Mobile Family Planning Unit: An innovation for expanding accessibility to family planning services in Bihar

"Mobile Family Planning Unit: An innovation for expanding accessibility to family planning services in Bihar"

Accessibility to cost effective and quality Family Planning services in remote and hard to reach area which are not well connected to the block and district towns is a major reason for poor uptake of family planning services in Bihar.Contraceptive prevalence is mere 33.3% percent in rural Bihar below national figure of 56.3%.⁽¹⁾ Female sterilization is being adopted for family planning purpose since long as the major contraceptive method(29.4%). Other methods used here are Condom(1.6%),OC-Pill(1.5%),IUCD(0.5%),Vasectomy(0.3%) and natural or traditional methods(3.7%).There is a huge unmet need for spacing(21.3%) and limiting(17.9%) in Bihar above the national figure of 6.2% and 6.6% respectively.⁽²⁾ Major reasons for poor acceptance in Bihar where IUCD coverage is a mere 0.4% in rural areas are due to lack of trained personnel,lack of connectivity and lack of awareness among Front Line Workers(ASHAs and AWWs)  & community.In this context,the Bill and Melinda Gates Foundation’s Integrated Family Health Initiative Project(IFHI) proposed an innovation of Mobile Family Planning Unit(MFPU) into piloting in Patna district which hypothesised that through MFPU along with trained and highly skilled providers the gaps can be minimized and Goal for spacing can be achieved.⁽³⁾  A study was conducted to assess the effectiveness of MFPU in improving accessibility and acceptance of IUCD services and minimizing the gap between target and achievement.This kind of MFPU for IUCD insertion was first of its kind for family planning services in Bihar.

The MFPU is a fully equipped and air conditioned ambulance with all facilities for examination of the client and IUCD insertion.The staffs in MFPU consist of one Van nurse who is trained for IUCD insertion,one Van Manager who looks after the organisation of camp and registration of clients,one female attendant who conducts pregnancy test and assists van nurse and one van driver.The unit travelled a distance of 10 to 100 kilometres in any van day from Patna to outreach areas and provided “Interval IUCD” insertion services to the identified clients.The micro plan for camps and travel route were prepared by IFHI team in advance in preceding month and shared among the unit staff.The required numbers of IUCD insertion sets were pre-sterilized.Every Front Line Worker of the piloting block was using a screening card to screen and send the women for IUCD insertion by van nurse.Guidelines were mentioned in this card for selection and rejection of any woman for IUCD insertion.

On camp day, the clients were mobilised by FLWs.The clients after reaching at camp went for a pregnancy test of their urine samples.Clients who were negative in pregnancy test got registered by Van Manager and counselled by the Van Nurse before IUCD insertion.The Van Nurse inserted the IUCD under all aseptic measures by using “no touch technique” of insertion.All aseptic measures and techniques of insertion from Government of India Guidelines were strictly followed.⁽⁴⁾

63(97%) camps could happen against 65 camps planned over a period of 6 months. The MFPU provided services for 7-11 days per month in remote areas of the pilot district.A total of 1508 women attended the MFPU in 63 van days averaging 24(23.9) per day.Out of 24 women attending the MFPU on any van day, 15 could be inserted,5.5 women could be followed up and 3.5 women were rejected on average.A total of 929(80.2%) women availed IUCD insertion from MFPU averaging 15 per day.230(19.8%) women were rejected for IUCD insertion who were found unsuitable for the procedure for reasons like positive pregnancy test,unexplained vaginal bleeding,foul smelling vaginal discharge,denial from woman after counselling, etc.349(37.5%) women out of 929 could be followed up subsequently after insertion.Number of IUCD insertions that happened was inversely proportionate to the distance of the camp site from the district headquarter.On some days, women had to return home without insertion due to lack of time.Most of the women were followed up at home by FLWs after 7 days of insertion.Women reported about spotting, menorrhagea, pain in abdomen etc  as complaints during follow-up.After counselling about effectiveness,Cu T-375 with contraceptive effectiveness of 5 years was accepted by 53 women(5.7%).Cu T-380A with contraceptive effectiveness of 10 years was accepted by 876(94.3%) women from MFPU.

Only 10.4% women with one child opted IUCD as a method of spacing.Majority of women(89.6%) who have two or more children had IUCD insertion.Indepth interview with these women revealed that most of them were not ready to accept permanent sterilization as a method to limit their family size.They were afraid of surgery needed for tubectomy.Rather they prefered Cu T-380A to be a safe non surgical method which could protect them aginst pregnancy over a longer period.Women who are in late reproductive phase(40-49 years) and afraid of surgery, opted Cu T-380A only to pass over their fertilty period.Women with 2 or more female children without a son,were not in favour of irreversible terminal sterilization. Some women with two or more children who were interested for a permanent method but got IUCD insertion.On the other hand the proportion of women(10.4%) with at least one child opting IUCD as a spacing method is less. These happened due to inappropriate selection and inadequate counselling of women with 2 or more children for long term IUCD.An exit interview with the women,who availed IUCD from MFPU,revealed that they had to cover a distance of less than 1 kilometer to 7 kilometers to reach the MFPU.Some clients came by walking while others were dependent on vehicular transport.It cost them about 10 to 15 rupees.All of them reported that they were informed by their ASHA/AWW about IUCD, Camp Date and Camp Site earlier.The camp used to start at 11.00 am and close at 5.00 pm on each camp day.Approximately, 15 minutes or more were given to each client for counseling and insertion.The van Nurse informed that, sufficient time was not available to give quality counselling to each of the client.Pre-procedural counselling on IUCD by the FLWs during the home visits could have decreased counselling time by the van Nurse and increased the number of insertions on camp day.

            Issues identified from this piloting were inadequate pre-insertion counselling of women, improper Client Selection, failure in detecting anaemia before insertion, huge client load of 18-30 per day against anticipation of 15-20 per day, less number of follow-ups, no system for complication identification and referral services after insertion, inadequate van days to meet unmet need for spacing and limiting through MFPU in the district of Patna and high operating cost of van.The objectives of the piloting were successfully achieved in reaching at door steps of the client in hard to reach areas of Bihar. Increasing accessibility to quality family planning services was proved feasible through this piloting.Taking the current piloting and huge unmet need into consideration, it is suggested that each district should have a MFPU for outreach family planning services at least 15 to 20 days a month.It is suggested that one nurse from each block PHC could be given hands on training on IUCD insertion in the van itself to increase access to IUCD insertion at PHC.

Reference

1.Census of India,2011: http://nrhm-mis.nic.in/familywelfare2011.html.

2.National Family Health Survey-III,2005-06.

3.Implementation Design for Integrated Family Health Initiative(IFHI) in Bihar,Final Document,September,2011,p:11-15.

4.IUCD Reference Manual for Nursing Personnel, Family Planning Division, Ministry of Health & Family Welfare, Government of India, December 2007,p:22-23.

A Letter to Kids-4

My dear kids,

Today, I think we should have a discussion on different “life skills”, those you should know and practice in your life. Human life passes through different stages like infancy, childhood, adolescence, adulthood and old age. During infancy and childhood you are cared and guided by your parents and care takers. Under their direct supervision you grow and enter into adolescents. Adolescence is that stage which includes individuals from 10 years of age to 19 years of age. During this stage of life you become a very interesting human being to yourself and others. This is a stage of transformation. At this stage you no more behave as a child, even if you behave as a child, others perceive it inappropriate. At this stage, you acquire new adult behaviours. When you behave as an adult, some might perceive it premature. It seems funny and strange as well to many of you. Adolescence is a phase of rapid physical growth and psychological maturation. In adolescence, you start abstract thinking and developing new ideas. You love and dare to experiment with a lot of good things and bad things as well. Sometimes you can’t recognize and distinguish between good and bad. Adolescence is a stage of creativity, adventures, risk taking. At this stage you may find your peers and friends more appropriate and correct than parents. You may even avoid and neglect to company and command of your parents. It is real and it happens to all of you, teenagers. Never forget my dear that adolescence period is a turning point in your life. This stage may make you more capable and potential, if you learn to live and pass through it successfully. Also, this phase may make you vulnerable to negative environment and spoil you.

            Then, a big query arises in your mind. How to deal with this stranger called adolescence! Only certain life skills will guide you in right direction. We can talk about 10 core life skills here proposed by World Health Organization for adolescents. They are Self Awareness, Empathy, Creative Thinking, Critical Thinking, Decision Taking, Problem Solving, Effective Communication, Interpersonal Relationship, Coping with stress and Coping with emotions.

            To inculcate self awareness, ask yourself these questions: “who am I” “what am I for”. You are giving time to friends, books and games. Do give some time to yourself every day. Recognise your strength and weakness. Recognise the opportunities and likings that you are enjoying. Recognise the threats, pressures, dislikes you are facing.

            Empathy means “feeling about others”. How much you are thinking about persons, you come across every day? How do you feel about a poor boy who doesn’t have enough money to have a bicycle like you? What do you feel when you see the poor girl is limping with a leg paralysed from polio? This feeling should be positive and it should help us to accept others. 

            We experience a lot of things every day. How many of us do analyze it with some objectives? Take an example of this instance. I saw a school boy of standard five throwing a stone at a street dog. The dog vanished from there with a lot of pain and limping. The boy and his friends laughed a lot. But his mother took note of it and told him to be kind to animals. She asked him what would be if that dog bites on your leg. Is it expected from a disciplined student like you? Now the boy started about thinking of his mistakes.

            How many of us think creatively? Creative thinking leads us to explore new opportunities, to discover new places, to invent new machines and to bring about new philosophy. Many individuals like Abraham Lincoln, Einstein and Shakespeare have become great leaders, great scientists and great writers only through creative thinking skills.

            Knowledge brings wisdom into our mind. Experience in life with addition of wisdom helps us to take constructive and calculated decisions about our action and course of life. Many times your parents take decision about your study and career. These decisions might favour your choices and sometimes they do not. No one’s life is free from problems and crisis. If we become knowledgeable and wise, we can either contribute to parents or help ourselves in solving problems in our life. Read a lot from magazines, news papers and journals to acquire knowledge. Reading is not all about reading text books only.

            Unless we express ourselves, we can’t know about what others feel about us and our plans. You should talk and share about your opinions, needs, fears and desires before others. You should not hesitate to ask for others’ advice and help in a time of need. It also helps you to utilise others’ knowledge, wisdom and experience in solving your own issues and crisis. Effective communication helps you to establish interpersonal relationship with your parents, relatives, friends and members in your society.

            Emotion is expression of our mind towards happenings around us. Intense emotions like anger and sadness have negative effects on your health. You should be able to recognize your and others’ emotion. We should have ability to recognize the sources of stress in our life. You should not let stress ruin the quality of your life. You should control the stress in your life. You should learn to relax every day and follow healthy life styles.

            “Life skills are the abilities for adaptive and positive behaviour that enable individuals to deal effectively with the demands and challenges of everyday life.” It is today’s “take home message” for all of us. Next time we’ll talk about healthy life styles.

Yours lovingly,

Uncle Prabir.

 1 January,2013

A letter to Kids-3

A letter to Kids-3

My Dear Kids,

Today we’ll have discussion on such a topic which might be of zero relevance to many of us. Many of us might find my discussion quite funny. Some might be serious enough to listen me and give due attention to share my opinion. Some might ask for scientific rationality behind my opinion. I think you could recall that in my previous address, I had told you that we would talk about God. Who is God? How does God look? Where does God stay? God is a male or female? I am also quite curious enough about the questions and queries arising in your tender mind. I’ll be glad if you ask me a lot of questions on God. Before going to discussion, I accept that this discussion might appear contradictory, incomplete and immature to many of us. I may say, I am taking this opportunity to share my perception about God which may not be an ultimate truth. But what we’ll discuss is one of the hypotheses about God. Since we exist on the earth and we are believer of science and logic always.

Since my childhood, I have been told that God is omnipresent. If he is omnipresent, why God is invisible? Does God really exist? I have never seen God. If we can’t see God, why should we lose our precious time in discussing about it? We can’t end up without reaching a conclusion.

It is a mystery that the earth got created. Who created a lot of flora and fauna on this earth? What is that force which is behind these mysteries? You may say that the nature with interaction of earth, air, water and fire produced first life. In this great universe there might be more than one planets sustaining life like earth which are yet to be discovered and established. If this great unseen force created dinosaurs, humans, plants, tigers etc on this earth, it really is above us. Who created us we coined that force and power as God. Whomever we worship today and pray today, all of them have come to this earth after its creation. We have accepted them as incarnation of that unseen force and power.

What religion the God belongs to? What gender the God has? Which caste the God is from? If the God is the creator of this universe and earth, the God should not have a caste and religion. The god should not have a gender. We the human beings worship God as our father and as our mother. God had created us and we have given God the gender and religion. Theist are those who believe in the existence of a god or gods, especially believe in a personal God as creator and ruler of the world.

An atheist would simply be someone without a belief in God. Atheism says that God may/may not exist but belief in God is not a factor in our life.  To be without a belief in God merely means that the term "God" has no importance. Surely this is quite different from denying the existence of God. Atheism is not a belief as such. It is the lack of belief in God itself.

It matters nothing to the creator of earth whether we believe in God or not. Most of us as members of modern civilization believe that our work will decide our fate. If we do well to others we receive the same in return. If I be kind to you will be same to me. We are going to temples, mosques, churches etc to offer our prayer as per our religious belief and it is a way to live. But my dear friends never forget there is something unseen and too powerful playing the role behind our existence on this earth. I’ll not tell you to go for a search for God rather I would like to make an appeal to you to believe in that “superpower” which is above this earth and universe to give you inner belief and strength to grow into a good human being. I would like to tell you to work hard to fulfil your personal dreams in life. This is for today. Now let me say ‘good bye’ to all of you. 

Yours lovingly,

              Uncle Prabir.                                                                                                                                                                                                                                                                                                                       

You can write me on my email: drprabir2007@rediffmail.com

Dr Prabir Ranjan Moharana

CARE-India, 14, Pataliputra Colony

Patna-800013, Bihar, India.

A letter to Kids-2

A letter to Kids-2

Patna,Bihar,India

 30 June,2012

My Dear Kids,

Welcome you back on board. I hope that you enjoyed thoroughly the most awaited summer break. I believe, the first issue of Baal Chaupaal would have been quite exciting for you.

In my previous talk we had shared about physical and mental dimension of health. This time, we would share about its social dimension. You know, human being is a social animal. During the process of evolution, man came out to be superior to other animals. But like other animals on the earth, man never left its group. In parallel with its anatomical and physiological evolution, man’s social evolution took place in a tremendous way. Man learnt about the importance and benefits of living in a family, in a community and above all in a society. Imagine a day, when you will be left alone in a new place where there will be no one from your family, friends and colleagues. There will be none to talk with you, to listen to you, to share with you. Every amenity will be provided to you except a single human being. How long you could enjoy with television? How long you could mange with books? How long you could play with computer? Imagine one day your power supply to your home went off. Your computer’s central processor got a break-down. And you finished reading all of the books supplied to you. You might say now that you could go outside to give a call to an electrician, to buy some new books and to go for a technician for repairing of computer. But I have told that there is not a single human being other than you. Now imagine that situation.

            In a human society every work is done by a different individual. A doctor can’t do the work of an engineer or vice versa. You can’t do the work of your teacher. I can’t match your dear parents in giving you a lot of affection and guidance in time which you need most. So in our daily living, we depend on someone for our cause and comfort. After a long tiring exercise at school we switch on our TV for a cartoon show. Think of those who have done so much hard work on drawings, sketches, animation and finally in production of a cartoon movie. Therefore, in a community we are dependent of each other. The attributes of living in a community is learnt from the family during our formative and early years of life. Family is a subset of the community. Our learning about community begins at our home. The morale and character we have in ourselves are acquired from our family. Being brought up in a good family and living with good members like parents, grandparents, uncles and aunts, cousins have positive effect on our own lives. In a joint family we have the opportunity to live with members other than our own parents. Now a day, due to changing socio-economic conditions, nuclear families are seen in large numbers. In a nuclear family dependent unmarried children live with their own parents where other members are absent. Nuclear families have their own importance like joint family. In a nuclear family, parents have to take more responsibility, physical and psychological stress in rearing up their children. Every member in a nuclear family enjoys more comfort and freedom unlike joint family. Even belonging to a nuclear family, we have a great responsibility to our own community and society. We should realise the importance of other fellows and neighbours living with us in our community.

            You may ask me how we could know that every individual in a community could play a role and have positive effects on our life? Five fingers of your hand are not of same shape and size. Like that you do not have the same quality that your friend has. If you are good in mathematics, your friend is very good in English. If you are a good orator, your friend is a very good singer. Living in a society has a great advantage. We get an opportunity to know about others’ good quality when we interact with them. My dear friends, I would like to suggest you that you should try to inculcate not to emulate the good characters and attributes of your fellows when you come across with them in your daily life. Chewing tobacco, smoking and drinking alcohol are very bad habits. They are very much dangerous to health. Even your father has many good attributes to follow and inculcate, you must never inculcate his bad habit of smoking cigarettes, if he is smoking. You should know that in many countries the adolescents (of age group 10-19 years) have become addicted to alcohol, tobacco and other dangerous drugs in very early and important phase of life. I myself had seen two boys of age around 11-12 years smoking cigarettes together on the street of Agra, the city of Taj Mehal. You ask yourself from whom they inculcate these dangerous habits??? Answer may be parents or friends or teachers or their favourite film actors etc. During adolescence one commits a lot of mistakes out of curiosity and anxiousness. We should take the help of parents and teachers to sort out our queries and anxieties. You should always take care to filter out the good characters and attributes of every person to inculcate in your own life. Your own home is a big school to learn many a things. Start learning the good attributes of your parents from today.

            I hope you would like to share the joy and experience you had in this summer holidays with us through writings to Baal Chaupaal. After summer break you have a lot of tasks ahead at school and home. I believe and pray God to guide you in completing those tasks. Next time I would like to talk about “God”, the creator of this universe. Now let me say ‘good bye’ to all of you.

 

Yours lovingly, 

Uncle Prabir.

A Letter to Kids-1

A letter to Kids (1)      

Patna,Bihar,India

 30 March,2012

My Dear Kids,

I welcome every one of you from each corner of the world to “Baal Chaupaal”. Literally this is a Hindi word meaning ‘Kids’ Club’. As a member-reader of Baal Chaupaal we would be sharing our experiences, our knowledge and wisdom with each other. We grow in life into a responsible child and citizen through our own experiences and knowledge. When we share others’ experience, it helps a lot to take important and proper decisions in right direction to achieve success in our life.   As a kid you are not only very precious to your dear parents but also to the Mother Earth. Mother Earth is a universal mother. As your parents expect a lot from you ie. You should read a lot to become scientists/professionals or you should play a lot to become world famous sportsmen/athletes. Mother Earth similarly expects that we could be her very loving and caring children. She expects a great sense of responsibility from each of us. You might be asking me that “Does Mother Earth talk?” or “Has Mother Earth ever told you to tell kids about this?”. It might be sounding funny if I say a strong “Yes”. But my dear kids you should grow into such a matured human being that you could be able to hear her voice. There is no doubt that you should become a great human being first. Whatever you do in life, whatever profession you choose to go for in future, always you should try to become a good human being. Unless you become a good human being with a sense responsibility to yourself and your family, a deep sense of compassion and kindness to others, you will never be appreciated and applauded. To become a good human being, every day you have to be in good health. Health means you should be physically, socially and mentally fit. But the dimensions of health do not complete here. Dimensions of health also include our education, society, culture and above all our environment where we live in.

To stay physically fit, we should eat good, nutritious and hygienically prepared food. This food should contain required amount of nutrients like carbohydrates, proteins, fats, vitamins and minerals. Then our food becomes balanced one. When you take any food item ask yourself: ‘Do I really need it?’, ‘Is it hygienically prepared?’, ‘Does it contain prescribed amount of nutrients?’ If you get the answer “yes”, then go for it. Every day we should eat a prescribed amount of food called ‘balanced diet’ which is scientifically appropriate for our age, weight, gender and physical activity. Always take care, neither to eat above the amount nor to eat below the prescribed quantity appropriate for you. During feeding we must take care of quantity as well as quality of food. Why are talking so much about the food? Because when we eat more, we become ‘over nourished’ and when we take less, we become ‘under nourished’. Over nutrition leads to diseases like obesity, high blood pressure/hypertension, diabetes mellitus, different types of heart diseases, cancers, joint problems etc. Under nutrition also leads to diseases like generalized weakness, anaemia, scurvy, rickets, recurrent infections from disease causing agents like bacteria, viruses etc. To keep ourselves fit we should do physical activity regularly everyday either in the morning or evening along with balanced diet. At least one should go for 30-45 minutes for routine physical activities like brisk walking, running, swimming, playing outdoor games like football, tennis, badminton etc. In our daily routine we must keep physical activities in order to save ourselves from diseases. I would like to share here, a joke with you. One day I was going with one of my friends. We came across a family of overweight parents and two very fat kids. Each of them was very sluggishly walking and feeling difficulty in walking. My friend asked me, “Could you tell about the problem which runs in this family?” I answered, “My dear friend, nobody runs in this family. And that is the problem.” Due to lack of daily physical activity each of them was suffering from obesity. I hope, you will prevent obesity to take over your body.

Our psychological, mental and emotional well being is very vital for our personal growth and development. Our ability to respond to various situations of life, our sense about purpose of life and our ability to maintain equilibrium or a balance in the relationship between us and other individuals around us determine our mental health. By a simple example we can understand the above three components. Now hear a story of a student who failed in final board examination. A student called John was very excellent in mathematics. To his surprise he scored very less in that subject for which he failed in the examination. He felt extremely bad and he developed a sense of doubt in him. Whether he is so poor in mathematics? Whether his answers are meticulously checked by the teacher? Whether the teacher knowingly awarded him least marks? Here an imbalance in psyche/thinking initiated with him. He could not accept that he had been failed really. He felt angry about his teachers and he suspected that the teacher knowingly has awarded least marks to him. He could not know and cognize where the real problem is which leads to such an unexpected happening with him. He felt restless and lost control. He burst into anger towards other individuals like his parents, his own siblings and friends. Here his emotion got disturbed. After that he continued on thinking about this day and night. He lost self esteem and avoided to mingle and play with friends. He lost interest in food and friends. He got less sleep at night. Due to loss of sleep he developed more anxiety and stress next day. He threw himself into a vicious cycle of mental disturbance called depression. There are many neurotransmitters like dopamine, serotonin etc in our brain which play a role in expression of feelings of our anger, happiness, sorrow. There is a balance between each of them. When this balance is disturbed we become mentally ill. In the above story we found that failing in mathematics was a real life situation for John that lead to internal conflicts and psychological upset. This upset lead a sense of bad feeling and irrational emotion in the form of anger. Finally continuous and repeated cycle of these events lead to over/less secretion of some chemicals in his brain putting him a state of depression, which is known a mental disorder in medical science. Remember kids, a mentally healthy person is never at war with himself/herself. The person accepts failure and success in life equally. The mentally fit person accepts criticism and praise from others equally. The person has a strong sense of self esteem and self control. He/she applies his/her intelligence and talks to seniors and experienced persons to solve problems in life, fight out stress and anxiety. I hope you will never hesitate to seek help of your parents, teachers and peers for solving your real life problems.

In my next conversation with you, we could talk about other dimensions of health left out here. I believe you will be enjoying reading Baal Chaupaal regularly. I would like to suggest you that you should give your feedback and raise the doubts on every topic we are discussing. You can also suggest some topics of your interest for a fruitful and effective discussion. Now let me say ‘good bye’ to all of you. Take care and enjoy. Yours lovingly,

                                                                                                           Uncle Prabir

 

My note: This article is currently being published serially in a quarterly magazine "Baal Chaupaal" by the children and for the children being published by "Ark Foundation-India" in collaboration with "Baal Chaupaal Inc". One can visit this magazine at www.baalchaupaal.org and can write for children.

 

 

When India will awake???

By Dr Cuckoo Choudhary, Gastroenterologist,Philadelphia, Pennsylvania

Email	:  cuckoo.choudhary@comcast.net

            "Aanchal mein hai doodh aur aankhon mein paani." I detest this quote now, although I must confess it was one of my favourite ones during school days, likely because it sounded "rich" from a literary perspective, and because I did not understand the meaning well. Regardless, my write up here is not about this quote. It is in some ways related and in other ways different from it.

It was all aunty's fault. Had to be. It began after my brief visit with her during my recent India trip. I vividly remember her precise words, "It is a great responsibility and liability to raise a daughter as opposed to a son, Cuckoo. I never wish for any of my near and dear ones to have a daughter." Okay, I thought. "Was I really listening to an educated woman?"

             Before I could open my mouth, she continued, "For instance, one can sleep at night even if the son comes home late as it really does not matter where he is and what he is doing. On the other hand, if the daughter is late, that is a major problem, because what she does away from home late at might end up becoming your responsibility."

I guess one does not have to be a rocket scientist to figure out the "responsibility" she was referring to. It had nothing to do with crime against women, in either Delhi or elsewhere. I was amazed, ashamed, and dumbfounded. My head started to spin. Why this double standards against female gender in ‘Mera Bharat Mahaan', even in 2012? I always hoped people would worry about both sons and daughters in regards to what they were doing away from home late at night. How come what a son does outside the home with, or to someone else's daughter, does not matter? Are we that selfish and shameless? Or was I just over-reacting?

The conversation left a very sour taste in my mouth, but I could not give it further thought till I boarded my plane back to Philadelphia that night. Her monologue stayed with me throughout my journey back home, and I was very uncomfortable and depressed. No wonder, I thought, discrimination still exists against female children in India to the degree that female feticide is still occurring there. Disgusting. I hated it. I was ashamed to be an Indian. But, how would that help me find a solution? I had a strong urge to do something about it, right that day, right at that moment.

Lo and behold, I come back home and become busy with the mundane, and the not so mundane activities till a few days later when I come across an article on female feticide in a magazine. Auntie's voice resonates in my ears, and it is not very pleasant. I start reading the article which states that in the year1992, 37 million women were reported as ‘missing' in India, and in 2001, the number rose to 44 million. The article made reference to another report published in December 2006 which stated that India had killed about 10 million girls in the last twenty Years. It read, "Ten million girls have been killed by their parents in India in the past 20 years, either before they were born, or immediately after, and a minister referred to it as a "national crisis".
            What absolutely amazed me is that this was happening despite a law in India that bans ultrasounds and other prenatal tests from predicting the sex of the unborn child. "The United Nations says an estimated 2,000 unborn girls are illegally aborted every day in India," the article continued.

I could feel the warmth in my face, my ears turning red and my blood pressure rise as I somehow managed to scramble through the remainder of the article.

I continued to read, "Punjab loses every fourth girl, and was reported as being the leading state in female feticide, followed closely by Rajasthan. Haryana had witnessed a dip in sex ratio as well; 618 girls for 1,000 boys, in all probability as a result of female feticide."

The article also described and commented on other ways in which women were being abused in our country including bridal burning, etc, but to me that was not important. What was vital was that these hideous crimes were still happening, I needed to find out why, and that they needed to stop.

Despite all advances in science, it is still not uncommon to see couples in India offer prayers to God in order to be blessed with a child. Not to say that a baby is not a blessing from God, but for many, if the child happens to be a girl, the blessing soon becomes a curse and the ‘precious gift' is done away with as soon as possible before extending another demand to God, which is that of a ‘male' child. It is also no secret that the yearning for son is deep-rooted in both rural and urban areas, and many prayers and lavish offerings are made in temples in the hope of having a male child.

A look at some facts. Abortion was legalized in India in 1971, mainly to assure that pregnancy can be aborted if it is a result of sexual assault, contraceptive failure, baby having severe congenital malformation, or if the mother is incapable of bearing a healthy child.

Another prenatal test, amniocentesis was introduced in 1975 to detect fetal abnormalities, but it soon began to be used for determining the sex of the baby. However, ultrasound has emerged as the all time winner of the various antenatal tests. Being non-invasive, it has quickly gained popularity within the masses, is now available even in some of the most remote rural areas in India, and is being used widely for sex determination, in many instances with the intention of aborting the fetus if it turns out to be a female.

We revere our 'mothers', worship Goddesses Lakshmi, Saraswati, Parvati, Durga, and Kali, claim they represent wealth, intelligence, strength and power and then offer prayers for a boy child, or worse still, want to abort a girl child! This is absolutely hypocritical, and instead of hanging our heads in shame, we proclaim "East or West, India is best"! Dear readers please do not get me wrong. I love India too, but we have to acknowledge its problems and fix them so that it can indeed become the best.

Feticide and infanticide are not the only issues with a girl child in India. At every stage of life, right from birth to adulthood, and even death, she is often discriminated against and neglected. Why? The reasons are numerous. The status of women in India, which, like elsewhere in the world is determined by their level of education, health, economic role in the society, professional presence, and decision-making powers at home, remains substantially lower than that of their male counterparts, even today. It is distressing that the image of women that Ramayana and Manusmriti have painted in our minds remains unchanged. Most Indians still see an ideal woman as being obedient and submissive, and always needing the care of a male: first father, then husband, and then her son.

If you look at Islam, it still permits polygamy and gives women fewer rights than men.

In all major religions practiced in India, a son is often seen as an "asset' since it is thought that he can earn money and support the family, whereas a daughter a liability since she is "married off to another family", and therefore does not contribute financially or otherwise to the care of her parents. So, then why should an average person in India not desire only sons? After all, what is the benefit of having a child who is of no use to parents in their old age? Why have daughters at all? Top that off with the stress of assimilating dowry for a daughter's wedding, which still exists in many parts of India, and the problem is quadrupled.

Enough complaining, I thought. How can this be fixed? How can we abolish the dowry system, improve the status of women in India, and thereby make female feticide a thing of the past?

Although rigid enforcement of laws will undoubtedly play a key role in this that is not the only solution to this problem. Our society at large needs to change their sickening attitude. We have landed in a sad state of affairs due to the Indian patriarchal society, male chauvinism, and our marriage system. These are the important root causes and they need to change education, and economic empowerment of women is imperative.

In addition, there is a dire need to give women power at varied levels, beginning at the level of the Panchayat to all the way up. I contemplated some, and then decided to discuss this with my colleagues, who had varied opinions, none of which I perceived as being helpful.

I was astonished when I realized that most held women responsible for feticides and felt only women could change this. Some thought that a woman should refuse abortion when asked to undergo one by her family. Yes, it is true that it is the women's body that is being subjected to feticide, and she should definitely resist abortion, but then she would be alone, without family support, and we all know that is not easy.

Societal pressures cannot be dealt with easily by educated, independent people, leave alone the not so educated, and dependent, young, pregnant, women. Why most of my friends were missing the point was beyond my comprehension. Many sophisticated people opined that young women should refuse marriage if dowry is involved. Although it may sound an excellent idea to many, I just could not consume all of this. Why can these well-read people not understand that if one girl refuses to marry because of dowry, the groom's side will find another bride to be, and so on, and so forth. So, I reflected, contemplated, and deliberated some more on the subject and concluded that, the change in the status of women can come about only when both men and women, preferably both young and old realize the problem, think as if it were their own, and try to fix it. We have to realize that this is everyone's crisis, and not just of those that have daughters and sisters. Women have remained nice, submissive, and lady like for too long and it is about time they changed their image, at least in some ways, so that they are not victimized. This reminds me of a poem written by the great Shri Ramdhari Singh Dinkar. Let me share a few lines with you:

Atyachaar sahan karne ka kufal yahee hota hai
Paurush ka atank manuj, komal hokar khota hai!

If my readers are wondering who I am writing this piece for, let me tell you that this is for all of us. I know that some will look at the heading of this article, let out a chuckle or two, and not proceed further. I discern, however, there will be at least four categories of people reading it. Of all those that read this, most will laugh or ignore it completely. Next in line will be the crowd that will read the article with interest, and then forget about it the moment they are done. The third group will take me seriously, may be even amend the way they think about women now, and God forbid, if they ever had plans of being involved in dowry or proceeding with female feticide, this article may deter them from doing that. And last, but not the least will be the most important category, obviously in minority, comprising of those that will actually do something to revolutionize the status of women in India. To them, I express my gratitude in advance.

Dear readers, it is about time we did something to bring about a change. Here we are, after sixty-five years of independence from British rule, and forty three years since man first landed on moon, still struggling with things such as dowry and female feticide. This is an embarrassment, is not going to change automatically with time, and something radical needs to be done. We have to change the image of woman from "abla" as specified in the opening quote by the famous poet Shri Maithili Sharan Gupta to "sabla" and much more.

So, in the end, meeting and talking to aunty was not such a waste of my time, as I initially thought. "A blessing in disguise", shall we say?

My Note: No doubt about Dr Cuckoo’s concern that Indians need a change in their psyche. One theory rather say hypothesis, I would like to share here that female feticides happen to those women who are well literate. From my own knowledge I would like to share that low literate/illiterate mothers of Bihar, Orissa, Uttar Pradesh with 4-5 daughters still struggle to be blessed with a son...Feticide a term they still do not know. Many well educated wives are fascinated about a son.  The well educated Indian women can go at any stretch to have a male fetus in their wombs. A woman kills a woman... We have to change these women of 21st century first of all...I am 200% against feticide of any kind and I must advise a lady to remain barren rather to go for a feticide...Dr Cuckoo’s thoughts are well reflected through these words. I hope she would keep up advocating against gender discrimination...