India’s effort to revitalize postpartum family planning (PPFP) and provide women the option of a long-acting method of contraception has a new convert in Dr. Indukala Siddalingappa.
Throughout her 36-year medical career, Dr. Indukala had serious reservations about the postpartum intrauterine contraceptive device (PPIUCD). As head of the obstetrics and gynecology unit at the Vani Vilas Hospital in Banglaore, India, she believed that the hospital and the women they serve—mostly from neighboring villages as well as the urban slums of Bangalore—would not be well-suited for the method.
“I work in a hospital where there are about 1,500 deliveries in a month. The workload is extremely heavy and we are understaffed,” she explained. “We are not able to give sufficient attention to asepsis and sterilization. In such a situation, just as a woman delivers, I did not want to push a foreign body into her and send her home with potential infections due to this IUCD.”
When the Government of Karnataka nominated her to attend a PPIUCD training at the Institute of Obstetrics and Gynecology (IOG), Dr. Indukala was very reluctant. The three-day training, conducted by Jhpiego trainers and IOG faculty, was aimed at improving doctors’ clinical skills in providing PPIUCD services. It included hands-on training for counseling on PPFP methods, PPIUCD insertion and infection prevention guidelines. The training was instrumental in helping Dr. Indukala begin to see the benefits of such services for women at her hospital.
Supported by the Bill & Melinda Gates Foundation, Jhpiego is providing technical assistance to the Government of India to revitalize PPFP, with an emphasis on the PPIUCD. Jhpiego is working in partnership with the Ministry of Health and Family Welfare to step up the service delivery of PPFP, including that of PPIUCD, in 16 states in India. This collaboration is part of Jhpiego’s ongoing work in India to help build the capacity of health care workers in delivering quality reproductive health services, strengthen health systems locally and nationally, and innovate to save lives.
Dr. Indukala is among those health providers benefiting from Jhpiego’s work. It wasn’t until she saw how a government hospital, similar to her own, had successfully performed more than 900 PPIUCD insertions, with few complications, that her perceptions of the contraceptive changed. Upon returning to her facility after the training, she began providing PPFP and PPIUCD services. Today it is an integral part of her family planning repertoire.
“At the training, I saw the advantages of this method. The [no-touch] technique minimizes the risk of infections. Even if any risk remains, it is minimal compared to the amount of good that it can do,” said Dr. Indukala.
She added, “The postpartum period is a very critical period to introduce a family planning method because the woman and her family are so receptive to our suggestions at this time. For people from this background, resumption of sexual activity is very erratic. They become pregnant dangerously early—without their knowledge or will.” Dr. Indukala believes that sending women home with a long-lasting and effective family planning method will limit unintended pregnancies and will give the mother time to recuperate and focus on her newborn.
During her lengthy career, Dr. Indukala says she has encountered many women who could have benefited greatly from a long-acting family planning method. She wants to make the PPFP/PPIUCD program in her facility a success so she can help all women who are in need of such services. With Jhpiego’s support, she has trained all of the doctors at Vani Vilas Hospital and has created a program that rewards doctors who successfully promote and perform PPIUCD insertions. She also plans to advocate for the inclusion of the PPIUCD in the Bangalore Obstetrics and Gynecological Society platform so that doctors from other facilities are aware of the method and can provide it safely.
Dr. Indukala has become a true champion of family planning to improve women’s health and save lives.