Sunday, March 6, 2011

The DMPA Street Theater Project

The Banglanatak troupe marched through the neighborhood searching for an ideal space to attract an audience. Their loud rhythmic drumming drove people out of their shops and homes onto the streets to witness the 'disturbance'. Many joined the excitement and procession, prodding the troupe for hints as to what was about to happen.

On the whole, audiences ranged from twenty to eighty, averaging fifty onlookers per show. In some places, people were clambering to see the street theater show, educating the population about the contraceptive Depot Medroxyprogesterone Acetate (DMPA). The DIMPA network project is implemented by PSP-One across nine towns and cities is shortly expanding to cover an additional ten towns in UP and Uttaranchal. The program objective is to promote the use of DMPA by enhancing consumer awareness of this method as a part of the basket of contraceptive choices and to ensure high quality of service provision by private clinics.

The role that wom en often fulfill in the management of the household, children and elders restricts her mobility and her ability to partake in the animated street theater spectacles. Discussions with the troupe leader revealed that their experience has been that more women attend if the group situates itself deep inside the residential sections of each colony. Earlier performances took place in markets- areas primarily populated by males. Market areas see a great deal of people in transit who are unlikely to assemble for more than two minutes, making it difficult to maintain a captive audience. Crowds in less commercial/more residential areas tend to stick around for the entire duration of the plays, which are brief- at most 15 minutes long. This is especially important in conveying social messages, beyond merely spreading the word that some strangers have appeared in the local area to make a vague public exhibition.

Use of local language or dialect is usually a better way to engage th e community. However, in the case of Aligarh, while the troupe spoke in a different accent, this difference did not prove problematic to the objective of the activity. An overwhelmingly positive response after each performance implies that this is not a barrier. The troupe reports similar encouraging and inquisitive responses from males and females of ALL ages, notably including adolescents, youth and the elderly. There were a plethora of questions following the performance, and many were interested in the DMPA information leaflets distributed by the performers. Further, there were several inquiries directed towards the group regarding details of DMPA as well as the location of providers.

Surprisingly, youth and adolescents were equally engaged in not only the animated performance and drumming but also the plot of the skits. Elderly women notably paid close attention to the contraceptive method messages. One lady approached the troupe with numerous questions, assertin g that her daughter-in-law was not present yet would benefit from knowledge of DMPA. She was so excited about the production that she disappeared, quickly returning with her son's wife at her side. Mothers-in-law have a great deal of influence within the household regarding her daughter-in-law, hence their involvement is key.

At the end of the short production, a moderator from the troupe pleases the crowd with a lively Question/Answer recap of the topics carefully covered in the skit. Three months, one lady hesitantly blurted out, before quickly readjusting her head cover, lifting one length of her shawl to cover her smile. The ladies hovering in the doorways and corners nearby were happily vociferous after of her correct response to DMPA's duration of efficacy.

The real benefit of street theater lies in one fact: It is a spectacle. Spectacles are out-of-the-ordinary events which present an abstraction of life. A plethora of evidence based studies suggest signif icant unmet needs for a variety of methods of contraception, yet contraception is absent in everyday conversation. The variety reflects the diversity of health, lifestyle and social circumstances in which women find themselves, with varying degrees of personal agency regarding their own fertility. Introducing an external 'spectacle' of sorts, to raise the issue of birth spacing, contraception and women's ability to determine her fertility are subjects that many simply lack facilities to address. Street theater is an effective means by which to introduce topics into public discourse and eventually, raise public awareness.

There were a few service providers from the DIMPA Network present at one staging of the performance. Abt Program Manager Sashwati Banerjee gave the feedback that their presence lent a greater sense of legitimacy to the message of the street theater play. Additionally, this easily serves to advertise the services of the providers and is an excellent wa y to link the traveling group of performers directly to the local context. Providers like Dr. Rakhi Mehotra recognized the potential synergy in the collaboration between providers and street theater, particularly among low income groups who may have limited exposure to mass media. One provider even suggested street theater productions near the provider's clinic in efforts to build local awareness.

The presence of local service providers at the performances may well alleviate any concerns about social differences/distances in language and class between the performers and the communities in which they work. Service providers should be encouraged to attend the street theater performances and field questions from audience members at the end of the performance. This synergetic relationship would allow both service providers and the local population to engage each other in a non-clinical setting, breaking barriers and diminishing reticence to discuss taboo subject matter in order to build a positive community dialogue about health.

Diepiriye S. Kuku-Siemons, MPH (Tulane) is a researcher/writer/consultant based in New Delhi, pursuing a PhD in Sociology focusing on urban sexuality and globalization. His primary areas of interest are Reproductive Health Justice and Public Health Communications.


Author:: Diepiriye S. Kuku-Siemons
Keywords:: Unmet need, Family Planning, Spacing Method, Limiting Method, Method of Contraception, Lactation/Lac
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