Interventions for Sexual and Reproductive Health in rural India
Health par Haq
Trigger warning: Mention of sexual assault, gender-based violence and abortions
Awareness and access to sexual and reproductive healthcare have long been significant issues, particularly in India, where dense populations and pervasive stigmas compound the challenges. This problem is especially worse for women living in rural areas, where resources are scarcer, and cultural barriers are stronger.
During the COVID-19 pandemic, these challenges were exacerbated, causing severe disruptions in the progress that had been made in improving healthcare access. Lockdowns, resource reallocation, and the overwhelming focus on combating the virus meant that essential sexual and reproductive health services were often sidelined. This situation highlighted the urgent need to make healthcare systems more resilient and pandemic-proof, as such crises disproportionately impact women's health.
DURATION
Ongoing
ROLE
Speculative Project
Personal
INDUSTRY
Gender & Health
PROBLEM STATEMENT
What innovative intervention strategies can be adopted to build resilient and sustainable SRH* systems for women in rural India?
* Sexual & Reproductive Health
01
Secondary Research
After reading articles and papers addressing the sexual and reproductive rights of women, and examining how the healthcare system intersects with caste and queer communities, I organised these insights into broader categories using a relevance tree for better clarity and focus.
02
Primary Research
Unfortunately, as this is a speculative project, I did not have the opportunity to conduct primary research with the target population. Instead, I have outlined various potential techniques which can be used to conduct primary research in the future.
03
Stakeholders Analysis
Given the involvement of multiple stakeholders, I conducted a cross-impact analysis and developed a stakeholder matrix. This helped me gain a deeper understanding of the nuanced interactions and influences between different groups, including government officials, healthcare providers, community leaders, and the affected populations. I’ve also created empathy maps of the different stakeholders to better understand each one’s POV.
04
Ideation
I have driven my ideation process through a brainstorming session and an appreciative inquiry approach, focusing on the parameters of discovery, design, dream, and destiny to reverse-engineer an ideal future. This can be a potential co-creation workshop to maintain a user-centered focus, ensuring that the solutions are directly informed by the needs and experiences of the target population.
05
Design
To outline possible interventions based on my research, I have created a comprehensive service blueprint. This thorough analysis allows for a clearer understanding of the process and helps identify key areas for intervention and improvement.
06
Future: Sustainability & Impact Analysis
Lastly, to ensure the system's sustainability and pandemic resilience, I have provided suggestions to regularly monitor the following : (i) the continuous implementation of the interventions, (ii) adherence to current regulations and evolving needs, and (iii) the measurable impact of the program. This approach ensures that the system remains effective, adaptable, and beneficial to the target population.
Methodology
Secondary Research
After reading multiple articles online, I created this mindmap that collates all the information under three large headings; contraceptives, abortion and menstrual products. Next, using this information I build a relevance tree on which I have circled my focus areas for this casestudy.
Primary Research
Below, I have designed speculative research methods that can be used to collect information about the target audience. This includes - Cognitive Task Analysis and a Repertory Grid.
Stakeholder Analysis
I conducted a cross-impact analysis and developed a stakeholder matrix - these tools allow me to identify key points and potential areas of conflict, ensuring a comprehensive approach to addressing the complexities of sexual and reproductive healthcare accessibility Next, I have created empathy maps based on my stakeholders to understand them better.
STAKEHOLDER ANALYSIS
This not only shows the capacity that each stakeholder will/can be engaging at but also how each one can be leveraged to their strengths.
CROSS-IMPACT ANALYSIS
Scale ranges from -5 being most negative impact, to 0 being no impact, to +5 being most positive impact. This is for SRH-related healthcare.
As this is speculative, it is based on secondary research. A lot may change with the addition of on-ground primary research. For example: NGOs might have a negative effect on patients/end-users rather than a positive one or Community leaders might have similar beliefs as the government and thus, lead to greater positive impact rather than negative.
From this analysis, either the intervention can add positive impacts where there is currently negative or no impact.
Co-creation Policy Making
Co-creation workshops with healthcare workers, NGOs, community leaders and government bodies to create policies. If they do involve community leaders, later the leaders can help spread awareness of SRH initiatives.
Success stories & Health Information
Healthcare providers & NGOs and can collaborate with media to spread awareness via real-life stories, fact-checked data and information on where to get the right medical assistance.
Community Outreach
NGOs can work alongside community leaders to come to a consensus through which they get help to collect data and spread SRH awareness because of their community outreach.
Streamline Services
Since NGOs conduct grassroots research and services, they can identify main roots of issues which can be addressed by healthcare providers directly. For example: women coming in for abortions can be reduced if contraceptives are effectively distributed alongside information. Then pregnancy and abortion healthcare can be provided by clinics increasing efficiency and reducing workload on both ends.
Media Channels
Media is a very popular and influential form of consumption which can be through radio, movies, TV, books or even newspapers. Thus, harnessing this reach to provide information on health initiatives (created by health institutes, government, NGOs and education institutes) while including trusted community leaders to disseminate it, can lead to big changes in thinking without it feeling like outsiders are trying to spread their agenda.
Long-term Awareness Campaign
The media affects the people’s perspective and the people’s opinions decides what the media shows. To break this cycle, long-term awareness campaigns with the government, NGO and community leaders through the media are critical. In addition education institutes can provide accurate information that can help counter fake news/information on the media.
Possible Interventions
EMPATHY MAPS - ABORTION
EMPATHY MAPS - CONTRACEPTIVES & MENSTRUAL PRODUCTS
Ideation
Now that I have enough research and understanding of the different stakeholders involved in this system, this phase is for ideating based on those insights.
Design / Final Outcomes
I have outlined the final interventions through a service blueprint and visualisations - a contraceptive vending machine, a mentorship programme, packaging for everyday products and a handbook for sex-education.
Future: Sustainability & Impact Analysis
(i) Continuous implementation of interventions
To ensure this, ASHA workers and NGOs have to be well-informed of these initiatives to keep a track on how people are responding to them. Interviews with users will also be fruitful to gauge if the interventions work or if they need to be altered. Supply chains require periodical quality checks to make sure the contraceptives going to rural areas are not compromised.
(ii) Adherence to current regulations and evolving needs
As time passes, policies change and so do the user’s needs. So information needs to be constantly updated on posters, visualisations and conveyed to on-ground workers. As one phase of the intervention sees a success, the next stage needs to implemented instead of continuing the same one. For example; once menstrual pads have been de-stigmatised, work on the next phase of providing other available menstrual products and creating affordable options.
(iii) The measurable impact of the program
As always, with most social interventions, this one is equally hard to measure due to its qualitative nature. However, there can be check-ins once in every one or two months to understand how the users are feeling, focusing on keywords to capture their thoughts. Additionally, interviews can be taken of adults who were adolescents when the programme started. It would show if the mindset, perspective and awareness has changed. In terms of data; rates of maternal mortality, unwanted pregnancies, consumption of menstrual products and data from the vending machine can be checked.
Reflection & Takeaways
Without primary research, projects such as this one are based only on secondary research which end up having superficial feeling interventions. If given a chance, I would love to build on this project using the research techniques outlined.
I also do believe that intersectionality plays an important role in these topics. It opens up a whole world of possibilities and might completely change the intervention strategies with a shift towards focus on the urban living population. Even though I did not dive into how gender, caste and religion play a significant role - there is a lot of potential left to design systems using this data but only with primary research, as there is limited secondary research available and it would be an injustice to do so without primary data.
A challenge that came up is the aspect of sensitivity - these topics are stigmatised and many people are not comfortable talking about them. It could be for cultural, religious or personal reasons. The approach to frame and ask these questions is of utmost importance and I do believe there is work to be done on that front.
This project also opened up a world of research tools to me - with so many available for each phase in the process. Picking which ones would be the best fit took time and a bit of going back and forth, but do I believe the chosen ones can create significant impact in the research.
This is a friendship cum mentorship programme for abortion-related healthcare. It will be a tight-knit network of local women who have undergone abortions or are the process of getting one. This way the women have trusted, safe spaces to ask questions from women similar to them - which can be done in-person or over calls. Their struggles would be similar and so would their language, making each other feel comfortable.
Here is a leaflet for the same that can be distributed - it outlines information about legal rights, different methods of available abortions, mental health resources, abortion clinics near them along with affirmations that they are not alone in this journey. Below this, are also posters to create awareness of this programme called ‘Maitri’ which means friend in Marathi.
A handbook* for adolescent girls with activities to guide, reflect and learn about SRH-related information. It uses on-ground research to create the character of 4 girls which they can relate to. The illustrations are all inspired and use scenes from real-life spaces that they interact with on
a daily basis like their school, hostel, bathroom, etc. Using activities is a subtle and engaging way to learn about SRH information.
* Created with Maaham as part of a project with Alt unfold
Community Meetings
Low interest but high influence stakeholders such as community leaders may be asked to hold discussions in public spaces or give talks on radios.
Radio & TV Shows
Breaking taboos on certain topics such as abortion, menstruation, etc. done through popular media outlets can normalise the concepts.
Listen to patients/end-users
Carefully listening and noticing implicit biases can help understand what they really need.
Involve NGOs in decision-making
NGOs work at the grassroots which not only builds trust in the community but also helps their understand patterns and root causes through everyday interactions. Thus, they are a great source to inform decision-making with stakeholders in the ‘high influence’ area.
Consistent Hospital/clinic check-ins
Even though health-providers may not have much influence, clinics and doctors should have routine check-ins to ensure smooth flow of services, no discrimination and cleanliness.
Possible Interventions
VISUAL DESIGN
This awareness campaign is about the use and choices of contraceptives. This will be printed on everyday objects, as seen on the matchbox, as well as on labels - this not only educated the buyer but also normalises the idea of seeing contraceptives through a milder way i.e. illustrations. Seeing
“abnormal” in “normal” settings frequently, reduces your hostility and increases your curiosity towards it. It can also be printed on products they use often in their daily lives such as coconut oil bottles, soap boxes, pesticide packaging - subtle, yet present in their everyday lives.