24 February 2012

Partnering For Family Planning in India

The following was written while I was in Delhi, India last week and appears originally in the PSI Healthy Lives blog.

Last week, I had the good fortune of spending time with the team PSI/India team here in Delhi. I learned about the work that PSI/India is doing in this area of the country to address the issue of family planning. The Women's Health Programme (WHP) focuses on using intrauterine devices as a non-permanent option for women to have the ability to choose when they want to have a baby. It's stated goal is "to improve the health status and quality of life among vulnerable and poor women by reducing maternal mortality and morbidity."
IUDs are already available and also have long been provided by the government. However, uptake of IUDs remained static at around 2%[1] for last 15 years due to prevalence of many myths and misconceptions. To close this gap, PSI/India is serving as a partner with private service providers and the Government of India to reach more people. One of PSI's strength is harnessing the core competence of the private sector, so it was only natural that it could be the bridge for the beneficiaries by expanding the choice between the public and the private facilities.

Through awareness and social marketing, PSI/India reaches out to women who are of reproductive age and may be interested in using an IUD as a form of birth control and medical professionals who recommend and insert IUDs.

An objective has been set to increase IUD uptake in 20 districts inDelhi, Uttar Pradesh and Rajasthan from 3% in 2010 to 4.1% in 2012. To do so, PSI/India uses targeted community health workers (called IPCs) to reach women of reproductive age group in the districts who are either not using any modern contraceptives, are  inconsistent condom users or are pregnant.

Initially, PSI team of IPCs canvassed every home of a district to provide information about expanded choice of contraception including IUDs. It was apparent that the method of outreach was slow and ineffective.

PSI/India started afresh by mapping every household in selected urban clusters of each district. The process involved the physical mapping of the households and then determining a profile for each. The data was then drawn and clusters were determined where IPCs could cover a group based on geography and households who fit the profile that is eligible for an IUD.
The baseline mapping found 900,000 households in the 20 districts. Of that number, 882,000 were determined to have eligible women. With the clusters and data, the IPCs set out to see 15 women a day. Each women is coded with a specific number in order to help protect her identity.

Today, I had the opportunity to see one of these visits in Delhi. The IPC presented a pair of women with information on IUDs. By using a model of the uterus, she was able to show the women what would happen when the device is inserted into them. A simple 10 minute procedure from start to finish by a doctor can ensure that a women will not get pregnant for five years. Being that it is as easy to remove as it is to insert, the IUD is a simple solution.

The visit was the second time the IPC had met with these women.  In the morning, the IPC completed her round of 15 new visits, where she shared information about options available for contraception and was using the afternoon for follow ups. By recording the information about each visit, she can identify which women are more likely to want an IUD in the future and be sure to follow up with them.

I also met one of the partner providers, Dr Sadhana Singh. She and her husband provide reproductive health services such as IUD insertions and vasectomies. The focus under the program is to provide quality services at an affordable cost. The follow-up with the beneficiary is done by the IPC and through an outbound call by a helpline.

Dr. Sadhana Singh explained that IUDs provide the best option for women to take control of their reproductive life and felt that it was paramount that this service be provided to them. By aligning partners like Dr Singh and the government ofIndiato meet the needs of Indian women, PSI/India believes that it can reach its objective of increasing coverage of IUD to 4.1% by the end of this year.

[1] International Institute for Population Sciences (IIPS) and Macro International. (2007). National Family Health Survey (NFHS-3), 2005–06:India:VolumeI. Mumbai: IIPS.