Preeti, a young mother of three small children, often attended meetings of her local women’s group, Disha Mahila Swasthya Samiti. Although the group frequently discussed the importance of healthy timing and spacing of pregnancies, Preeti was not interested in using family planning. When Preeti became pregnant with her fourth baby shortly after having her third, the women in her local group were concerned for her health. Soon after her baby boy was born, complications required a hospital stay and resulted in a sizable medical bill. When Preeti’s family could not afford to pay, the doctors refused to release the baby. The women of Disha Mahila Swasthya Samiti advocated for Preeti, negotiated a discounted medical bill and collected money from the community and from group members to cover some of the costs. This strengthened Preeti’s trust in the women’s group and convinced her of the importance of contraception in her own life. Now Preeti has not only begun using contraception, but she has also become a family planning advocate, educating pregnant women about the need to use family planning for spacing and to use permanent contraceptive methods once their families are complete.
According to the Urban Health Initiative (UHI) baseline survey conducted in 2010, in six cities across Uttar Pradesh, 30 to 40 percent of women are married before the age of 18. This is cause for concern since, according to the World Health Organization, pregnancy and childbirth pose far greater risks to girls ages 15-19 than to women 20 and older. In low- and middle-income countries, complications from pregnancy and childbirth are a leading cause of death among girls ages 15-19.
Among currently married women and men in these cities, at baseline, the vast majority of survey respondents said their ideal number of children was two. Yet the total fertility rate in the respondents’ six cities ranged from 2.8 to 4 among the overall population, and from 3.9 to 5.2 in the poorest wealth quintile. These data suggest that not everyone who wished to space or limit their births had access to family planning information and services.
UHI has trained existing community groups and civil society organizations like Disha Mahila Swasthya Samiti to educate women throughout urban slums in Uttar Pradesh about the health benefits of family planning and link those who wish to space or limit their pregnancies with information and services. UHI worked with 22 nongovernmental organizations in 11 cities to provide family planning outreach. They recruited and trained peer educators and outreach workers and partnered with community groups, including women’s health groups, religious groups and federations of women’s groups.
“In the beginning, things looked difficult. At that time, we were just 4 to 5 ladies, but now we are around 2,000 ladies together, so every issue looks small in front of our strength, which we get from each other. There is immense power in togetherness.” – Ms. Ganga Devi Ji, Vishal Shehri Mahila Vikas Samiti Federation
Because the local women’s groups are embedded in their communities, they can easily identify peers in need of family planning services, support the delivery of services, generate interest and demand for services and ensure family planning programs are responsive to the needs of the community. The benefits of this initiative extend beyond family planning—these groups have fostered a sense of community and empowered members to address other pressing issues such as safe drinking water, education and economic development.
UHI is currently advocating with district-level forums to provide a venue for community representatives to voice their concerns and ideas. UHI is also providing suggestion boxes at health facilities as another mechanism to allow community members to share feedback. Given the success of the program so far, UHI will continue to work with civil society and community organizations to increase contraceptive knowledge and prevalence and to facilitate overall improvements, as the urban poor still face pressing education, sanitation, nutrition and health challenges.
“Now I feel the way my life is getting spent is how I always wanted.” – Prem Wati Ji, Vishal Shehri Mahila Vikas Samiti Federation
This story was originally written by the Measurement, Learning & Evaluation Project, which evaluated the Urban Reproductive Health Initiatives (UHRIs) in Kenya, Senegal, Nigeria and India. The Challenge Initiative is charged with expanding access to the proven solutions and successes developed under the UHRIs.