TARUNI: Empowering young women to gain control of their fertility

taruni_sakhi_meeting Location and population coverage: Approximately 200,000 low income population in and around Udaipur city in Rajasthan.

Time frame: 2014-2017

Introduction: Taruni project has been initiated to help the younger and poorer women to facilitate the exercise of reproductive choice in the Udaipur region of Rajasthan by promoting greater adoption of reversible contraceptive methods, antenatal care, safe and legal abortion and rational treatment of infertility. The ultimate aim is to contribute to lowering fertility rate in selected area by creating a delivery model on information and services on Sexual and Reproductive Health that widens contraceptive choice, avoids reliance on method specific targets and address health needs in an integrated manner.

Situation Analysis Lack of access among poorer young women to information, counseling and services for reproductive health underlies low use and high unmet need for contraception. This lacuna is compounded whenever they face uncertainty and anxiety about becoming pregnant. In spite of ASHAs being mandated to provide Nischay pregnancy tests under the National Health Mission, access on the ground has been low because the service has remained largely unpublicized and re-supply of kits have been irregular. We hypothesize that pregnancy testing constitutes an opportunity for engaging with the reproductive health needs of women or couples. Rural young women hesitate to seek care from clinics or city hospitals because they consider them to be unfriendly, time- consuming or unpredictably expensive.

Interventions This comprises four components — self-testing for pregnancy, a telephone counseling centre, SRH care clinics and escort service to empanel Reproductive Health Service Providers. Neighbourhood volunteers offer pregnancy test kits to women for self testing and collect basic data; young women can (after or without pregnancy testing) telephone a call centre which will counsel them on options, offer some services at ARTH clinics and/or referral (with an escort if needed) to empaneled specialist providers. The project features a baseline and end line survey of pregnancy testing and care-seeking linked to pregnancy – contraceptive initiation and sustained use, action for wanted and unwanted pregnancy and failure to conceive.

Expected outcomes

  • The intervention is expected to create the platform for women to share SRH related concerns with neighbourhood volunteers and telephone counselors, thereby enhancing reproductive choice.
  • Easy access to a pregnancy test performed by the woman herself will act as an entry point to aspects related to her fertility status at the time.
  • The intervention will lead to higher rates of adoption of: pregnancy testing, modern contraceptive methods, antenatal care, safe abortion and rational treatment of infertility, on part of young women.
  • In the medium term, the intervention is expected to lead to: higher contraceptive prevalence rate as assessed among recently married women, and a higher proportion of reversible contraception within the method mix
  • In the long term, the intervention will help young women to control their fertility and thereby contribute to their empowerment

Progress

Baseline survey progress : House listing for baseline survey had conducted covered 180,174 population includes 96,717 (54%) rural and 83,457 (46%) urban and peri-urban area. After house-listing, random sample of 7,200 young women was selected for carrying baseline survey. A total of 5122 interviews had conducted (Urban-19.7%, peri-urban-22.3%, near rural-30.4% and remote rural-27.5%).
End line survey has already been started since Mar 17.

Promoting Self testing for pregnancy through Taruni Sakhis

Taruni Sakhi : Upto Mar 2017, 373 young and literate women between age group of 15-35 were identified and trained covering the topics of reproductive health issues, menstruation cycle, importance of early urine test, contraceptives etc. that forms the essential part of this project. Taruni Sakhis had enrolled 14487 young women as members of Taruni Helpline. The enrollment kit contains one pregnancy test strip with pictorial envelop illustrating how to do urine test and a membership card. A pamphlet, home stickers contain helpline number for members, hoardings, wall paintings have made for creating awareness about Taruni helpline.

Commodities distribution to community Women: To promote the exercise of reproductive choices at hands in local area only, Taruni Sakhis distribute pregnancy test, oral contraceptive pills, condoms, and emergency pills(EC) at minimal prices. Value addition had made to Taruni Sakhis’ kit by including some other valuable products like petroleum jelly, PCM tablets, ORS, etc.

A telephone counseling centre: 2661 incoming calls have received from April 15 to Mar17. Calls were largely related to need for clinic visits for treatment like abortion, infertility treatment, white discharge and menstrual problems. 998 successful outgoing calls were also made(Feb-16-Mar 17) for post-partum contraception FU while text and voice SMS (90,603 sms), related to reproductive health were also sent to helpline members.

SRH care clinics: 3 clinics (two in rural and one in urban area) provided basic SRH services including ante natal care, delivery, post natal care, reversible contraception (oral pills, condom, DMPA injection, copper T), safe medical and surgical abortion, obstetric care, referral services, vaccination, etc. The clinics were staffed by trained nurse-midwives and a gynecologist visited clinics once or twice a week. These clinics were branded and promoted as “Taruni Clinics”. The members were referred to Taruni clinics from both, urban and rural areas. Nearly 32,916 young women (15-30 age group) visited these clinics from January 15- Mar 17. Majority of young women belong to tribal community.

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