Meeting Unmet Family Planning Needs
in Rajasthan, India

Box 22

A programme in the impoverished Indian state of Rajasthan is using a new strategy to assist people who want to limit their family size or space their children's births, but do not know how to or where to get contraceptives. Conceived by the Indian Institute of Health Management Research and implemented by the state's health department, the programme began in April 1995 in two of Rajasthan's most populous districts, Tonk and Dhausa. Some 17 per cent of couples surveyed in these districts in April 1995 expressed an unmet need for family planning services.

The door-to-door survey was conducted by grassroots health workers and auxiliary nurse midwives, who recorded the names of all eligible couples and their need for contraceptive services as well as pre- and post-natal care. Reproductive health centres have been set up in several villages. Motivated nurse midwives and female health assistants offer their clients a mix of family planning and child survival services. A majority of couples contacted under the programme have accepted one of the four methods of contraception offered—the pill, intra-uterine device, condom and sterilization. The advantages and disadvantages of each method are clearly spelt out for all participants. Under the programme, there is no compulsion, no targets, and no motivation fee.

The IUD is the most popular contraceptive method, but the discontinuation rate for IUDs has been extremely high because of a high incidence of reproductive tract infections and anaemia. Consequently, the programme offers an IUD only after verifying that the woman is healthy enough to retain it. Others can receive an IUD after their infections are treated. The result has been a vast increase in the IUD retention rate.

Between April 1995 and April 1996 the percentage of couples using modern contraception in Tonk and Dhausa has increased from 31 and 35 per cent to 41 and 40 per cent, respectively. The programme has since been extended to the whole state.

Source: UNFPA. 1997. "Bringing Hope to Rajasthan." Populi 24(1): 4-5.