Safe for sex? Many impoverished, rural Indians are finding the answer in an SMS

[Originally posted on the Tech in Asia site here.]

“It is often men who pick up the phone and update us about their wives’ menstruation dates.”

Ramya Kancharla, who heads the CycleTel Humsafar family planning service in India, stumps me with that line! In the rural interiors of India, where any mention of menstruation is taboo, why would men be so forthcoming about information on their wives’ periods?

The answer lies in the persuasive powers of this free, mobile-based service that’s using the good old SMS to help people from lower economic segments and grassroots India plan out their families.

The name CycleTel, if you haven’t guessed already, is derived from a woman’s menstrual cycle. ‘Humsafar’ is the Hindi word for companion.

CycleTel determines when it is “unsafe” for a couple to have sex if they don’t want a pregnancy.

Since 2015, it has reached out to over 40,000 people in the northern region, including the most populous state of Uttar Pradesh, besides Rajasthan and some working class areas of Delhi. Of these, 5,000 have registered themselves as users.

While that may seem like a drop in the ocean in a country of 1.2 billion people, Ramya sheds more light on the figure. “Around 60 to 65 percent of the users had never used any family planning method before,” Ramya tells Tech in Asia.

The program, funded by USAID, was developed by the US-based Institute for Reproductive Health (IRH) at Georgetown University. The institute is involved in health initiatives worldwide. Ramya is country manager at IRH. A graduate of the Indian Institute of Management, Bangalore, she has been working in the field of public health for almost a decade.

“There is a huge, unmet need for family planning in India. Ours is a natural method, with no side effects, is free, and 95 percent effective.”

Plus, it leverages the power of the SMS in a country that is increasingly taking to mobiles. “The SMS will work even if a phone doesn’t have data or wifi, and chances are that a family which earns US$146.50 or less will not have a smartphone anyway. This also provides a solution for a woman who may not be highly educated but needs family planning.”

A woman’s cycle

CycleTel determines when it is “unsafe” for a couple to have sex if they don’t want a pregnancy.

This is done by using a technique called the Standard Days Method. “If a woman’s usual cycle is around 26 to 32 days, then days 8 to 19 are unsafe for the couple,” explains Ramya.

On each of these days, the service sends a reminder SMS to the user that it is an unsafe day. These messages are in Hindi, English, or Hinglish (where the language is Hindi but the script used is English). Only women who have not used hormonal contraception for three months are eligible, because hormonal contraception affects the cycle.

CycleTel first spreads word about the program through partner NGOs that work with women in rural and peri-rural areas. Their workers conduct door-to-door campaigns and community meetings.

Mass media campaigns, especially at crowded places, are also carried out. Ramya points to one at the hugely popular Kumbh Mela, a religious fair in India’s most populous state of Uttar Pradesh that draws millions of people, and another at a Big Bazaar supermarket in the same state.

“However, while mass media campaigns are important, it is equally necessary to build a sense of trust among women. We are able to do that because the NGO outreach workers belong to the very communities they serve.”

There are around 120 such community workers. Besides Uttar Pradesh, the NGO partners are spread across working class neighborhoods in Delhi like Badarpur and Narela, in Jaisalmer and its surrounding areas in Rajasthan state, and Chhattisgarh.

Once someone is persuaded to become a user, he or she can send a text message or call a toll-free number (1800 1800 8000) to speak to CycleTel counselors. A user has to regularly update the counselor about her period dates.

The counselors, drawn from the Indian Society for Healthcare Professionals (ISHP), are science graduates, all trained in reproductive health.

The men with mobile phones and their moms

Trouble is, not too many women in joint families in rural India own phones. “In fact, 70 percent of our callers are men!” says Ramya. “It is the men who usually call us, it is the men who pick up the phone when we call back,” she says.

Besides, for the program to work, the husband has to be willing to abstain or use a condom during the unsafe period. “Family planning is a sensitive matter. It can get a woman into trouble,” says Ramya. Hence men play a key role.

Getting the women to talk about sex or periods is a huge challenge. Frank, open conversations are extremely important for this to work. Another problem is young women are not the decision-makers.

It is here that mothers-in-law come into the picture, especially in joint families. “We train our outreach workers to get a sense of who is the decision-maker in the family. Often it is the mother-in-law,” says Ramya.

Narrating an anecdote from the Narela area of Delhi, she says, “Once we persuaded a woman to get her daughter-in-law to adopt CycleTel, and when she saw how effective it was, she made us to go to a neighboring village to help her married daughter do the same!”

Women in migrant worker colonies like Badarpur usually have their own mobile phones, points out Ramya, while those in joint families such as in Lucknow city depend on their husband’s phone.

SMS versus app

India claims to be the first country in the world to have launched a National Programme for Family Planning in 1952. This lays emphasis on Intra Uterine Contraceptive Devices, condom distribution by community health workers, tubectomy, and vasectomy.

“We increase the basket of choices when it comes to family planning,” says Ramya.

In the next year, CycleTel plans to spread more in Rajasthan and target Madhya Pradesh. “We are also looking at Jharkhand.” But all of those are in Hindi-speaking northern India, why not other regions as well? “For that, we have to first develop content in local languages and get NGOs there to run our program,” replies Ramya, who herself is a native of Andhra Pradesh in southern India.

Incidentally, IRH also runs the CycleBeads program through which women can keep track of their menstruation dates with the help of physical beads or an app.

The app is available across the world, and IRH has run some programs with it in African countries like Kenya. It can be downloaded on Android phones in India too; in the long run, Ramya expects a shift to the app.

But, says Ramya, “Because of low phone costs and greater mobile penetration, India is a great place for the SMS service.”