• [Image: Sarita Barpanda]

    Sarita Barpanda

    India

    Interact Worldwide

    “India’s flagship national health programme – the National Rural Health Programme – primarily focuses on family planning, reproductive health and maternal health. But family planning is the most under-implemented aspect. The focus is on maternal health, and people haven’t yet made the connection between maternal health and family planning.”


    “Most of our work has been with young people, and it’s clear that they simply don’t have access to contraceptives. There isn’t even adequate information about reproductive health. For example, we’ve been running projects for young people in three states,


    focusing on meeting demand for contraception. It’s very difficult to link them up with services because, at community level, family planning and contraception are not priorities. All these people can get are oral contraceptive pills. And, not only are there no condoms, but the service providers are not trained to inform young people how to use a condom correctly. It’s a vicious cycle to create a demand but then not have supplies to cater to that demand.”


    “Government providers are reluctant to talk about or give out anything except oral pills. In the past year they have started providing emergency contraception, but they don’t appear to have adequate information about how to use it.”


    “We conducted formal focus group discussions with young people in one of our projects, and it emerged that emergency contraception is in huge demand, but people aren’t trained to distribute it. Again, demand and supply gaps and information gaps are huge issues in many states in India.”


    “We’ve worked in both rural areas and urban slums, and the issues are the same. The only difference is that information and supplies are more easily available in urban areas if you have the money to buy them; in the rural areas there is simply no access at all.”


    “We’ve talked about price with people, and frankly people would prefer contraceptives to be free. However, they don’t have much faith in what’s being provided for free by governments. For example, at a Q&A session with adolescents, we were talking about myths and misconceptions, and one thing that came out was that government-provided male condoms often break. This is because they aren’t stored properly or were expired. These are some of the things we’ve heard from young people, and reasons why, even where governments are providing services and supplies, there is less reliance on these sources. In addition, there are no good storage facilities within government institutions, so there is this feeling that the government-provided contraceptives are not good products that people can use with faith. As a result, there’s always a dependence on private providers, getting it from the chemists or pharmacy, which is much easier, but there is still limited choice.”


    “We need to understand that one of the priorities in family planning programmes should be access without shame or guilt. This is missing from most programmes. In general, there are very high levels of stigma and discrimination in health services such as family planning. And the needs of HIV-positive people are not addressed. There has been a narrow, myopic view of providing services, but this needs to be widened: we need to see it through a justice lens.”


    Other quotes:


    “I’ve talked to girls as young as 15 at abortion clinics, and I’ve taken girls there when they requested it. One of the things I keep complaining about is the counseling in abortion clinics, which is very poor. I remember taking this young girl to an abortion clinic and the counselor shamed her. I was very angry – the girl was already in a bad situation, and the counselor was making it worse. However, I don’t think it was the counselor’s fault – she hasn’t got enough quality training. Many people simply avoid counseling and related services because they think it’s going to make things worse.”


    “Most young adolescent boys talked about good brands of condoms, such as those that are scented or flavoured. Female condoms, on the other hand, are simply out of reach and too expensive. In one of our projects, they piloted the female condom with female sex workers, and it was successful and it should have been introduced, but it wasn’t. One of the things that is quite risky is that in Orissa there are lots of times when there are no condoms available in places like the Malisahi brothel. Sex workers need condoms, but the government has not attempted to work with these women or to offer them condoms. Some private organizations do make an effort, but even for them procurement is faulty and they find it difficult to get supplies. There are long periods of time when the government does not have any stock. Condoms are not a priority for the government, nor are sex workers’ health needs a priority for the government.”


    “In the case of this young girl, the doctor took her into a room to examine her, and I said I also wanted to go because she was very young and scared. The doctor asked the young girl how many weeks pregnant she thought she was, and the girl said “four weeks”. The doctor then started shouting at her, and said “you don’t know how many weeks? You think I’m a fool?” So I told the doctor to talk to me, instead. The doctor said that the girl was more than 20 weeks pregnant. I asked her how the girl is expected to know when her periods start and end, when she’s not even aware that her period has stopped.”


    “The bottom line is that we are not providing quality services, and we are all responsible – government, NGOs, everyone. The clinic I just described is run by an NGO.”


    “Abortion in government hospitals is linked with abortion clinics, so doctors refer patients to these clinics. This puts up a barrier for women, because they can’t go into government providers and access abortion services, so you have to rely on abortion clinics run by NGOs.”


    “I feel just providing contraception is not enough – with these contraceptives, you need to link them up with other services, like quality counseling.”