A known face at Allahabad’s busy District Women’s Hospital—a hospital that caters to about 400 clients per day and 350 births per month—is that of the hospital gynecologist, Dr. Sharmeen Ahmed. She is also a state-level master trainer for postpartum IUCD (PPICUD) services and has trained hundreds of providers from her state of Uttar Pradesh in quality PPIUCD services. A staunch advocate of family planning, Ahmed feels a great need for it in the community she serves. “Many people are unaware of the family planning methods. Limitation of the family is necessary for the health of the mother, of the child, and the family can be taken care of in very limited resources,” she says while explaining the advantage of adopting family planning in the postpartum period. “Whenever a client chooses a family planning method in the postpartum period, she goes back with a sense of security that she will not get pregnant until she wants a child again.” In a state like Uttar Pradesh—with a population of almost 200 million[1], a fertility rate of 3.1[2] and an unmet need of family planning as high as 20.7[3]—providers like Ahmed are a huge asset.
The state government recognizes the need and importance of providing access to quality family planning services to its people and has made huge investments in this direction. Mr. Amit Ghosh, Former Mission Director, NHM, and Executive Director, SIFPSA, and current Secretary, Health, Government of Uttar Pradesh is clear about the reasons for this investment. “We find that good family planning practices lead to significant reductions in maternal mortality, as well as child and infant mortality,” he says. He also points out the important role that Uttar Pradesh, a state that accounts for every sixth Indian, has to play in India’s commitments towards the global family planning agenda, “Uttar Pradesh has to meet 26% of the targets of FP2020 for India. And that translates to about 126 million new users. That’s a large number. So we feel that family planning effort is going to be crucial to the way we move forward in the state.”
Jhpiego has been providing technical assistance to the state of Uttar Pradesh since 2009 in achieving its family planning goals, especially with respect to strengthening the provision of postpartum IUCD services. Having started with one facility—the Queen Mary Hospital of King George Medical University—the state now has 25 training sites and has prepared 3,610 providers (both doctors and nurses) in PPIUCD service provision, of which 61 have been further trained to serve as Master Trainers. Today, PPIUCD services are provided in 420 facilities in the state, which includes medical colleges, district as well as sub district level facilities. As of April 2016, 191,492 women have accepted PPIUCDs while 198,934 women have accepted interval IUCDs in Uttar Pradesh.
One of the important reasons for the success the PPIUCD program has seen in the state of Uttar Pradesh is the hiring of counselors for reproductive, maternal, newborn, child and adolescent health (RMNCH+A). Dr Rekha Gaur, Retired Chief Medical Superintendent, Women’s Hospital, Lucknow endorses the important role the counselors play in increasing the acceptance of family planning, “I think the most crucial part [of the increase in family planning acceptance] has been the provision of counselors. In most health facilities, doctors and staff nurses cannot devote that much time to educate and counsel patients. But these counselors’ only work is to educate patients and explain to them the advantages of all family planning methods. And I think that is been the biggest reason for being able to increase the number of family planning acceptors at our facility.”
Today, Uttar Pradesh has 245 RMNCH+A counselors dedicated to providing health messages to the clients and more than two million counseling contacts have been made with women for family planning.
Equally important has been the inclusion of nurses in the pool of providers providing PPIUCD services. The latest feather in the state’s cap has been the policy decision to include Auxiliary Nurse Midwives, Lady Health Visitors as well as AYUSH doctors as service providers for PPIUCD services.
Along with preparing a robust pool of providers and ensuring informed choice through counseling services, Uttar Pradesh prioritizes monitoring and accountability of providers. Mr. Ghosh says, “One thing that we want to do concurrently is to have a very robust system of monitoring—reaching conclusions and giving feedback to the field and also taking corrective actions. In this no monitoring system can really succeed if data is not there. So we are working to strengthen our HMIS and working to improve the reporting systems.”
With strong political commitment, policies that provide a conducive environment and the commitment to better the health of women, children and families, Uttar Pradesh is set to play a very significant role in deciding the trajectory which the country will take in achieving Sustainable Development Goal 3—“Ensure healthy lives and promote well-being for all at all ages.” Providers like Sharmeen Ahmed with their remarkable work in providing access to women and families with quality family planning services, are helping the state, and indeed the whole country, move towards achieving this goal. “My vision for India is for all mothers to have free access to family planning and the right to choose how many children they want,” says this impassioned star provider from Allahabad.
[1] UP Population: 199.812 million (Census 2011)
[2] SRS 2013
[3] AHS 2012
