After an extremely successful Family Planning session in our community, we directed ourselves to the herculean task of accessing government portals that would assist us further in our initiative of getting the interested individuals operated and gain access to other birth control methods.

The Delhi government website directed us to the family planning welfare division in BHAGWAN MAHAVIR HOSPITAL. A very helpful Dr. Diwan, informed us about the various facilities we could use for the same and provided us with important contacts. We were told that we would be able to get all help from the area’s dispensary and some other hospitals.

DISPENSARY

We, then, tried to enquire from the dispensary about the facilities they provide under their family planning / nutrition program.

We found out they could provide us with:

1) A health camp: Every dispensary has an appointed (Auxiliary Nurse Midwife). She is appointed to take care of the health of the entire community. She was readily available to assess the health/immunization needs of the children.

2) Health Talk: Apart from health needs of the children, the parents and other mature adults in the community would be addressed by the Doctor and ANM. They would be informed about the various measures they should take to stay healthy, hygienic and clean.

3) They would provide us with free medicines based on the needs of the community.

4) They were ready to carry out operations for the women. However, the compensation for the same was pretty lower than what we had learnt from others.

We decided to visit some other hospitals, to get a clearer picture and know more in terms of the procedure, compensation, facilities and registration requirements.

SUNDER LAL JAIN HOSPITAL

There is family welfare department in the hospital. We learnt from them that they will operate the women; however, they can’t provide them with compensation, due to the latest government policy to stop providing compensation to private hospitals. However, they have said they will have a meeting, where they would discuss if they could do something to provide compensation to the women getting operated.

BABA SAHEB AMBEDKAR HOSPITAL

The head Gynaecologist explained to us the entire procedure. She told us that the women would be required to visit the hospital for investigation that would take around two days. After this, they would be admitted, operated and discharged on the fourth day. Compensation was around Rs. 250-600, depending on the papers (Ration card, BPL papers etc)

BHAGWATI HOSPITAL

This is again a private hospital. The same issue of non compensation arose in this hospital. However, they were helpful enough to guide us to an NGO, Marie Stop, that operates in areas of family planning.

We came to know of a few NGO’s that dedicated themselves to such activities. We went ahead and paid a visit to them

SAMPOORNA

Sampoorna is an NGO running from the past 19 years. It provides an ample lot of services to the poor and underprivileged. Sampoorna put forth their support in organizing a health camp and a family counselling session at the project site. We received a very satisfying response.

MARIE STOP

This NGO is completely dedicated towards family planning. It carries out investigations, operations in day and does a free follow up for the next 30 days. There is an initial fee of Rs.50 for investigation purposes. This NGO was being provided with funds by the government to be used as compensation. However, with its recent policy, they are now not able to provide any compensation to the patients.

ISSUES WE ARE FACING:

1) Time:

As the women in the community are daily wage labourers, they cannot afford to spend a day without work. If the woman were made to undergo surgery, they would need to spend a maximum of 5 days (2 days of investigation and 3 days for operation and post operative precautions). After this, they would be asked to avoid heavy work for a period 50 days minimum. This sounds unfeasible.

The alternative to this method is laparoscopy. This is a procedure of ten minutes and would require 2-3 days of precaution. This would be followed by a follow up after a week to remove the stitches. The recuperation period for the same is 2 weeks.

2) Compensation:

The government scheme to provide compensation to every individual who get themselves operated was an excellent incentive and a huge motivator. The compensation amount varied in different hospitals. In government hospitals, for women it is around Rs.250- 300 and for men, Rs.1100. Those who are BPL (below poverty line) and SC/ST, get an amount of 600 for women and Rs.1500 for men. In addition, the motivator (mediator between the patient and the doctor) get a sum of around Rs. 150- Rs.250. These could be given to the patient too. In the dispensary, it is Rs.150-250 for women and Rs.500 for men.

The government recently stopped providing these facilities to private organizations. Hence, this narrows down our options.

WHAT WE NEED TO DO

1) We need to prioritize laparoscopy over operation as it is less invasive, less time consuming and has a fast recuperation period.

2) We need to ensure maximum compensation, or convince them that compensation isn’t as essential as getting operated.

IDEAS WE ARE CONTEMPLATING

1) We are planning to talk to the site supervisor, if he will be able to provide a paid leaves to the women for three days, while they recover.

2) We can get them operated in Marie Stop and direct the funds received from this month’s Meal a month program to cover the transportation costs.

3) We can get them operated in the dispensary; however the compensation will be less.

4) We are waiting for Sunderlal Jain Hospital to contact us after their meeting.

5) We can enquire in a government hospital away from the area and if they provide us with better compensation and speedy recovery, then the motivator’s money could be used to cover transportation expenses.

Please put forth your opinions/ideas, if any, so that it can help us overcome all the obstacles in our initiative.

1) It was observed most men didn’t use any measure of birth control. They made their wives take precautions etc.
2) Some men had their families back home, but had already planned their families. They were encouraged to spread the message of birth control among their friends in the community.
3) Bengali Men were told to talk within their community, and Bihari Men within theirs, to ask how many are interested in getting themselves a vasectomy.
4) A few of the women had already gotten themselves operated. Citing their examples, we encouraged the rest to do the same. This resulted in a few willing to get permanently operated but asked for time to discuss the same with their husbands.
5) Women who had their daughter’s recently married, or daughter in law with them, were told about CuT. Queries of spacing came up which were resolved.
6) It was observed that some women wanted to get themselves operated; however, they feared their husbands would not agree. For the same, our volunteers addressing the male community were given the names of the husbands. They interacted with them and were able to partially convince them.
7) Cases of abortion came up; we told them about the possibilities of continuous abortion resulting in cervical cancer.
8) Some woman asked for contraceptives and pills and refused to even listen to the benefits of CuT/Tubal Ligation.

Follow up plans:

- A male and female who have already adapted to the birth control measures would be chosen as community leaders. He and She would guide the rest on the same and solve their queries.
- Individual Follow up would be done for those who showed partial hesitation towards permanent methods of birth control.
- If hesitation persists due to fear, we would call upon an activist/Doctor who could further convince them.
- Helping the women interested in getting tubal ligation. These would also serve as an example for the other hesitant woman, who would be able to see the benefits and remove their fears.

General Information we gave:

The experience of imparting informal education, on various family planning methods available, to the local community at Pehal project site was phenomenal. It’s been a long time since we have had such an open session on this mostly hesitated n timid topic. People are also hesitant because of the medical and prohibited terminology. This is always the hot focus and an ever demanding issue for public health personnel.

Well, I m scribbling down about this area of focus to make the other non medico volunteers acquaint themselves with the terminology of family planning methods. This is the brief overview of the barrier control methods which are commonly known as FAMILY PLANNING METHODS.

The common methods are:

• Temporary: Male Condom, Oral Pill and CuT 380 A
• Permanent method: Vasectomy in males and tubal ligation in females.

1) Temporary:

a) Male condom: Easily available without prescription.
b) Oral Pill: Available to women with prescription (Mala D. Mala N, Saheli,etc.). These have some side effects.
c) CuT 380A: The females have always some or the other fear in her mind while inserting this device. Firstly, it irritates and secondly, it brings excessive vaginal bleeding. Regarding irritation and excessive bleeding, one can explain as it would take 2 to 3 days to come into normal life. It’s important to make them aware to check the left out thread to assure it is in place, which is probably the third most fear of the device being misplaced.The advantage of this device is that it is the long lasting; lasts for at least for 10 years and never needs to be replaced.

2) Permanent solutions are the best possible methods if the couple does not want any more children. They are available for both men and women. But male sterilization or vasectomy is easier than female operation or tubectomy. The male can start working normally after 48 hours of the operation. Nowadays, it is conducted through telescopic method, which requires only 2-3 stitches.

It is a black and white brief to give the basic picture of the most wanted topic.

Happy volunteering!!!