Public Sector

Any attempt to improve women's health and status will be incomplete without focussed attention on their reproductive health needs. These needs go way beyond mere contraception and include a constellation of services with emergency obstetric care deserving high priority.

In Uttar Pradesh, the maternal mortality ratio (MMR) is very high at 707 maternal deaths per 100,000 live births. This number is particularly disturbing since it is almost twice India's MMR of 407. Poor ante natal care (ANC), home deliveries, lack of access to emergency obstetric services are the crucial factors contributing to high maternal deaths.

All pregnant women are at risk of obstetric complications. Most life threatening complications occur during labor and delivery, and these cannot be predicted. Therefore, every pregnant woman needs access to facilities with capacity to provide emergency obstetric care. Further, safe motherhood is only one part of the equation. It is imperative that healthcare is available for newborn babies as well. Preventing newborn deaths and improving newborn health and survival go hand in hand with promoting safe motherhood.

In Uttar Pradesh, the government delivers reproductive and other health services through its network of sub-centres, primary health centres (PHCs) and community health centres (CHCs). As CHCs, PHCs and sub centres, without exception, are not geared to provide emergency obstetric care services, the District Women Hospitals (DWHs) are the only functional public sector facilities available for these services. As a result there is an overload on the DWH resulting in clients receiving poor quality care. Moreover it is inconvenient for the clients, as they have to travel considerable distances to be treated by overworked and often insensitive providers.

Recognizing the above gaps, SIFPSA is piloting a project in Meerut district of UP for Strengthening Emergency Obstetric Care & New Born Care from September, 2003. The project aims to address the delay in deciding to seek care, in reaching a first referral level facility and in actually receiving care after arriving at the first referral level facility which often lead to maternal and neonatal mortality.

The Govt. of UP has recently introduced the 380A IUCD which provides 7 to 10 years of contraception. This device is now available at most CHCs, PHCs and sub centres. However, awareness of its features and benefits among both service providers and prospective clients is abysmal. In light of this, SIFPSA has planned a campaign on IUCD promotion. As a first step towards this, separate handbills and leaflets have been designed both for use during provider orientation and for distribution to clients during counselling sessions. These are being made available to districts through SIFPSA PMUs.