In Bihar, a landlocked state in northern India, 46 percent of girls will marry before they are 18. Nearly 60 percent of girls become pregnant by age 19. Those who marry are likely to have an average of four children, the highest fertility rate in the country. At the same time, close to 8,000 mothers die every year while giving birth. More than 150,000 babies don’t live to see their first birthday.
Those statistics would shake the resolve of almost any physician working to improve the maternal landscape in Bihar. Not Dr. Sushma Pandey, Chief of the Obstetrics and Gynaecology Department at Patna Medical College and Hospital (PMCH). Dr. Pandey is determined to reduce the number of maternal and infant deaths by providing safe, accessible family planning (FP) services.
In India, women who are within one year of their last pregnancy have a greater unmet need for contraception than any other group. Contraception for postpartum women is critical to address this need and prevent unintended pregnancies. At this time, women are highly vulnerable to becoming pregnant again. This period is a crucial time to reach women with FP services.
Consider Usha Devi, who arrived at PMCH for her second cesarean section after a prolonged obstructed labor, her frail body gripped with pain. She feared what another pregnancy would do to her health. Usha and her husband were counseled on all the FP methods that they could adopt to prevent pregnancies, including an IUD to be inserted within 48 hours of giving birth. Since she was having a cesarean section, Usha and her husband decided on an IUD, which was placed in her uterus following the birth of their daughter. She is now safe from pregnancy for 10 years. Whenever Usha is ready for another baby, she can have the IUD removed.
Never before had Usha felt so in control of her life.
As the Chief of Ob-Gyn at Patna, Dr. Pandey has taken several steps to ensure that Usha and other female clients are counseled at every point of contact with the health system—during prenatal care visits, at the time of early labor, after delivery when women are still at the hospital and during immunization visits. She puts great emphasis on counseling pregnant and postpartum women about FP because of its crucial role in improving maternal and neonatal health and in making every pregnancy an intended pregnancy. It took a strong resolve to reach this point.
“There were many myths and misconceptions in people’s minds when we introduced the services. Some thought it [the IUD] may cause cancer, or may lead to weight gain, etc. But through proper counseling we have been able to overcome many of these challenges. We have been able to achieve quite a degree of success here at PMCH. I feel counseling plays the main part in the woman and her family agreeing to adopting an FP method,” says Dr. Pandey, who is among the dozens of health care providers trained by Jhpiego, an international health, nongovernmental organization with offices in more than 50 countries.
Through the Bill & Melinda Gates Foundation, Jhpiego is providing technical assistance to the Ministry of Health and Family Welfare, Government of India, to revitalize postpartum family planning (PPFP), including the postpartum intrauterine contraceptive device (PPIUD), and to step up the use of PPFP services in 16 states in India, especially in Bihar. A key element of its strategy is to generate awareness of and demand for these services. Jhpiego also works to strengthen the infrastructure of health facilities and upgrade the clinical and counseling skills of health care providers. Its interventions are designed to improve performance through the Standards-Based Management and Recognition (SBM-R®) approach.
The air of optimism is growing in Bihar. Says Dr. Pandey, “With Jhpiego’s support, we have got a big reinforcement in our family planning efforts. Jhpiego corrects us where we go wrong, and suggests ways to improve.”
There is nothing more rewarding than empowering thousands of women like Usha Devi with FP choices they never knew existed—strengthening their health and their children’s health and, ultimately, making families stronger.
Childbirth, Contraception, Family Planning, Maternal Health, Women's Health, Women, Newborns, Children's Health, Pregnancy, Infant Death, Bihar