TCI-Coached Gynecologist in Rawalpindi, Pakistan, Strengthens Local Capacity in Postpartum and Post-Abortion Family Planning

Feb 26, 2024

Contributed by Aiman Haroon and Raja Nauman Hafeez

TCI-Coached Gynecologist in Rawalpindi, Pakistan, Strengthens Local Capacity in Postpartum and Post-Abortion Family Planning

Feb 26, 2024

Contributed by Aiman Haroon and Raja Nauman Hafeez

Dr. Rubab (right) during the two-day capacity strengthening workshop.

District Rawalpindi in Punjab province is a vibrant tapestry of cultures, beliefs, and traditions in one of Pakistan’s five most populous regions. In the peri-urban colony of Dhok Mangtal, Dr. Umm-E-Rubab, a Master Coach trained by The Challenge Initiative (TCI), is a practicing consultant gynecologist at the Municipal Medical Health Center (MMCH) dispensary.

Dr. Rubab acknowledges that the diverse cultural, religious, and ethnic backgrounds of her community informs her approach to healthcare provision, including family planning services. The population in her catchment area overwhelmingly consists of the Pashtun community, migrated from Khyber Pakhtunkhwa province in Pakistan and Afghanistan, where polygamy and large families are common. Recognizing the norms and values of the Pashtun community in Dhok Mangtal is especially critical to effectively deliver family planning services tailored to their needs.

The lack of knowledge that married couples had about family planning led to women more frequently turning to abortion instead of adopting contraceptive methods, ultimately compromising the health of the mother, child, and entire household. But that situation is changing thanks to Dr. Rubab being nominated by the Government to serve as a master coach for postpartum and post-abortion family planning (PPFP and PAFP). She immediately began coaching women Medical Officers, Lady Health Visitors service providers, and others.

Improving the Situation

The District Health Authority in Rawalpindi arranged a two-day capacity strengthening workshop for 20 healthcare providers on PPFP and PAFP (two of TCI’s high-impact practices). Dr. Rubab’s role as a master coach was instrumental in facilitating this training and fostering an environment for interactive learning and skill development. She took participants through theoretical aspects and hands-on skills-building exercises over the course of the two days. The training was interactive and participatory, with participants sharing their experiences and real-life situations. The participants learned concepts such as the three postpartum periods, post-abortion care and family planning methods.

By equipping healthcare providers with the necessary knowledge and skills, Dr. Rubab empowered them to provide non-judgmental and comprehensive family planning services. This approach is helping to address myths, misconceptions, and fears surrounding long-acting reversible contraceptives (LARCs) and encourages informed decision-making among women and couples. Dr. Rubab mentioned that during and after this training, she observed a substantial improvement in the trainees’ perspectives and values regarding PPFP and PAFP. The participants also improved their hands-on and counseling skills.

Dr. Rubab’s philosophy of “miss no opportunity” led her to integrate PPFP, PAFP, and contraception with other capacity-building sessions that she conducts, like Safe Birth training for trained birth attendants and nutritional counseling sessions. The trained staff now counsel women during all stages of pre and post-natal care so they can take advantage of every occasion to save and improve lives and monitor maternal indicators. She also ensures that the patients counseled for PPFP and LARCS are followed up with regularly, maximizing opportunities for family planning counseling and education at every point of contact with healthcare providers. Dr. Rubab shared:

 Women can be game changers in family planning. When you counsel one woman, you counsel 10 women through her. The ripple effect can create a massive impact and enable women to make informed decisions.”

Dr. Rubab (right) leads a hands-on training session.

Dr. Rubab appreciated TCI’s efforts and has seen a gradual but continuous increase in LARC uptake in Rawalpindi since TCI engaged the city in June 2022. Previously, women and couples favored short-term methods but now ask for LARCs as they are counseled by trained service providers and lady health workers. It clearly shows that clients’ myths, misconceptions, and fears regarding LARCs have been allayed. To provide more tailored services, they have added client data for postpartum intrauterine device (IUCD) insertions into the monthly statistics, boosting confidence amongst the service providers and beneficiaries.

Engaging Young Married Couples

Recognizing the importance of male engagement in family planning decision-making, Dr. Rubab emphasizes the role of social mobilizers in creating demand for family planning by engaging couples in discussions about family size and maternal and child health. Now, when young married couples visit the facility for family planning counseling, 25 social mobilizers are available to provide them with accurate information.

Dr. Rubab’s commitment to monitoring and evaluating the uptake of family planning services, including postpartum IUCD insertions, demonstrates her dedication to continuous quality improvement. By regularly assessing the effectiveness of these interventions and addressing challenges, healthcare providers can ensure that services meet the evolving needs of the community. Dr. Rubab convinced service providers of the importance and implementation of PPFP as the only way to upscale this intervention effectively and efficiently. Also, building the capacity of the healthcare providers and developing them as new master coaches can bring out small but powerful and meaningful changes within the health system, directly serving the communities’ needs.

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