Day 10. PSI.
Our first full day in Delhi was spent with Populations Services International, otherwise known to most of the world as PSI. PSI is 3rd largest NGO in the world. That is huge! Leading programs include targeting malaria, child survival, HIV, reproductive health and non-communicable disease. In India particularly, PSI has been working there for almost 30 years - working effortlessly on HIV/AIDS, reproductive health, malaria prevention and child survival. Our day was focused on learning about the reproductive health programs. We began our day in the PSI office of Delhi learning about the Freedom 5 project, or the promotion of IUDs in women of reproductive age (WRA) amongst vulnerable and poor women. Our two hours at PSI was very similar to sitting in class at GW - learning about the objectives, goals, and impact of this project. The goal of this initiative is to increase the use of IUDs by 1.1% by 2012. Now, that at first seems small but let's talk about the number of women that live in Delhi - 1.1% will make an impact!
After gaining an understanding of the mission of this initiative, we were guided to a specific neighborhood the Freedom 5 program is implemented. We first went to a clinic that is often visited by poorer families. Here we spoke with the physician on call to learn more about the women that come in asking for an IUD. According to the physician, most women come in after their fourth or fifth child at which time they are ready to stop having children (at least for awhile)!
We then went to a specific locality where health promoters were conducting their work - going door-to-door obtaining information on who lived there, the number of children, what languages they speak, etc --essentially a census, a very detailed census. This allowed the health promoters to be more strategic in talking to women and families about PSI, family planning and IUDs. It was incredible to watch. These health promoters had so much information one each household in the entire neighborhood. They knew their health issues (more than just the reproductive health concerns). As these women gained credibility in the neighborhoods, they gained relationships with the families living there and were able to have honest conversations around family planning and also help women understand the process and implementation of an IUD. There were a number of things I found to be quite interesting today.
1. In many instances women asked to wait for their husbands to come home from work so they could have the conversation of family planning together AND the mother-in-law was the one in most households who remained the barrier to obtaining proper family planning tools. It made sense but wasn't my first thought. I initially just assumed husbands would be the largest barrier in implementing this program.
2. How is this being sustainable. Yes, wonderful health promoters are going into the field and teaching women the notion of family planning and empowering them through education and birth control essentially, but what happens after that? Once women have IUDs inserted - are they teaching others the power of education and smaller families particularly in lower income neighborhoods?
3. How is this being evaluated? There seems to be a lack of data when it comes comparing women who discuss and implement family planning vs. not.
Our day spent in these neighborhoods was extremely educational. Learning from PSI, an internationally known integral NGO it was calming to see how a program is conceived in a conference room and then fully implemented in the field. Our other days in India, we focused on smaller firms that had more narrowed mission spaces. Seeing that even larger NGOs can continue on a focal point was refreshing. I think at times, I get caught up thinking that larger firms fall into the corporate traditional enterprise and the smaller firms though they are doing amazing work get caught in the struggle of limited funds and low resources. Today affirmed that it really does not matter where you work -- the programs get initiated the same way and the work gets implemented with determined, honest, and passionate individuals.
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