“Yes, I am the one. I am using copper-T. My mother-in-law didn’t approve of it initially and neither did my husband. They would tell me that getting the sterilization done is a gunah (sin) according to our holy book. They would scare me for what my fate would be after death, if I underwent sterilization”, says 32 year old A. Parveen, who belongs to a minority backward community in Sugaon village of Jehanabad district of Bihar. Sugaon is a typical village of Bihar, having a mixed hindu and muslim population of 1300.  Most of the houses are kuccha made of mud, straw and bamboos with agriculture as their primary source of income. 

“ASHA and AWW didi used to counsel me to take up some form of family planning method, as I already had 4 children. The feeling of helplessness was bothering me but I wanted to respect my family’s words also. I had to stop somewhere. So I managed to find a middle path. I took a stand and started using copper-T. God, I hoped, would not mind. I told my family, let’s try this for 5 years. If, after that, we feel we need more children, we can go ahead. Or else we may think of sterilization.” says A. Parveen, sitting barefoot on the stairs outside her home with other female members of family. She speaks with a mix of blush and new found confidence.

 “I have 4 children, 2 girls and 2 boys, each of age 2, 5, 8 and 10 years. When I was pregnant with my youngest child, it was a routine affair for family. We are 4 daughters-in-law in this family. Every 2-3 years, someone in our family would get pregnant. But for me, parturition was like someone trying to snatch the soul out of my body and me fighting to retain it. I was scared to death once again. Hospital was a frightening place. All the injections, tablets, IV fluids and then surgeries, everything scared the hell out of us. So we preferred home deliveries. But things were about to change for us. AWW and ASHA didi came to me when they knew I was pregnant. They registered me and entered my name in home visit planner. The CARE had provided a home visit planner to each AWW and ASHA didi, wherein, they could list all the beneficiaries in their area and plan their dates for home visits. This planner also indicates what messages are to be given to what kind of beneficiary at what time. They call it giving right messages at right time to right beneficiary. So on the visit-due-dates, both ASHA and AWW didi came all through my pregnancy and advised me to go for regular ANC checkups and to take proper diet, rest, IFA tablets and TT injections. In 6th month of pregnancy, I was told to prepare a birth preparedness kit which included soap, new blade, and clean soft cotton cloth for baby and myself, clean new thread, and some money saved for delivery. I was also told about my referral plan, which helped me to identify the nearest hospital for my delivery, my conveyance to hospital and my birth companion.” recalls A. Parveen with a sigh of relief, managing her red suit.

“They asked me to attend the monthly meeting at sub-center level. It is a meeting started by CARE India, where ANM, ASHA and AWW didi meet every month to review the health and nutrition activities in the target population. Pregnant females are also called there for health education and counselling. Initially, I was shy and reluctant to participate, but now, I am glad I did. There were other pregnant females from my village also. All were given appropriate messages according to their gestational age. I was told about the kind of care my new baby should get after delivery. They also explained me the importance of family planning methods and told me about all the options available. I felt pampered for the way they were taking care of me and my baby. I looked forward to their visits and always learnt something new. I followed their instructions and had a happy safe delivery in the hospital this time.”

“ASHA and AWW have been visiting the homes of all beneficiaries earlier also. However, the messages were never so organized and timely. Thanks to the platform provided by CARE India, in HSC meetings, ANM didi teaches our ASHA didi and AWW all the new things and in turn they teach us. I can see the difference in the kind of care my first and last child got. I hardly knew of any vaccinations for my first child. But my youngest child has got all the vaccinations, has been exclusively breast fed and I started complimentary feeding after 6 months. Masha Allah, I can give tuitions on the whole process of maternal and new born health. Earlier I didn’t know anything, but now I know and I will use this knowledge. What is the point of knowing something, when you are not using or implementing it? I am glad I took up family planning method and my children are studying in school.  Now I complete my daily chores and even get time to relax. Otherwise, I would still be waiting outside the hospital with a swollen belly, ready to deliver”, says A. Parveen with a giggle.

A.Pareveen has been an inspiration for the other 3 females in her family. One of them is using OCPs for spacing and the other two got the permanent tubal ligation done from the local government hospital. Another minority female in the village, inspired by A. Parveen also got permanent sterilization done.

It is not uncommon in the village to have 2-4 children, and may be more in some cases. However, what is overwhelming to see is the change in the health seeking behaviors and practices of the community. The minority community here, especially females, have realized the importance of FP methods and speak more often against the traditional mind set.  Many females of Sugaon village are empowered today to take charge of their own reproductive and maternal health.  CARE India, in the form of Technical Support Unit to Government of Bihar, intends to start a chain reaction by building the capacity of local FLWs at the HSC platform and then transferring it to the community. The dream of transforming the health and nutrition appears more realizable now and that gives me a sigh of relief!!!


* ANM: Auxillary nurse midwife

* AWW: (Aaganwari worker) and ASHA: (Accredited social health activist) are the female link workers in the communities in India for nutrition and health respectively.

* Minority community refers to Muslim community

* Didi is a Hindi word for sister

* HSC: health sub center, the first point of contact of community with Indian public health system.

Prairna Koul