With one of the most dynamic economies in the world, India is currently experiencing a tremendous economic boom. Growth in information technology and telecommunications has catapulted the country to the frontline of international business.
Despite the rapid growth, however, poverty is widespread and exacerbated by a continued reliance on small-farm agriculture — a precarious source of income given the dependence on the annual monsoon.
India's large population is diverse — religiously, culturally, economically, and politically. Indian Hindus, Muslims, and Christians, among other religions, speak 15 official languages and numerous regional dialects.
In addition, India's borders with Pakistan, Myanmar, Bangladesh, China, Nepal, Bhutan, and its proximity to Sri Lanka contribute to great cultural richness but also continued political-ethnic tensions within the country. Economic inequality also characterizes Indian life: despite the economic boom, nearly half the population survives on less than $1 U.S. dollar a day.
Many Indians lack access to quality health care, especially those in rural areas who account for nearly three-quarters of the population. In India, government spending on health as a percentage of the GDP is the lowest in South Asia, making public hospitals and clinics — riddled with problems of absenteeism — unreliable sources of health care for those who cannot afford to pay for private care. It is the poorest women, who have a relatively low status in Indian society, that face the greatest health risks.
Spousal violence is common, with more than 35 percent of women experiencing it at some point in their lives. And there are significantly less women than men due to female infanticide, neglect of female children, and sex-selective abortion.
These factors conspire to create an environment in which women are at high risk for reproductive health problems. Only half the population uses modern contraception methods.
The majority of women give birth outside of medical facilities and without the presence of a skilled birth attendant, compounding the risks of pregnancy and childbirth. And while abortion is legal in India, lack of funds and access for many women make unsafe abortion a leading cause of maternal death and disease.
In recognition of these challenges, the 2000 National Population Policy emphasized the need to improve the quality of and access to sexual and reproductive health care in India.
PPFA in India
Since 1972, Planned Parenthood Federation of America (PPFA) has been working in India to improve the sexual and reproductive health of women, men, and youth. With the aim of building capacity and long-term sustainability, we provide grants and in-depth professional assistance to our four local, nongovernmental partner organizations in the states of Jharkhand, Rajasthan, Uttar Pradesh, and West Bengal to implement projects, improve medical systems, and strengthen organizational management.
Our four partners, The Child in Need Institute, Tata Steel Family Initiative Foundation, Prerana, and Action Research and Training for Health, oversee similar projects countrywide and follow the same innovative program models. The current phase of our youth program in India focuses on adolescents aged 15-19. PPFA supports an innovative program focused primarily on preventing unintended pregnancy and sexually transmitted infections among adolescents.
The program provides reproductive health education and contraceptives, and garners parental and community support for efforts to address their unique needs. Recognizing that young people are often better able to connect with their peers than adults, particularly in a culture where talking about sexuality is taboo, our partners train community adolescents to serve as peer educators that provide sexual health information to their peers and distribute contraceptives directly to them in their communities.
Recognizing the young age of marriage in India, and the influence of men on reproductive decisions, one of the approaches used by our partners involves training young adult couples to educate and provide contraceptives to married adolescents, a group often missed in adolescent health programs. The goal is to help young couples see the benefits of delaying childbearing until the woman is at least 18 and to allow adequate space in between children, which can reduce the risk of harmful outcomes to both mother and child during pregnancy and childbirth. It can also greatly improve economic opportunities for the family.
Peer educators try to integrate their work into local customs. One of these customs is the traditional pre-wedding/newlywed ceremony held in honor of young nearly or newly married couples. Peer educators — who are members of the communities in which they work — attend these parties to congratulate the couple and offer entertainment with a positive sexual and reproductive health message, such as a song or short play. Their aim is to establish a connection with the couples so they will feel comfortable coming to them for sexual and reproductive health needs well into the future.
Our India program is also working to improve access to safe abortion services. Although abortion is legal in India, many poor women cannot afford safe abortion services. As a result, more than 20,000 women die each year from unsafe abortions.
PPFA is trying to change that by implementing safe abortion techniques that are cost-effective and appropriate for low-income settings, including those that do not require a reliable supply of electricity or expensive equipment. PPFA's partners are helping to establish pregnancy testing and safe abortion facilities, train providers, and develop networks of providers that foster the exchange of ideas and support.