By Rama Lakshmi
Washington Post Foreign Service
Monday, January 5, 2009
NEW DELHI -- The phone rang at a call center in New Delhi one recent afternoon. When an agent picked up the receiver, a young woman whispered hesitantly. She said that she lived with her large extended family in a remote rural settlement and that nobody knew she was calling.
"I told her to be open and have no fear. She paused after every word," recalled Payalkumari, 27, the call center agent, who uses only her first name. "Then she slowly opened up. She was newly married. She said her mother-in-law wanted her to have a child right away, but she was not ready to. She asked, 'Is there some contraception that I can use secretly and nobody else will get to know in the family?' "
Payalkumari has taken hundreds of such calls since June, when India's government-sponsored National Population Stabilization Fund opened a call center to provide reliable information about such socially taboo subjects as family planning, contraception and reproductive health -- the first service of its kind in the country.
"In our culture, we cannot have open conversations about sensitive subjects like sex, contraception, abortion and pregnancy. People want answers, but who do they ask? Not parents, not teachers, not elders. They hesitate to go to the doctor. People are shy to even utter the word 'condom' at a pharmacy," said the science graduate, who acknowledged that her family is like that as well. "But they can call here anonymously and ask any question. I give them all the information that they need. These are the people I need to convince for controlling India's population growth."
Every year, 24 million babies are added to India's 1 billion-plus population, and estimates suggest that the country will overtake China as the world's most populous by 2030. Moreover, India has 17 percent of the world's population living on slightly more than 2.4 percent of its land. The National Population Stabilization Fund seeks to pare down the growth to sustainable levels by means of contraception and reproductive and child health care.
Officials say it may take some Indian states 18 to 45 years to achieve the stabilizing fertility rate of 2.1 children per woman; the government originally set 2010 as the date for achieving the goal. Nearly half of Indian women marry by age 18, and many become mothers soon afterward. And 188 million couples in India are in the reproductive age group, but only 53 percent of them use contraceptives.
"The call center fills a critical information gap that exists in Indian society about these issues. This is the first line of call for many young men and women who would otherwise end up going to street-corner quacks, use inappropriate contraception methods or not use any," said Shailaja Chandra, executive director of the National Population Stabilization Fund. "There is no lecturing involved. People call and ask questions, and we empower them with answers."
Many calls are from hinterlands underserved by health-care and social workers. From May to October, the center received more than 25,000 calls, and most of the questions were about contraceptive methods. Callers often faltered for a few minutes before they summoned the courage to ask questions. The 17 agents -- men and women -- said they calmed nervous callers by speaking to them in local dialects or addressing them as "brother" or "sister" to build an informal rapport. Most calls were made from the privacy of cellphones, which are common in Indian villages. Some men called on behalf of their wives.
The family-planning call center's biggest problem is that the phone number is not toll-free. When the lines opened in June, the center received almost 800 calls a day. But slowly the number declined to 250 a day.
"If the number is toll-free, the calls could go up to 1,000 a day," Chandra said. She is applying for a toll-free number and additional funding so the center can advertise the number at train stations, cinema halls, village fairs and on the radio. "More rural women would call if it is free," she said.
Some people, however, have expressed concern that a toll-free number would increase the number of men who call just to harass the women at the call center.
Chandra said she did not want the center's female employees to be whistled at by men when leaving their office building. So she entrusted the help-line work to vCustomer, a company that was running a big call-center business here for U.S. retail and technology companies. Her 17 agents, who earn a little more than $210 a month, sit among the 1,800 vCustomer employees taking regular outsourcing calls -- a setup that provides the invisibility the family-planning center's agents need to do such socially sensitive work.
"We run a large call-center operation for a number of international clients. The family-planning work is a small part of our business and is run on a not-for-profit basis," said Navin Joshua, vCustomer's executive director.
All the agents giving family-planning advice have college degrees in life sciences and can use a computer. They are given voice training and taught telephone etiquette by vCustomer and attend a medical school for two weeks of technical training.
But what agents find they need most is cultural empathy and patience.
"Some callers tell me things they have never spoken aloud before," Payalkumari said. "I used to feel bashful in the beginning. It was not easy for me. But now I have changed, too. I try to understand the circumstances in their family and boost their confidence."