Sexual and Reproductive Health

Awareness and care provision in abortion

Globally unsafe abortion is one of the major preventable causes for maternal deaths. Laws protecting women’s health and rights are important for decreasing the number of women undergoing unsafe abortion. In SEAR, India and Nepal has most liberal abortion laws. The quality of available services, clinical skills of the service providers, timely records, standardized reporting mechanism, use of records/ reports in decision making, and availability of services have to be tracked and researched. There is a need to find out both supply and demand side factors which is affecting the accessibility, availability and use of existing services.

SEARO, WHO has developed a tool which has two parts;

  • The first part is to understand the demand side factors like capturing women’s knowledge on abortion laws in the country, the services availability, their utilization and existing social norms and support.
  • The second part is a service provision tool to capture the type of available abortion services, post abortion care and family planning including complications management.
  • Read More

Awareness of cervical cancer among different community stakeholders and development of package to strengthen capacity of community health workers

Background

Cervical cancer is the second most leading cause of cancer deaths in India, which mostly occurs in women of the age of 35 years and above. To eliminate cervical cancer by 2030, WHO proposed a global strategy which says that 90% of girls must be fully vaccinated with HPV vaccine by the age of 15 years; 70% of women must be screened with a high-performance test by 35 years of age and again by 45 years of age; and 90% of women identified with cervical disease must receive treatment.

The disease is preventable through vaccination and screening. However, in India, HPV vaccination is yet to be included in National Immunization Programme (NIP). The availability of this vaccination is limited to private health facilities. Moreover, as per National Family Health Survey India (NFHS, 2019-20), only 3.1% eligible women have undergone screening.

To understand the reason for this gap, SWACH undertook a study supported by WHO. The study aimed to explore the current awareness level of cervical cancer amongst the various community stakeholders.

Read More

Community based response to adverse sex ratio

Background

The census data from 2001 revealed a concerning decline in the sex ratio in India, particularly in the age group of 0-6 years, dropping from 945 females per 1000 males in 1991 to 927 in 2001. This imbalance was particularly evident in states like Punjab, Haryana, Rajasthan, Gujarat, and Maharashtra. The data indicated an increasing trend in the relative mortality of girls after birth and gender imbalance in most states. Rajasthan, despite an overall improvement in sex ratio, experienced a continuous decline in the 0-6 age group from 954 in 1981 to 909 in 2001.

Sex ratio imbalance is seen as a result of both higher mortality rates for girls after birth and an increase in sex-selective abortions, reflecting underlying socio-economic and cultural practices. To address this issue, the Dignity of Girl Child (DGC) Program supported research and interventions in Rajasthan, impacting government administration, Community Based Organizations (CBOs), and mobilizing communities to enhance the dignity of girls in the state. Organizations were supported to strengthen grassroots and official responses against sex selection through sensitization and training on implementing the PC PNDT Act (Pre-Conception and Pre-Natal Diagnostics Technique Act).

Read More

Updating Family planning decision making tool (FPDMT)

Background

The Decision-Making Tool (DMT) of the World Health Organization on Family planning is a comprehensive resource designed to assist healthcare providers in offering personalized family planning services to their clients. It provides evidence-based guidance on various contraceptive methods and helps the providers to engage with the clients in a shared decision-making process based upon the individual needs and preferences, as well as medical eligibility criteria. The DMT aims to improve the quality of family planning services and increase access to contraception, thereby promoting reproductive health and rights for all.

The Decision-Making Tool (DMT) was created in 2005. Recently, the World Health Organization updated the DMT to include all the new methods of contraception as well as updating the existing methods.

Read More

Fortified salt for the improvement of micronutrient status among women of reproductive age and preschool‑aged children in Punjab, India: a randomized, controlled, community‑based trial.

The burden of iron, zinc, vitamin B12, and folate deficiencies among women of reproductive age (WRA) in India is high. India’s 2016–2018 Comprehensive National Nutrition Survey (CNNS) found that while 31% of adolescents were deficient in zinc nationwide; in Punjab, this prevalence was 52%. Micronutrient deficiencies during the preconception and antenatal period increase the risk of adverse pregnancy and birth outcomes. Zinc is essential for immune health, reproductive function, growth, and development, and its deficiency during pregnancy has been associated with an increased risk of preterm birth. Vitamin B12 and folate are essential for DNA synthesis and neurological development, and deficiencies increase the risk of miscarriage and congenital abnormalities, including neural tube defects. Large-scale food fortification (LSFF) is an effective, low-cost, and safe strategy to address micronutrient deficiencies at the population level. Among the food vehicle options available in resource-poor settings, salt is considered effective because it is relatively inexpensive, consumed in fairly consistent amounts across population

Read More

Community based Research on understanding of male reproductive health and feasibility of specific interventions

Background

Reproductive and child health (RCH) has received increasing attention in India. The MCH and family planning program were consolidated into child survival and safe motherhood program. A major deficiency in these programs is the relative inattention to male involvement. This is now being increasingly discussed. With the rising rates of sexually transmitted infections (STIs) and increasing threat from HIV/AIDS epidemic it is being increasingly realized that marginalization of men will be harmful to the health of the women as well. Meaningful involvement of men in reproductive and child health requires a deep understanding of sexuality, male sexual behaviour and their determinants like alcohol, drug addiction etc. In addition, understanding of perceptions regarding sexual health problems in males and their care seeking pattern when sick are important in shaping the policy towards male involvement in reproductive health. Keeping these points in mind, a study was conducted with the following objectives

Objectives

  • To determine men's perceptions and understanding of their own and their partner's reproductive physiology and sexuality.
  • To understand men's pattern of marital and non- marital sexual behavior.
  • To assess men's health care seeking with respect to sexual and reproductive behavior.
  • To investigate popular health care providers practices in the management of men's reproductive and sexual health problems.
  • To improve the treatment practices and prevention advice given by the popular health care providers in dealing with the problems relating to men's reproductive health.
  • To strengthen the capacity of the popular health care providers in tackling
  • Common concerns and behavioral reproductive health problems of men through interpersonal communication.
  • To create awareness in the community regarding male reproductive health problems
  • To enable the use of appropriate preventive and health care seeking behaviour.
Read More

Capacity development and convergence of village committees (clean pads)

Background

Practice of using homemade pads during menstruation is quite widespread in rural and urban slum areas of Haryana. Home-made pads are made from old clothes or rags that are available in households. These are generally not clean. A project supported by Department of Rural Development Government of Haryana was started to bring out a change in the existing practice of discontinuation of the homemade pads and use of clean pads. The access to clean pads available in market as sanitary pads is limited in the urban slums. Locally assembled clean pads may help to increase their access. In order to promote women empowerment, and narrow the gender imbalances, it was proposed by SWACH to bring about convergence amongst different committees established at the village level (village panchayat, health and sanitation committee, sakshar mahila samuh etc.) and interested people in the villages and urban slums to promote the adoption and use of clean pads during menstruation. This would contribute to better hygiene, reduction of HIV/AIDS, STI and RTIs, and women empowerment by reducing the absenteeism at school and at work resulting from menstruation. The adoption of this practice would also serve as an entry point for building the life skills of female adolescents.

Methodology

  • An advocacy kit was developed that comprised of definition of menstruation, its importance, and current practices relating to menstruation in the rural area, the implications of the use of home-made pads, clean pads and sanitary pads that are sold in the market. It includes a description of the correct use and safe disposal of the used pads. The kit also provides a broad guidance on the promotion of use of clean pads in the villages and urban slums. Guidance is also provided on the possible role that different members in the community can play to promote the use of clean pads/sanitary pads. The advocacy kit was developed to seek the support and cooperation of state and district level officers of various departments i.e. health, rural development, education, social welfare, women and child development etc. for the promotion of clean pads and to enlist their support. The kit was used during the district level orientation meetings and subsequent meetings with individual officers and functionaries at different levels.
  • Read More

Guide to community based health workers and booklet for the community to support Individual's Self Care on safe-abortion, post-abortion care and contraception

The study was an extension of the project of developing the Illustrated guide and Pictorial booklet on Safe abortion with the aim to pilot the two documents before adoption by member countries of South East Asia Region of WHO, It was conducted between 16.10.2023 to 31.12.2023 with the funding from WHO and had the following specific objectives:

  • To translate the ‘Illustrated Guide for Community based Health Workers’ and the ‘Pictorial booklet for women in the community’ for promoting self-care on Safe abortion, Post-abortion care and Contraception into ‘Hindi’.
  • To train Community based Health Workers on the contents and usage of the ‘Illustrated guide’ and ‘Pictorial booklet’
  • To pilot the ‘Illustrated guide’ and the ‘Pictorial booklet’ on self-care in the community and determine the change in knowledge levels of the participants.
Read More