Creating the conditions for scale-up of the Men in Maternity intervention in India

The Frontiers in Reproductive Health (FRONTIERS) program conducted an operations research study, called the Men in Maternity (MiM) study, in collaboration with the Employees\u27 State Insurance Corporation of India (ESIC), aimed at involving men in the antenatal and postpartum care of their partners to raise knowledge and use of postpartum contraception and preventive practices against sexually transmitted infections, as well as improving pregnancy outcomes. This report details the MiM scale-up process, which worked well in terms of ESIC assuming ownership of the training component of the program and being able to build capacity for training. However, to further scale up MiM in the remaining dispensaries in Delhi there needs to be commitment from ESIC for supervision and monitoring of the implementation process so that delays can be minimized and MiM can be fully integrated into the dispensary norms for maternity services. To fully institutionalize MiM in ESIC services, limited and continued external support is required, particularly in the area of supportive supervision and MIS. This could perhaps be achieved through expansion, better coordination with implementing hospitals, and reinforcement of similar messages in different venues such as ESIC hospitals

Lactational amenhorrhoea method for birth spacing in Uttar Pradesh, India: Supporting technical data

Following the International Population and Development Conference in Cairo, there has been widespread consensus in the international community that family planning (FP) programs must be people-centered and focus not just on contraception, but on the reproductive health (RH) of men and women throughout their lives. This policy brief reviews the research and policy implications of promoting the Lactational Amenorrhea Method (LAM) as a component of FP counseling in India. The Government of India and the Population Council are using a pregnancy-based approach in Uttar Pradesh to improve the delivery of FP services through the rural primary health care system. Introducing pregnant women and their families to LAM offers a number of health benefits for mother and child. It promotes breastfeeding, which benefits the mother by reducing risk of postpartum hemorrhage and lowering risk of breast and ovarian cancers. The benefits to the fully breastfed infant include protection from hypothermia, neonatal hypoglycemia, and infections, in addition to nutritional advantages. Breastfeeding reduces postpartum fertility, thus delaying the need to use other contraceptive methods. LAM introduces couples to the concept of nonpermanent contraception and child spacing in a culturally acceptable way

Iron supplementation: Knowledge, perceptions, and usage among pregnant women in rural India

In India, severe anemia has been one of the causes of high maternal mortality and death of newborns and infants due to low birthweight. The prevalence of anemia among women ages 15–44 is extremely high. The Government of India has provided iron and folic acid tablets (IFA) as a prophylaxis against nutritional anemia among pregnant women as part of the Child Survival and Safe Motherhood program and will continue to do so in the Reproductive and Child Health package. This paper presents findings of both qualitative and quantitative research conducted among pregnant women to investigate the extent of distribution and use, information provision, and knowledge and perceptions regarding IFA tablets and reasons for nonuse. The study shows that consumption rate of IFA tablets is high if women are knowledgeable and have positive experiences after taking the tablets. Findings suggest that more accurate and complete information should be provided to pregnant women while distributing IFA tablets along with health and nutritional education messages. At the same time, follow-up visits and counseling are essential to address symptoms that are not related to IFA

Analysis of price change on the perceptions and use of DMPA among clients using reproductive health services in Uttar Pradesh, India

Depo-medroxy Progesterone Acetate (DMPA) is a progesterone-only injectable contraceptive that has been approved by the Government of India for provision in the commercial sector, where it is marketed under the brand name Depo-Provera. In 1996, it was available at rates between Rs. 140 to Rs. 180 per injection. At this price it is often beyond the reach of many women wanting a safe and effective contraceptive. In January 1996, DMPA was provided to women in three cities of Uttar Pradesh through Parivar Seva Sanstha’s (PSS) clinics at Rs. 150. In July 1996, as part of operations research (OR), the price was reduced in Agra to Rs. 50, in Varanasi to Rs. 0, and Lucknow to Rs. 100. Information was collected for 18 months to understand how price influenced demand, perceptions, and use of DMPA among urban women in Uttar Pradesh. This report states that DMPA appears to be an acceptable, safe method of contraception when offered with good client counseling and follow-up. More effective availability of the product at an affordable wholesale price in India would meet the needs of potential clients and facilitate the financial sustainability of the service by PSS

Development of a quality assurance procedure for reproductive health services for district public health systems: Implementation and scale-up in the state of Gujarat

This project was carried out in India, in two districts each in Gujarat and Maharashtra states. It confirmed that quality assurance (QA) checklists and an implementation manual, developed by the USAID-funded Frontiers in Reproductive Health (FRONTIERS) Program of the Population Council in collaboration with UNFPA/India, are useful and effective tools that the Ministry of Health and Social Welfare (MOHFW) can use to monitor the quality of services provided by health facilities. It also demonstrated that this QA mechanism can be easily institutionalized at the district level management. One key lesson has been the critical role that the commitment of state officials plays in the success of such interventions and their scale up and institutionalization. The proven effectiveness of the QA mechanism and its scaling up in Gujarat State has prompted the national MOHFW to introduce it into six other states, with a slightly enlarged scope for the QA visits. FRONTIERS, PATH, and EngenderHealth are providing technical assistance to support this scale up, with funding from USAID, UNFPA, and GTZ

Men in maternity study: Men matter

The Population Council and the Employees’ State Insurance Company are collaborating in a Men in Maternity (MiM) study in India to test a model of antenatal and postnatal services designed to help thousands of couples, especially men, redefine their roles in reproductive health and improve birth outcomes and maternal health. This is part of a global study that will assess the impact of male partnership in improving pregnancy outcomes and reproductive health, primarily by reducing the prevalence of STIs and increasing postpartum family planning use. Studies suggest that the lack of men’s participation in reproductive health actually undermines women’s health. The MiM study is the first of its kind in India. It includes more than a focus on contraception or safe motherhood and covers topics ranging from child survival and postpartum services to STI diagnosis and treatment and prevention of HIV/AIDS. This research update provides an overview of the MiM experimental intervention and some lessons learned in establishing the new services and maintaining operations during the first 14 months of the study’s intervention period

DMPA provision in PSS clinics in Uttar Pradesh: Costs and prices

The injectable contraceptive DMPA was introduced in the private sector in India in 1993, contingent on completion of a post-marketing surveillance study of users. The commercial price of a dose of DMPA is about Rs. 150-180, exclusive of the fees of the medical provider. This price puts it beyond the reach of most Parivar Seva Sanstha (PSS) clients in need of safe and effective family planning (FP) services in Uttar Pradesh. Since April 1996, an experiment has been underway with three PSS clinics in Uttar Pradesh to study the effect of price on demand for DMPA. The study seeks to better understand the issues of service delivery, client profile and the price at which the service can be offered in a sustainable way. Since April 1996, PSS has charged clients selecting DMPA Rs. 50 in Agra, Rs. 100 in Lucknow, and the product is offered free in Varanasi. All other PSS clinics in India offer the product at Rs. 50. This cost analysis has two main objectives: to estimate the cost of providing DMPA services at three clinics in Uttar Pradesh and to analyze the price at which DMPA services can be sustainably offered given the cost structure at each clinic

Men in maternity study: Results from the pre-intervention survey of pregnant women and their husbands at the three interventions, and of only women at three control Employees\u27 State Insurance Corporation dispensaries in Delhi, India: Preliminary findings

The Frontiers in Reproductive Health program, a USAID-funded project of the Population Council, is conducting an operations research (OR) study that investigates the effects of male participation in a new model of maternity care that is gender sensitive and provided at the primary-care level. The immediate objectives are to increase the use of family planning methods in the postpartum period and to promote STI primary preventive practices in men and women. The three-year study called Men in Maternity (MiM) is being conducted in South Africa and India. In India, the project is collaborating with the Employees State Insurance Corporation (ESIC). The MiM intervention is facilitating the inclusion of men in their wives\u27 antenatal and postpartum care with couple and individual counseling during pregnancy and at six weeks postpartum. The data presented in this report is derived from the baseline survey conducted from November 2000 to November 2001 of pregnant women between 10 and 26 weeks of gestation who were attending antenatal clinics at the six ESIC dispensaries

Men in maternity study: A summary of the findings from pre-intervention interviews with women and their husbands attending antenatal clinics at ESIC facilities in Delhi

The Frontiers in Reproductive Health program, a USAID-funded project of the Population Council is conducting an operations research (OR) study that investigates the effects of male participation in a new model of maternity care that is gender sensitive and provided at the primary-care level. The immediate objectives are to increase the use of family planning methods in the postpartum period and to promote STI primary preventive practices in men and women. The three-year study called Men in Maternity (MiM) is being conducted in South Africa and India. In India, the project is collaborating with the Employees State Insurance Corporation (ESIC). The MiM intervention is facilitating the inclusion of men in their wives\u27 antenatal and postpartum care with couple and individual counseling during pregnancy and at six weeks postpartum. The data presented in this update derives from a detailed Preliminary Findings Report. Interviews, conducted from November 2000 to November 2001, took place in all cases only after consent was first given by the women

Rapid appraisal of IPP-VI training of ANMs in Uttar Pradesh

This report provides findings of a rapid appraisal of the Auxiliary Nurse Midwife (ANM) training program in Uttar Pradesh, India. The appraisal was undertaken by the Population Council and State Innovations in Family Planning Agency (SIFPSA). As SIFPSA is in the process of planning a training program to strengthen the technical skills and competence of ANMs and update their contraceptive knowledge, it was felt that a rapid appraisal of the training program would help in understanding the strengths and weaknesses of previous training efforts. The ANM training initiatives of SIFPSA would then build upon the experiences gained from earlier training programs and the existing training needs of ANMs. The emphasis was on improving ANMs\u27 technical and counseling skills by providing on-the-job practical training. The program was a three-week skill-based training, during which ANMs were attached to a CHC/PPC or a district hospital. This was followed by one week of training at an ANM Training Centre in IEC and counseling. The objective was to review how the training program was organized and how it helped improve the technical skills and competence of ANMs