Providing high-quality contraceptive services to women is one of the keys to achieving the Millennium Development Goals of improved maternal and child health (MDGs 4 and 5). The Government of India (GoI) repositioned its family planning (FP) program in 2009 to improve maternal and child health by helping to prevent unwanted and mistimed pregnancies, which can result in adverse outcomes for both mothers and newborns. Given the global evidence of postpartum intra-uterine contraceptive devices (PPIUCD) as a safe and effective long-term, reversible method of contraception, the GoI, with USAID support through the ACCESS-FP Project, initiated the provision of PPIUCD services to women within 48 hours of childbirth as critical component of the initiative. The program started in one national and two regional training sites in February 2010.
By March 2010, service providers from two service delivery sites (one medical college and one district hospital) of 16 states were trained and services had been initiated. In just one year of collaboration with the GoI, with technical support from USAID/MCHIP in three states and from the Bill and Melinda Gates foundation in 16 states, the postpartum family planning (PPFP)/PPIUCD program is now working in 19 states with more than 40 sites providing these services.
To observe and learn from this exciting initiative in India, a study tour was organized in June 2011 at SMS medical college, Jaipur, India. The Zanana Hospital and Mahila Chikitsalaya of the SMS medical college and Kanwatiya Hospital, the district level facility in Jaipur, were the clinical demonstration sites. Eight international maternal health experts and representatives from ministries of health in Asia, Africa, Latin America, and the US participated in a five-day experiential learning workshop.
Dr. Kiran Ambwani, Deputy Commissioner, Family Planning Division, Ministry of Health and Family Welfare, GoI, briefed the delegates regarding the issues in initiating a new program and working with senior level ob/gyn specialists. She stressed the importance of having champions among policy makers as the driving force and trained providers/managers as advocates at the service delivery sites to move the initiative forward.
Drs. Bulbul Sood, Country Director, Jhpiego and Kailash Saran, State Program Manager, Jhpiego/Rajasthan, along with the facilitators from Jaipur Drs. Neelam Bhatnagar, Oby Nagar, and Hariom N. Sharma shared their experiences in rolling out and expanding PPFP/PPIUCD programs at the national and state levels. Discussions that followed were mainly related to the challenges and lessons learned. The delegates visited the labor and postpartum wards of the three hospitals to observe the process of counseling clients and PPIUCD insertion techniques. Each participant had a chance not only to observe but also to practice PPIUCD insertions on the clients.
Dr. Yolande Hyjazi, Country Director/Guinea, shared her country experience in the PPIUCD program. Dr. Rosemarie Madinda, representative of Ministry of Public Health, Tanzania, discussed the interest of her country to initiate the program. She also said, “This study tour widened my horizon on the subject of repositioning PPFP. It is therefore very important to emphasize that PPIUCD is also a vital entry point in reducing maternal, newborn and child death. We are all aware that postpartum sexuality, returns to fertility and pregnancy risk are intertwined and PPIUCD should be adopted and integrated in the MCH programs. On my perspective this training was very successful, despite [some] communication barriers… I was very happy and satisfied with the skills and achievement. I am now more confidence to perform the skills.”
Delegates from Nepal (Dr. Kusum Thapa), Mozambique (Dr. Veronica Reis) and Tanzania (Dr. Rosemarie Madinda and Dr. Chrisostom Lipingu) said that on returning back home they would work to initiate the PPFP/PPIUCD program in their countries. The delegate from Afghanistan, Ms. Rabia, mentioned that she appreciated the opportunity to counsel clients’ family for PPFP and the ability to have family members with the postpartum woman in the wards, which she will try to introduce in her hospital. “I learned something new,” she said. “When I get to Afghanistan, I will be confident to provide services.”
Dr. Yolande Hyjazi, Country Director/Guinea, summed up the experience, and sentiments of many: “Thanks to MCHIP and Jhpiego [for organizing] this kind of meeting. It was helpful to all of us here and we will take the lessons learned home to improve our programs. The discussions we had here [will allow] us to standardize our activities.”