I met Fefli two years after she had a Copper-T reinserted. This is her story.
Sitting on the earthen floor of her mud and thatch house amidst drying corn kernels, Fefli chuckled when I asked, “How old are you?” “Umar katri vegi? Kai tha? Aap dekhi lo apre hame hi hu mu to” (Age? Who knows? I’m right in front of you—write whatever you think.) Looking like she was in her late 40s, Fefli, mother of four, was busy with daily chores. She lived with family in a small hamlet of Kesar village in Rajsamand district, Rajasthan. Her husband, Goparam, worked at a saree shop in Surat.
Each pregnancy brought increasing pressure to bear a son, from those around her, yet Fefli went on to have three daughters. Ultimately, the fourth was a boy and she was relieved. Realizing that another child would only add to her burden, she considered contraception, even though she lacked prior experience. Her husband disagreed about sterilization, worrying it might affect her ability to work. He gave her money to try out other options. She declined oral pills, fearing she might forget to take it daily. She then overheard neighbours mentioning the Copper T. Despite some misgivings, she visited the ARTH Health Center nearby. After counseling and examination, she had a Copper-T inserted for Rs 200.
There was some abdominal pain and vaginal discharge that subsided after a month. “I liked the Copper-T. I didn’t face a problem — periods came on time and blood was flushed out each month. It felt good”. Having heard myths that lack of periods caused blood to accumulate in the body, the regular periods reassured her. Unlike sterilization, getting a Copper-T didn’t require her to rest or take time off from her demanding daily schedule. She continued with household chores without interruption.
Years went by and Fefli hardly thought of contraception—she didn’t need to. Ten years later, she returned to the ARTH Health Centre. When the nurse-midwife suggested she could opt for another method, she was resolute about wanting another Copper T. “Husbands stay away from home for work, visit occasionally. So we have to take care of the children ourselves”.
Action Research and Training for Health (ARTH) introduced the “Ten year Copper-T” (TCu 380A) in 1998 at a time when the government programme provided only the three year Copper-T or TCu 200B, and “Mukti” (hormonal IUD) in 2016, both at nominal rates. Since then, ARTH facilities have provided 2,840 Copper and 3,257 hormonal IUDs in southern Rajasthan. About 75 women have returned to have their Copper or hormonal IUD reinserted after full duration of use. There is a definite role for intrauterine devices in enabling low cost, long-term, non-surgical contraception in rural India, for the large fraction of women who do not wish to undergo sterilization.
Gunjan Khorgade (gk@ccr.arth.in), ARTH