Sharing the FP task in India

Strengthening sexual and reproductive health services is fundamental to efforts that strengthen our overall health system; but despite the availability of a wide range of methods, unmet need for family planning in India is estimated to be 12.8 percent.

Only a quarter of postpartum women are using contraceptives.

Unmet need for modern contraception leads to unintended pregnancy, which in turn has a direct impact on maternal and neonatal morbidity and mortality. FIGO’s Postpartum IUD programme offers a roadmap for collaborative scale up of access to family planning, putting the needs and realities of women at the heart.

In low‐resource settings, childbirth is often the only time when a healthy woman comes into contact with a healthcare provider. Doctors are not available in many of the peripheral health centres, and nurses play a vital role in motivating women to choose a contraceptive method.

India is one of six countries where, in 2015, FIGO expanded a programme to institutionalise counselling and delivery of postpartum IUD services. Responding to the Government’s work to reinvigorate and scale up use of long-acting reversible contraceptives (LARCs) in the postpartum period, we partnered with our National Member Society FOGSI (Federation of Obstetrics and Gynaecological Societies of India) and AVNI Health Foundation. Together we established the programme in regions where maternal deaths were high, and availability of family planning options was poor.

Skilled health personnel are essential to ensure quality postpartum IUD services, and limited availability poses a challenge for increasing access. When FIGO, FOGSI and AVNI first began working in Kalyani Hospital, PPIUD uptake was less than 1 percent.

Together we identified task sharing, a globally-accepted solution for accelerating access to health services, as a strategy to expand the provider base. Over two and half years we were able to prove that collaboration between doctors and nurses could make postpartum family planning services available to more women.

68 percent of nursing staff at Kalyani completed training in the first six months, and this one step led to a swift increase in IUD insertions by nurses: 86.6 percent in year two, and 99.5 percent in year three of the total postpartum insertions. The failure rate was low, just 0.3 percent, with similar results between the nurse and doctor insertion subgroups.

Said Emily-Anne Tunnacliffe, Project Manager,

“Task sharing with nurses allowed postpartum family planning to be much more accessible to women, as demonstrated by the dramatic increase in insertion rates following nurse involvement. The majority of women who choosing IUDs were age 18 -25, delivering for the second time. By making birth spacing accessible, respectful and above all informed, we can support young women to achieve active participation in their own health and rights.”

The impact in Kalyani in just a few years has been significant. At the end of the study period, postpartum IUD uptake was at 37 percent. 63 percent of women returned for follow-up, and 94 percent reported a desire to continue with their postpartum IUD.

‘Health for all,’ the growing global movement towards Universal Health Coverage, is not just the availability of health services. It is a complete state of physical and mental health that enables a person to lead a socially and economically productive life, and for women that means fundamental integration of sexual and reproductive health and rights (SRHR).

FIGO recommends this strategy for task sharing postpartum family planning services be taken up by other units where nurses conduct vaginal deliveries, as we work together to ensure that every woman, wherever she lives, has the right to make decisions about her own body.