“Agar biwi bolegi toh karwa loonga”, (If my wife tells me I will get it done) says Dashrathi Mullick on a little prodding. Dashrathi is talking about vasectomy. He was taken aback when I asked him if he would undergo an operation instead of his wife having to go through one. Hesitant at first, he concedes after Mamta Digal, his co-worker, joins in the questioning. He says he will get vasectomy done if his wife wants him to. Dashrathi’s commitment, or rather comment, is a progressive one.
According to the 2005-06 National Family Health Survey (NFHS-3), knowledge of contraception is almost universal in Odisha, but female sterilisation is more popular. The survey further shows that Adivasi women are less likely to use contraception, and in the villages, vasectomy is almost taboo. It is believed that vasectomy will make the man weak but more importantly, he will not be accepted by God, after his demise, if he underwent an excision.
Like Dashrathi there are others (a few) who have at least started talking about male contraception. Condoms and birth control pills are made available by the ANM (Auxiliary Nurse Midwives) and ASHA (Accredited Social Health Activist) during the Mamta Diwas or the Village Health and Nutrition Day (VHND). But since this has become a women’s only day, men, much to their convenience, are kept out of it.
I say ‘convenience’ for a reason. During meetings with male members of the Gaon Kalyan Samiti (the Odisha version for the Village Health Sanitation and Nutrition Committee (VHSNC)), they said “but maternal health is for women. It does not concern us.” Convenient. A small detail that they contributed to the pregnancy seems to skip the mind of the men folk. Clearly it’s a mindset problem- women have babies and they should be concerned about their health not the men.
Keeping men out of these occasions is a bad idea. We were at the anganwadi centre in Jharasbalaskumpa village in the Duti Mendi gram panchayat, on a Mamta Diwas. The attendance was pretty impressive – while the ANM was conducting her check-ups, the ASHA was talking about contraception and arranging the contraceptives – condoms, pills — for women to pick. Despite their efforts, there were a couple of 30 year olds with their fifth and sixth babies on the way.
It is this mindset problem, says Anil Rout of Centre for Youth and Social Development (CYSD), they are trying to tackle. And tackling they are; through films.
“The idea was to spread the message through a different medium. Villagers suggested folk music and dance. We went a step further and thought of films; with local actors.” So they hired a production house, zeroed down on topics, scripted the films, scouted for local talent and shooting locations. Actors were chosen from among the villagers, some of them were health workers, for instance Martha Digal. Martha is a ASHA from Rajika Khol village in Kandhamal.
The films have done many things for the project. First, they have brought to the discussion table many topics that were earlier brushed under the carpet – male contraception, birth spacing and the issue of women working during pregnancy. One pregnant woman said she discontinued her MGNREGA work after one of the film screenings that showed that ample rest and nutrition was paramount during pregnancy.
Second, these films have also brought men and women under the same roof discussing the same topics. One of the films on the nutrition requirements of pregnant woman has an all male cast and is targeted at men. The story is of a man who wants to marry a girl from the neighbourhood but has to meet one requirement of the father of the girl — to give him a list of all the food that he would give his wife when she would become pregnant. The man then attends a meeting, gets the information and takes it to his future father-in-law. Only after the father is convinced does he agree for the wedding. It is because of a film like this that men are slowly but gradually opening up to discussions, related to regular health checks and nutrition of pregnant women, at the Gaon Kalyan Samiti meetings.
Third, the films have proven to be a good medium of teaching and retaining. The actors themselves confess to picking up a few important nuggets of wisdom. 35-year-old and a father of two, Dashrathi has acted in a film on vasectomy and he is now open to the idea of getting it done
Like Dashrathi, the other actors too are learning along the way. Martha wishes she was told about birth spacing and contraception a few years ago; Martha was married at 15 and is a mother of three. Although after being appointed ASHA in 2012, and working closely with CYSD and Oxfam, Martha has ensured 100 per cent institutional delivery in her village. Martha has played herself in a film on institutional delivery – ‘Well Done Amit’.
Mamta, from the neighbouring village, has played a pregnant woman in the short film titled ‘Mamta’ that talks about the prevalence of anaemia in pregnant women. She knew about the prevalence of anaemia, but what she is most impressed with is the fact that the films stress on the need to rest and not work. “It is taken for granted. No one really cares. But these films show that these things do matter.”
And fourth, it has given these villages their own stars and role models. Martha’s achievements are known across other villages in the two districts thanks to the films. Since 2012, her village has not reported any case of infant mortality, maternal mortality or malnourishment. In 2014, she was awarded the best ASHA (on a district level). One of the films talks about her achievements and her work. “Other villages want ASHA like Martha” says Anil.
Filming took about a year to complete. Eight short films were produced in Odiya on five main issues- institutional delivery, contraceptives, nutrition, birth spacing and antenatal care (ANC). The screenings of the films began in August 2014. CYSD, health partners of Oxfam in Kandhamal and Sundergarh, have screened the films in 69 villages in the two districts (they work in 70 villages) and have reached out directly to nearly 2500 adults and 1400 adolescents.
Meetings and trainings obviously help. There is someone, handy, to answer questions and solve problems. But films help break barriers. There will be few giggles and hushed whispers but they will open up. Films help retain for longer. Films can be seen again and again to understand better and drive home a point.
The films are working. There is a demand for more – Mamta, for instance, wants one in which the entire process of vasectomy is explained in details so as to allay fears and old age myths. This is a new medium that keeps the interest of the audience piqued; the government should perhaps consider it as a part of the community based monitoring system under the National Rural Health Mission.
Also, perhaps the government should consider making it mandatory or incentivising the presence of the father during the Village Health and Nutrition Days or the Mamta Diwas. This will ensure both parents bearing equal responsibility for the child, instead of it being the sole duty of the mother.
The author is a research coordinator with Oxfam India.