The Birth Control Trust of The Galton Institute

The generous donation of £15,000 received from the Galton Institute last year has been utilised by two reproductive health projects in India. The Institute’s support has enabled Marie Stopes International (MSI) and its partner in two locations of India to work towards fulfilling the similar objective of both projects: ‘To enable low income women, men and adolescents to access information and take effective measures to improve their reproductive health status, and achieve safer motherhood, including the means to protect themselves against unwanted pregnancy and sexually transmitted infections.’

The report contains information on the main components of each of the projects, namely the static centres; mobile outreach services; information, education and communication activities; and training to give you an idea of how your donation has helped to improve the quality of life for women and their families in Calcutta, North Parganas and Bangalore in India.

India has 30 per cent of the world’s births, 20 per cent of the world’s maternal deaths, and 25 per cent of the world’s child deaths. Of the 1,002 million people in India, 36 per cent have not yet reached their fifteenth birthday. The danger here is that this group of young people will not be able to find the education, health services or employment prospects necessary to live their lives to the full. This lack of opportunities is felt particularly acutely by girls, as adolescent pregnancy in India is the norm. Beginning childbearing so young reduces not just their opportunities of employment, it leaves them with fewer resources with which to support their children, and if followed by repeated childbearing, worsens their health and reduces their life expectancy. As one in every 11 children in India dies before reaching the age of five, this is sadly only too often the case.

The scale of the problem in India can be seen by a quick comparison with the figures for the United Kingdom. For a women in the United Kingdom, her risk of dying from causes related to pregnancy or childbirth is one in 5100. For a woman in India, it is one in 47. The major causes of maternal mortality are unsafe births, lack of access to family planning (FP), and unsafe abortion. Currently, only 43 per cent of married women have access to modern methods of contraception, resulting in unwanted pregnancies. Where pregnancies are too close together, not only is the mother’s life threatened, but the well-being of her existing children. In India, 72 out of every 1,000 babies die before their first birthday, compared to just under six per 1,000 in the United Kingdom. Child survival is lowest where the mother is younger than 20 years, where the child is the first or the seventh or more to be born, and where birth spacing is less than two years. Discrimination against girls in health care is also still evident as at ages one through four they have an almost 50 per cent greater chance of dying than do boys.

The two projects have been implemented by MSI’s partner, Parivar Seva Sanstha (PSS) which has been operating innovative reproductive health (RH) and family welfare projects in India since 1978. The projects have several components: the establishment of one static centre in each of the project locations providing a comprehensive range of RH and basic primary health services; provision of RH/FP outreach services to meet the needs of marginalised communities in the two project areas; the development of vital information, education and communication (IEC) materials and activities to raise awareness of the importance of and availability of RH services; and training to improve the quality of RH care.

The project in Bangalore, which was co-financed by the European Commission, began in October 1994 and ended during September 2000. The centre in Bangalore has established a good reputation, meeting the RH needs of low-income women in the area. Over 70 per cent of the centres clients belong to families existing on a monthly household income of less than Rs 2000 or approximately £30.

The centre services were promoted through advertisements in the newspapers, billboards, kiosks, and tinplates. Also, the centres Business Development Representatives (BDR) visited doctors, chemists and health promoters in and around Bangalore to inform them about the centre and its services. This referral network accounted for between 65 to 70 per cent of all clients accessing centre services. Over the life of the project a total of 83,520 Couple Years of Protection (CYP) have been provided from centre services enabling individuals to determine their fertility and improve their RH.

The centre in Barasat in the district of North Parganas only opened on 28 April 2001 and provides the same full range of RH/FP services as the Bangalore centre.

In Bangalore the mobile health team reached slum dwellers in 16 areas, as well as the rural poor. The mobile team visited each location once per week with a doctor, nurse, nursing attendant, field worker and driver. It is estimated that over the life of the project 86,456 people benefited from the mobile outreach activities, including immunisation camps, baby shows, health camps and house visits.

The project in North Parganas has two mobile teams comprising a lady doctor, an auxiliary nurse midwife, field educator and driver. The mobile teams visit selected areas at a predefined frequency which is communicated to the women in the area in advance by the voluntary health workers (VHWs). There has been a steady growth in numbers of those accessing the services of the mobile centre as the high quality of services has been circulated by word of mouth. The latest figures for 1999 to 2000 show that in that year 12,194 individuals benefited from the services which is significantly more than the 2,162 people reached during the first year of mobile services in 1996.

Information on preventive health care in relation to women’s, men’s and adolescents’ health, is the first step towards enabling them to make informed decisions about their RH and FP needs. PSS’s programme of health education is helping to dispel myths, fears and inequalities that restrict the freedom of choice of women and adolescents in particular. For example, information on HIV prevention which takes into account the characteristics of particular groups is key as a condom will not help prevent HIV infection if a person can not negotiate its use. Therefore, educational programmes are designed to account for each group’s specific needs.

Training was carried out by both projects during the reporting period for VHWs and Dais (or traditional birth attendants). PSS and MSI believe that training is essential to achieve long term sustainability of the projects by creating a pool of local health workers that can provide consistent, quality health care, as well as refer their clients (when necessary) to PSS static centres.

As Dais are the traditional birth attendants in India and are the first choice for many women who are giving birth, it is important to ensure that their methods are up-to-date and that they are providing women with appropriate information. Therefore a total of 141 Dais in Calcutta and 8 in Bangalore were given training in the following areas:

PSS has encountered some challenges during this reporting period in the recruitment of personnel with the suitable level of technical and professional expertise for field jobs. A high staff turnover in key positions has also affected the momentum of both projects. However, PSS has persevered with the recruitment process and now have competent teams in place in the project areas.

Key activities to be implemented during the next year, with regards to the project in North Parganas, include the:

The static centre in Bangalore will continue to provide quality RH services to the community beyond the EC funding period. The centre is able to partially recover its costs and the balance will be met by PSS. However, the educational and promotional activities will have to be curtailed to manage the centre with limited funds. It should also be noted that the Bangalore project has met its initial working objectives and developed over the years providing a model of quality services for others to emulate.

The grant from the Galton Institute has been invaluable in helping to continue the important RH and FP projects in India. The Indian Government simply does not have the resources or facilities to provide the level of curative and preventive services required. Without such intervention the situation in India can only deteriorate as the population expands, placing more and more stress on an already overburdened health system. The loss of every woman's life bereaves a family and leaves a hole in the fabric of her community. By providing funding for these projects, the Institute has made a real and felt impact on lives of women, men and adolescents, and through them, on their families and communities. All MSI projects also aim to increase the pool of health expertise within the countries in which we work through training. Therefore, the Institute’s donation has an added impact of expanding the benefits of the project to outside the project areas. MSI and PSS have the experience, knowledge and commitment to tackle the RH and FP problems in India and have been able to carry out this essential work because of the continued support of concerned donors like the Galton Institute.