Healthcare

stigma versus need

Though slowly and steadily condoms are getting acceptability in the mindsets of semi-urban Indian populace but in the rural areas, it is still to find relevance in terms of acceptance. NACO’s efforts to promote the usage may change the situation. By Mohd Mustaquim
stigma versus need

The National AIDS Control Organisation (NACO) is running Condom Social Marketing Programme (CSMP) in the country. However the rural mindset, social sensitivities, demographic diversities and traditional drawings somehow bring such kind of jolts on the way of its initiatives. People have hesitation in talking about condoms, they feel embarrassed to purchase it from the stores. Many people think, condom promotion may lead to premarital sex among the youth, which is against the Indian cultural values.

THE PERIPHERY
As usual all males and particularly the females are hesitant to ask the third person for supply of condom because of prevailing socio-cultural conditions in the country. The lack of privacy in the stores and the social stigma associated with condom’s use are the most significant barrier in its usage.

People still want to have the free supply of condoms and most of them do not want to be shown buying condoms in the stores due to the socio-cultural conditions. Many women in the country do not want their husbands to use condoms, as they are anxious that this will inspire promiscuity, and there is also a general thought that the sexual satisfaction derived with the use of condoms is much lesser than without condoms.

The low level of education and socio-economic conditions are the most significant causes of use of condoms in India. As socio-economic and educational levels increase, simultaneously the use of condom increases. In the Indian patriarch society male sex partners has always been dominating, the situation gets changed when the female partner is educated. She may force to her partner for using the condoms, make decisions, whether she wants to get pregnancy or not and in some way it encourages the use of condoms and other precautions.

The use of condoms is found lower among the couples where the education and socio-economic levels decrease. Even though, the community based area project for social marketing of condoms and contraceptives is being implemented through various non governmental organisations (NGOs) for creating better access in underserved rural areas so as to generate demand for increased condom usage. However, due to the persistent backwardness and low education, the condom promotion in rural areas has not been an easy task.

In accepting new things, there is a human psyche to be anxious, would the new things be proved true on its claims or will just be a spurious? Especially in the regions where the education level is very low. They cannot be persuaded easily. Unprotected sex is the major cause by which AIDS is spreading in the country. This makes it important to provide correct and consistent awareness among the masses. Along with understanding how men and women may have differing perceptions about condoms and its access. Currently the condom use in India is very low and it is used mainly for family planning.

Moreover, States and Union Territories are provided funds for Information Education and Communication (IEC) under National Rural Health Mission (NRHM) for creating awareness on the use of contraceptives.

PARADIGM SHIFT
The overall impact of several years of communication on the topic has had an impact on the awareness levels about condoms in the context of their role in preventing unwanted pregnancies on one hand, and sexually transmitted infections, HIV/AIDS, on the other hand. Awareness about their preventative role, the establishment of certain brand identities, building facilitating environment such as freedom from embarrassment during purchase or hesitancy to talk about condoms, have all been attempted. Most of them have been successful, but the impact on behaviour adoption in the context of usage of condoms has not been commensurate with the efforts made for its promotion.

Availability and accessibility to condoms, inequality in accessibility and availability of quality of health care facilities is the universal phenomena in developing countries. For that reason, India has to overcome these challenges. UN in India concluded that many couples, even poor and illiterate rural residents wants to limit child birth, but are discouraged from doing so by the difficulty of obtaining contraceptives.

The study also found that, the prevalence of condom fell by 0.2 per cent with every extra Kilometre distance from the Public Health Centres (PHC). If there was a PHC in every village this would increase the prevalence of the condom use from 4.4 to 5.9 per cent. Generally, the distance to access and high price of condoms put the poor people out of reach and this may be the reason for poor use of condoms. More the outlets of condoms more are the use. Accessibility is the big problem and much remains to be done so as to empower the poor populace living in the remote areas.

When low cost condoms were introduced in Louisiana, USA, the average sale of condoms remained barely 2 per cent of the condom distributed for free. But in the Indian scenario, the poor people can afford spending on low cost condoms and the situation can change.

CHALLENGES AHEAD
A Condom Mela was organised in Chandigarh in 2005 to increase awareness of condom use against STI and HIV. Condoms and their usage were openly discussed there. The results showed a substantial increase in the awareness was achieved after the completion of the mela. The community in general and particularly those who had visited the Condom Mela felt that similar melas should be organised at regular intervals. Apart from other efforts to increase male awareness, male participation in family planning and this kind of positive experience of holding melas could also be replicated in various parts of the country, especially in the rural areas.

There is a need of hour to make awareness programmes according to the ways of neuro-marketing, consumer’s behaviour needs to be read that what the way they can be persuaded. The rural consumers should be guided to understand the advantage of condoms such as prevention from sexually transmitted infections, HIV/AIDS, unwanted pregnancies and family planning is for there welfare. Its availability needs to be made easy.
In the stores and public health centres, there is a need to maintain a privacy, reason being no one wants to be disclosed due to the social stigma that he or she is purchasing a condom. Prices need to be reviewed so that the poor people can afford it easily.

There is also a need to implement policies that support women’s education, especially in rural areas. Behavior change and communication programmes (BCCP) especially among rural areas, low performing states, and couples from the lowest socio-economic regions need to be increased.

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