“I don’t want my child to face the same hardships as we are facing and that is why I send him to school,” says Salma. Salma migrated with her husband and child to Gau ghat, a small urban slum in Allahabad situated right beside the stench-filled Yamuna bank in the Indian state of Uttar Pradesh. They barely manage to earn a living from rag picking but make it a point to educate their child.

Salma was speaking on a Wednesday, the day of the week when her community holds its Urban Health Nutrition Day, which usually focuses on childhood immunization but now included family planning counseling from Accredited Social Health Activists (ASHAs).

Salma said she and her neighbor Pinki had previously met with an ASHA and Salma was surprised to find out that Pinki was using an intrauterine contraceptive device (IUCD) and did not have any problems. In fact, Pinki had it removed once so she could have another child. Salma had held a deep-rooted belief that contraceptives harm the body and may also limit the possibility of conceiving again. Even though she lived in fear of becoming pregnant again and did not want more children in the near future. After hearing Pinki’s story, though, Salma went with the ASHA and Pinki the next day to a nearby urban primary health centre (UPHC) where she got an IUCD inserted.

The Challenge Initiative for Healthy Cities’ (TCIHC) city manager in Allahabad was on hand to observe UHND that day and hear Salma’s story about how she became convinced to avail herself of the family planning services provided by the government. This was not the case before April 2017, when women here mostly visited private practitioners and were not aware of how to find government services. Besides, Gau ghat was an urban slum where ASHAs were relatively new and not yet trained. They hardly visited this slum and even when they did, they did not focus on providing family planning counseling to woman during their visits.

TCIHC’s city manager arranged for ASHA trainings, but he also made regular visits to the monthly meetings of Auxilliary Nurse Midwifes (ANMs) and ASHAs, where he emphasized that they focus on one simple message in their counseling: Giving women the choice to plan their families is the key to resolving many issues, including poverty and maternal health.

TCIHC is encouraged by stories such as Salma because it provides hope that one day soon all women in Allahabad and India will have the choice to plan their families.

Contributors: Vivek Malviya, Sanjay Pandey and Mukesh Sharma