Reproductive Health Within Reach
The IFPS Project was designed before the Cairo Conference. Thus the project objective was to expand family planning information and services to increase contraceptive prevalence and reduce fertility. It was only after the mid term assessment of the Project that it was decided to include reproductive health indicators in 1998. These relate to ante natal care and safe delivery services. After preliminary research it was decided that the percentage of pregnant women receiving two doses of Tetanus Toxoid (TT) would be a suitable indicator of access to antenatal care. Similarly, deliveries attended by trained providers could act as a surrogate for safe delivery services. Expected levels of achievement were determined for each of these indicators year wise by USAID. These were to be annually tracked by independent surveys.

O	Deliveries Attended by Trained TBAs

Extending Antenatal Care
SIFPSA also started a host of activities for orientation, capacity building and service delivery related to reproductive health. Notable among these was the tetanus toxoid campaign for pregnant women.
This innovative strategy was adopted to bring services to difficult to reach target groups quickly, in a cost effective manner, using a mix of private and public sector resources.
A door to door enumeration of pregnant women was carried out by grassroots workers to register them for antenatal care. An innovative IEC campaign involving women’s groups and community based female volunteers with a strong interpersonal counselling element was used. This conveyed the benefits of TT immunization both for the mother and the new born and exhorted women to visit the immunization centres during the campaign period.
The antenatal coverage which was stagnant, rose sharply to well above planned levels from 1999 onwards till the campaign continued upto 2002. During this period, ambitious targets of ANC were met. The campaign also sharply raised awareness levels about the grave risk of tetanus to mother and new borns and that tetanus was preventable.

Pregnant Women Protected from Tetanus	O

Improving Delivery Practices
Simultaneously SIFPSA developed its traditional birth attendant (TBA) training strategy. What set it apart from other similar programmes, however, was the process followed, which had a unique private-public sector partnership component.
While the private sector (an NGO in each district) handled the training of lead trainers, the health department actually conducted training of the dais and maintained post-training linkages to provide services to all pregnant women and screen referrals of high-risk cases. It also saw the development of a training curriculum as well as materials to support the training drawing on the best expertise available in the government & NGO sectors.
The dais were trained for the following :
1. to conduct deliveries in aseptic conditions using “five cleans”
2. to identify and refer high risk pregnant women
3. to promote family planning
4. to counsel on importance of antenatal care.
Since the dai is normally an illiterate village woman, record keeping and reporting by dais was kept to a minimum and these were in pictorial form.
Efforts were made to train at least one dai from every village. Support of pradhans was elicited by inviting them to the valedictory session of the training programme. Trained dais were provided identity cards & name boards. They were followed up & supervised by ANM. Promotion of safe motherhood & trained dais through wall paintings & other activities was also done.
As a result of this intervention which began in 1999 and spread to 17 districts, the safe delivery indicator shot up to well above planned levels and is today about 8 percentage points above the targets set by USAID.