Beauticians Help Childbearing Couples To Space Their Children 

Kanchan Devi’s small beauty parlour in the mofussil town of Sheikhpura in Bihar is abuzz with activity. Bright lights, the smell of talc, make-up essentials, mirrors and furniture get complemented with stuff to read strewn all over the place, and a tablet to watch. Kanchan’s beauty parlour stands out with these features, creating excitement among her women customers, particularly women of child bearing ages.

Sonam Kumari says what it feels like. The 17-year newlywed has arrived to get her eyebrows done at Kanchan’s beauty parlour. This is not the first time she is visiting a parlour, but this one is different. The cosmetics seem to go well with the digital tablet, a flip book and posters – all replete with information on contraceptive measures young girls like her need to know about. In uncommon parlance, these are called information, education and communication material. 

As Sonam takes her seat to get her eyebrows done, Kanchan, almost twice her age, turns on the tab sitting above the mirror to play a series of short films that talk of sexual and reproductive health – stuff she has spoken with her friends over sessions of giggles and laughter, but never with a peer.

Kanchan plays peer, speaking while one end of the thread is stuck in between her teeth as the deft fingers carry the thread through the edges of Sonam’s eyebrows and telling the young woman how important it is to wait it out for four years before she goes the family way. There are injections and medicines to keep pregnancy at bay and there is more in the marketplace, like condoms for her husband, Kanchan tells Sonam. It is difficult to miss the underlying message: Make informed choices.

Sonam, of course, has understood all that has been said during the beauty session. How she wishes she could laugh openly at the innocent, uninformed girl she was moments ago!

At the end of the session, Kanchan gifts Sonam a customised bridal kit – small things of beauty a young woman values, together with modern contraceptives along with cosmetics. 

Up to six women arrive at Kanchan’s beauty parlour on any day, most of them newlyweds. Beyond the makeup, Kanchan tells them about the right age to have a baby or about spacing between children and of the contraceptive measures they can use in the interim.

Kanchan is one of 10 beauticians engaged by UNFPA, United Nations sexual and reproductive health agency, and child rights non-profit, Plan India to make newlyweds aware of sexual and reproductive health and rights (SRHR). This is a campaign centring around the beauticians who are so naturally positioned to speak on these issues, otherwise considered taboo in these parts of the country.

This is among a host of initiatives taken by UNPFA and Plan India in Sheikhpura, 160 Km from the state capital, Patna. The effort is targeted at young Dalit and tribal couples whose information and knowledge on matters of sexual and reproductive health is often way too low. 

Every fifth person among Sheikhpura’s 6.36 lakh population is a Dalit or Scheduled Castes. Together with tribal communities, they are noticeably unaware of family planning or of available contraceptive measures. Families marry their daughters early in life, totally unprepared to decide on important questions surrounding their married lives. What will be an ideal age to marry? How to postpone a pregnancy? How many children they must have and how to maintain a gap between children? 

Apart from beauticians, there are Yuva Mitras (Friends of the Youth), community mobilisers and grassroots activists working on sexual and reproductive health issues among these communities. They are also the government’s partners in the implementation of its Mission Parivar Vikas programmes like Nai Pahal (New Beginning), Saas Bahu Sammelan (Mother-in-law and daughter-in-law conferences), Sarathi (Charioteer), etc.

The 10 beauticians roped in for this campaign have so far counselled over 400 adolescent girls and women who have visited their beauty parlours. The girl-talk sessions are now history for these women. They are now confident enough to demand contraceptives through the beauticians engaged on account of the UNPFA and Plan India partnership. 

Kanchan was surprised when she was first contacted to participate in the programme one and a half year ago. It seemed strange. Speaking sex is still considered a taboo in the countryside. So she kept postponing her decision until, after the third meeting, she agreed and started counselling the newlywed couples on sexual and reproductive health issues. 

But the ease with which she gives this information to the customers today was not there when she began. “Initially, women used to get angry when we would say all this.  They would say they didn’t like to hear any of this and so customers were hesitant to visit my parlour,” Kanchan says, adding that she persisted. “But, I continued to tell them what I had to and now we have a situation where newly married women come here for makeup and then ask me for contraceptives. I convey their demand to the village Accredited Social Health Activists, (ASHAs), also called Asha Didis, who provide them with the supplies.”

Soni Kumari, 25, who runs a beauty parlour in Sheikhpura’s Mahuli Chowk and is part of the campaign says, “I felt embarrassed to speak about these private matters and customers would stop us from telling all these things. But now they listen patiently and even ask for contraceptives from us. They also tell me that it would have been better if they had have known about all these things earlier.”

For instance, 20-year-old Sapna Kumari, mother of a one-year-old daughter, came to know about contraceptives from the beauty parlour itself. “Earlier, I was not sure how many children I wanted, but now I have decided to have only two children. Right now I am taking contraceptives as I want my next child only after three years. Whenever the medicine runs out, I inform the beautician,” she says.

“Dekh rahalhu ha didi e photo? E Antara sui hai. Ek baar laga lab-hu ta teen mahina tak garbh nai rahto. Jab tak bachcha nai chaahi tab tak teen mahina ke antaraal par sui lagai ho” (Can you see this picture didi? This is the E Antara contraceptive injection. Once you take the jab, you can avoid pregnancy for three months. Do get this injected at intervals of three months until the time you want a new one),” 31-year-old Pinki Kumari, says in the Magahi dialect, showing a flipbook with an illustration of a needle to the group of women assembled under an asbestos roof in Dalhar, a Dalit-dominated village.

For the next half hour, she talks to the group about contraceptive measures available including sterilisation, child bearing age and ideal gap between two children. It is called the Samvaad (Dialogue). Having devoted some four hours daily to raising awareness of sexual and reproductive health and rights among Dalit couples, she has become adept at organising and facilitating the Samvaad.

And then, there are also men only clubs – the Purush Samvaad (Dialogue with Men) and the Ratri Chaupal (meeting place in a village in the evening). “We organise Purush Samvad and Ratri Chaupal and visit 10-15 households daily to inform couples about it,” Pinki says. She is one of the dozens of Yuva Mitras active in Sheikhpura, making young people aware of sexual and reproductive health issues.

The impact of these initiatives is clearly visible on the ground as well. The hesitation among women coming from Dalit and backward classes to adopt contraceptive measures is going away. Women are now themselves asking for contraceptive from ASHAs.

Rinki Devi, 23, a Dalit woman from Vrindavan village, was married 10 years ago and had her first child when she was 17. The infant died soon after birth and Rinki spent a month in hospital nursinKhug medical complications. A year after she was released from hospital, Rinki gave birth a second time and in a matter of time, much before she was even prepared for it, she gave birth to her third child. 

In the meantime, Rinki attended a Nari Samvad (Dialouge with Women) programme organised in her village and learnt about contraceptive measures. After some initial hesitation, she began taking birth control pills and opted to have a baby for a fourth time after a gap of two and a half year.

“Had I known about ways to avoid pregnancy earlier, I would have kept the gap between the first two children,” she says. Her fourth baby is five-month-old and she is back to taking contraceptive pills. “I am now absolutely sure that I do not want to have any more children and will continue to take birth control pills for this.”

Sudhanshu Saw, a local tailor, is 23. His wife is 19. They got married last year. Sudhanshu, too, participated in the Yuva Mitra’s Samvad programme, where he learnt about condoms and has been using these regularly since then. “I want to have a baby only after two years and till then I will use condoms as a precautionary measure,” he says.

According to the National Family Health Survey-5 (2019-2020), 37.2% currently married women (15-49 years) and 0.2% men have undergone sterilisation in Sheikhpura, but these ground level campaigns have started bearing results, says Dr. Ashok Kumar Singh, Sheikhpura’s Additional Chief Medical Officer, who is also the nodal officer for family planning in the district and has seen the development very closely.

“It was very challenging to prepare people mentally to use contraceptive measures but with the help of grassroot workers of the health department and Plan India, we were able to inspire men and women to adopt sterilisation and contraceptive measures,” he says. “Our biggest success was motivating men to undergo vasectomy, in which we are successful.”

Singh says, “Through this campaign, now Scheduled Caste women have become more aware about family planning and contraceptive measures. We are hopeful that our numbers will be even better in the coming days.”

Abhijit Mukherjee, project lead of the SRHR project in Sheikhpura, says, “We started this campaign on a pilot basis as we wanted to work in a district which is small in size and has a high population of Dalits. In such a situation, Sheikhpura was an ideal district. Secondly, it is also included in the list of aspiration districts of the central government, so we chose it.”

He adds, “The focus of this entire campaign is newlyweds of the Scheduled Caste community. In the last two years, our team has added more than 30,000 new couples to the programme and are continuously monitoring them. Our team members meet them regularly and inform them about sexual and reproductive health.”

The demand and supply situation for contraceptive measures was very poor in the district, according to health officials, but it has also improved as the project team deployed a mobile App launched last year for women to generate their demands for contraceptives whenever they might need one. So far, some 30,000 married women have registered themselves on this app.

Women are not only able to order immediately, but they also do not have to step out of their homes since the message is passed on to the ASHA worker, who gives them supplies at home.

Preeti Kumari of Chaudhdargah village used to buy contraceptives from the shop earlier. It used to cost her anywhere Rs 200 to Rs 300 each month, which is a lot of money for these Dalit families. But she does not need to go to the shop since she registered on the app last year. She says, “If I order the medicine over the mobile app, the Asha workers deliver it immediately.”

ASHA worker Ranjana Kumari says the mobile app has helped tremendously in strengthening the distribution of contraceptives. “Earlier many beneficiaries were left out. Many a times, women were hesitant and could not ask for contraceptives from us. But with the advent of the mobile app, they do not need to ask anyone. They place their order directly on the app and we deliver the medicines to them.”

“Earlier contraceptives would lie unused and on the other hand women would not get them.  Now the demand and supply gap has improved by 90%,” Dr. Singh says. 

Given the initiative’s success in creating awareness and promoting uptake of contraceptives, Sheikhpura is set to act as a model district in advancing SRHR in the rest of Bihar.