ASHAs (accredited social health activists) are voluntary community health workers who work in all health areas in Indian communities. With multiple priorities, family planning was often the last thing on their mind. ASHAs were also not equipped to identify and counsel family planning clients.
The Challenge Initiative (TCI) worked with the Indian government to coach and mentor ASHAs about family planning and prioritizing young low-parity women (15-24 years). During household visits, ASHAs provide informed-choice counseling on all family planning methods. An ASHA in Saharanpur helped 19-year-old Anita accept a desired method voluntarily. TCI supports the Saharanpur government in strengthening urban family planning and adolescent and youth sexual and reproductive health services for its urban poor population.
Anita, First-Time Parent in Saharanpur
Tell something about yourself, your family background, your education, etc.?
My name is Anita, I am 19 years old and I am a homemaker. My husband Sachin is a labourer. I live in Chak sarai, Saharanpur. I have studied up to fifth class. I live with my mother-in-law, father-in-law, my husband and son, elder brother-in-law and sister-in-law. I belong to Saharanpur only, but before marriage I was living in the Punwarka area of Saharanpur with my grandparents, parents and five siblings.
What did you want to be when you were a child?
Answer: I aspired to be a teacher, but I could not complete my education. I am from a very poor family, my father is a labourer.
What is most important for you in life? What is the happiest moment in your life?
For me, my son is most important. The happiest moment in my life was his birth.
Tell something about your marriage?
My marriage was arranged. My family was big and my parents were unable to arrange food and education for all of us. I am the second born in my family, hence they arranged my marriage at a young age. They didn’t ask me before fixing my marriage. After I got married, I lost touch with my old friends. I have not met them even once after marriage. I don't have any friends here yet.
Was your first pregnancy planned?
My first pregnancy was unplanned as soon after my marriage I got pregnant. At that time, I was afraid and nervous, I didn’t know how I would manage the responsibilities of a child and family because I am so young.
When and from whom did you hear about family planning for the first time?
Answer: Before marriage I was not aware of family planning. When I became pregnant, I heard about family planning from ASHA didi. She told me about the benefits of family planning. She said family planning is very important for maintaining a gap between children and is very good for maternal and child health. She emphasized keeping a three-year gap between pregnancies. She explained to me all the family planning methods- centchroman pill (chhaya), OCP (oral pills), Antara (injectables) condoms and IUCDs (intrauterine contraceptive devices).
Did you talk to anyone about family planning after getting this information? If yes with whom and what happened? What did you do and why?
I spoke to my husband, but he said ‘All these things are useless’ and said I should not pay attention to it. I spoke to my mother-in-law also but she has an old mindset, so she refused to talk about it, but in fact she was not even aware of family planning. ASHA didi explained to my husband the advantages of all the family planning methods. She helped me convince my husband of the benefits of family planning. Apart from these people, I have never talked about family planning with anyone else. Once my husband was convinced, I got a post-partum IUCD from the government hospital where my son was born. This method will help me maintain a gap between children. I want me and my child to be healthy.
How did your mother-in-law react to your decision?
My husband told her about it. She did not like it and only said ‘do as you wish.’
How important is family planning to you?
Family planning is very important for me. I might have gone through frequent pregnancies that could have adversely affected my health and led to neglect of my son’s health and care. My husband is a labourer, so he can't afford so much expenses.
How many kids do you want?
I want to have a second baby after three years as by then my son would have grown up a little. After three years, he will start going to school and will not be so dependent.
Have you noticed any changes in the last two years related to family planning information and service availability?
I have noticed changes. Now many women visit government facilities for family planning services and ASHAs provide information related to family planning methods and services.
Do you think family planning is important for women and society? If yes, why?
Yes, family planning is very important for women and society. It helps to maintain a gap between pregnancies that enables women to be healthier so they can properly take care of their children. Family planning controls population growth and this is important for social development.
What are the challenges faced by young married women in adopting family planning?
Mostly young women are not aware of family planning. Also sometimes, mothers-in-law can create barriers and problems.
What message would you like to give to other women?
After adopting family planning I am happy, hence I want other young married women to also go for it because frequent pregnancies weaken the uterus and lead to weight loss.
Do you still aspire to achieve your dreams and aspirations?
My husband does not have enough income, hence I cannot fulfill my dreams. Now my dreams are associated with my son. I will take proper care of him by giving him proper attention, good education, nutrition and hygiene. For fulfilling this dream, the spacing between children is very important to me.