Access to Sanitary Napkins – An Affordability Issue.

When girls and women cannot afford a sanitary napkin, they go for cheaper and more convenient options, that most of the times are unhygienic or unsafe. Imposing GST on sanitary napkins may have caused girls and women to use unhygienic options like reusable clothes to absorb the menstrual blood. School-going girls may have been highly affected because of this decision. Imposition of GST did not only cause unsafe practices but also hindrance in girls’ education. This may have been another reason for to drop-out of schools, affecting their personal development, economical status, and eventually their health. Girls who use inappropriate sanitary materials even when in schools, are always worried, distracted, and have the fear that their uniform/dress might get soiled and hence will be embarrassed in front of others. This can have a great negative impact on their psychological health.

Therefore, I believe that the GST exemption on sanitary napkins was a much-needed change. Now that sanitary napkins have been exempted from GST, I wish to congratulate all women and request them to use hygienic methods of managing their menstruation. Stay safe and healthy!

 

KOMALPREET KAUR,

21 YEARS,

MOHALI.

 

Ray of Hope for ‘Stigma-Free Menstrual Health’.

#MenstrualHealth, #BleedWithoutTax, #lahukalagaanMaaf, #Sanitary, #MenstrualHygiene and so many other interesting tags are emerging and hitting on social media. One may think what will be the reason for all these comments and tags? If you think seriously about menstrual hygiene you will get a foremost decision made by 28th Goods and Service Tax (GST) council meeting. Interim Finance Minister of India, Piyush Goyal has declared this decision which has attracted many hopes.

India is a country where people are still not aware of their personal health and hygiene. Among which, ‘Menstrual Health’ is a subject that is being discussed within the four walls. This subject has remained mysterious and unknown to many adolescents, especially for girls until their first periods. According to some of the surveys made, almost 70% of women and girls in India are not able to afford the menstrual hygiene products. There are heaps of reasons for this unawareness, among which the affordability of the products is one.  Sanitary napkins plays a vital role and help a woman to maintain her health during periods. The importance of menstruation in a woman’s life need not be reiterated here. It is known that periods are natural and especially during periods, a woman has the right to maintain her health.

After various controversial comments, actions, and cases filed in High Court and Supreme Court, the government has made sanitary napkins GST-free.  This announcement has attracted many hopes for the development in women’s health and hygiene, in the country.  Earlier sanitary napkins were taxed at 12% under GST, but as this is not a luxury product, many activists and social organisations such as Family Planning Association of India had raised their voice to make sanitary napkins tax-free. Family Planning products like the condom have already been made tax-free and on that basis, 12% tax on sanitary napkins was also questioned. Many girls in rural India, tend to also drop-out of schools due to periods, which may ultimately result in a social loss for the country.

Till date, many women and girls use reusable cloth or a cotton swab, or even unhygienic materials to absorb the bleeding during their periods for not being able to afford sanitary napkins. Sometimes girls and women are hardly aware of what to use during their periods to absorb the bleeding. These signs indicate the poor menstrual hygiene and conservative mentality related to it in our society which causes a severe physical, mental, and social effect on girls and women.

Government of India’s decision to exempt GST on sanitary napkins has been a big win for all the individuals and organisations such as FPA India. FPA India has always been supportive of and insistent on menstrual health and hygiene management, and has taken initiatives to provide not only low-cost sanitary napkins to underprivileged girls and women but also information on menstrual health and hygiene through various programmes such as Adolescents Education Program Plus (AEP+), Comprehensive Sexuality Education (CSE) Sessions, special service sessions, etc.

The decision made by the GST Council to exempt sanitary napkins from GST will be beneficial for the entire community. Let us hope to get the sanitary napkins and better menstrual health and hygiene facilities to women and girls of underprivileged backgrounds. With this decision, a ray to develop a healthy India has emerged, so let’s walk towards it, to meet the ambitions, aims, and happiness in our society.

 

ROHAN PASTE,

CENTRAL EXECUTIVE COMMITTEE (CEC) MEMBER (YOUTH),

FAMILY PLANNING ASSOCIATION OF INDIA, MUMBAI

MENSTRUAL HYGIENE MANAGEMENT – A NECESSITY; NOT A CHOICE!

The Goods and Services Tax (GST) Council on Saturday, 21st July, 2018, announced that sanitary napkins would be exempted from GST. Hitherto they were taxed at 12% under the one-year-old GST regime. The highly controversial “luxury tag” on sanitary napkins has finally been scrapped. This move is welcomed as a much awaited first step for economic empowerment of girls and women.

In India, there are over 355 million girls and women who menstruate. 71% of girls have no knowledge about menstruation prior to their first period and 70% of women lack access to sanitary napkins. It clearly shows that the majority of girls and women depend upon low-cost, affordable alternatives during menstruation.

Menstruation has forced young girls to stay out of school due to a lack of toilets while facing the fear of soiling their dresses and getting teased by boys. In rural areas, many girls drop out of school once they hit menarche. In this way, lack of knowledge and access to clean, affordable, and hygienic menstrual products have acted as an impediment to education of girls.

India has witnessed a 70% increase in Reproductive Tract Infection (RTI) over the years and 23% of girls drop out of school once they reach puberty. The harsh reality is that most women in India prefer to use unsafe alternatives to sanitary napkins not because they want to but because they simply cannot afford menstrual hygiene products. Therefore, they have no other option than to use unhygienic ones.

Poor menstrual hygiene affects physical, mental, and social well-being of females. Thus, this is a violation of the human right to health. Family Planning Association of India’s initiative to provide not just low-cost/affordable sanitary napkins to underprivileged girls and women, but also to provide information on menstrual health and hygiene through Comprehensive Sexuality Education (CSE) is aimed at empowerment of girls and women.

Access to menstrual hygienic products every month is neither a luxury nor a choice. It’s an absolute necessity. Applying a tax to products which are solely used by women is an indicator of institutionalised gender discrimination. GST on sanitary napkins hit women and girls, hence from the beginning, sanitary napkins should not have attracted GST.

However, the latest decision of the government is a major step in normalising menstruation as a biological process. To ensure that women across India have an access to sanitary napkins and other menstrual hygiene products, accountability from the government as well as policy changes is required. There should be sufficient allocation of funds and transparency in their disbursement to promote menstrual hygiene among women. Eco-friendly and bio-degradable supplies of menstrual hygiene products such as sanitary napkins, menstrual cups, and tampons, should be made more affordable and accessible to the women and girls of India. At the same time, information on menstrual hygiene management should also be provided, just as FPA India has always been doing.

 

ARSHPREET KAUR,

BRANCH EXECUTIVE COMMITTEE MEMBER (YOUTH),

FPA INDIA, MOHALI.

A YOUTH CHAMPION PASSIONATE ABOUT EMPOWERING GIRLS AND WOMEN.

Menstruating without fear and GST

The Indian Government has given us a reason to rejoice by making sanitary napkins GST-free on 21st July, 2018, which was earlier under the 12% slab. Now there will be a hope of getting more affordable sanitary napkins.

Removing GST from sanitary napkins was a much needed step, as pads are not a luxury item, in fact they are the basic necessity of every girl and woman. Many girls in today’s date are still using cloth to absorb their menstrual flow. Majority of them are unaware about which kind of material to use. They lack the knowledge regarding menstrual hygiene. Many of them don’t even know the biological reason/process behind the menstrual cycle. Due to lack of the information, women consider the menstrual flow as dirty and toxic, which is entirely a myth.

Very often, girls and women are made to believe that during menstruation, they are not supposed to enter places of worship, not permitted to touch the pickle, or not allowed to sleep on the bed; all this because they are considered “impure” during those five to seven days. Why should women bear the brunt of this misconception? There is a huge need for educating our society, our women about menstrual hygiene, to eradicate all such myths.

Many girls in rural India drop-out of school because of the inconvenience they have to go through while they are on their periods. The tension of staining their uniforms, being teased by boys, feeling uncomfortable with cloth they use, are some of the reasons due which young girls are unable to get education.

In fact, getting access to affordable sanitary napkins and to have a happy and hygienic period is the right of every girl. The girls who opt for unhealthy methods of managing periods could also suffer from severe health problems. Depriving girls and women from accessing safe menstrual hygiene methods is a violation of human right to health. The act of exempting sanitary napkins from GST was possible because of many campaigns and protests lead by many social activists and organisations like FPA India.

Providing low-cost sanitary napkins is not the only solution, it will work more effectively when ‘information’ on menstrual health and hygiene will also be provided. FPA India has undertaken many such initiatives for years, along with distribution of sanitary napkins, through AEP (Adolescent Education Programmes) and CSE (Comprehensive Sexuality Education).

Menstrual hygiene and health helps girls in their socio-physiological well-being and plays an important role in their overall development and empowerment. After all “swasth rahega India, tabhi to badhega India!” (Only when the people of India are healthy, will the country make progress). India’s dream of becoming a leading nation will be fulfilled when if half of its population (49% females) get access to and affordability for basic health requirements.

Thus, removing GST from sanitary napkins is just one of the steps in the journey of making the girls and women of India, healthy and empowered.

 

KHUSHI,

19 YEARS,

CHANDIGARH.

 

 

 

FPA INDIA FOR MENSTRUAL HYGIENE – In context of the recent GST exemption on sanitary napkins.

The Goods and Services Tax (GST) is an indirect tax that was introduced in India in 2017, in order to replace multiple indirect taxes in the country. This tax was however, levied on sanitary napkins as well. GST of up to 12% was to be paid by the consumer on the purchase of sanitary napkins. This made the most basic product essential for maintaining menstrual hygiene, even more difficult to afford.

In a country like India, many women and girls still resort to using unhygienic methods to manage menstruation, because they are not able to afford or access sanitary napkins, or are still not aware of the benefits and importance of using them. In such a scenario, the entry of GST was only precarious.

However, after multiple efforts by various organisations and activists, the GST levied on sanitary napkins was exempted (from 12% to 0%). This decision was announced in parliament on Saturday, July 21, 2018. Family Planning Association of India (FPA India) welcomes this much-needed change. Access to sanitary napkins, and other health and hygiene facilities is the human right of every girl and woman, and it is necessary to ensure that they are empowered to exercise their rights.

FPA India has been working to empower young girls and women with their Sexual and Reproductive Health and Rights (SRHR), especially awareness and practices for menstrual health and personal hygiene management. Besides, training programmes and sensitisation workshops are conducted for teachers, parents, counsellors, peer educators, and even boys and men. FPA India has been engaging young people for more than five decades to empower them with information on SRHR. Some of them have even become change agents and volunteer to support other adolescents.

One of the recent case studies of FPA India includes an intervention project funded by a renowned organisation under their Corporate Social Responsibility (CSR), in order to create an income generation activity of manufacturing low-cost sanitary napkins and ensure menstrual hygiene for women. As per the plan, a sanitary napkin manufacturing machine was purchased and handed over to a Self Help Group (SHG) in a remote village in Gujarat, which was selected in consultation with the CSR team. Seven women from this SHG were trained in preparation of sanitary napkins and would manage and sell them at a nominal cost to women and girls from the village. Feedback received from the community was positive and encouraging. This project turned into a successful initiative to ensure menstrual health and hygiene for women and girls and empower them economically.

Similarly, many initiatives to distribute low-cost, affordable sanitary napkins to girls and women, have been undertaken by FPA India. Information and counselling on menstrual health and hygiene are essential components of the Adolescent Education Programme Plus (AEP+) conducted for in and out-of-school adolescents. This programme provides Comprehensive Sexuality Education (CSE) to make them aware of their sexual and reproductive health and rights. Local Community Service Organisation (CSO) were also engaged as partners in other such initiatives.

FPA India believes that poor menstrual health and hygiene not only has an impact on girls’ or women’s physical health, but also on their socio-psychological health. Many a times girls tend to drop-out of school due to lack of facilities for menstrual hygiene, or due to unaffordability of sanitary napkins and hence the fear of staining in school. In , FPA India started an initiative, ‘Let’s Get Girls Back To School’ as a part of the TATA Mumbai Marathon, 2018, wherein they raised funds to ensure that adolescent girls were empowered with the following – low-cost, affordable sanitary napkins, iron supplements to prevent anaemia, Comprehensive Sexuality Education (CSE), and life-skill training to help them (school drop-outs) earn a living. An amount of INR 1080/- was calculated to provide these to one girl for an entire year. This initiative received an overwhelming response from individual and corporate donors who supported the initiative to empower young girls make their sexual and reproductive health choices.

FPA India has been and will keep undertaking such initiatives to empower young girls and women with adequate information and affordable products to maintain their menstrual health and hygiene, leading to their physical and psychosocial well-being. The exemption of GST on sanitary napkins should be utilised as a great opportunity to empower girls and women and increase their access to menstrual hygiene facilities.

 

(Written and published by Family Planning Association of India)

Use Sanitary Napkins and stay away from infections!

Ajay Goyal

FPA India Agra branch conducts Comprehensive Sexuality Education (CSE) sessions for school-going girls and for women at various occasions, through which they are made aware about the use of sanitary napkins during menstruation.

However, in a lot of remote villages, many girls and women have not been using sanitary napkins due to a lack of adequate information. In addition to this, poor girls and women use dirty cloth and other unhygienic methods to manage their menstruation since they cannot afford to buy sanitary napkins. This may cause various infections. FPA India Agra branch has played a significant role in creating awareness among girls and women about menstrual health and hygiene

The recent exemption of GST on sanitary napkins is a great initiative. With sanitary napkins available at affordable prices, more and more poor women and girls will be able to use them. The day is not far when all women and girls in our country will start using sanitary napkins during their periods, to maintain menstrual health and hygiene.

 

AJAY GOYAL

YOUTH VOLUNTEER,

FPA INDIA, AGRA.

Talking about Menstruation with FPA India.

Menstruation is a natural process, but still there is stigma associated with it. Using sanitary napkins is considered a private affair, due to which asking for money to purchase them brings with it some hesitation. However, after sensitisation of parents and teachers by FPA India, we can comfortably have conversations around periods and sanitary napkins, or ask for money to buy the same.  Also, FPA India helps make girls like us aware of correct knowledge about their periods. During these meetings, teachers also feel confident to speak up and provide information on the topic. These sessions have even led to informing schools to allot funds for sanitary supplies. FPA India also raised funds through the “Let’s get back girls to school” campaign in the Tata Mumbai Marathon, 2018, to empower young girls with sanitary napkins and information on menstrual health and hygiene. FPA India also sensitises young boys on menstruation to de-stigmatise this topic and create a stigma-free environment. It is my opinion, that exemption from GST will not only help women and girls afford sanitary napkins, but will also be a campaign contributing significantly to de-stigmatising menstruation. I congratulate FPA India and wish them all the luck in their initiative to empower young girls and women with information on menstrual hygiene and affordable sanitary napkins.

 

Madhushree Anishettar,

Age 21,

Student from Dharwad.

FREQUENTLY ASKED QUESTIONS (FAQs) ON FAMILY PLANNING.

Family Planning is an essential component of Sexual and Reproductive Health and Rights (SRHR). As per the World Health Organisation (WHO), Access to safe, voluntary family planning is a human right. Family planning is central to gender equality and women’s empowerment.’ To enable as many people as possible to access their right to opt for Family Planning methods, Family Planning Association of India (FPA India) answers a few Frequently Asked Questions (FAQs).

If you wish to ask some questions, feel free to leave them in the comments section below.

[Source for answers: Education in Human Sexuality – A Sourcebook for Educators, Third Edition. By Late. Ms. Dhun Panthaki.
AND
Family Planning: A Global Handbook for Providers, 2018 Edition.]

FAQs and Responses:

1. What is Family Planning?

Answer: Family planning is a right of all people to determine whether and when they have children, how many, and with whom. It allows people to attain their desired number of children and determine the spacing of pregnancies. Family Planning is a broad concept and goes beyond merely ‘avoiding having children’. It includes the following:

  • Regulating and spacing childbirths
  • Choosing suitable methods of contraception
  • Helping childless couples to conceive
  • Counselling parents and would-be parents

 

2. What are the advantages of family planning?

Answer: Family planning is achieved through the use of contraceptive methods and the treatment of infertility. It aims at improving the quality of life by regulating the family size so that the couple can have a child when they are physically, emotionally, and even economically ready to have one, if they wish to. It is important to ensure that the offspring also gets the necessary time and resources from the parents, where parents are able to afford to raise the children and give them adequate nutrition and education. Planning a family can ensure that all the members in it have adequate time, energy, and resources.

With a minimum gap of two years kept between consecutive pregnancies, the mother gets a time to recover the strength after the first pregnancy, healthier babies with better immunity, both parents find time for each other to strengthen their relationship and time to plan for and ensure that the next child gets the required resources as well.

 

3. How effective are the different methods of contraception and which is the best method?

Answer: Modern methods of contraception are essential to ensure sexual health and well-being. A contraceptive method is a device or drug used to prevent conception and pregnancy. Using modern methods of contraception can ensure more chances of avoiding pregnancy, as compared to traditional/natural methods. HIV/STIs can be prevented with the use of condoms.

The function of Modern Methods of Contraception:

  • Prevent ovulation (formation of egg) in the female body
  • Prevent sperms from meeting with or fertilising the egg
  • Preventing fertilised eggs from settling in the lining of the uterus

How effective they are, when used correctly and consistently:

  • Barrier methods such as male or female condoms – 95%
  • Combined Oral Contraceptives (COC) – almost 100%
  • Progestogen-Only Pills (POP)/ Mini-pill – 99%
  • Injectable contraceptives – 97-99%
  • Combined Patch – 92-99%
  • Intrauterine Devices (IUDs) – 96-99%
  • Implants – 99.9%
  • Permanent methods (Vasectomy and Tubectomy) – 98-99.9%

 

4. What are benefits/risks of oral contraceptives?

Answer: For Combine Oral Contraceptives (COC) / Progestogen-Only Pills (POP) – A woman can start taking these as per the doctor’s prescription if she is certain that she is not pregnant.

Benefits:

  • They are easy and convenient to use
  • Does not interfere with sex
  • Very effective if taken regularly
  • Monthly menstrual cycles are regular, with reduced bleeding and pain
  • Can be discontinued when a pregnancy is desired
  • While POPs can be taken whilst breastfeeding, it is advisable to not take COCs during the breastfeeding phase

Risks:

  • May not work as effectively if not taken daily
  • Rare cases of slight headache, giddiness, nausea initially
  • Does not protect against HIV and other STIs

 

5. Will using oral contraceptives have an effect on my chances of conceiving in the future?

Answer: When Oral Contraceptive (OC) Pills are taken daily as prescribed by a qualified medical practitioner, the woman does not tend to conceive. Women who stop using OC pills can become pregnant quickly as possible. The day taking OC pill is stopped or is delayed by more than 12 hours, the woman’s chances of conceiving go back to normal.

 

6. Is it alright for unmarried women to use IUDs?

Answer: Intrauterine Devices (IUDs) are safe and suitable for women of any age (including adolescents and women over 40 years of age), women who have just had an abortion or miscarriage, breastfeeding women, women doing hard physical labour, women who have had children and those who have not, women having vaginal infections, Pelvic Inflammatory Diseases (PID), or anaemia. IUDs are very effective and private (nobody can tell if someone is using it). IUDs have no further costs once inserted and the user is not required to do anything after insertion.

 

7. Which is the best family planning method for an HIV/AIDS infected individual?

Answer: Use of condoms is best advised for safe sex, so to prevent the transfer of HIV/AIDS or Sexually Transmitted Infections  (STIs). Other family planning methods could be used for preventing a pregnancy, only after appropriate consultation from and counselling by a certified medical doctor. The method will also highly depend upon the severity of the virus and its implicating infections.

 

Family planning is a human right and anyone can access it. Access to high-quality, affordable sexual and reproductive health services and information, including a full range of contraceptive methods, is fundamental to realising the rights and well-being of women and girls, men and boys. FPA India gives you an opportunity to access Sexual and Reproductive Health (SRH) care, including Family Planning.

 

If you’ve got questions, leave them in the comments below so that we can answer them, too!

 

Positive Approaches to Adolescents and Sexuality Education: A Case for Expanding Regional Vocabularies

(Article by Ms. Isha Bhallamudi, Mumbai. Cover Photo: FPA India, Rajkot)

Adolescence is a transition time between childhood and adulthood. But are we ready to equip adolescents to handle this transition successfully? One of the many things adolescents discover during this time is their emerging sexuality, and a healthy curiosity in sex and sexuality at this age is absolutely normal. Early adolescence is a good time to impart crucial information that will help young people understand the need to avoid risky behaviour and make safe decisions. But are we prepared to be the responsible ones, and start having adult discussions with adolescents?

There is an intense stigma about sex in Indian society. Young people frequently crib that before marriage they are expected to be totally clueless and naive about sex, and after marriage they are socially pressured to have non-stop sex and prove it by having more and more children. This double standard is both unreasonable and dangerous. Yet it is highly prevalent.

Adolescents are all the more curious about sex because it is made to seem like such a taboo topic. Normally and socially it is not possible to ask questions about it or talk about it openly. When faced with a reactions of distrust, shame, and fear to natural curiosity, where do you think they will go? They may approach friends (who may have half-baked knowledge themselves), online sources (which may or may not be accurate), or worse, pornography (which perpetuates violent and misogynistic perceptions of sex). You can probably guess the effect this can have on young people’s perceptions of sex, reproductive health and healthy relationships! Their explorations may end up being severely misinformed and place adolescents in real danger: of emotional abuse, STDs, unwanted pregnancies, and physical or sexual abuse. Additionally, in the absence of adequate information, they may be vulnerable to sexual abuse, violence and unwanted sexual advances.

So, we see that keeping adolescents unaware and absent from any discussion about sex and reproductive health can actively harm them and increase their vulnerability to harmful consequences of sexual exploration. But what is the way out? Instead of this negative approach, we need to encourage adolescents to discuss these topics with healthcare providers, parents, and reliable online sources. Positive approaches to sex education involve giving adolescents awareness, information, and safety strategies. Such approaches directly equip adolescents with the tools to protect themselves instead of magnifying their vulnerability to risk. Studies have consistently shown that when adolescents are provided with sex education and contraception, their rates of unwanted pregnancies and unsafe sex tend to fall.

In India, it can be very difficult for adolescents to find an open, reliable and non-judgmental space to access information about sex and sexuality. This is something that needs to change. Let us talk specifically about the home. Parents and adolescents find it incredibly difficult to open up honest and easy lines of communication about anything to do with this taboo topic.

There are many barriers which make these conversations difficult at home. One, parents are socialised to believe that sex before marriage is strictly taboo. They also fear that talking about sexual health will encourage more risky behaviour, rather than more responsible behaviour, in their children. They may find it impossible to accept adolescents and young people as sexual beings. At the same time, there is an even greater panic if adolescents are not sexual in the “correct”, socially mandated ways; for example, if they are asexual or homosexual. On their end, adolescents fear judgment, shame and punishment from their parents and society. These are only some of the barriers at play.

All these reasons have been discussed a lot in research, media, and policy. But there is one more, simple but rather insidious reason which is also contributing to this problem along with all the others above. This is the problem of vocabulary. Think of your mother tongue. What are the words for ‘sex’, ‘vagina’, ‘penis’, ‘foreplay’, ‘breasts’, etc.? Aren’t these words loaded with very heavy vulgar, misogynistic connotations? The English words above may sound appropriately clinical. Yet translate them into regional vocabulary and all you have are swear words.

Parents and adolescents cannot even begin to talk about sex if these are the only words available to them. Words loaded with shame, embarrassment, crudeness, and overt violence. Besides, the children are only yelled at if their curiosity gets them to touch their private parts.

We need to think about this: How are families supposed to talk about sex and sexual health in positive, respectful, and open ways when they don’t have the words to do it with?

There is a serious need to expand the vocabulary for talking about this most natural of human behaviours. We all need to figure out how to frame these conversations in comfortable ways within the home. In the long run, this will help keep the lines of communication open at home, increase trust between parents and adolescents, and help adolescents develop more responsible and safe behaviours. If we want to protect adolescents from the consequences of unsafe sex and risky sexual behaviour, we have to be able to talk to them about it in ways which make sense to them.

(Isha Bhallamudi is currently an independent researcher working within the intersections of gender, health, and young people in India. She has previously worked at the Tata Institute of Social Sciences, where she carried out research projects for UN Women and UNICEF. She holds an MA in Development Studies from IIT Madras.)

 

[Disclaimer: The views and opinions expressed in this article are those of the author’s and under no circumstances can be regarded as reflecting the position of Family Planning Association of India (FPA India).]

 

Family Planning Association of India launches ‘Antara’ – a three-monthly progestin-only contraceptive injection.

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FPA India welcomes the introduction of three new modern, reversible contraceptives injection DMPA (Antara), Centchroman Pill (Chhaya) and Progestin Only Pill (PoP) in the National Family Planning Programme. This is indeed a step in the right direction to expand contraceptive choice and make modern contraceptives accessible and affordable to women to meet their reproductive health goals. The roll-out of these new contraceptives has been initiated in a phased manner across public health facilities in the country by the Ministry of Health and Family Welfare since last year.

On the occasion of World Population Day, FPA India Mumbai Branch, in collaboration with the Public Health Department of the Municipal Corporation of Greater Mumbai, has launched ‘Antara’ a three-monthly progestin-only contraceptive injection, at the Awabai Wadia Health Centre.

It is our endeavour to support health care providers in the public as well as private health sector in delivering high quality injectable contraceptive services so that eligible clients can choose and use contraceptives with confidence to enhance the quality of their reproductive and sexual lives.

 

About ‘Antara’

This contraceptive injection is composed of a synthetic female hormone (progestin) known as Depo Medroxy Progesterone Acetate (DMPA). Every dose of the injection contains 150 mg of DMPA as an aqueous suspension of one ml and needs to be given every three months as an intramuscular injection.

When the prescribed dosing schedule is followed, injection DMPA is considered to have a failure rate of less than one pregnancy per 100 women using the method over the first year. The effectiveness largely depends on regular and timely follow-up visits for re-injection. As commonly used, pregnancy rate is about 3 pregnancies per 100 women over a year.

Like for every other reversible, modern method of contraception, clients will be counselled about the safety, reversibility, effectiveness, dosage, repeat injection visits, side-effects and warning signs of ‘Antara’ (inj DMPA, also known as Depo-Provera) and also informed that they are free to switch to any other method any time they wish to.

‘Antara’ should be made widely available to women who need an effective contraceptive method and who may not be medically eligible to use other effective hormonal methods.Most women can safely use ‘Antara’, including women who breast-feed, as early as 6 weeks post-partum and if the woman is not breastfeeding, it can be administered within 6 weeks postpartum as well. Thus, this method of contraception can also be positioned to fulfill the unmet need for contraception by post-partum women who may be undecided yet about choosing a long term method to limit their family size or for those women who may indeed have short-term needs for an effective yet reversible, woman oriented method of contraception.

 

Supporting informed choice and voluntary decision-making

Every woman has the right to choose and use a method of contraception that is best suited to her needs and lifestyle. However it is also the duty of the service provider to screen her for medical eligibility to use that method and ensure that the method is safe for her. Women need to be educated and empowered so that they can control their fertility and have access to a wide range of contraceptives suited to their age and reproductive life stage. Careful profiling of the client and method-specific counselling cannot be emphasized more, before offering injectable contraceptives. Service providers need to be equipped with updated technical information, service delivery guidelines and job aids so that they are able to offer an informed choice of injectable contraceptives and quality services to support use.

 

The FPA India experience with Injectable DMPA

FPAI believes in and has strongly advocated for expansion in the basket of contraceptive choices in the National Family Planning Programme, so that poor and needy women are not denied of choice due to affordability issues. Injectable DMPA has been a part of the contraceptive method-mix provided through FPA India clinics for nearly two decades now, ever since this method was approved for use in India in the year 1993.

Providing injectable DMPA in the outreach during special service delivery sessions, capacity building of various cadres of service providers through technical updates with an emphasis on counselling skills, development of a comprehensive tool kit for various cadres of service providers to support informed choice of injectable contraceptives, training of providers in using the tool kit and sharing of best practices have contributed to a steady uptake of this method from FPA India service delivery points.

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