Last two weeks I was busy with interviewing women who are social mobilizers. I got an opportunity to travel various districts and met amazing women in the rural areas. After meeting them and interviewing them I realized the meaning of empowering women in the field of sexual and reproductive health & rights.
These women have been working as Female Community Health Volunteers for long time. They have an inspiring grass root level experience on working in the communities and making community people aware of pregnancy, pregnancy check ups (ANC & PNC), contraceptives, vaccinations, nutrition and other aspect of SRHR. They do not have received formal or intensive trainings on SRHR but have been received orientations from government and NGOs working in the field of SRHR.
One of the social mobilizer shared, “It’s not easy to work as social mobilizer and go door to door for making women aware of their own uterus. Women are never open to talk about their private parts. It’s not only about educating them. We must realize the life cycle of women and how they survive. Their decisions are influenced by their mother-in-laws and their husbands. We have to aware their counter parts as well.” These FCHVs and social mobilizers are given targets every month to refer women for accessing contraceptives and pregnancy check ups in health facilities by government as well asNGOs. Therefore, they have to visit door to door and use their interpersonal communication skills to make people aware and convince women to use long acting reversible contraceptive methods like IUCD and IMPLANT.
One of the FCHVs shared, “I have to work in my own community and adjoining VDCs. I have not faced any difficulty to talk about women’s SRHR to other community people but have been facing challenges to convince my own family and community. When I started working as FCHV, I have to carry condoms and oral pills in my bag. I have to distribute it among men and women of my own community. People gave me a tag “CONDOM DIDI”. I have been harassed verbally many times. However, at the end of the day the same person seek advice with me regarding pregnancy, contraceptives and even asked for condom.” She continued saying she has been working and “CROSSING THE LINES”. This means she has been crossing the gender construction of women not allowed to talk about SRHR among her family and relatives. She added, “Till today it’s very difficult for women living in rural part of Nepal to their own decision regarding their uterus. She has been seek advice from her husband. We have to support her. Therefore, crossing the boarder Of socially constructed norms that we must feel shy talking about contraceptive to in-laws, I have been talking to my brother-in-laws on using condom or letting their wives using IUCD or IMPLANT. It’s not easy though. I have been accused of misleading their wives to promiscuity. Whenever I have to talked to husbands I have to apology them in the beginning saying ” I’m crossing the boarder” and I care about their health.”
It was also found that these mobilizers love their work and dedicated to work for women and with women. However, they have limited experience on working with young people. They shared it might be due to generation gap or age difference they have not experienced young girls and boys approaching them for contraceptives. Instead they have been in direct contact with young married boys and girls. The FCHVs said, ” Not a single pregnant woman is passed unnoticed through their eyes.” One of the FCHVs referred herself as an astrologer. She shared, ” As I am quite popular in their community as FCHV, I am invited in most of the functions. It’s Nepali culture that you have to dance and sing in most of the functions. I am jolly person and I insist everyone to join me during dance. If someone denies to dance, it catches my eye. I have to ask her indirectly whether her husband is here, whether she has morning sickness and then they start to explain themselves about their pregnancy. After that now it’s my responsibility they visit health post regularly or atleast 5 times before delivery. And I fee chance to talk to the couple regarding using contraceptives.”
We also talked about barriers and difficulties they face in their work. Most of them shared that they have to visit the same woman for more than 5 times to make her decision to use contraceptives. Sometimes, even if a woman is willing to use contraceptives her husband might not allow her. You convince her today and next day she decides not to opt for contraceptives. FCHVs also observed that there are various myths and misconception regarding contraceptives in the community. There has been challenge to address those myths. They have been cases like woman comes to them and insist to use contraceptive as she thinks they have enough children. The woman uses contraceptives. She is happy and return to her home. After few days she comes again and requests to remove the contraceptive. Most of the male in the community are migrant workers. Therefore, women comes to them insisting removing the IUCD or IMPLANT as their husbands are away. Later they ends with having unwanted pregnancies.
My another curiosity was whether all these FCHVs know about “ABORTION”. My assumption was they are not aware of legality of abortion. They might be against abortion. However, my assumption was totally incorrect. These FCHVs knew abortion is legal in Nepal. They are positive towards abortion services. They have been referring women with unwanted pregnancies to safe and legal abortion service centers like district hospitals, Marie Stopes Centres, Family planning clinics, etc. On asking how you determine whether the health clinics are safe and legal abortion providers, they shared the Health clinics should have safe abortion logo and service providers should be trained and certified. They also shared they are against sex selective abortion. Almost all FCHVs have observed women in their communities seeking traditional methods of abortion and ending their life with complication and resulting into deaths.
Few FCHVs shared their experience of having safe and legal abortion. One of them shared, “Two children was enough for me. We also need to think about our economic status and raising our children with quality life but I was forced to keep my third pregnancy. Somehow I heard about abortion service centre. I went there by myself and talked with service provider. She did my pregnancy check up and on same day I had my abortion. I never regret for that as now I have happy family with two grown up kids.”
Another FCHVs shared, “In 2050 B.S. I was married. After 10 years , I became FCHV. By that time I had two girl child. It was embarrassing for me to go around my relatives or celebrate any festival together. Each and everytime I was asked when I am planning for another pregnancy. They wished my another pregnancy could result a baby boy. Until I had a baby boy even my daughters are not respected in my family. They were also looked down. This gave a sense of revenge and wanted to show my relatives that I can also give birth to a SON. I performed abortion for two times. I was not ready for another pregnancy. However, my husband and I decided to have one more child and we wished that to be male child. For god’s blessing my last pregnancy turns out to be male child. After that I opt for female sterilization. Looking back, I feel myself a stupid person that I took it as challenge to give birth to a male child. Now this means nothing as my daughters are more respected in my family. All of the are doing good in their studies.”
This is a treasure of memory that will inspire me to be one of them in future. It was indeed great to meet them and interact on perception of SRHR in the community and how they are battling in it. All of them are champions and in real sense they are hero of our community. They are contributing a lot in our health sector and making it possible to achieve national health objectives and targets.