Changing the world, one child at a time

In the public health world and in the nonprofit sector, so often it is necessary to wait until the numbers have been crunched to determine whether or not the services provided are making an impact. However, this is not the case with Salaam Balaak Trust.
On our last full day of the course, we spent the afternoon with Salaam Balaak Trust, an organization providing basic services to runaway and homeless children, many of whom come to Delhi and other major cities via the train system. Iqbal, our tour guide, lead us through the alleys and pothole-ridden streets of one of the neighborhood bordering Delhi's main train station, explaining the nature of the runaway community, opportunities they seek to earn money, and trials and tribulations of their journeys, literally and metaphorically, into and through homelessness. Iqbal explained that many children have been abused or neglected – he himself was simply left in a busy market by his father at 5 years old – and SBT works to reach out to children on a level they understand, building relationships based in respect and trust, and thus maximizing opportunities to reach these children.
We were lead to SBT's intake center on the second floor of a simple building next to the train station. SBT staff, each providing individual attention to one child, worked diligently to fill out forms, complete a basic medical exam or just talk to the child with whom the were working. Other children, who ranged in age from 10 to 18, sat on the floor together, talking amongst themselves while drawing or coloring.
We were then brought to one of the many shelter homes run by SBT, this one in particular for boys. Our group missed the talent show they put on just minutes before, but had the opportunity to spend some time with the boys. I sat down in the front of the room and was swarmed by 4 boys, all of whom quickly introduced themselves to me, and immediately challenged me to thumb wars, and taught me some of their handshakes. They were so excited just to have us there, to have their pictures taken and, I could tell, just to be noticed.
I can not begin to imagine the things some of these children have gone through, especially with no safety net to catch vulnerable populations such as young children should they fall. Social services to the degree of those available in the US are not available in India. If it was not for SBT and organizations like it, these boys, along with the 1000 other children SBT serves, would be out on the street. While this is a grant-funded organization, they do have an income generating aspect – they charge a small fee for tours, such as the one in which we participated, and sell t-shirts, postcards of artwork by or pictures of children served by SBT, and chai carriers made from wire. All proceeds go directly back into the organization.
The work SBT does is incredible, and the impact they make is palpable when standing in a room with those they serve. It was a great way to close out the course: in terms of social services, there is so much needed in India, and it was so refreshing to see a functioning organization making a real difference. They reach those who are outside of the system – children with no families or homes. It was exhilarating to just be in the presence of these children – to see how they clung to Iqbal the moment he walked in to the room – they love him and it is a direct reflection on the organization and the good work they do. SBT is an excellent example of innovation of services, as well as orchestrating efforts with others working in a similar space, such as ChildLine. This organization provides much-needed services to the under-served and I felt privileged for a glimpse into their work.

Reproductive health is everyone's health

Wednesday, 08.10.11

Today we met an organization that focused on the population and issues that get me fired up. I mean REALLY get me fired up.

I spent two years in undergrad marching down Peachtree Street in Atlanta, Georgia towards the State Capitol with one hand holding a Planned Parenthood poster and the other hand raised high and clinched tightly like the Che Guavara spirit I was channeling. I was a revolutionary for family planning – or really for reproductive choice. I was loud, I demanded to be heard, and I wasn’t going to listen to any prolife stance. Damnit, I was right!

circa 2008

Over the next 3 years I have been earnestly trying to find a way to channel that energy and passion into a tangible impact. Activism is great and definitely serves its purpose of letting an issue ring in everyone’s ears. For me, however, I knew the real change I wanted to make would be individualized; helping men and women at the grassroots level one person at a time. I focused my senior thesis around reproductive health in Latin America, organically leading the topic of my thesis to be centered on family planning initiatives by President Alberto Fujimori in Peru in the 1990s – showing that investing in family planning and women’s health can lead to significant economic, social, and political impacts. There were some issues with Fujimori’s approach to nationalized family planning programs, so invite me over for some tea and I can tell you all about it. For now, though, we’ll stay on topic.

My senior thesis is what helped mature my desire to be in public health, particularly women’s health and family planning. I was finally able to see a very powerful link between investing in women and developing a nation; my background in political science was finally paying off! After graduation, I worked at the American Cancer Society to get my foot in the door of the public health arena and be sure this was the path I wanted to pursue. It was and still is. After having worked in a very conservative, professional environment, having many conservative friends, and having had my foot shoved into my mouth a few times, I am learning how to explore family planning from all perspectives. My goal has been and continues to be focused on having a respectful and calm dialogue regarding family planning that promotes dignity, respect, empowerment, and development for all parties involved. Graduate school has aided in this much needed perspective, directing me towards facts and figures to back up my side of the argument. No longer am I just some fiery twenty-something belting prochoice mantras into a megaphone, attempting to lead my reproductive revolution. It’s befitting to say that I can now carry a calm conversation (well, sometimes) that is centered on helping women help themselves through reproductive health. You’ve definitely come a long way, baby!

All of this brings me to my reflection on my time with PSI (Population Service International) and what information I want to share with you. I appreciate the work that PSI is doing and the vast communities that they serve. They are really making a difference even if it is still too soon to measure statistical significance (all you biostat people). Their service in Delhi is focused on family planning through IUDs (intra-uterine device) and medical abortion (MA) kits. Given the very conservative community that PSI is serving, there are definitely many barriers that this organization faces by introducing these forms of family planning methods. One of the female doctors from the local hospital shared with us how many women have to seek out the IUD secretly because they cannot get their husbands approval. Most of the women asking about the IUD are married women who have already had three or more children. The community that we visited in Delhi was predominantly Muslim and contraceptives are not allowed by the conservative sect of this religion. So what’s a woman to do? She lives in a developing nation where there are high maternal and infant mortality rates, mediocre health care, and lack of access (and rights) to pregnancy-preventing contraceptives. Well, in this case study, women go to their local physician and have an IUD inserted.

Here’s a commercial produced by PSI India that plays on local TV stations addressing the importance of family planning and IUDs for married couples: Lock and Key

Here is my stance, one that has taken some time to mature and understand completely -

Overall understanding of the importance of family planning:

*When a woman has control over her fertility (through contraceptives, family planning, sterilization, or abstinence), she has the ability to finish her education (versus adolescent marriage and/or adolescent motherhood) and pursue a career all her own and become a contributing member of society. The developing world is not investing in half of their population and the well-being of those nations is definitely suffering from this investment slack.

[Quickly let me add that stay-at-home moms are great, especially if they choose to stay at home. However, a mother/woman being tied to the house because she keeps getting pregnant and has no choice in the pregnancy and/or is forced to quit school because of pregnancy/marriage without her choosing is not okay by me]

• Women have the RIGHT to have full authority over their body and decisions regarding their body
• Women have the right to choose what family planning measure works for them
• Women should be allowed to access all contraceptive measures available
• Women have a right to an equal education
• Women have a right to equal job opportunities
• Women should be allowed to have control over their fertility and the amount of children they have
• Women have a right to quality and affordable health care
• Women are amazing J

Given my stance, let me say that access to IUDs and medial abortion kits are crucial in my book. I uphold that your political/social/religious opinions are moot when it comes to contraceptives access. You do not have to use the contraceptives, you do not have to condone the contraceptives, but they should ALWAYS be readily available and the right of women (and men) to access them should ALWAYS be there.

There should always be quality and affordable healthcare available to all people and contraceptives should be in ample supply and nearly free of cost to all communities. When a nation invests in their family planning programs and services they are investing in the well-being and future success of their nation. Take Peru for example, via my senior thesis escapade. When Peru invested in nationwide family planning programs and services, they experienced monumental economic and social growth – finally they were investing in the other half of the population! (Read “Half the Sky” to get the full picture of my point).

Family planning = growth, prosperity, and an end to the cycle of poverty (poor people making more poor people making more poor people). Brilliant!

Now, I know the whole idea of the medical abortion kits might turn many readers’ stomachs. Unfortunately, family planning’s red-headed step child is definitely abortion. However, abortion is not a preferred family planning measure, so rest assured that MA kits will rarely be chosen over continuous, effective birth control methods. Abortion is used mostly in dire situations, where other measures have failed. (I have oodles of statistics on abortions in the US that I can share sometime…)

When a community invest in family planning and respects the female and her decisions with her body, abortion rates significantly decrease. Abortion would rarely, if ever, be needed if reproductive health was given the same focus and investment as cosmological surgery and consumer product purchasing in the US. However, in some settings, in some situations, another child is too much. Especially in developing countries, in impoverished communities, another mouth to feed is damn near unfathomable when a family is subsisting off of less than $2 USD per day. That’s when the PSI medical abortion kits come into play. Whether a pregnancy is intended or unintended, safe medical services are vitally needed. Too many maternal deaths and morbidity occur from illegal, unsafe abortions. What PSI is doing is providing a safer means for a very discrete and difficult decision to end the possibility of a pregnancy. Whether we agree with abortions or not is beyond the point right now – what is so incredibly important is that there are services out there for women and families and that the option of a safe, affordable (nearly free) emergency measure is readily available. According to the pharmacist we interviewed in the Muslim community in Delhi, 4 to 5 medical abortion kits are sold daily. Let me repeat that: daily. Obviously, there is a need for serious family planning services in this community. Until that investment can be made by the government, the community, and the individuals themselves, emergency contraception is going to have to remain part of the equation.

What I am hoping is that a community like the one I visited in Delhi will begin to embrace the use of contraceptives and family planning services, such as IUDs, so that medical abortion kits will not be needed as much. But things happen, life happens, accidents happen, mistakes happen, terrible things can happen so medial abortion kits should always remain readily available.

I was so impressed by the services and information provided by PSI. Bravo for them for tackling a VERY testy subject that manages to impassion just about everyone (in one direction or the other). There is definitely room for growth, development, and data evaluation in their services to know what sorts of differences are being made within the specific communities. However, their services are just the start – just the beginning of the conversation surrounding family planning in this community. As I mentioned, your opinion on contraceptives and abortion is moot in the grander cry for access to all forms of family planning methods. When a woman/family/couple has a choice over fertility and family size, so begins the conversation on gender equality, respect, and overall well-being of the community as a whole.

Family planning is the answer. Access, quality, and affordability are nonnegotiable terms to a healthy future for any community.

Unlimited Capacity for Change

Our last day in Mumbai we went to the “Hub” - a place where social entrepreneurs, visionaries, and volunteers have a place to share ideas, and create and implement change. I loved being at the Hub. The place was built to welcome innovation and collaboration.

At the “Hub” we met with UnLtd India and Acumen Fund – both organizations that help build capacity for social entrepreneurs and projects.

UnLtd India is an organization that provides seed funding to start-up NGO’s and stands as an incubator for social entrepreneurs. Their goal is to help initiate NGO’s and accelerate their progress from inception. Whereas, Acumen Fund seemed more similar to an investment fund, supporting social enterprises.

I was particularly intrigued by UnLtd India and the sustainability they provide in initiating ideas and organizations. With such a large number of organizations failing within the first six months of inception due to various reasons (lack of money, sustainability, resources, etc) UnLtd India provides a mechanism for these organizations and ideas to continue to exist. Its just so much more than an organization folding within six months. It’s the community that could have been saved or the people that could potentially have better access to health care, better education or improved lives. UnLtd India really attempts to alleviate this.

It seemed quite fitting to be at the hub as today provided more of a space for us to think about logistically how this all works. How do non-profits exist? How do they remain sustainable? How do they get to the bottom line: Social Impact? Today helped hone in even more questions I continue to ponder over and marinate as I continue to think what else can I do and how else can improve existing organizations and/or ideas to maintain sustainability while improving lives.