Now women in ten more districts in Uttar Pradesh, Rajasthan and Delhi can have more control over their reproductive health with the launch of phase III of Pehel — a women’s health project aimed at reducing maternal mortality burden by promoting family planning and safe abortions.

Incidentally, U.P., Rajasthan and some parts of Delhi are still lagging behind the rest of the country in several health indicators. According to the National Health Profile report, the high maternal mortality rates (MMR) in these States adversely affect the average MMR of the country and hampers the realisation of the Millennium Development Goals of improved maternal and child health.

The initiative is being implemented by the Population Services International (PSI) in collaboration with the Federation of Obstetrics and Gynaecological Societies of India (FOGSI). It would take the total number of districts under Pehel to 30 — 14 in Rajasthan, 15 in U.P. and South-West Delhi — with 1,100 private service providers participating in the project from across the three States, an increase of 18 per cent over phase II.

The phase III aims to place 350,000 IUDs (intrauterine devices) through private service provider clinics and to generate demand among women of reproductive age for long-term contraceptive methods.

The MMR of U.P. and Rajasthan stands at a high 359 and 318 respectively — many of which could be avoided through family planning and safe abortions. Data from various district-level health surveys shows that there are 17.9 per cent, 33.7 per cent and 13.9 per cent unmet needs of contraceptives prevailing in Rajasthan, UP and Delhi, respectively, which have fuelled the rate of unwanted pregnancies associated with high maternal mortality and morbidity.

According to Pritpal Marjara, managing director of PSI, “Pehel Phase III will continue to complement the government’s efforts to reduce MMR and increase the contraceptive prevalence rate (CPR).The project level goal is to improve CPR in the target districts from 54.8 per cent in 2012 to 58.7 per cent by 2015 and increase the percentage of women of reproductive age using IUDs from 4.3 per cent in 2012 to 6.1 per cent by 2015.”

The Pehel project was launched in July 2008 and initially implemented in 10 States providing free services for IUD insertion. Based on the Phase I results, it was decided to focus the programme on just three States for better concentration of resources.

During 2011-2012, a total of 185,739 IUDs were distributed to healthcare providers across the three States, out of which 137,769 were inserted. About 348,402 Medication Abortion (MA) kits were also sold and 1,815 postpartum IUDs inserted during the time period.

Hema Divakar, president of FOGSI, said, “Several States, including Maharashtra, West Bengal and Kerala have proven that family planning helps to promote maternal health and reduce maternal mortality. If we promote family planning in Rajasthan, U.P. and Delhi, it can help us reduce MMR considerably.”

The FOGSI will advocate changes in the Medical Termination of Pregnancy Act, 1971, and encourage the establishment of ‘Doctors Opposing Sex Selected Termination of Pregnancy’ (DOSST) cells by all the FOGSI societies.

India recorded around 56,000 maternal deaths in 2010, which translates into one mother dying every 10 minutes during pregnancy, child birth or within 42 days of delivery. The current national MMR is 212 per one lakh live births, which compares poorly with just 16 for the developed nations. Unsafe abortions are also a leading cause of maternal mortality in India. Of the 6.4 million abortions performed in the country, 3.6 million (56 per cent) are deemed unsafe. Estimates for the contribution of unsafe abortions to maternal death in India vary from 8 per cent to 20 per cent. Unsafe abortions are carried out in unsatisfactory conditions in poorly equipped clinics run by inadequately qualified staff. The problem is acute in rural areas where there is no access to quality healthcare and abortions carry a social stigma.

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