Indian Journal of Public Health

LETTER TO THE EDITOR
Year
: 2015  |  Volume : 59  |  Issue : 3  |  Page : 236--237

Newer innovations in family planning service delivery: A comment on the mobile family planning units


Renu Chauhan 
 Assistant Professor, Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Tanda, Himachal Pradesh, India

Correspondence Address:
Renu Chauhan
Assistant Professor, Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Kangra (Tanda), Himachal Pradesh
India




How to cite this article:
Chauhan R. Newer innovations in family planning service delivery: A comment on the mobile family planning units.Indian J Public Health 2015;59:236-237


How to cite this URL:
Chauhan R. Newer innovations in family planning service delivery: A comment on the mobile family planning units. Indian J Public Health [serial online] 2015 [cited 2019 Jun 20 ];59:236-237
Available from: http://www.ijph.in/text.asp?2015/59/3/236/164671


Full Text

Sir,

We read the article "Mobile Family Planning Unit: An Innovation for Expanding Accessibility to Family Planning Services in Bihar" published in the Indian Journal of Public Health, Volume 58, Issue 4, October-December, 2014. [1] The authors have expressed their concern on the low contraceptive prevalence rate as well as a huge unmet need for spacing and limiting methods. The Bill and Melinda Gates Foundation's Integrated Family Health Initiative (IFHI) Project-proposed innovation of the mobile family planning unit (MFPU) was piloted in Patna district under the hypothesis that MFPUs with trained and skilled providers would increase intrauterine contraceptive device (IUCD) insertions. [2] The MFPU could however be called a "mobile IUCD unit," as the entire focus was on promoting IUCDs. The proverbial "basket of choice" appeared missing, and the role of barrier methods, which not only prevent unwanted conception but also protect against sexually transmitted infections, was undermined.

The average attendance of 24 women/day against an anticipated 15-20/day reflects a high unmet need for family planning. Two hundred thirty (19.8%) women were rejected for IUCD insertion as they were found unsuitable for the procedure for various reasons. This reflects problems related to providers' knowledge and skills, leading to improper selection of clients and poor counseling, all resulting in poor quality of services. Only 37.5% of the women were followed up after insertion. Follow-up is recommended after IUCD insertion because it provides an opportunity for providing care and support to clients who experience any side effects as well as for assessing the general well-being of the clients. [3] The follow-up visits can be utilized for answering questions and reinforcing key messages, and also serve to strengthen the faith of people in the health services. Poor counseling and lack of follow-up, along with improper client selection, are known factors for discontinuation of the use of IUCDs.

There were also some ethical concerns with the functioning of the MFPUs. The exit interview revealed that in spite of traveling up to 7 km, and spending ₹10-15 to reach the mobile van, some women had to return home without insertion due to lack of time or on the pretext of being marked as unsuitable for IUCD insertion. These issues not only reflect managerial and training problems but also raise ethical concerns. Besides, the quality of services should never be compromised in an attempt to increase quantity. Insertion of IUCDs with insufficient emphasis on follow-up care would not only endanger the health of the clients but also adversely impact the faith of the clients in the health system.

The authors have cited lack of trained personnel in public facilities, lack of awareness among Accredited Social Health Activists (ASHAs) and Anganwadi Workers (AWW)s, and lack of accessibility to quality IUCD services as the major reasons for the poor acceptance of IUCDs as spacing methods. The IFHI Project also recommended to the Government of Bihar that each district have a MFPU for outreach IUCD services. This strategy would be appropriate as a stopgap arrangement. A better approach would be to focus on strengthening the health infrastructure in these areas, train and retrain health manpower, and improve public access to quality health services by identifying and addressing the barriers to access.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Moharana PR, Kumari N, Trehan S, Sahani NC. Mobile family planning unit: An innovation for expanding accessibility to family planning services in Bihar. Indian J Public Health 2014;58:289-90.
2Implementation Design for Integrated Family Health Initiative (IFHI) in Bihar, Final Document; 2011. p. 11-5.
3IUCD Reference Manual for Nursing Personnel, Family Planning Division, Ministry of Health and Family Welfare, Government of India; 2007. p. 57-58.