From Fear to Acceptance: Supporting Young Women’s Reproductive Choices in Rural India

Komal, a 16-year-old girl from a remote village in Assam, faced a daunting challenge when she found out she was pregnant. In her village, abortion is highly stigmatized due to fear of judgment, gossip, and social ostracization. For unmarried girls like Komal, the pressure is even more intense. Her family, concerned about their reputation, insisted she ends the pregnancy, but Komal had no clear path to safe abortion services, a struggle many young women in rural India face.

Adolescent girls and young women across the country face numerous barriers when seeking abortion services. These challenges are rooted in a complex mix of socio-cultural, economic, and structural factors that create a complex and often hostile environment for those seeking to terminate a pregnancy. In India, unsafe abortion remains the third leading cause of maternal mortality in India.   

Peer-Led Support and Community-Based Solutions for Reproductive Health 

Komal found hope during a sexual and reproductive health (SRH) education session at her school in Assam’s Mamudpur village led by Pallabi, a youth leader trained by Ipas Development Foundation (IDF). Pallabi, who had been trained to educate adolescents and young women on SRH, was approached by Komal for help. Pallabi provided compassionate support by talking to Komal’s parents, offering reassurance, and guiding her through the process. She accompanied Komal to a nearby government health facility supported by IDF, where Komal received the care she needed in a safe and confidential manner. 

IDF’s innovation focuses on creating a sustainable ecosystem to improve access to SRH services including contraception and safe abortion. This approach integrates system strengthening with community-level interventions to build a robust SRH ecosystem. System strengthening involves providing technical support to public health departments in four states to expand and decentralize abortion care, aligned with the 2021 amended abortion law. 

Additionally, a youth-focused model introduced in selected parts of two states educates young women and their partners on SRH rights and access. A critical part of this model is on SRH issues – preventing and managing unintended pregnancies, offering referrals and support for safe SRH services like abortion, and empowering them to uphold their agency and challenge several restrictive socio-cultural norms. They also help navigate public health facilities and challenge restrictive socio-cultural norms. 

To address mobility challenges, the initiative decentralizes services to lower-level health facilities and strengthens community-based contraceptive distribution and counseling through health intermediaries. 

Expanding Access to Reproductive Health Services and Changing Lives 

Youth leaders have emerged as dynamic leaders, championing an understanding of sexual and reproductive health within their communities. These empowered leaders are central to the innovation providing young women and men with SRH knowledge and life skills essential for informed decision-making. They guide young women through the complex process of accessing abortion care and actively work to challenge and change restrictive socio-cultural norms within their communities.  

“Earlier I had no experience in this field, but now my understanding of sexual and reproductive health has increased. I feel empowered by the opportunity to work with young women and help them make informed choices about their health.” — Arjina Ahmed, Youth Leader, Assam

So far IDF reports the following results from the two intervention states:

• Youth leaders mentored by the innovation have reached out to over 100,000 young women and 90,000 young men with messages on SRH including abortion and contraception.  
• Over 5,400 young women and men benefitted from the referral support provided by these youth leaders. 
• The innovation has expanded the provider base for abortion services in public health facilities through training of 1,422 providers across four states, resulting in more than 150,000 women receiving abortion services.
• Assistance in the establishment of 72 Medical Boards (under the amended abortion law) has significantly improved access to late-term abortion services for cases involving congenital anomalies, simplifying the need for women to seek court intervention.
• Strengthening youth-friendly health services has enabled over 88,000 adolescents and young women to access SRH services at intervention health facilities in two states. 

“The intervention has really created a strong social capital in rural communities. Our youth leaders are equipped to inform and guide young women seeking abortions and other reproductive health services. The referral and accompaniment support are a big boon and we know that it is playing a critical role in care seeking. We believe the young workforce we will leave behind in communities will go a long way in improving the health and lives of women and girls” — Moumita Sarkar, Ipas Development Foundation

“During my 4-day training with IDF, I gained essential knowledge about contraception, safe abortion, and the MTP Act Amendments. It also enhanced my counselling skills and provided tools to better support clients with their reproductive health needs. With this expertise, I now confidently offer appropriate advice, contributing to informed contraception choices in my community. Thanks to the education sessions and referral support from the IDF Youth Leader, more young couples are now coming to my health facility for contraception” — Rexona Begum, Community Health Officer, Chotogiripar Health and Wellness Center, Assam.

“Pallabi Didi’s support was crucial in helping me to come out of the immense state of guilt and fear enabling me to regain my health  and move forward with my life. Her assistance not only provided me with the necessary services but also fostered a supportive environment for acceptance within my family. I first met Pallabi Didi in my school where she was conducting a session on sexual and reproductive health, our rights, and available SRH services. The session allowed us to openly discuss topics often considered taboo in my village. Through these discussions, we got correct information dispelling the myths about abortion, contraception, and menstruation, and I got the confidence to share my personal issues and seek support.” — Komal, Village Mamudpur, Assam

 

This story is shared by Ipas Development Foundation.

Names of individuals in the story have been changed to protect their privacy.