Contraception and safe abortion are key to women's growth

Contraception, safe abortion and the ability of women and children to decide on the number of children to have unleashes their potential, ensures their empowerment, says Ulla E Muller, President and CEO of EngenderHealth, a leading global women’s health organisation. Committed to ensuring that every pregnancy is planned, every child is wanted, and every mother has the best chance at survival, Ms Muller is currently fighting American President Donald Trump’s Global Gag Rule (GGR) that prohibits international family planning organisations receiving U.S. aid from providing information, counselling, or referrals related to abortion. This rule is applicable even if organisations are using non-US funding and the practices are legal in their own countries.

In Delhi working with her team leaders for a strategy to reach reproductive health services to an additional 18 million women globally by 2020, she points out that the GGR, earlier called the Mexico City Policy, has terrible consequences for women and their families. Operational between 2001 and 2009 under the Republican regime, the policy forced clinics to cut back on a range of critical health services that have nothing to do with abortion, such as family planning, HIV testing, and malaria treatment.

On the impact of GGR on India and the funding it receives from US based organisations, she says we are working with the India country office how best to deal with the situation. EngenderHealth works in 20 countries but the new funding policy will impact some 60 low- and middle- income countries that benefit from US global health assistance.

Striking a note of optimism, she points out that though the US is a big donor for health services, it is not the biggest. A significant number of donors are from the EU. To counter the impact of the US cutbacks, health activists are already looking at alternate sources of aid. Private foundations have stepped in and large donors have pledged additional $ 50 million globally. The Gates Foundation support too continues for attaining the Family Planning 2020 goals. She Decides, an organisation started in Holland, now supported by Sweden, Denmark, Belgium and other countries met in Brussels early this March and pledged additional $ 200 million for contraception and safe abortion. Countries that could not provide funds, promised political support for women’s health and development.

Even in America, we will not be silent says this born activist, brought up in Denmark by a single mother who taught her to stand up for her rights. “We are protected by the Constitution and will continue to advocate for women’s rights!”

Women and girls who have access to contraception and safe abortion are more likely to finish their education, more likely to find work and more likely to reinvest in the health and education of their children, and all these are objectives closely linked to the Sustainable Development Goals countries have endorsed.

Commending the Indian government for including injectable in the basket of contraceptives available to women, she says injectable offer women convenient, safe, reversible and cost-effective birth control that is as effective as sterilisation.  DMPA, a 3-month progestin-only contraceptive, has been widely used in the United States since it was approved by the Food and Drug Administration in 1992. It has been used by more than 68 million women in more than 114 countries. The safety and utility of injectable has been endorsed by WHO and 32 NGOs who came together under the banner of Advocating Reproductive Choices. EngenderHealth also endorses implants and intrauterine devices for women of all ages, including adolescents and those who have never been pregnant. However, there must be proper, well-equipped facilities that can also remove these contraceptives when the women want them out. Of the innumerable human stories that Ulla Muller has seen in her years of work in Africa and Asia, the most memorable ones are of two young girls of 13 and 14 who were provided contraceptives. The 13- year-old from Tanzania was unmarried but her mother brought her to the health facility and demanded a suitable contraceptive. “I can’t protect her from rape but I can protect her from an unwanted pregnancy,” she asserted. The second case is of 14-year-old Rahima who, though married and pregnant, wanted to be sure she would not conceive again after delivering the child in her womb. She wanted to get back to school and studies. She was given an IUD. Around the world teenagers are getting pregnant showing they are sexually active. So in addition to life skill curriculum in schools, adolescents should have access to contraception and safe abortion, Ms Muller reiterates. Long-acting reversible contraceptives, as well as permanent methods like voluntary male or female sterilisation, are the most effective modern contraception— safe, convenient, easy for the user, and do not require daily action to remain effective.

On EngenderHealth’s role in bringing the focus to NSV (no scalpel vasectomy), she said between 2009 and 2012 technical assistance was provided for successful interventions in UP and Jharkhand. NSV acceptance increased threefold in two years. Quality NSV services were introduced in five Centres of Excellence in medical colleges in Allahabad, Kanpur, Meerut, Ranchi and Bokaro. Arguing for greater involvement of men in family planning, Ms Muller points out fertility rate is determined by the number of children a woman has. However, it is men who have more children.

Even after divorce they continue having children with new relationships. If fertility is determined by the number of children a man has, the demand for NSV would probably increase. In India, for over 20 years EngenderHealth has been working closely with the government, supporting family planning/reproductive health and maternal child health capacity building and service delivery at national, state and district level. It trains service providers on the full range of contraceptives available in the public health system and develops training manuals, guidelines and protocols for clinical service delivery. In Rajasthan and Gujarat to reduce maternal mortality and morbidity it increased contraceptive use and IUD services and trained 1063 health provider to deliver high quality IUD services. There was focus on quality of care, respect for the woman and counselling to enable women take informed decisions. In Jharkhand in 2008, it helped the government implement the ARSH (adolescent reproductive sexual health) project and take it to scale. In 2011, EH initiated activities to replicate the Jharkhand’s ARSH model in three districts in Bihar and extend it state-wide in a phased manner.

In Bihar between November 2015 and 2016 end, bridges of cooperation were built between the Bihar government and NGOs for implementation of the Rashtriya Kishor Swasthya Karyakram, national programme for adolescent health. The programme is working in 10 districts of Bihar by setting up adolescent friendly health clinics and working with peer educators. Ms Muller points out, “From the time of the Beijing Conference on women’s rights in 1995, promises have been made for upholding women’s rights. It is high time they were honoured. Governments and international organisations have to be made accountable. They cannot keep pushing the goalposts away!”

The writer is a veteran journalist based in New Delhi