Reshma has a relationship with each of the women she is counseling. She understands their cultural and social context.
There are decisions – and then there are informed decisions. And I’m sure we’ve all had opportunities to make both kinds. But when it comes to making decisions about when and how many children to have, there aren’t many more important decisions than that. It’s why informed decision-making on these issues is what the Urban Health Initiative (UHI) is helping to foster in Uttar Pradesh, India, specifically for women living in urban slum areas.
Frontline health workers are active in these areas to meet unmet need for birth control by providing clear information about the benefits of planning a family and the choices of contraceptives that are available to the women.
I met one of these frontline workers last week in an urban slum in Lucknow, and talked with her about her role in supporting informed decision-making.
Reshma, as a peer educator for UHI, knows and has mapped all of the households in her area and has registered the more than 2,000 people living there into a database. She visits each household with a woman of reproductive age on a regular basis to track need for and use of contraceptives and to make sure the families understand their choices.
Reshma discusses birth spacing and helps a family decide if they are ready for another child or if they want to wait longer before having another or stop having children altogether. And she links them to service providers who are improving the way they deliver services.
UHI frontline workers have a kit of information—samples of products of different contraceptive methods, color coded counseling materials, referral cards for clinic-based procedures, and method-specific pamphlets for distribution to family members, especially husbands and mothers-in-law as they are instrumental in the decision-making. They also provide condoms and oral contraceptive pills.
Reshma is not the only one talking to women and their families about birth control options. She refers women to clinics with nurses and doctors who also present the information and counsel women as they make an informed decision.
From a health care provider’s perspective, ensuring women have the chance to make an informed decision means providing all the information on contraceptives and counseling on the best options, which of course will be different for each woman.
Reshma has a relationship with each of the women she is counseling. She understands their cultural and social context. Some of the women she counsels want to wait a few months or perhaps years before having another child. In this case injectable contraceptives may be the best option. Some women don’t want any more children but their religion doesn’t allow a permanent method like sterilization, so an intrauterine device (IUD) may be their best option.
It is the provider’s responsibility to present the options and provide counseling on the best ones for each woman. To ensure the best quality of care, all health care workers, from community-based to clinic-based, need to be trained on family planning methods, communication and counseling skills, and receive regular supervision. They should also understand the cultural and societal context in order to provide appropriate counseling for each woman. And that is what the UHI is doing—ensuring providers have the correct information, knowledge, communication skills, a range of contraceptive products, and referral mechanisms to make sure a woman and her family can make an informed choice and then respect that choice and enable her to act on it.
Deciding when and how many children to have can be a difficult decision, but having the proper information can simplify the process. And this decision can be life-saving.
Are you inspired to act on behalf of women who desperately need access to family planning education and contraceptives? Keep an eye out for ongoing information about, and ways to pledge support for, the upcoming Family Planning Summit on July 11, 2012. The Summit is being hosted by the Gates Foundation and the UK’s Department for International Development (DFID) with the aim of addressing the unmet need for contraceptives for the 200 million women in the poorest countries who want and need, but don’t have access to them. It’s about putting family planning front and center on the global agenda. Follow @Gatesfoundation and check Impatient Optimists regularly for details.