovate one part of the large building.

    While the centre has been inaugurated, the community members were still found to be apprehensive of several things that needed to be put in place before the centre could become actually functional – a boundary wall, electricity, functioning toilets in the facility, and whether the doctors and nurses posted there would travel so far out everyday. However, they were happy at having made the first step. They hoped that women from the villages nearby could deliver at the facility, and services to treat for snake bite would be provided.

    Towards gender equality

    Sirmaur district, Himachal Pradesh

    In a society, where having a son is seen as a matter of necessity and prestige, and a daughter, as a burden and source of worry, Babli Devi, 24, took a bold step by deciding to have only a daughter despite immense family pressure.

    Babli Devi has studied upto Class 10. She got married in 2008 and has a 4-year-old daughter. She lives in Rampur Banjaran Gram Panchayat, Development Block Paonta Sahib, District Sirmaur, Himachal Pradesh.

    After her daughter was born, her in-laws wanted her to try for a son because they felt that only a son could carry forward their family name, take care of the ancestral property and also support them during their old age. However, her husband Vijay Kumar, stood by her in her decision. He said in the present scenario there is no difference between boys and girls. Many educated couples go for only one daughter, but this does not mean that their family would not be carried forward. The couple discussed that with their weak financial condition it would be better to have just one child so that they can fulfil all her needs within their limited resources. Babli shared her decision with the local health worker who encouraged her to opt for female sterilization. In December 2012, Babli got sterilized in Chandigarh.

    The health worker shared Babli’s story with the anganwadi workers and Mahila Mandal (women’s group) members in the area. They started motivating Babli to become a member of the Kanya Bachao Samiti (Save the Girl Committee) that have been set up by our partner NGO, SUTRA, in some districts of Himachal Pradesh, as she was setting an example for the community by not hankering for a son and giving the best possible education and care to her daughter.

    babli devi being awarded by MLA Kimesh Ganj

    Babli Devi became a member of the Kanya Bachao Samiti in January 2013. Her confidence has increased and she is an enthusiastic and active worker. She now motivates women to stop gender based discrimination at their homes.

    Babli has been awarded by NGOs and the Child Development Department for her contributions to society.

    The people in her village now respect and appreciate her decision of not having more than one daughter. They say if they would have valued the birth of their daughters, they would not have had two to three daughters in their quest for having a son. Babli Devi says, “I believe both girls and boys are equal. In fact, girls are more caring towards parents than boys. I will, therefore give, good education to my daughter so that she can raise her head in the society and lead a respectful life.”

    Babli is a great change agent who leads by example.

    Timely care and trained staff can save lives

    Arsikere Sub-Centre, Karnataka

    Huligamma, 21, and her husband, Yellappa, work as coolies. On a routine visit, the ANM of the Arsikere Sub-Centre, which falls under Chandrabanda Primary Health Centre (12 kms from Raichur city), found that Huligamma had recently moved into the village and was 34 weeks pregnant. She registered her for the antenatal check-ups. The initial examination showed she weighed 46 kg and her haemoglobin was 8 gm. IFA tablets were prescribed and she was advised to take nutritious food. She was referred to the PHC for further check-ups. A lab test showed that her Hb level had further fallen to 6 gm. As this was her first pregnancy, and she was a high-risk case, the ASHA and the ANM visited her regularly.

    One morning, a few weeks later, when she developed labour pains, the ANM called for the ambulance and she was shifted to the PHC within 45 minutes. She was examined and advised to go to the First Referral Unit. However, probably due to her financial condition, she refused.

    Her labour progressed gradually. The staff nurse who had undergone a skilled birth attendant training maintained the partograph, as she was aware of all the risks involved. Huligamma’s blood pressure, pulse and contractions were monitored and recorded. An episiotomy had to be performed as she was a primigravida. She delivered a baby weighing 3.1 kg at night and immediate care was given to the newborn. Unfortunately, she developed postpartum hemorrhage and was treated right away with oxytocin. Simultaneously, her abdomen was massaged and digital compression applied to the uterus to stop the bleeding, which was brought under control within an hour.

    The difficult labour could be managed at the PHC as the nurse had undergone the skilled birth attendant training. These trainings as well as refresher courses for the staff are supported by the government and PFI. The percentage of safe deliveries has risen.