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In pictures: Expanding access to safe abortion in India
Mother of three, Parivar Swasthya Kendra (PSK) client
Konika is 20 years old, and the mother of three girls. Like many local young women, she decided to have an abortion when she became pregnant for the fourth time within five years. Citing financial issues as the driving force behind her decision, despite her mother-in-laws desire for her to have another child, hoping this time it would be a boy.
Through a neighbour, she approached the PSK clinic in Bhiwandi for an abortion. In Konika’s community, many young women are married and have kids by the time they are 20. Now with PSK, women like Konika have a choice to be pregnant or not.
Family Planning Association of India, works with a network of volunteer link workers, who disseminate information about services available in the PSK clinic, make referrals, and often accompany women to the clinic for support. One of these link workers is Rehkha.
Rekha says: "I have been involved with PSK for five years. And today I can proudly say that since the first awareness campaigns, there has been not a single death in the village due to an unsafe abortion."
She adds: "These women are my flesh and blood. They know I only want the best for them… Within our communities we spread the message of safe sex and safe abortion through songs and skits which are easily understood. And I think the trick is to include mother-in-laws in our work. We have a high success rate in providing safe abortion care.”
Shajahan is a link worker in the nearby Muslim district, where women pack into a house in the narrow village lanes to wait to speak to her.
She says: "I am a Muslim. In my community, abortion is frowned upon, and contraception is considered a sin. Initially, the women thought I was going against our customs, and the men thought I was a bad influence on their wives. Some of the men in our area even approached my husband and asked him to order me to stop these efforts."
But her husband was supportive, telling other men that it was also their responsibility to be part of the process. It took several years, but eventually Shajahan won the trust of the women and men of her area. "Today, every woman in my area comes to me when it concerns matters of sexual health."
Gauri has worked for FPAI for years and remembers hearing about the experiences of women who’d had unsafe abortions.
"I had heard first-hand accounts of [unsafe] abortions that left women reeling in pain, suffering permanent infertility. I had also seen the grief in the faces of men whose wives died. So today when I see women leaving us, after an abortion, in perfect health, I feel like I've done something right with my life."
Gauri continues: "My work may have started with one area, but I want to reach every corner of the country with FPAI - so that no woman in India becomes a statistic."
At 23, Nisha Boudh is already a mother to two children and severely anaemic. She feels she is in no position to have a third child, but her in-laws are not supportive. Nisha chose to have an abortion at FPAI’s Gwalior clinic.
“I have been weak since childhood and, honestly, motherhood has taken a toll on my health. Doctors in other clinics were not willing help me and I would have died had FPAI not come to my rescue. With their doctors’ advice I have now decided to undergo an operation [tubal ligation] as I do not want to conceive. My mother-in-law was upset with my decision but I want to live to see my other children grow,” said Boudh.
Diti is a sex worker living in Kolkata. She says she, "owes her life to PSK". Diti was forced into an early marriage when she was just 12 years old. "Before my body could even develop, my husband was forcing himself upon me." By the age of 20, Diti had five children. Struggling to cope at such an early age, and married to an abusive husband, Diti ran away.
"I don't enjoy having sex with strangers, but I need the money." She makes 300 rupees a day ($4 USD). When Diti became pregnant she didn’t want to continue with the pregnancy. "There's no way I can feed a child. Besides, this is no place to bring a child into the world. Another sex worker recommended the PSK clinic.”
Diti was worried about visiting the clinic, fearing stigma and discrimination from staff for working as a sex worker. Her experience was vastly different, finding the clinic team to be welcoming, reassuring and supportive. "They treated me like a human being."
“The big problem in this part of India is early marriage and pregnancy. Both of which need to be handled very delicately,” says medical officer Mala Tiwari.
“Slowly, things are changing as women are becoming aware of their rights. Previously when GCACI did not exist there was very little interaction with the link workers, and they [and the community] feared it was illegal to get an abortion. They did not know they did not need the consent of their husbands and in-laws. They now know, women have a right over their body.”
Mother of two, Parivar Swasthya Kendra (PSK) client
Manju Rana was forced to marry at fifteen. “I have had two children in eight years of marriage,” she says. “My mother-in-law wanted me to keep having children. She does not understand I would not be able to give them a good education if I had more children. My husband is a driver and we cannot afford to have any more. When I learnt I was pregnant, without taking anyone’s permission, I went with the link worker of my area to the clinic and had an abortion.”
Manju adds: “In these affordable clinics we can choose about pregnancy. They also made sure I was counselled, as coming to a decision about abortion is not easy.”
The Global Comprehensive Abortion Care Initiative (GCACI) improves access to quality abortion care and contraception in IPPF Member Association clinics. The Parivar Swasthya Kendra (PSK) clinic outside Mumbai sees a wide range of clients from the underserved communities in the district. The Family Planning Association of India (FPAI) opened the clinic at the request, and need, of a local fisherwomen’s group.
Hasina turned to sex work when her husband died and left her and her three-year-old daughter without an income. She admits it initially made her feel powerless until she began working as a peer educator with Family Planning Association of India. She now feels that she has some control over her own body.
Neelam Dixit is the branch manager of FPA India's GCACI clinic in Gwalior in Madhya Pradesh. Through the work they are doing within their local community, she is slowly seeing a shift in attitude on abortion and the stigma that surrounds it.