Editorial of the month
Uptake of family planning methods in health centre not far from Patna - a cause for concern"
By Leena Uppal
Published in Eastern Chronicle on 31 October 2013
Primary Health Centres is the first point of contact of a citizen in India with Medical Officers; for an ordinary poor villager this is quite intimidating and my visit to Khagaul PHC proved that for a woman waiting to meet the Medical Officer and sharing her problem was not only intimidating but also quite difficult. Khagaul PHC serves 1 Lakh population and is a Nagar Parishad (a satellite town) in the district of Patna located at a distance of 13 km from Patna city.
My visit to this PHC was on Thursday which is a fixed day static facility that is this was the day every week sterilisation operations are undertaken. Thursday saw the PHC brimming with clients. The PHC was in a dilapidated condition and has been undergoing renovation since the last 2 years; as there was paucity of space sterilisation operations were performed in a temporary operation theatre, and the lab tests were performed in the veranda.
The head nurse at the PHC peeked out of her room with great interest at us (we were a team from Centre for Health and Social Justice, Delhi and IRADA, Patna, a local organisation working on women's health and rights). She called us inside her room and shared her woes and the challenges she faces managing the PHC.
The PHC has only 5 beds for patients. The X-ray room has been converted into the O.T. and the dark room into the infection control room, with only an autoclave placed inside. We need safai karamchari (cleaning assistants); O.T. clothes, draw sheets and mackintosh for patients and mask and gloves for the staff as well as for the patients however there is always dearth of these. There is no running water available or any alcohol-based rub". Not surprisingly, we have to put women on the floor after operations on occasions when the patient load is high".
An assessment of family planning services and informed choice in Danapur block of Patna, confirmed that the health workers have with full energy and vigour focussed on ensuring that they achieve the target set for their PHC in the monthly meeting. This has resulted in no informed choice and complication management, leading to an increase in risk of life of the clients.
“I have never seen an IUD, but the ASHA has said that this is the safest method and I can remove it whenever I want it to be removed. The ASHA or none of the service providers have shared with me that this has any side effects or there are any other birth control methods. The ANM has said that this is the best method.
Meena (age 21 years) of Mathiapur tola of Jasola village
The ASHA had visited Meena twice and sat at her home and convinced her that this was the best method; she and her family members were convinced and she happily went across to the PHC. However ten days after the IUD was inserted, she started bleeding profusely. Frightened, she visited the PHC with her mother in law and was given a medicine to stop bleeding. With no relief in sight she went with the ASHA and forced the Head Nurse to remove the IUD. Meena's plight is shared by many other women in the Danapur block who have been facing excessive bleeding after the IUD insertions.
As per the NRHM PIP 2001-2012, the Bihar state government spent 5.70 Lakhs on procurement of IUD Kit at PHC level. The Ministry of Health and Family Welfare officials in New Delhi insists and has given statements that the government is now focused on a wide spectrum of contraceptive methods. The idea that there could be contraceptive methods other than sterilisation is something of a shock as for the ASHAs who have undergone family planning training till the seventh module still feel shy when they talk about contraceptives especially about condoms with men. The fact that it is easier to motivate women to come for an IUD, instead of men to use condom has forced the ASHAs to promote IUD instead of condoms to men. What comes as a surprise is the fact that men in the villages are yet to know about contraceptives though they do know that condom stops AIDS, many of them are not aware about dual protection from STI infection and pregnancy.
By Leena Uppal
Published in Eastern Chronicle on 31 October 2013
Primary Health Centres is the first point of contact of a citizen in India with Medical Officers; for an ordinary poor villager this is quite intimidating and my visit to Khagaul PHC proved that for a woman waiting to meet the Medical Officer and sharing her problem was not only intimidating but also quite difficult. Khagaul PHC serves 1 Lakh population and is a Nagar Parishad (a satellite town) in the district of Patna located at a distance of 13 km from Patna city.
My visit to this PHC was on Thursday which is a fixed day static facility that is this was the day every week sterilisation operations are undertaken. Thursday saw the PHC brimming with clients. The PHC was in a dilapidated condition and has been undergoing renovation since the last 2 years; as there was paucity of space sterilisation operations were performed in a temporary operation theatre, and the lab tests were performed in the veranda.
The head nurse at the PHC peeked out of her room with great interest at us (we were a team from Centre for Health and Social Justice, Delhi and IRADA, Patna, a local organisation working on women's health and rights). She called us inside her room and shared her woes and the challenges she faces managing the PHC.
The PHC has only 5 beds for patients. The X-ray room has been converted into the O.T. and the dark room into the infection control room, with only an autoclave placed inside. We need safai karamchari (cleaning assistants); O.T. clothes, draw sheets and mackintosh for patients and mask and gloves for the staff as well as for the patients however there is always dearth of these. There is no running water available or any alcohol-based rub". Not surprisingly, we have to put women on the floor after operations on occasions when the patient load is high".
An assessment of family planning services and informed choice in Danapur block of Patna, confirmed that the health workers have with full energy and vigour focussed on ensuring that they achieve the target set for their PHC in the monthly meeting. This has resulted in no informed choice and complication management, leading to an increase in risk of life of the clients.
“I have never seen an IUD, but the ASHA has said that this is the safest method and I can remove it whenever I want it to be removed. The ASHA or none of the service providers have shared with me that this has any side effects or there are any other birth control methods. The ANM has said that this is the best method.
Meena (age 21 years) of Mathiapur tola of Jasola village
The ASHA had visited Meena twice and sat at her home and convinced her that this was the best method; she and her family members were convinced and she happily went across to the PHC. However ten days after the IUD was inserted, she started bleeding profusely. Frightened, she visited the PHC with her mother in law and was given a medicine to stop bleeding. With no relief in sight she went with the ASHA and forced the Head Nurse to remove the IUD. Meena's plight is shared by many other women in the Danapur block who have been facing excessive bleeding after the IUD insertions.
As per the NRHM PIP 2001-2012, the Bihar state government spent 5.70 Lakhs on procurement of IUD Kit at PHC level. The Ministry of Health and Family Welfare officials in New Delhi insists and has given statements that the government is now focused on a wide spectrum of contraceptive methods. The idea that there could be contraceptive methods other than sterilisation is something of a shock as for the ASHAs who have undergone family planning training till the seventh module still feel shy when they talk about contraceptives especially about condoms with men. The fact that it is easier to motivate women to come for an IUD, instead of men to use condom has forced the ASHAs to promote IUD instead of condoms to men. What comes as a surprise is the fact that men in the villages are yet to know about contraceptives though they do know that condom stops AIDS, many of them are not aware about dual protection from STI infection and pregnancy.