Parivar Seva Sanstha has carried out several pathbreaking innovations in the area of Population and Development. Most of them are in its core area: Reproductive Health. This has been possible due to the commitment, initiative and perseverance of Parivar Seva team members. Many innovations were possible due to the support it received from its donors and partners. Only a few key innovations are mentioned below:
(a) Mewat Sevika
In 1987, the Ministry of Health and Family Welfare, Government of India under its Innovative Programme, supported Parivar Seva Sanstha to design and implement a project to introduce family planning to a highly resistant mostly Muslim population in Mewat, a very backward area of Haryana. Since forced sterilizations, mainly vasectomies had taken place there and huge excesses committed during the Emergency, a few years back, the population and local leaders were totally against family planning. The challenge was great as women had no position in the community and their literacy was only 2%, polio was rampant, people were very poor, there was huge scarcity of water, the terrain was very harsh and modern transportation almost non-existent.
The project Mewat Sevika was evolved, using the platform of general and maternal health as well as child survival, with absolutely no mention of family planning and contraception. The focus was on pregnant women, safe deliveries and child immunizations. Two mobile vans fully equipped and with trained OBGYs covered every week each of the selected 45 villages.
A mobile van in a village.
Through intense community mobilization women were selected as “Mewat Sevikas”, meaning women who serve Mewat. They were trained in communication, leadership and also management of simple diseases and medical problems. Using colored charts, they were trained to dispense basic medicines in the villages at a very low cost. This helped to cover the community during the balance six days when the van did not visit the village. However, during an emergency, a van would make an unscheduled visit in the concerned village. Soon, women confided that they did not want to bear too many children and wanted help. Injectable contraceptive was a boon as it could be kept very confidential. It was not too long before women openly sought sterilization. The team did the screening and arranged the procedures at the nearest government Community Health Centre at Nuh.
This highly successful project was soon supported by the USAID under its PVOH II programme and continued for many years.
It was then decided that in order to sustain the project and also provide the much needed safe delivery services, there was need for a stationary clinic. The British High Commission supported this. A hospital, Mewat Sevika was set up on a land donated by a local land owner, where comprehensive Reproductive Health and Paediatric services became available with help from Government of India, especially for the youth and men. Most of them focus on counselling in the given environment of the target group.
Inaugration of Mewat stationary clinic by Sir Nicholas Fenn British High Commissioner on April 10, 1995.
(b) AADHAR – The Youth Friendly Services Project (YFS)
Working with young adolescents is also one of the focus areas of PSS. In view of the burgeoning adolescent and young population residing in urban slums and to address their health issues, the Management Institute of Population and Development (MIPD), a unit of PSS successfully designed and implemented an innovative experiment in providing youth friendly services in slums by involving the community. The pilot project, known as Aadhar (Foundation), is based on PSS’s considerable experience in working with adolescents and youth as well as its expertise in the area of delivering quality comprehensive Sexual Reproductive Health (SRH) services to both men and women through its clinics.
YFS was initiated in partnership with UNFPA in 2005.
In the first phase, the initial focus was on dual protection of adolescents aged 10-19 years and youth aged 20-24 years from HIV/AIDS and STIs and unplanned pregnancy. In its current phase, the project has expanded to include the health of family members, sanitation and livelihood training, using community mobilization. For delivering services for prevention of unwanted pregnancy and HIV/AIDS, this innovative model provides youth friendly services in reproductive health. The challenge is to remove barriers faced by the youth in accessing clinical reproductive health services. This is achieved through packaging a group of related services and intensive involvement of ‘gate keepers’ in the community.
In the first phase, Jawahar Nagar Kachi Basti, a slum in Jaipur, Rajasthan was selected as the project area. The design for the project was conceptualized on the need to address social powerlessness, lack of information on risks and prevention, social taboos around sexuality of adolescents and barriers in accessing sexual and reproductive health services by young adults. The project aimed at creating a sense of positive self-esteem and empowerment among the youth. This was done by establishing a youth friendly service centre known as Aadhar in the project area to provide basic SRH, developing a system for effective referrals for abortion, sterilization, HIV testing etc., creating a group of peer educators and forums through recreational and vocational activities.
The second phase focused on providing greater access to youth friendly sexual and reproductive health services including HIV prevention and information. Among the areas of attention were increasing the age of marriage, delaying the first pregnancy and avoiding unwanted fertility, ensuring that young women receive ante natal care and are referred to trained birth attendant or institution and receive post-natal care, improving the nutritional status of young adults and conducting health camps and sessions in schools and colleges.
MIPD is currently working with governments and other partners to scale up the Aadhar experiment in major urban centers of India.
The innovative part is a comprehensive package of clinical services (related to reproductive and sexual health) being offered in the clinic in YFS centre exclusively catered for adolescents and young only. The youth is motivated to attend the YFS centre by adding career development training. As the clinic is co-located in the YFS centre, adolescents take the opportunity to take the advice of the attending physician for any problem related to reproductive and sexual health without any hesitation as privacy is maintained. In addition, this opportunity is used to educate them about reproductive and sexual health issues and provide them relevant services. This is necessary as adolescents do not enter a clinic and avail reproductive and sexual health services due to the stigma attached to it.
The second innovative part of this project is that the peer educators have been selected from the community and they are trained on the reproductive and sexual health of adolescents. These peer educators go to the community and make them aware of reproductive and sexual health of adolescents. As a result of which adolescents are further encouraged to start visit Aadhar clinic for various problems regarding their reproductive and sexual health. Such measures have resulted in a fall in the RTI/STI cases and the unmet needs of contraception are timely met.
(c) Purush Clinics
For several years, Parivar Seva Sanstha had been interested in the possibility of setting up a male only clinic in India. Ms. Sudha Tewari, MD, PSS visited PROFAMILIA, an NGO which has successfully implemented a nale only clinic in Bogota, Columbia in 1986 and liked the idea and approach used there.
Male involvement plays a crucial role in Reproductive Health programmes. There are hardly any organizations or clinics catering to the male needs and tackling their problems. Realizing the importance and necessity of meeting this unmet need, apart from the family planning clinics, which cater mostly to women, Parivar Seva also started two male only clinics, Purush, at Chennai (1998) and Cuttack (2000). Besides emphasis on family planning, the clinics provide men with an opportunity to find answers to their queries on sexuality. The clinics offer counselling and treatment on sexually transmitted diseases. There is a great demand for psycho-sexual counselling in these clinics. The services offered include vasectomy operations, treatment for urological problems and infertility. Apart from these, the clinics also address queries pertaining to various issues like AIDS.
The Purush clinic in Chennai caters to sexually active males in the age group of 18 to 45 years, who have a monthly family income of Rs 500 to Rs 4,000. The target groups are transport workers, organized factory workers, unorganized physical labourers, salesmen, executives, clerks, unemployed youth and college students. Centrally located in T Nagar, it belies the misconception of such clinics being operational in dark and dingy areas. The very location is an encouraging sign for acceptability without any inhibitions. The location is strategic as there are two railway stations and a bus terminal in the vicinity, making it a high risk area in terms of STDs.
The Purush clinic at Cuttack is also located near the bus stand, the railway station and the city’s business centre. Since 40% of the population here comprises migrants, it has been difficult to implement a successful family planning programme here. PSS could make a successful intervention here because the Family Planning programme here was only reliant on sterilization and contraception whereas the need of the hour was sensitization to the needs of the populace here. People were skeptical about the methods due to the irreversibility. Men were wary of accepting Family Planning methods and often persuaded their wives to do so. An integrated approach and an effective outreach programme were lacking to find greater acceptability. The projection of the clinic as a comprehensive service provider for Reproductive Health instead of an STD clinic has helped to break away from the stigma of the latter. The package of services offered at the clinic at an affordable price with quality of care and confidentiality has established credibility with the target audience.
(d) Advocating Reproductive Choices (ARC)
Parivar Seva has spearheaded the programme to control unwanted births in the country and has worked in tandem with the government. In fact it has played an important role in influencing government policies and decisions. PSS’s persistence has made abortions safer in the country and helped to expand contraceptive choices. Its impact has been felt in the international reproductive health scene.
Advocacy has been an important component of PSS’s work over the years. This includes involvement with the government and multilateral agencies to develop national standards and guidelines in various areas of RH as well as playing a proactive role in advocating, innovation, new schemes, policy changes and amendments to legal parameters.
In 2004, PSS organised a workshop on “Expanding Choices of Contraception Injectables: Learning from Experience” at Manesar. From this emerged a coalition, Advocating Reproductive Choices (ARC) with an aim to create an enabling environment for making a range of effective and safe methods of contraceptive options available to men and women. What is important is that they are suitable to them individually and as a couple, during their different reproductive phases to improve maternal health.
PSS formed an effective 32-member coalition, representing national NGOs, donors and technical support agencies such as ICMR, MOHDW, INFPA and WHO. Recently, PSS passed on the Secretariat to another agency.
(e) Sparsh tele-helpline service
Way back in 1987, PSS initiated communicating with young people on reproductive and sexual health. The need was realized when Parivar Seva observed that young people seeking services for unwanted pregnancies at the clinics or in the community did not have access to correct and scientific information on important aspects of life like health, nutrition, hygiene, reproduction, motherhood, process of growing up, family planning etc. In order to address various issues related to reproductive and sexual health Parivar Seva had set up ‘Sparsh’ which literally means ‘sensitive touch’ in 1993 on a pilot basis. It is a 24×7 tele-helpline to address the concerns of young people on reproductive health which provides answers and counseling on sensitive issues like Sexually Transmitted Infections, including HIV/AIDs, family planning, unwanted pregnancies. This service received an overwhelming response from the general public and the media. This also provided us with strong referral network and helped us to connect with a larger community-another pioneering effort.
(f) Blue Star Centres (Franchising through private practitioners)
Blue Star Clinics are franchised clinics formed in partnership with private practitioners. They help to reach more communities with a range of reproductive health services. This model was developed involving over 50 allopathic private practitioners in two districts of West Bengal to provide injectable contraceptives in addition to condoms, oral contraceptive pills and emergency contraceptive pills. Management of reproductive tract infections was also an important component.
The project to promote oral contraceptive pills (OCPs) and condoms for dual protection against pregnancy and STI/HIV was carried out with support from the Government of Federal Republic of Germany through Kreditanstalt fur Weideraufbau (KfW).
The current use of condom in the state of West Bengal increased from 2.9 % to 4.5% between 2002 and 2005. The focus is on low income young couples of reproductive age and HIV/AIDS highrisk groups with extension of programme especially to rural areas in West Bengal. The Centre for Operations Research and Training (CORT), Vadodara carried out the endline study for the PSS-KfW intervention project. Earlier CORT also carried out the baseline study in 2005.
Although the use of injectables as a method of contraception has been accepted worldwide, it has been dogged by controversy in India due to objections raised by some representatives of the civil society about their adverse effects on the health of women. Despite the government’s decision to make injectable contraceptives available to the public for free under the national family planning programme (FPP), Indian society is largely splintered on the issue.
In 2010, the United States Agency for International Development (USAID) commissioned a study on the past, present and future of injectable contraceptives in India through the Innovations in Family Planning Services Technical Assistance Project (ITAP). This was done to understand the historical and legal legacy that restricts access to injectables, document information on manufacturers and suppliers of injectables in India, document the experience of distribution, provision, and use of injectables in India, summarize relevant country experiences from the region and prepare recommendations for introduction of injectables in the public sector and expansion of their use in the private sector.