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Community Health Workers Play a Major Role in Lowering Maternal Mortality

Health workers in West Bengal are counseling and motivating men to undergo vasectomies, and addressing the social determinants of health like gender dynamics and conditions of living.

Five women in India die every hour due to complications at childbirth. Tupen Sarkar, too, had lost his first wife to childbirth complications. When Sarkar took his second wife, Basanti, to the ASHA workers (frontline health workers) in their village for sterilisation after she had borne two children, she was operated on and the surgery deemed a success. But after three and a half years, she conceived once again.

Although India’s maternal mortality rate has declined over time, the onus of birth control lies on women, and uninformed and improper sterilisation for women has often led to deaths. When Basanti was taken to the health sub-centre again, Shefali Chakraborty, a frontline health worker motivated Tupen to undergo a vasectomy instead, debunking the myths around the procedure and its after-effects.

“Initially, I was skeptical about undergoing the procedure but I realised that I must keep my family small or I won’t be able to provide for them,” says Sarkar, adding that he is happy with his decision.

Jahanara Bibi, the Community Correspondent who documented the Sarkars’ case, speaks to ANM (auxiliary nurse-midwives) and ASHA workers in South Dinajpur to understand why men are reluctant to undergo vasectomies.

ASHA workers like Shefali Chakraborty are recruited and trained under the NRHM (National Rural Health Mission), and function as frontline health workers in rural areas. Apart from providing basic physical healthcare services, they are also responsible for creating awareness about and addressing issues like conditions of living, social exclusion and gender equality, all of which affect health and illness.

“Many men are afraid of vasectomies because they believe that they it will weaken their physical strength, it is very difficult to motivate them” says Kakoli Chandra, an ANM. Loss of physical strength is not the only myth around vasectomy, prostate cancer is another, which has now been proven untrue. But the root cause remains patriarchy and the resultant social stigma inflicted on men undergoing the procedure, equating it with a loss of ‘manhood’ and virility.

While ASHA workers and ANMs perform a crucial role in helping people make informed decisions pertaining to family planning, a woman’s ability to exercise agency is still determined by families and communities. Charkraborty also tells Jahanara that in case contraception fails and a woman conceives, she can carry on with the pregnancy only if she wishes to. If she does not, the health sub-centre will help her get an abortion. Contrary to Chakraborty’s sensitive approach to such situation, hundreds of women face severe stigma at abortion clinics.

Basanti Sarkar was lucky to not have to undergo another sterilisation surgery because of the counseling and support that she and her spouse got from the health workers. The government, too, is pushing for vasectomies as a method of family planning. Starting November 21, the Health Ministry is observing Vasectomy Fortnight, in line with World Vasectomy Day which is observed on November 20. The government also offers a higher cash incentive (1100 rupees) to men as opposed to the 600 rupees offered to women for undergoing sterilisation. Currently, only 0.3% men undergo sterilisation compared to 36% women, according to the National Family Health Survey. The reluctance to undergo vasectomy remains.

Globally, there have been initiatives to promote vasectomies and debunk myths around it. But these efforts often fail to address the underlying patriarchy. In the United States, men undergoing vasectomies can now treat themselves to steak, some liquor and a game on a big-screen television after the procedure. The Wall Street Journal termed these as ‘brosectomies’. Incentives of the sort may increase the number of vasectomies but reinforce a culture of machismo.  

Programmes for women’s sterilisation are unlikely to offer such incentives; it is assumed that a woman must unquestioningly undergo the procedure. Community health workers like Chakraborty and Chandra are trying to change this through their counseling and caregiving.

Video by Community Correspondent Jahanara Bibi

Article by Alankrita Anand, a member of the VV editorial team

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