‘Where control is crucial’

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Monica Dawar Photography  (1)
Anjali Sen/56 South Asia Regional Director, IPPF (Photo: Monica Dawar)

As South Asia Regional Director of the International Planned Parenthood Foundation (IPPF), Anjali Sen has been working in the field of sexual and reproductive health for the last 12 years. Before joining the social sector, she was an officer of the Indian Audit and Accounts Service. IPPF actively networks with the government and non-profits around the world to improve women’s status.

Edited excerpts from an interview •

The IPPF literature says the organization works in 172 countries towards a world where women, men and young people everywhere have control over their bodies, and therefore their destinies. What are the barriers to progress in this context?

It was the IPPF in India which advocated for a National Family Planning Programme way back in 1952. Other public systems such as education and livelihoods also have an impact on women’s health and the extent of their reproductive autonomy. In India the key challenges are the high fertility rates due to early age of marriage and subsequent lack of contraceptive prevalence which, when coupled with the social status of women and prevalent myths or stigma, lead to a women losing all control over her body and ultimately causing higher suffering and death.

The Family Planning Association of India (FPAI) runs vocational trainings, reading groups, comprehensive sexuality education in schools and for out-of-school children, sexuality counselling, services for sexual and /or gender-based violence survivors, special services for men and boys, for transgender populations, sex workers and people living with HIV, contraception including permanent methods, safe abortion care, cervical cancer screening and many other services. The FPAI is part of all national forums on women’s and/or children’s health and is a vocal champion of women’s rights.
The current focus of our work in India is service delivery, with special focus on young people and delivering the maximum range of services to the most unreached in rural India.

IMG_9943IPPF has expressed concern that expectant women die because they cannot access abortion services and many die of preventable causes in childbirth. Are you working with the government’s health services in any tangible way to bring down avoidable mortality?

We are a key partner of the government of India in safe abortion care — which indeed is an essential service which saves lives. In India, FPAI has been working with the government for advocacy of the Medical Termination of Pregnancy (MTP) Act in the 1970s and then the amendments to the same in 2015. Last year, we have in India averted more than 2,34,000 unintended pregnancies and more than 71,000 unsafe abortions through our services and through providing more than 6,15,000 couple-years
of protection.

IPPF has a rights-based to sexual and reproductive health (SRH). How are you spreading the message?

IPPF places individual’s dignity and needs at the centre of the design, implementation, monitoring and evaluation of our programmes. We aim to protect full, free and informed choice for family planning and SRH. Some of the initiatives and entry points are as follows:

Gender and Empowerment: IPPF works on empowering women and young girls to acquire voice and agency to demand and claim rights through community mobilisation programmes, economic empowerment, micro credit and income generating activities. Family planning and SRH are an integral part of these empowerment initiatives. Our frontline female workers and outreach teams offers full and accurate information on contraceptives, ensure supplies and provide referral for contraceptive services.

Quality of care and counselling: IPPF delivers high quality integrated family planning and SRH services through clinics and outreach teams to the most underserved areas. Counselling is an important intervention to support women to exercise their rights and choices (broad choice of methods; free of cost services; highly trained staff; value clarification sessions; follow up; services to all clients including unmarried and young people; free from any form of discrimination, coercion and violence)
Verify client’s voluntary and informed consent for sterilisation in a written consent document signed by the client

Integrated approach and outreach: We try not to miss out on any opportunity for service provision. There are diverse service delivery outlets such as frontline workers, community based distributors, mobile units, paramedic based clinics, etc.

Client rights are reinforced through routine monitoring and evaluation that incorporates clients’’ views on the choices they are offered and the quality of services provided (such as client exit interviews)

In this context, what has been done to involve men and boys as partners?

We have adopted multi-pronged strategies for engaging boys and men as equal partners, clients and agents of social change. This includes campaigning for change, building alliances and providing counselling and clinical services through diverse service delivery outlets in the region.

IPPF have contributed to more men and boys stepping up, speaking out, and acting for gender equality and SRH. It has mobilised men, women and young people through by sharing best practices and information, and through community mobilisation projects. In Bangladesh, Bhutan and Pakistan, thousands of women (25,000 +) have reported declines in interpersonal violence and improvements in SRH health status as the result of the involvement of their spouses and other male family members in the micro-credit and women’s empowerment programmes. In Pakistan, male support groups and partnership with law enforcement agencies to support men and women’s SRH and also in humanitarian settings.

For last few years, we have conducted regional studies; developed programmes, training manuals and guidelines; undertook trainings and regional/global workshops and developed user-friendly resources for our clients seeking health services in clinics and outreach. We are in the process of finalising the Global SRH Service Package for Men and Adolescent Boys, in collaboration with UNFPA, and it will be available by end of
this month.

IMG_9942You have put forth some startling statistics about women accounting for two-thirds of the 1.4 billion people currently living in extreme poverty. How is this calculated? Do you categorise women as poor if they don’t earn their livelihood? Is this fair?

Yes, it’s unfair but the reality is that women are still the poorest of the world’s poor, representing 70 percent of the 1.3 billion people who live in absolute poverty. When nearly 900 million women have incomes of less than $1 a day, the association between gender inequality and poverty remains a harrowing reality. Women comprise the majority of economically disadvantaged groups. They perform 66 percent of the world’s work, produce 50 percent of the food, but earn only 10 percent of the income and own only 1 percent of the property. Out of the 572 million working poor in the world, an estimated 343 million, or 60 percent are women. (UNIFEM, Strengthening Women’s Economic Capacity based on absolute poverty line)

Each additional year of schooling improves a girl’s employment prospects, increases future earnings by 10 percent and reduces infant mortality by 10 percent. What is being done to keep girls in school?

When girls are educated, they lead healthier and more productive lives. They gain skills, knowledge and self-confidence to escape the cycle of poverty. Increasing access to quality education is a most viable and potent means to empowering adolescent girls. Access to quality education has a direct relation with the positive health outcomes for women and girls across the world.

The risk of maternal death is 2.7 times higher among women with no education, and two times higher among women with one to six years of education than for women with more than 12 years of education.

Economists have estimated that an extra year of girls’ education cuts infant mortality by 5-10 percent. Further, research has shown that rates of early marriage decline as girls gain an education, which would eventually mean delay in pregnancy. Girls’ education also reduces the risk of domestic violence and dramatically affects fertility rates.
So, when parents understand that their daughters’ education yields such important family benefits, they are more likely to send them to school.

Sex education is said to lead to a positive impact on behaviour, including increased condom and contraceptive use and reduced risk-taking. Yet such programmes are not available in India. Are you aware of this lacuna and if so, what are you doing about it?

Sex and sexuality has always been looked upon as a taboo and most of the time our actions, both by community and polity, are influenced by this premise. We have always found ourselves nervous talking openly about sex, particularly with young people, either because we are worried about the reaction that we will get from them, their parents and community at large or because of the participants’ feelings of embarrassment about sex.
IPPF believes in a rights-based positive approach to Comprehensive Sexuality Education (CSE). Our CSE programmes ultimately aim to support adolescents and young people to achieve this vision of sexual health for themselves through empowerment and support in realising their sexual rights and the rights of others and not merely limit ourselves to focus on few positive health-seeking behaviour.

In 2009, the Rajya Sabha Committee headed M Venkaiah Naidu objected to sex education in school and immediately after that many states banned it. But then on, things have changed — now many states have gradually withdrawn this embargo and have initiated adolescent education programme in the schools. We have been working in these states with different stakeholders to ensure provision of CSE in schools and advocating with state governments for the same where it still is banned.

This is done in various ways. We train students as peer educators, train teachers, and support government in developing CSE curriculum.

In your literature, there is an intriguing mention of out-of-school CSE programmes. How exactly are they conducted?

The out-of-school CSE programme is an effective means for us to reach out to school drop-outs, young girls who had under-age marriages, and young employed persons. We follow the same CSE framework for conducting the sessions in out-of-school settings like community centres, panchayat bhavans, and spaces donated/provided by community members. These sessions are conducted by peer educators from the same community who are trained by member associations and at times staff from our member associations also facilitate these sessions.

What kind of advocacy work do you do with the government? What are your thrust areas?

Advocacy is central to the work of the IPPF. It is only with governments’ steady political and financial commitment that we will be able to achieve both universal access to reproductive health and the protection of SRH rights of all individuals, so that they may exercise these rights freely. We challenge world leaders to keep their promises.

At global, regional and national levels, IPPF holds governments to account on sexual and reproductive health and rights, persuading them to change policy and to fund programmes and service delivery. These changes are having a major impact on the health and well-being of millions of people around the world.

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