India
ABSTRACT
In Siddharthnagar, Uttar Pradesh, India, The YP Foundation has been promoting sexual and reproductive health and rights (SRHR) for the past five years. Initially, the community didn’t take SRHR seriously, and there were evident gaps in accessing crucial health services, including safe abortion and contraceptives. There was a clear lack of awareness about SRHR. The youth in the community expressed their discomfort in discussing or asking questions about their bodies and SRHR due to existing societal taboos and the shame tied to these topics. Even discussing pleasure was met with giggles or uneasy looks. However, over the years, we’ve focused on strengthening the community’s understanding of SRHR through a holistic program named ‘Know Your Body, Know Your Rights.
ENABLING FACTORS
India’s first queer and trans* affirmative and inclusive curriculum (open source) was developed and implemented. This also takes into account the diversity of social locations that can impact one’s access and decision-making capacities. A drastic change was noticed in the way that the community now addresses SRHR-related issues.
On 26 September, a protest march was organised by the team, which concluded in a town hall meeting on the access and availability of contraception and safe abortion services. It was led by two adolescent peer educators from the cohort; Prabhat (15 years old) and Shikha (19 years old), under the guidance of our Master Trainers Ms Mamta Verma and Sambhawati Devi.
The team, led by Ms Verma and Ms Devi, ran a week-long awareness and signature campaign across 10 villages in the district of Siddharthnagar. The campaign was designed to encourage greater discussion around our reproductive rights and the programmes the government is currently implementing in the area, focused on reproductive services and family planning.
PROGRAMME DESCRIPTION
With a plethora of misinformation, shame and stigma attached to sexual and reproductive health concerns, the community was unable to access basic healthcare and demand their rights. Following the curriculum implementation, on the basis of a longitudinal study, a 50% knowledge shift within the community was observed. Some participants have blossomed into CSE advocates, not only in their own homes but also in their neighbouring communities through the peer education model of the programme.
With the increase in awareness about individual SRHR, access to contraception and safe abortion services was identified as a strong ask and need from the community. ASHA (Accredited Social Health Activists) workers are government volunteers mandated to provide reproductive counselling and contraceptive devices at village level. Previously, a lack of resources, training for the ASHA workers and a steady supply of contraceptives were all noted.
At the block level, the community health care centre did not offer a private space for women to meet with a gynaecologist. On many occasions, the general practitioner performed reproductive consultations as there was no gynaecologist assigned to the centre. The supplies of condoms and other forms of contraception were erratic. There were no abortion services available at the community healthcare centre, leading to the people traveling to district hospital to be able to access services for the medical or surgical termination of pregnancy. An hour’s travel in a rural area – where most people do not have their own vehicle – is often prohibitive to an individual’s ability to access the reproductive services that they need.
The protest march and 10-day campaign centred around two demands from the community: a) the availability of ultrasound devices, Medical Termination of Pregnancy (MTP) services at the Community Healthcare Centre (CHC); and b) regular and easy availability of barrier and medical forms of contraception at the CHC as well as with ASHA workers. The community took part in a signature campaign, which was then attached to the list of demands that we presented to the government officials.
On 26 September 2022, 375 members of the community marched through the village in protest, demanding accessibility to these services. The community had the opportunity to advocate for their needs directly with the government, via a town hall meeting.
Finally, the public pressure created by the march, the demands letter and the town hall meeting produced a positive response from the government. Some of the community’s demands were fulfilled within three months, an achievement unheard of in rural India. The village now has a gynaecologist assigned to the CHC, along with an ultrasound technician. These steps have also successfully ensured a constant and steady supply of contraceptive methods, both with the ASHA workers and at the CHC.
