In addition to having available supplies, counseling is key to help anyone choose a family planning solution.

Manisha is a family planning provider at an urban primary health center (UPHC) in Sant Nagar, which is located in the city of Firozabad in Uttar Pradesh, India. She recently recalled how another district once referred a young woman with five children to her for family planning services. Manisha counseled her  about the various family planning methods got to know her need of limiting her family. Post examination, she told the woman was a good candidate for an intrauterine contraceptive device (IUCD), and recommended one. The woman thought for a while and agreed to take the method but  suddenly developed cold feet and refused the IUCD and other family planning methods.

A year later, she returned pregnant to the same UPHC where Manisha worked, asking “Abhi aur bache nahi chahiye, kya karen” (now I don’t want any more children, what should I do?). Manisha recalled thinking to herself if only she had taken a family planning method a year ago, she would not be pregnant for the sixth time and still looking for solutions.

A study commissioned by Uttar Pradesh (UP) -Technical Support Unit in 25 high priority UP districts in June 2017 showed that almost 32% of all pregnancies are unintended or unplanned. In terms of volume, this translates into nearly 1.9 million unplanned births and an unmeasurable burden on the system.

Manisha said clients may be nervous or fearful about trying new family planning methods because of age-old myths and misconceptions, especially related to long-acting reversible methods such as the IUCD. In addition to myths and misconceptions, family planning supplies and equipment are also an issue.

The Challenge Initiative for Healthy Cities’ (TCIHC) team in Firozabad reached out to the Chief Medical Officer (CMO) to get funds released for the UPHC to purchase family planning supplies (IUCDs etc.) and other equipment. The city manager noted that the program implementation planning (PIP) tool developed under TCIHC provides clarity on supply issues that could affect their success in providing family planning services.

Manisha can now offer her clients IUCDs – she provided two in November 2017 – and also counsels them about other modern methods so they can choose a method without any fear. However, the woman who returned pregnant for the sixth time remains etched in her mind as a failure so she now makes it a point to counsel each women on available contraceptive methods for her.

“This is the only way to demystify myths and make a woman comfortable in talking about and asking for family planning service of her choice,” says Manisha.

Acknowledgement: This is one of many efforts being conducted under The Challenge Initiative for Healthy Cities (TCIHC) where the project is working towards scaling up proven solutions in three Indian states. TCIHC is a new approach for providing life-saving reproductive health and family planning information and services to individuals, families and communities. It builds on the demonstrated success of the Bill & Melinda Gates Foundation’s Urban Reproductive Health Initiative (URHI), Expand Access and Quality (EAQ) to broaden method choice and USAID’s Health of the Urban Poor (HUP).

Story Courtesy of Deepti Mathur, Deepak Tiwari, George Philip, Mukesh Sharma