To encourage the use of spacing methods by young women, the Centre proposes to provide contraceptives at the doorsteps now. This will be done by giving monetary incentives to Accredited Social Health Activists (ASHAs) for motivating, follow-up and retention of Inter-Uterine Device (IUDs) and supply of oral and emergency contraceptive pills to prevent unwanted pregnancies.
The financial incentive of Rs. 100 in lump sum will be given at the end of 12 months, if the client motivated by ASHA is able to retain the IUD at the end of 12 months from the date of insertion, she visits the client every third, sixth and twelfth month an the individual is not pregnant at the end of the year.
Statistics show there has been no increase in the acceptance of IUDs in the country over the years which has remained stagnant at 1.7 per cent and the main reason for this is lack of follow-up care after insertion, lack of screening facility to prevent reproductive tract infections and technical incompetence in IUD insertion. It has often been seen that there are minor complaints of spotting and lower back pain after IUD insertion forcing women to get the IUD removed rather than suffer the side-effects.
According to the Ministry and Health and Family Welfare, at least 50 per cent of the IUDs are being administered at the sub-centre and primary health care, and since the auxiliary nurse midwives are already overworked with the service delivery responsibility and documentation, they are unable to follow up with the IUD clients. Since the jurisdiction of ASHAs covers a huge population right up to the sub-centre, their services have been considered useful.
The scheme, expected to cost Rs 6 crores annually, will be rolled out all across the country since the acceptance of IUD is poor in all States irrespective of their Total Fertility Rates (TFRs).
The services of ASHAs will also be used for delivery of contraceptives at the homes of the beneficiaries. They will be allowed to charge Re 1 per pack of 3 condoms, Re 1 for one oral contraceptive pill (OCP) cycle and Rs 2 for an emergency contraceptive pill (ECP), from the beneficiaries. The condoms and pills will be provided free of cost to the ASHA.
The scheme is proposed to be launched in two phases. In the first phase, 223 high focus districts in 20 States with low health indicators which account for high TFR will be covered and if successful, will be extended to the rest of the country. The high focus States include UP, MP, Jharkhand, Uttarakhand, Bihar, Chhattisgarh, Rajasthan, Gujarat, Orissa, Himachal Pradesh, J&K and North Eastern States.
The scheme will cater to the needs of eligible couples who are otherwise unable to access contraceptive services due to lack of privacy. Charging a token amount for the facilities will also increase acceptance and the data of usage would be more credible and accounted for.