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.

Affirmation at PSI

Our first meeting in Delhi was with Population Services International (PSI). PSI is the third largest NGO in the world and is the undisputed leader (in my mind anyway!) in global health program marketing and communications, as well as program efficacy. Their interventions bring aid to millions of people around the world and their programmatic efforts span a variety of topics including malaria, reproductive health, safe water, and others.

Our meeting with PSI inspired me on many different levels. The most basic, yet perhaps the most important, is that it reaffirmed the lessons that we are learning in the classroom through the MPH program at GWU. This was truly an opportunity to see classroom knowledge being applied in the field, with success. As we listened to the very sophisticated reproductive health program presentation, it was so affirming to see simple things like health and behavior objectives incorporated into the presentation. I find myself sometimes actually being in awe of people who are successful in their careers, in areas where I would want to work and this was truly a moment where I thought “hey! I can definitely do that” and this feeling is directly attributed to my classroom experience at GWU. It’s funny, isn’t it, how sometimes you have to travel halfway around the world to have an affirming experience for what you are completing back home.

The PSI program for reproductive health is extremely well thought out, and has many components. My friend and classmate Kelly Healy has done simply an unbeatable job outlining the program in her blog today so I will spare another identical recap and will instead blog about what I found to be the best aspect of the program: the use of contraceptives through empowerment.

It was stressed numerous times during our discussion that empowerment was the major objective of the program, a sentiment that I truly appreciate. Giving women a contraceptive without information or skills is akin to giving them nothing at all. The PSI program uses a variety of techniques to truly empower women. Their outreach program identifies leaders in the community and trains them as Interpersonal Communicators (IPC). These IPC’s then go out into their own community, where they are already known, to educate and provide tools to empower women to talk to their husbands about contraception and understand where and how they can get it. PSI uses the Freedom5 intrauterine device (IUD) to do this. The IUD is a cost effective, long lasting (5 years), proven effective and reversible form of birth control that is sustainable for these communities.

From my perspective, there is so much that PSI is doing right in the area of reproductive health. Their programming combines grassroots community efforts on the ground with high-level social media campaigns that reach masses of people with just one television advertisement. They truly are a world-class organization and are worthy of every cent of funding.

The meeting with PSI also provided a type of full-circle experience for me as I reflect on this course as a whole. In addition to affirming classroom lessons from the MPH program as a whole, meeting with PSI provided great contrast and similarity to some of the smaller, more community-based NGO’s we met with in Mumbai and Delhi. Comparing a PSI program to an Acorn India (the NGO we met with in the Dharavi slum in Mumbai) provides a case study in its own right on the full spectrum of social entrepreneurship as well as NGO’s who are truly making a difference in communities, from the top to the bottom. PSI may have more money and resources to put together a power point, speak at a conference or provide marketing materials --- but is what they are doing so different from Acorn or Impact India? I don’t think so.

I appreciate so much about what PSI is doing in India, and around the world. Their funding allows for true market research to be conducted – resulting in more efficient, effective and targeted program. Now, if only every NGO could have such funding! It can be easy to become blinded by the celebrity and sophistication of programs from PSI; however, it is so important to remember that their mission is the same as any of the other smaller NGO’s we’ve seen in India. PSI wants to help people, they have identified target areas in which to do so, and they create programs for communities that provide education, resources and support.