24-year-old Malti visited the antenatal ward for the routine HIV test and the results showed up as likely positive. The lab technician at this facility was oriented on the association between HIV and potential intimate partner violence, and so contacted the Sajha counsellor about Malti.

Counselling session in progress in Sajha rooms

The counsellor learnt that this was Malti’s 4th pregnancy, and she had lost all three new-borns, all between 3 months and six months of age. Malti was constantly crying and was very weak with an abysmally low haemoglobin level. The counsellor suspected Malti was facing other forms of violence as well, especially since she had come to the hospital all by herself, despite her poor health. When she was informed that she was likely to be HIV positive and would need a confirmatory test, Malti broke down.

The counsellor followed the LIVES protocol which helped Malti calm down. She shared that there was no financial problem in her family, and her in-laws were generally supportive of her, despite the neonatal deaths. However, she eventually shared that neighbour frequently taunted her for ‘killing’ all her own children, and that had slowly got to her husband, who too had begun to mock and taunt her and hold her responsible for the deaths. He had issued an ultimatum after the 3rd neonatal death that if Malti did not give birth to a healthy child in a year, he would divorce her and remarry. This had made her distraught and of late, she had developed suicidal thoughts.

The counsellor explained that her HIV test was only indicative, and the positive status would be confirmed only after another test. The counsellor looped her supervisor in, and in the next counselling session, explained how the disease spreads, the risks, the quality of life. They discussed about the potential reasons for her neonatal deaths and emphasised that none of it was her fault. They learnt that in none of the three pregnancies Malti had undergone the mandatory HIV test, though on one occasion she had registered at a government facility, and once had delivered at a private maternity home.

The Sajha counsellor arranged for Malti’s testing at the next higher level health facility; she tested positive. The husband was also tested, and he tested negative. The couple was counselled at PPTCT and ART and asked not to plan for any more children. The ongoing pregnancy resulted in a live birth; the child tested negative, and his medication is ongoing as per protocol. Malti and her husband are reconciled to the facts and upon the most recent follow up, she said that her husband is not violent with her anymore.

About the Programme: SAJHA is conceptualised as a learning pilot intended to assess the sustainability and feasibility of scaling up of health systems’ response to women who report injuries caused by physical abuse from their intimate partners/spouses. While during the covid lockdown in 2020, when most of the social support services were closed or partially functioning, SAJHA continued to be completely functional and strategised pathways to spread its reach into the community.

Posted by: Ms. Anshu Kumari

Location: Lalganj Block, Vaishali district

*To protect the beneficiary’s identity, all names in the narrative have been changed, and no images have been taken.