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Arth offers pregnancy, post-natal and contraceptive care
to women in 27 villages in Rajasthan
Twenty-eight-year-old Hunki Bai has travelled 10 kms to
reach Arth, a clinic run by Drs Kirti and Sharad Iyengar. She has come all
this way to get her three-month pregnancy aborted. Hunki Bai has four sons and two daughters, and
doesn't want any more children. But very few young couples in rural
Rajasthan use contraceptives. In a society
which places great importance on a woman's fertility, women rarely
have either the knowledge or the opportunity to control their fertility.
This has devastating effects on the health of women and their children.
And when women have little access to essential healthcare, pregnancies --
even desired ones -- can threaten their health, their lives. One hundred
thousand In!
dian women die from problems related to pregnancy every year. Most of
these deaths could have been prevented if they had access to prenatal
care, clean delivery practices and emergency obstetric care. It was this scenario which prompted Dr Kirti Iyengar and
her husband Sharad to start Action Research Training in Health (Arth),
located in Kucholi village in Kumbhalgarh tehsil, 52 kms from Udaipur.
In 1998, Arth did a baseline survey of
pregnancy-related care in the villages they covered. Only 29 per cent of
pregnant women received prenatal care, 34 per cent were immunised against
tetanus, and 33 per cent got iron folate tablets (for anaemia). Just 2 per
cent of home deliveries were conducted using disposable delivery kits,
asnd the use of gloves during home deliveries was unheard of. Arth works in 27 villages covering a population of
30,000 people. They have three 'social animatorsR!
17; who provide men with health education, 40 village-level women
volunteers, two nurse midwives and one field supervisor. Arth offers
pregnancy and post-natal care, gynaecological consultations, guidance on
contraception and safe abortion services. The clinic is open twice a week
and has serviced 1,869 clients in the last year. Arth responds to women's unvoiced demand for
contraception, believes Kirti. More than 22 per cent of the clientele
come for abortions; 24 per cent are looking for contraception. Initially the programme faced some resistance. The local
people suspected the doctors' motives, thinking they were religious
workers trying to convert them. Men were furious when they found out that
their wives were opting for contraception without their knowledge. When
men were given condoms, women felt it made it easier for the men to go to
prostitutes. However, things are changing. Arth has taken contraception and reproductive health to the
community through its outreach programmes in nearby villages. It works
through female volunteers who distribute oral contraceptives, condoms,
delivery kits and iron tablets and also educate and motivate
women. Many of Arth's efforts will
reduce the number of women dying during pregnancy, though its effect is
not easy to measure. Maternal death is a relatively rare event, so
maternal mortality as an 'outcome indicator' is difficult to
measure in small surveys. However, since most maternal deaths are to do
with access to care, 'process indicators' which reflect
healthcare access can give a good picture of the situation. When Arth did a follow-up on their baseline survey two
years after they started work, they got striking results. Fifty-two per
cent of women in the area received prenatal care (29 per cent in 1998), 56
per c!
ent were immunised against tetanus (34 per cent in 1998), 52 per cent got
iron folate tablets for anaemia (33 per cent in 1998), a massive 61 per
cent of home deliveries used disposable delivery kits (2 per cent in
1998), and 30 per cent used gloves (none in 1998). Finally, contraceptive
usage among women with one or two children had gone from 8 per cent to 18
per cent. In other words, increased access to
contraceptive services and essential maternal care have had a positive
impact on the women of these Rajasthan villages. Contact: Dr Sharad
Iyengar
ARTH
39, Fatehpura
Udaipur - 313004
Rajasthan, India
Email:
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