In the tribal Shahpur taluka where knowledge of contraceptives such as condoms, pills and intra-uterine devices was negligible, an intervention — to spread information on family planning in the form of a toll-free helpline — has brought a radical change. Unwanted pregnancies have taken a plunge and use of condoms and pills has shot up.
So much so, that when the pilot study began, the use of contraceptives stood at 1.7 per cent in the 533 people surveyed. In a year, it rose to 6.2 per cent, and in three years, the figure has risen to 13.4 per cent.
Sambhaji Ubale, a tribal living in Ambedkar Nagar village of 350 houses, has started using condoms for over a year now. His desire for a son and unprotected sex led to four daughters in his five years of marriage with Rupali. Another baby died during Rupali’s pregnancy. In 2013, female community worker Reshma Malik counselled Rupali, and male worker Dattatray Sase counselled Sambhaji. Both were taught what pills and condoms could be used for and that they were provided free. “Now I take pills every time,” says Rupali, who has studied till Class X. Until two years ago, she did not know she could prevent pregnancy by taking a pill. The only birth-control measure she knew was tubectomy, which she was scared.
She now calls up the helpline (1800-270-0909) for sexual health queries. Earlier she could not discuss anything face to face with doctors at camps.
The couple represents the three lakh population spread over the 34-square-kilometre stretch of Shahpur taluka. Arundhati Char, president of U-Respect Foundation, says, “This region had high malnutrition due to early marriage, not much gap between children and no family planning. We found contraceptive usage was abysmally low.”
In June 2013, the Thane district health officer asked Millenium Alliance, a collaborative body of USAID, FICCI, and Technology Development Board of government of India to start their intervention in 354 villages of Shahpur. The pilot programme, to counsel men and women separately through a toll-free helpline, is in its final lap ending in June this year. From 1.7 per cent population using contraceptives in the survey, the usage has risen to 13.4 per cent.
According to Aarti Kandala, secretary, U-Respect, the hike in the use of contraceptive pills by women was most followed by Copper-T device, and then condoms. “Men are still hesitant to use condoms due to superstitions. Also, family planning is considered a woman’s domain in a tribal community”, she said.
Milind Ubale, who owns a fruit shop in Kanhavli village, is initially shy to talk. “Only unmarried men use condoms. How can married men buy it from stores,” he asks. Field worker Dattatray explains that if married men use condoms, they are suspected to be having an affair. “Through the helpline, men feel free to call anonymously. We explain that using condom should not have social bias,” he says.
In the pilot programme, all nine primary health centres were approached and male and female volunteers were appointed and given free contraceptives for distribution. Contraceptives were also kept in grocery shops. In the initial three months in 2013, volunteers went door-to-door to propagate the helpline number.
“When calls started coming in, we realised the low level of awareness. I would counsel women on menstrual cycle and birth control measures,” says counsellor Lata Mhesde. She receives about 10 calls every day on reproductive health.
“Several men did not know what a condom was. I had to demonstrate how to put it on,” says Dattatray.
Anita Ubale, who has one child and was married three years ago, feels lucky to have come across the helpline. “I call them for menstrual problems, for nausea after taking pills and for understanding how to prevent sexual diseases. It is comfortable to talk on phone,” she says.
Three years ago, she neither knew about HIV virus, nor about birth control measures. “My son is three years old. Now, I can have my second child,” she smiles. Her husband and mother-in-law, who were counselled too, have started supporting her.
Ramesh Rathore, Taluka health officer for Shahpur, says, “We were already doing family planning intervention by holding monthly camps for permanent sterilisation. But with the helpline, people seem to have opened up to discussions on contraceptives as they are more comfortable with the confidentiality.”
Plans to scale up the model are under way in Thane district. For field worker Malik, it has been a success — from awkward refusals to talk about their sex life, residents have warmed up to discussions on sexually-trasmitted diseases and sterilisation.
In Maharashtra, Shahpur is one of the worst-hit talukas in terms of malnutrition deaths in Thane district, along with Jawahar and Mokhada. Health officials claim that malnutrition in the taluka is linked to early marriage, poor family planning, small age difference between two children and lack of sterilisation methods or contraception use. Data from the taluka health office shows that Shahpur recorded 47 deaths due to malnutrition, maximum in Thane district, of children under six years from April to June in 2013. Shahpur was chosen for this intervention since it has 70 per cent tribal population with a poor literacy rate. On an average, each family has 4.4 children.