LETTER TO THE EDITOR
Year : 2014 | Volume
: 58 | Issue : 4 | Page : 289--290
Mobile family planning unit: An innovation for expanding accessibility to family planning services in Bihar
Prabir Ranjan Moharana1, Nilam Kumari1, Shamik Trehan1, Nirmal Chandra Sahani2,
1 CARE-India, 14, Patliputra Colony, Patna, Bihar, India
2 Department of Community Medicine, SCB Medical College, Cuttack, Odisha, India
Prabir Ranjan Moharana
CARE-India, 14, Patliputra Colony, Patna - 800 013, Bihar
|How to cite this article:|
Moharana 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;58:289-290
|How to cite this URL:|
Moharana 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 [serial online] 2014 [cited 2021 Jan 18 ];58:289-290
Available from: https://www.ijph.in/text.asp?2014/58/4/289/146308
Contraceptive prevalence is 33.3% in rural Bihar below the national figure of 56.3%.  Tubectomy is being adopted since long as the major contraceptive method (29.4%). Couples use condom (1.6%), contraceptive-pill (1.5%), intrauterine contraceptive device (IUCD) (0.5%) and vasectomy (0.3%) for spacing and limiting. There is a huge unmet need for spacing (21.3%) and limiting (17.9%) in Bihar above the national figure of 6.2% and 6.6% respectively.  Major reasons for poor acceptance of IUCD for spacing in rural and hard to reach areas are lack of trained personnel in public facilities, awareness among front-line workers (Accredited Social Health Activists (ASHAs) and Anganwadi Workers [AWWs]) and community and accessibility to quality IUCD services. Bill and Melinda Gates Foundation's Integrated Family Health Initiative Project (IFHI) proposed an innovation of mobile family planning unit (MFPU) into piloting Patna district which hypothesized that MFPU with trained and skilled providers will increase IUCD insertions. 
The MFPU is a fully equipped and air-conditioned ambulance for examination of the client and IUCD insertion. Staffs in MFPU consist of a trained nurse, a van-manager, a female attendant and a driver. The unit travelled distance of 10-100 km on any van-day from Patna to outreach areas to provide "interval-IUCD" insertion services. The clients were selected and mobilized by Front Line Health Workers (FLWs). They went for a pregnancy test of their urine samples. Clients who were negative for pregnancy got registered and counseled. The nurse inserted the IUCD under all aseptic measures as per guidelines from the government of India. 
Sixty-three (97%) camps could happen against 65 camps planned over a period of 6 months. The MFPU provided services for 7-11 days/month in remote areas of the pilot district. A total of 1508 women attended the MFPU in 63 van-days averaging 24/day against anticipation of 15-20/day. Out of 24 women attending the MFPU, 15 women could be inserted; 5 could be followed-up, and 4 women were rejected on average. A total of 929 (80.2%) women availed IUCD insertion from MFPU averaging 15/day. 230 (19.8%) women were rejected for IUCD insertion who were found unsuitable for the procedure for reasons like positive pregnancy test, unexplained vaginal bleeding, foul smelling vaginal discharge, denial from woman after counseling, etc. 349 (37.5%) women out of 929 could be followed-up subsequently after insertion. Number of IUCD insertions that happened was inversely proportionate to the distance of the camp site from the district headquarter (Patna). On some days, women had to return home without insertion due to lack of time. Most of the women were followed-up at home by FLWs after 7 days of insertion.
An exit interview with the women, who availed IUCD from MFPU, revealed that they had to cover a distance of <1 km to 7 km to reach the MFPU. Some clients came by walking while others were dependent on vehicular transport. It cost them about 10-15 rupees. All of them reported that they were informed by their ASHA/AWW about IUCD, camp date and camp site earlier. The camp used to start at 11.00 am and close at 5.00 pm on each camp day. Approximately, 15 min or more were given to each client for counseling and insertion. The nurse informed that, sufficient time was not available to give quality counseling to each of the client. Preprocedural counseling on IUCD by the FLWs during their home visits could have decreased counseling time in the van and increased the number of insertions.
Improper client selection and inadequate preinsertion counseling by the FLWs increased attendance by 3-10 clients/day and wastage of time. Inadequate van-days to meet unmet need for spacing and high operating cost of the van were major issues. The objectives of the piloting were successfully achieved by reaching door steps of the client in hard to reach areas of Bihar and increasing accessibility to quality family planning services. IFHI project recommended to Government of Bihar that each district should have a MFPU for outreach IUCD services at least 15-20 days/month.
Integrated Family Health Initiative Project, CARE-India, Patna, Bihar-800013.
|1||Census of India, 2011. Available from: http://www.nrhm-mis.nic.in/familywelfare2011.html. [Last accessed on 2013 Aug 31].|
|2||International Institute for Population Sciences (IIPS), Mumbai and Macro International, National Family Health Survey (NFHS-3), 2005-06, India: Key Findings, 2007; p. 6.|
|3||Implementation Design for Integrated Family Health Initiative (IFHI) in Bihar, Final Document; September, 2011. p. 11-5.|
|4||IUCD Reference Manual for Nursing Personnel, Family Planning Division, Ministry of Health & Family Welfare, Government of India; December, 2007. p. 22-3.|