Annapurna Kesarwani– Urban ASHA in Prayagraj
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This is a story of an ASHA who – like most women – faced challenges related to family planning. TCI spoke to Annapurna Kesarvani who shares her some of her life’s journey.
ASHAs (accredited social health activists) are voluntary community health workers who work in all health areas in Indian communities. With multiple priorities, family planning was often the last thing on their mind. ASHAs were also not equipped to identify and counsel family planning clients. The Challenge Initiative (TCI) worked with the Indian government to coach and mentor ASHAs about family planning and prioritizing young low-parity women (15-24 years). During household visits, ASHAs provide informed-choice counseling on all family planning methods. An ASHA in Prayagraj is empowering women to take family planning decision. TCI supports the Prayagraj government in strengthening urban family planning and adolescent and youth sexual and reproductive health services for its urban poor population.
Tell us something about yourself, your family background, your education, etc.?
My name is Annapurna Kesarwani, I am 40 years old. My husband is a street vendor, sells snacks on a pushcart (chaat ka thela lagate hai). I hold a bachelor’s degree in Arts. I have two kids, 17 years old daughter and 16 years old son. I always aspired to have a career that would allow me to educate others. I considered teaching at first but perhaps fate had something else in store for me. My in-laws want me to stay at home to take care of the family. My husband’s income was not enough to fulfill the family requirements. To provide financial support to my husband in 2011, I applied for the ASHA (Accredited Social Health Activist) position. Luckily I got selected and for the last 10 years I have been working as an ASHA in the Gaughat slum area, which is under the Dharikar Basti urban primary health center (UPHC). In the Gaughat slum area women mostly work as rag pickers and are illiterate.
When and from whom did you hear about family planning for the first time?
Until my second pregnancy, family planning was completely a new thing for me; as both my pregnancies were unplanned. Within one year of marriage I got pregnant. After the birth of my daughter, my in-laws evicted us from the property and house because they wanted a male heir. We had no savings at that time, hence we started living separately in an affordable rented house near the slum area. After a year, I was pregnant again – those were the hardest days of my life. It was during my second pregnancy’s prenatal check-up, I heard about family planning from a gynecologist and soon after delivery, I adopted a long-term contraceptive method of my choice.
How important do you think family planning is for your community?
Before I became ASHA, I wondered why do undernourished poor women die during childbirth. I used to note the cases of stillborn/premature births due to multiple pregnancies. I learnt that it is the lack of education and awareness amidst other factors that prevents women from accessing contraceptive information and services. Family planning is very important for the community. I associate family planning with women’s empowerment because the range of barriers – like lack of access to family planning information and services, lack of support from their husband and family – restricts them to build a healthy future for themselves.
How do you promote family panning in your catchment area?
I work in an area that mostly has rag picker women who are illiterate and poor. There are many barriers that impact these slum women’s motivation and ability to access contraception – for instance, lack of knowledge, financial constraints, restricted mobility, distance to district hospitals, fear of side effects, lack of support from family, social stigma, myths and misinformation. Initially, it was difficult to motivate them for family planning. With the support of TCI and my supervisor (an Auxiliary Nurse Midwife), I enhanced my counseling skills. I learnt about the importance of establishing a rapport and cordial relation with women of my catchment area. Apart from health services, I make efforts to address family planning barriers and also help them to avail benefits of other government schemes.
Now, I start with family planning counseling of a woman during the gestation period itself so that she is aware of post-partum family planning services and prepares herself to make an informed decision to make use of family planning methods post-partum. That is the most suitable and the recommended period by doctors as well. In the case of young couples or first-time parents, I involve decision-makers of the family (husband, mothers-in-law) in counseling sessions. I have identified 20 champions, one in each cluster of the ward. These champions are smart educated women, active members of Mahila Arogya Samiti (MAS or women’s support groups) and Anganwadi Workers. Each champion covers 10 households and creates awareness among poor women on the economic and health benefits of family planning, nutritious diet, antenatal and prenatal care, immunization, COVID vaccination, hygiene etc. The fixed day static (FDS) service, which was initiated at Dharikar Basti UPHC by the city government, with the technical support of TCI, is helping these counseling efforts. (The FDS approach is a collaborative effort whereby trained manpower, equipment, commodities and supplies at the facility are made available on a pre-announced day and time known to the community.) Woman who make up their mind do not have to wait for a long time to access family planning services. Mahila Arogya Samiti members promote FDS service, and at times escort women on FDS day as well. They also organize group meetings in their cluster area where I create awareness and counsel women and mothers-in-law on the advantages of family planning.
Apart from this, along with champions, I provide basic education to slum women. In fact today most of them can do their own signatures. I help them with the school admission of their children. As a result, women in my area understand the importance of family planning, they themselves (in few cases along with mother-in-laws) visit UPHC on FDS days and make use of family planning services. They value family planning, education, and health overall. Most of all, today they listen to me, respect me and seek my advice in many things.
What kind of progress would you like to see in the area of family planning?
Family planning is a key factor in the development of society and nation. Each and every eligible couple should have access to short-term and long-term family planning services since this will help them to avoid unintended pregnancies and plan the size of family as per their choice. Apart from creating awareness on family planning methods, the correct and consistent use of contraceptives should also be emphasized. Furthermore, there is a need to motivate men to adopt family planning methods.
What message or statement you would like to make for other women?
Family planning is not only beneficial for mothers and children, but it is for the entire family. Family planning provides an opportunity to woman to give more time to her family and herself. Women who have fears or believe myths associated with contraceptives should seek correct information from service provider. And women who are using contraceptives should promote the benefits among their peer groups.