Sumoni Mukherjee

Introduction: The broad objective of this study is to understand the challenges and barriers in treatment seeking for victims of pesticide poison in rural India from key stakeholders’ perspectives. Methods: A Cross-sectional multi-centric prospective study was designed using a mixed method approach in seven states of India from April 2019 to July 2021. Fifty key stakeholders' interviews were conducted with village heads/leaders, pesticide shopkeepers, doctors/health care professionals, and police officials, and 17 case studies collected information on the treatment-seeking behaviour of pesticide poison survivors. Findings: Unregulated buying, selling, and usage of pesticides have led to increased cases of pesticide poisoning in rural India. Some farmers cross the Indo-Nepal border to purchase banned pesticides. Self-poisoning is often hidden due to fear of police involvement, lengthy legal procedures, and negative family reputation. Lack of awareness about legal procedures and illiteracy are the main reasons for hiding self-poisoning incidences. Victims often do not receive necessary treatment due to a lack of hospital infrastructure, staff shortages, the high cost of medicines, and the distance of referral units from the villages. Conclusions: Awareness generation activities about the impact of pesticide poisoning, medico-legal procedures, and safe use of pesticides are urgently needed to be implemented in rural India to reduce deaths due to poisoning. Additionally, the frontline functionaries of health and police departments needed to be motivated to address these cases with empathy. To reduce fear of police and legal procedures, police departments need to leverage convergence activities between the Ministry of Health and NCRB. Key words: poisoning, rural, availability, stigma, community, perception

D espite the high level of usage of traditional contraceptive methods, particularly among the urban and educated couples, the eastern Indian state of West Bengal has achieved the replacement level of fertility. This paper attempts to understand the patterns, dynamics of contraceptive use and associated outcomes (method failure and abortions) during the inter-pregnancy intervals among the urban educated-couples who ever used any traditional contraceptive methods in Howrah, West Bengal using both quantitative and qualitative approach. The findings showed that the use of traditional contraceptive methods was high due to lower comprehen- sive knowledge and misconceptions about modern methods, particularly among men. High prevalence of unintended pregnancies and induced abortions was observed, particularly for traditional contraceptive users. The calculated unintended pregnancy rate and ratio in the study population were 235 per 1,000 pregnancies and 570 per 1,000 women, respectively. Similarly, the calculated rate of induced abortion was 78 per 1,000 pregnancies with an abortion ratio of 99 per 1,000 live births. Due to the motivation to have small families, couples if they had at least one surviving child, opted to regulate their unintended pregnancies with induced abortion, especially among only traditional contraceptive users. This indicates that women considered abortion as a process of birth limiting rather than spacing to maintain the desired family size and the choice of contraceptives determining number of pregnancies.