The Birth Control Trust of the Galton Institute

This is a report on the second tranche of funding from the Galton Institute towards an essential reproductive health (RH) care training and information education and communication (IEC) project in India. The project aims to enable low income women, men and adolescents to access information and take effective measures to improve their RH status, and achieve safer motherhood, and the means to protect themselves against unwanted pregnancy and sexually transmitted infections (STIs).

The Indian Government was one of the first in the world to formulate a national family planning (FP) programme in 1951. However, India remains the most populous country in the world, contributing around 20% of world births with a total population that may well exceed two billion within this century. Despite commitment on the government's behalf, only 43% of women have access to any form of modern contraceptive resulting in a fertility rate of 3.4%. In addition to this only 42% of births are supervised by a skilled attendant and this combined with an inability to control fertility and space pregnancies contributes to a maternal mortality rate of 444 per 100,000 live births.

The overall objective of the project is to improve knowledge and increase adoption of basic health practises particularly RH among women and families who have an unmet need for FP services. The projects comprise several components:

The centre in Barasat, North Parganas opened in April 2001 after obtaining the necessary licences from the health authorities, corporation authorities and other departments such as the pollution control board. The centre is located on the main road half a kilometre from the market to maximise accessibility to the inhabitants of Barasat and the surrounding area.

As Barasat is a new area for PSS considerable efforts have been made to make the local people aware of the centre and the services provided. A number of local promotional activities were carried out including the distribution of banners, posters and leaflets and advertisements on the radio and in the local newspapers.

The centre is now successfully providing a comprehensive range of services including: gynaecological procedures, sterilisations, depro mexdroxy progestrone acetate (DMPA) injections, medi checks, ante and post natal care, pregnancy testing and FP consultations and services.

Community outreach involves trained health workers travelling out into the community and hard-to-reach areas situated outside the main towns to provide services and information. The cost involved in travelling to the static centre in the main town is often prohibitive to many potential clients seeking services. By taking the services directly to their communities it enables them to access services with minimal disruption to their working patterns at minimal cost. In 2001 12,418 individuals were reached as a result of the mobile outreach services.

The mobile van, equipped with a doctor, auxiliary nurse/midwife and field educators visit the project areas on days predetermined by volunteer health workers (VHWs).

As indicated in the table below the project has successfully increased its outreach services in each year of implementation. In addition to this, service provision of both permanent and temporary methods of contraception increased between 30 and 49 % over the project period.

In response to local demand and at the request of the chief medical officer PSS organised field sterilisation camps in the district of Barasat. In 2001 42 such camps were organised wherein 2560 sterilisation cases were performed to individuals who had completed their families.

This reporting period experienced a consolidation and strengthening of a selected number of special programmes particularly the immunisation, special health and ENT camps which have experienced increases of 77%, 153% and 477% respectively on the previous years number of beneficiaries.

Providing individuals with accurate, relevant and culturally appropriate information regarding their RH is the first step in enabling them to make informed decisions about their RH needs. IEC is essential in removing the misconceptions that surround RH and FP. The IEC activities in this project are being conducted by field supervisors and educators along with VHW and involve community based activities along with promotional activities in the media.

In the field the IEC campaign involves activities such as household visits, mother's meetings and youth group meetings, in addition to promotional activities such as baby shows. Various topics on a range of RH subjects are covered in these meetings including FP methods, and the symptoms and risk associated with sexually transmitted infections (STIs) and reproductive tract infections (RTIs). In the reporting period a total of 14,660 individuals benefited from the IEC campaign. The details of the various IEC activities are summarised below:

The Barasat centre has experienced recruitment problems throughout the project period particularly with regard to administrative staff. Efforts are continuously being made to recruit an effective team. PSS have also experienced shortages in the availability of consultants including anaesthetists and laparoscopist surgeons.

The project team found that involving the beneficiaries in the implementation of the project helps to ensure that the services provided are in line with those demanded and thus ensure the effectiveness and long-term sustainability of the project. The organisation of field sterilisation camps came about as a direct request from the chief medical officers in response to local demand. Not only did these prove successful in regard to client numbers but it assisted PSS in achieving the support of the local authorities and enhanced their reputation in an area that is new to them.

Thanks to the support of The Galton Institute, PSS has continued to provide essential RH care and IEC to a previously under-served area in India. The project has been very successful, in fact, considerably more successful than originally anticipated. This has resulted in PSS having the capacity to contribute a greater proportion of the project costs themselves displacing the need for the Galton Institute's final contribution to this project. This success means that the project is almost fully sustainable and the support of the Galton Institute has ensured the long-term provision of essential RH services and information to the communities of Barasat and the surrounding areas.