Increasing Postpartum Check-ups and Contraceptive Use Among Young Women in India: Creating Conditions for Scale-up Mary Philip Sebastian & M.E.Khan India Partners: LLRM Medical college, Meerut; Department of health and family welfare; & Integrated Child Development Scheme (ICDS) project

Purpose Background: 28% of all births are spaced less than two years apart Goal: To promote 24 months birth to pregnancy interval for better pregnancy outcomes Best Practice: Promote Lactational Amenorrhea Method (LAM) and postpartum contraception Reason this BP chosen: Tested BP in phase 1 and now expanding Budget:US$169,894

Progress Orientation of district officials – District officials, PHC medical officer, DPO, CDPO and supervisors from ICDS – TOT completed; date for community worker training finalized Training of community workers from 52 villages – Completed in Batches with 25 workers – 471 community workers trained – Pre-post training test conducted Educational campaign and service delivery is ongoing

Pre & Post Test results: Community workers training Sub-district Name Average % correct- Pre-testPost-test Sardana66*96 Daurala68*97 Mawana2683 Hastinapur4389 * High since covered in Phase 1

Baseline measures compared to post-intervention, Index women Mentioned:Baseline (n=820) Monitoring check (n=220) At least 2 health benefits of HTSP 67%98.6% 3 conditions of LAM2%54.5% Fertility returns in about 40 days after delivery 1.1%54.5% Out of 416 index women delivered so far; 364 (87.5%)were delivered in institution

Voices from Field ASHA said “ We’re happy you chose our village for training. First time we are being taught all this. We did not know spacing could save lives ”. Initial visits shows that project has created supportive environment for IUDs. – One pregnant women said “ I will use IUD after delivery because I want next pregnancy after 3 years ”.

Capacity Building Activities Undertaken Orientation of district officials Training of community workers Training supervisors in monitoring and supervision Sharing monitoring check results in monthly meetings and reorientation on needed topics

Challenges Identification of private doctors was Time consuming – Most village doctors are quacks – Identified MBBS doctors from adjacent areas – Difficult to persuade for full day training Pulse polio campaign left very few dates available for training of community workers Frequent transfer of officials; Vacancy and frequent transfers is expected to continue

Lessons Learned Simple to implement, and very effective in achieving outcome of HTSP, practice of LAM and postpartum contraception Acceptance of community workers in family increases if counseling focus is HTSP and its benefits to mother, child and family Monitoring improves community workers’ quality of counseling IEC materials, counseling aids and work registers developed are effective and useful tools

Modifications Long term technical assistance required Monthly meetings for ASHAs need to be organized regularly ASHA should be given topics for group meetings in monthly meetings Quality of monitoring and supervision in villages needs improvement Make registers and supervisor checklists part of MIS, effort ongoing