Districts in Uttar Pradesh, Rajasthan and Delhi are set to benefit from the launch of Phase III of Pehel, the much-applauded womenâs health project of Population Services International (PSI) that is implemented in collaboration with the Federation of Obstetrics and Gynecological Societies of India (FOGSI) to help reduce the maternal mortality burden by promoting family planning and safe abortions.
This would take the total number of districts under Pehel to 30 with a totalof 1,100 private service providers participating in the project from across the three states, an increase of 18% over phase II of Pehel. Fourteen of these districts belong to Rajasthan and 15 districts to UP. The remaining district comprises the south-west part of Delhi.
The Phase III of Pehel intends to build on the success story of Phase I and II by aiming to place 350,000 IUDs through private service provider clinics. Another aim is to generate demand among women of reproductive age for long-term contraceptive methods.
Says Pritpal Marjara, Managing Director, PSI India, âPehel Phase III will continue to complement the Government of Indiaâs efforts to reduce maternal mortality rate (MMR) and increase the contraceptive prevalence rate (CPR).The project level goal of Ph-III is to improve the CPR in the program districts from 54.8% in 2012 to 58.7% by 2015 and increase the percentage of women of reproductive age using IUDs in these 30 districts in urban India from 4.3% in 2012 to 6.1% by 2015. We would also be working to improve the quality of care that women receive from private healthcare providers with respect to IUD and safe medical abortion (MA) through continues capacity building of the providers.â
Rajasthan, UP and some parts of Delhi are currently far behind the rest of the country in several health indicators. According to the National Health Profile report of Government of India, the high MMR in these states adversely affects the average MMR of the country and hampers the realization of the Millennium Development Goals of improved maternal and child health (MDGs 4 and 5).With a yearly population growth rate of 22% and total fertility rate of 2.1, Delhi is currently home to 16.7 million people. But 14.2% of this population lives below the poverty line.
For UP and Rajasthan, the MMR is even higher at 359 and 318, respectively. Many of these maternal deaths can be prevented through family planning and safe abortions. Data from various district-level health surveys shows that there are 17.9%, 33.7% and 13.9% unmet needs of contraceptives prevailing in Rajasthan, UP and Delhi, respectively, which have fuelled the rate of unwanted pregnancies associated with high maternal mortality and morbidity.
The Pehel project was launched in July 2008 and initially implemented in 10 states across the country providing free services for IUD insertion. Based on learnings from Phase I, it was decided to focus the program on just three states for better concentration of resources.
Says Marjara, âDuring 2011-2012, a total of 185,739 intrauterine devices (IUDs) were placed with healthcare providers across UP, Rajasthan and Delhi, out of which 137,769 were inserted. About 348,402 Medication Abortion (MA) kits were also sold and 1,815 postpartum IUDs (PPIUDs) inserted during the time period. About 908 healthcare providers and 11,527 pharmacists have been involved with Pehel in Phase II.â
Said Dr Hema Divakar, President, FOGSI, âFOGSI has joined hands with PSI to provide technical assistance, training and advocacy for long-term birth spacing methods (IUDs) and safe medical abortion services (Safe Abort Kits). We aim to meet the unmet need by expanding these services and making them safe and accessible. The FOGSI-PSI partnership will also undertake research on the safety and efficacy of long postpartum intrauterine device (PPIUD) inserters.â
Dr Divakar added, âSeveral states including Maharashtra, West Bengal and Kerala have proven that family planning helps to promote maternal health and reduce maternal mortality. If we promote family planning in Rajasthan, UP and Delhi, it can help us reduce maternal mortality considerably.â
Family planning, according to WHO, allows individuals and couples to anticipate and attain the desired number of children through appropriate spacing and timing of births.This is achieved through the use of contraceptive methods and the treatment of involuntary infertility. A womanâs ability to space and limit her pregnancies has a direct impact on her health and well-being as well as on the outcome of each pregnancy.
Highlighting the benefits of family planning, Dr Nozer Sheriar, Secretary General, FOGSI, said, âPromoting family planning and ensuring access to preferred contraceptive methods are essential in securing the well-being and autonomy of women, while supporting the health and development of communities. These include preventing pregnancy-related health risks in women; reducing infant mortality; empowering people; enhancing education; reducing adolescent pregnancies; and slow population growth â all of which contribute to meeting the eight Millennium Development Goals.â
Talking about the medical abortions kits, Dr Sheriar said these have been a game changer in enhancing the access and affordability of abortions for women who are faced with an unwanted pregnancy. Highlighting the positive contribution of medical abortion kits in reducing maternal mortality, he stressed the need to take their availability to the next level.
Dr Sheriar said that FOGSI will advocate changes in the MTP law and encourage the establishment of âDoctors Opposing Sex Selected Termination of Pregnancyâ (DOSST) cells by all the FOGSI societies.
India recorded around 56,000 maternal deaths in 2010, which translates into one mother dying every 10 minutes during pregnancy, child birth or within 42 days of delivery. The current maternal mortality rate in India is 212 per one lakh live births, which compares poorly with just 16 for the developed nations. Unsafe abortions are also a leading cause of maternal mortality in India. Of the 6.4 million abortions performed in the country, 3.6 million (56%) are deemed unsafe. Estimates for the contribution of unsafe abortions to maternal death in India vary from 8% to 20%. Unsafe abortions are carried out in unsatisfactory conditions in small, poorly equipped clinics run by inadequately qualified staff. The problem is acute in rural areas where there is no access to quality healthcare and abortions carry a social stigma.