USAID Health Policy Initiative Task Order 1

This United States Agency for International Development Health Policy Initiative (USAID) document describes progress in achieving the goals of the Uttar Pradesh (UP), India, Population Policy adopted in 2000. It includes the implications of alternative fertility and mortality trends during the next decade, and strategies and programme initiatives recommended by national and state policymakers and other experts.

Following a project analysis, UP policymakers and other stakeholders made the following recommendations in December 2007 at the Lucknow, UP, roundtable as strategies for new initiatives in UP’s Reproductive and Child Health Program to help move the state closer to the goal of population stabilisation.

• "Make communication strategies more focused and strategic" - "UP must develop and implement more focused communication strategies to reach the target populations with relevant and appropriate information."
  1. "Considering the importance of socio-cultural factors, the key audiences for communication should include mothers-in-law and husbands - the main decision makers at the household level. Health-related messages, such as "mothers-in-law care", "family planning saves children’s lives", or "modern contraceptives can prevent unsafe pregnancies", need to be created to reach these specific audiences.
  2. General communication strategies should also emphasise the socio-economic benefits of family planning, such as allowing mothers and fathers to work and save money so that their children can attend school and family members can have a better future.
  3. Many women who use traditional methods for birth spacing experience high rates of unintended pregnancy due to method failure, incorrect use, or inconsistent use. Health providers need to provide women using traditional methods with complete and accurate information on correct use of these methods, as well as information on modern contraceptive methods so that they can make an informed choice."
• "Strengthen community participation" - "UP must strengthen community participation and fine-tune strategies to identify and sensitise local leaders in the communities. This is especially important in communities where local groups oppose family planning. Such groups might launch campaigns to block the implementation of family planning policies or programs or prevent segments of the population from availing of family planning information and services. Other community members might not be well-informed about the benefits of family planning and sources of contraceptive methods."
  1. The Reproductive and Child Health Program can broaden its outreach by involving community leaders to mobilise local groups in mass information campaigns about the benefits of family planning to families and the community.
  2. Community leaders can foster the active participation of household members, particularly mothers-in-law and husbands, who are often the ones who make family planning decisions. Much can be achieved if these key household members are involved in community campaigns aimed at wider appreciation of the benefits of family planning for maternal and child health.
  3. Involving community leaders and representatives in dialogue with UP policymakers and other stakeholders is also important in identifying and addressing barriers to access and in promoting community ownership of the Population Policy goals. Various stakeholders should also be involved in assessing and implementing policies and programmes.
• "Stimulate private sector involvement and public-private collaboration" - The private sector should be engaged more fully, as it encompasses non-governmental organisations (NGOs), cooperatives, commercial entities, and private health providers.
  1. The policy environment to determine and address the disincentives to private sector involvement in family planning services must be reviewed and barriers to their active engagement removed.
  2. To expand the role of the private sector in family planning, the Reproductive and Child Health Program must identify the different market segments for family planning services and assess the capabilities and reach of service delivery mechanisms and providers.
  3. The Reproductive and Child Health Program should also work to build partnerships with NGOs and other private groups on a large scale that reach out to the economically poor and other vulnerable populations with family planning services.
  4. Cooperatives - especially those in the agricultural, manufacturing, and service sectors - need to be involved so they can help disseminate family planning information and provide support services to their members.
  5. Large commercial or manufacturing establishments with in-company health services are also potential partners in increasing access to family planning services.
• "Make postpartum family planning a standard service" - "'Jannani Suraksha Yojna,' which encourages women to deliver in health facilities, is a highly popular program under the National Rural Health Mission in UP and has succeeded in increasing the number of institutional deliveries. This program can serve as a model for the integration of postpartum family planning as a standard service within delivery institutions in UP. These programs can also reach women during their stay at the health facilities, provide them with family planning information, and motivate them to consider using family planning. Doctors, nurses, and accredited social health activists (ASHAs) can all play a role. The postpartum setting is also an opportunity to reach out to husbands and mothers-in-law, as one or both usually accompany the woman for delivery."
• "Ensure contraceptive security" - “Contraceptive security” means that all people are able to choose, obtain, and use high-quality contraceptives whenever they want and need them. The roundtable discussions reaffirmed the importance of ensuring the timely supply of services and commodities to achieve the goals of the Population Policy. Participants emphasised the provision of high-quality family planning information, counseling, products, and services through various channels, including public institutions, the network of ASHAs, and non-governmental service delivery organisations.
• "Produce higher quality data and analysis" - The identification of specific family planning needs requires statistical and health systems that provide high-quality, region-disaggregated data on basic population and health information. Moreover, information on gender, caste, religion, language, and other socio-economic factors is needed to effectively develop targeted communication, service, and outreach strategies and interventions.

During the second meeting in New Delhi, senior policymakers from the Ministry of Health and Family Welfare further discussed meeting unmet needs through repositioning family planning within the overall package of reproductive and child health interventions in UP. Participants deliberated on the state-specific interventions identified during the Lucknow roundtable and then generated targeted actions to ensure contraceptive security, strengthen communication strategies, and increase community involvement in decision-making. These actions include:

• "Increase the availability of maternal health, reproductive health, and child health services by having round-the-clock services in a minimum of 10 percent of primary health centres, as is being done in other states;
• Conduct a study on the acceptability of the multi-load copper intrauterine device...;
• Expand the basked of family planning methods available under UP public services in order to offer more method choice...; and
• Improve access to high-quality services by having fixed days for sterilisation instead of periodic sterilisation days....."

Health Policy Initiative website accessed on April 14 2009; and email from Cynthia Green on May 19 2009.