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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 2  |  Issue : 1  |  Page : 10-14

Assessment of family welfare services with respect to couple-years of protection in a primary health center of Varanasi, Uttar Pradesh


1 Department of Community Medicine, Maharshi Vashishtha Autonomous State Medical College, Basti, Uttar Pradesh, India
2 Primary Health Centre, Varanasi, Uttar Pradesh, India

Date of Submission26-Dec-2020
Date of Decision19-Jan-2021
Date of Acceptance31-Jan-2021
Date of Web Publication31-Mar-2021

Correspondence Address:
Dr. Kshitij Raj
Department of Community Medicine, Maharshi Vashishtha Autonomous State Medical College, Basti - 272 124, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jphpc.jphpc_30_20

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  Abstract 


Introduction: Program for family welfare or planning is one of the earliest health programs running in Independent India. Budget estimate of Family Welfare Schemes in India for the year 2019–2020 is 950 crores. Despite this, irregularities and under performance of various contraceptive services are reported. Objectives: To assess the family welfare services in a primary health center of Varanasi. Methods: Monthly data of family welfare from April 2018 to March 2019 were collected from PHC and analyzed with permission of Medical Officer in Charge, Chiraigaon. Services were assessed in terms of total family welfare OPD females, total counseling (antenatal case/postnatal case), deliveries, and various methods of contraception. The Couple-years of protection for the individual methods of contraception was calculated. Results: About 51% of females attending clinic were counseled, 40% of females delivering in PHC utilized postpartum intrauterine contraceptive device (PPIUCD). Correlation coefficient between females counseled and parameters such as sterilization varies from weak to strong positive. Two new services Depot Medroxy Progesterone Acetate Antara and oral contraceptive pills Chhaya were introduced, but their availability was not regular. Conclusions: Adequate services for family planning were available, but regularity of few was having issue in the year analyzed. More efforts are required to increase PPIUCD use.

Keywords: Contraception, couple-years of protection, female, primary health center


How to cite this article:
Raj K, Chaurasia R, Singh AK. Assessment of family welfare services with respect to couple-years of protection in a primary health center of Varanasi, Uttar Pradesh. J Public Health Prim Care 2021;2:10-4

How to cite this URL:
Raj K, Chaurasia R, Singh AK. Assessment of family welfare services with respect to couple-years of protection in a primary health center of Varanasi, Uttar Pradesh. J Public Health Prim Care [serial online] 2021 [cited 2021 Jun 21];2:10-4. Available from: http://www.jphpc.com/text.asp?2021/2/1/10/312699




  Introduction Top


Today, the family planning (FP) program is incorporated in the reproductive and child health component of the National Health Mission in India. The Sustainable Development Goal 3.7 also states that by 2030 everyone should have access to FP and reproductive health to be integrated into the national strategies and programs.[1] The FP schemes in India and Uttar Pradesh are encouraging the use of modern methods of contraception as evident from the NFHS 4 data that the prevalence of the use of modern contraceptive methods is more than that of the traditional methods.[2] Public health sector is the source of providing modern contraceptive services to more than two-third of the users in India according to the NFHS 4 data.[3]

The Indian government is trying effortlessly to lower the fertility by encouraging FP through free counseling and contraception through primary health services and cash incentives for sterilization. Budget estimate of about 950 crores is to be expended for Family Welfare Schemes in India for the financial year 2019–2020,[4] but in discretions and low performance of several contraceptive services are reported in many newspapers and in NFHS 4.[2],[5]

While new contraception methods are being introduced in the rural India, the contraceptive use is still relatively low in compare to urban (NFHS 4).[2],[5],[6] There is an urgent need to increase the use of contraception in the rural areas to stabilize the population. The provision of the contraceptive and other services are done through primary health centers. In view of the above, the study was planned with the objective to assess the family welfare services in a primary health center of district Varanasi.


  Methods Top


Ethics

the study is on the secondary data obtained by permission and help of Medical Officer in Charge, PHC Chiraigaon, Varanasi. The information of the study may support the medical officer in charge to improve the contraceptive services. The individual data of any person are unknown to the authors as no study subject was interviewed; hence, the study is in harmony with the ethical standards of the World Medical Association Declaration of Helsinki (1975), revised in 2000.

Monthly data of family welfare services of Primary Health Center (PHC) Chiraigaon, Varanasi from April 2018 to March 2019 were collected with the help of the Family Welfare Counselor PHC Chiraigaon and analyzed with the permission and help of Medical Officer in Charge, PHC Chiraigaon. Services were assessed in terms of family welfare OPD females, total counseling (antenatal case/postnatal case) done, deliveries, postpartum intrauterine contraceptive device (PPIUCD), intrauterine contraceptive device (IUCD), female sterilization, male sterilization, Depot Medroxy Progesterone Acetate (DMPA) Antara, oral contraceptive pills (OCP) Mala N, OCP Chhaya distributed, and condoms distributed. Couple-Years of Protection (CYP) is defined as “The estimated protection provided by FP services during a 1-year period, based upon the volume of all contraceptives sold or distributed free of charge to clients during that period.”[7]

The CYP for the individual methods of contraception was calculated using the conversion factors given on the official website of the USAID (United States Agency for International Development).[7] The data were entered, and graphs were plotted using MS Excel version 2010. Correlations between different services were calculated and analyzed using the software SPSS version 16. (IBM SPSS Statistics, U.S.A.)


  Results Top


A total of 9121 females attended in the year for seeking reproductive health and contraceptive services in PHC Chiraigaon and about 51% of them were counseled regarding family welfare services. The number of deliveries conducted was about 38% of the number of females counseled. Two types of the IUCD were in use, Cu380A and Cu375. Female sterilization done though account for maximum CYP was similar in number to PPIUCD inserted, but merely eight male sterilizations were done. In the year 810, menstrual cycles were covered by OCP (Oral OCP) Mala N, calculating to 54 females contracepted throughout the year. On an average, 237 condoms were distributed every month directly from the PHC but account for mere 23.7 CYP. Two new contraceptive services, namely DMPA (Depot Medroxy Progesterone Acetate) injections and OCP Centchroman (Chhaya) were introduced/reintroduced in the PHC during mid-year with CYP by DMPA of 25.25. CYP conversion factors of Centchroman were not available [Table 1].
Table 1: Services provided at primary health center Chiraigaon during April 2018 to March 2019

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From the line diagrams [Figure 1],[Figure 2],[Figure 3],[Figure 4],[Figure 5],[Figure 6] below, we can observe that there is a wide difference in the month to month utilization of the some contraceptive services and the variation seems some incongruence with the variation in the females counseled or delivered.
Figure 1: Monthwise total outpatient department and total counseling done

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Figure 2: Month-wise total deliveries, postpar tum intrauterine contraceptive device and interval intrauterine contraceptive device provided

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Figure 3: Month-wise female sterilization done

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Figure 4: Month-wise mala N (oral contraceptive pills) distributed

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Figure 5: Month wise depot medroxy progesterone acetate injected and Centchroman pills provided

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Figure 6: Month wise condoms distributed

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Both OPD numbers and total counseled show rise and peaks in the months of August and March. The use of PPIUCD peaked in the month of November which does not coincide with the peak month of the deliveries. Female sterilization and OCP Mala N peaked during the month of March 2020. The use of OCP Chhaya dip to zero in February from 24 in January indicates the irregular/interrupted supply of the OCP. The line diagram of condom use depicts that except in the month of July which shows drastically a high number of condoms, regular distribution is below 200 with a rising peak in the assessment month of March.

The utilization of OCP Mala N and Female sterilization shows correlation coefficient of more than 0.5 with counseling while only PPIUCD shows correlation coefficient of more than 0.5 with deliveries conducted. Of all services, only the correlation of OCP Mala N use with counseling comes to be statistically significant [Table 2].
Table 2: Correlation of the contraceptive services with the counseling and deliveries done

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  Discussion Top


It is imprecise to estimate the actual prevalence of contraceptive use and thus unmet need because many women and men were using private sector medial services, services from subcenters, community health center, district and divisional hospital for contraception and that data are unaccounted here.

As seen from the PHC data and similar to the NFHS 4 reports,[2],[5],[6] female sterilization is still the main mode of contraception in family welfare program contributing to roughly two-third of the total CYP [Figure 7].
Figure 7: Month wise couple-years of the protection by various contraceptives service. 1 to 12 is months starting from April 2018 as 1 to March 2019 as 12

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About two-fifth of the females delivered opted for PPIUCD which is similar to the findings of Mohan et al.(41.5% of both cesarean section and vaginally delivered) in 2015[8] and Kant et al. in 2016[9] but more than the finding by Ramya et al.(29.7% of vaginally delivered) in 2017[10] and Gupta et al. in 2013[11] and less than by Harani et al.[12] (58.8% of both caesarian section and vaginally delivered) in 2019. The differences may be due to the differences in the sociocultural practices, incentives, counseling, etc.

PPIUCD was also about thrice more accepted than interval IUCD by females of the community which may be due to the fact that recently delivered women agree more to practice of PPIUCD, due to its quick insertion.[13]

Although DMPA seems to be slightly more accepted than OCP Centchroman in the PHC, OCP Centchroman being more feasible and easy for community-based distribution than DMPA, its acceptance in the community level can be increased. Centchroman was developed by the Central Drug Research Institute, Lucknow, India, in 1991.

According to the National Center for Health Statistics data brief, the most frequent contraceptive methods used among women of 15–49 years in the United States, 2017–2019[14] were female sterilization oral followed by OCP followed by long-acting reversible contraceptives followed by the male condom similar to the findings of this study unlike the findings of Saudi Arabia[15] in 2020 where pills were most frequent method and the surgery was least which could be due to religious and cultural differences.

Although the Government of India promotes the condom use by various materials and advertisements, its use is still low.[16] NACO started and run condom promotion program. In this study also [Figure 7], the total CYP of condoms distributed from the center was the lowest among all the methods used. Exceptional distribution of condoms is observed in the month of July which may be due to awareness camps, etc., conducted in that month.

Muhoza et al. in a multi-centric survey of reversible contraceptives published in 2020[17] found that IUD is account for the most of CYP followed by OCP then condoms and then injectables, and there were high quarterly variations in CYP of contraceptives, especially of condoms and injectables similar to this study.

The limitation of the study is that it is based on the secondary data of a PHC and not community based. The affectivity of different contraceptive methods, age of women cannot be specified because of limitation of secondary data which do not include the individual information. Furthermore, data for after the effects of contraceptive use were not available, but Medical Officer in Charge stated no mortality due to contraceptive use during the study period.


  Conclusions Top


Slightly more than half of the females seeking reproductive health and contraceptive services were counseled which seems nice owing to the presence of single counselor with other duty burdens, but it should be increased by making extra efforts.

The contraception part of the family welfare services is based on the females as female sterilization and PPIUCD are used far more than male sterilization and are the most CYP yielding methods while and condom is least. More study is required in the area as the distribution of the condoms is from the PHC only. DMPA and OCP Centchroman can perform well provided with regular sufficient supply and promotion. Mala N is still most common oral contraceptive used in the PHC. Although PPIUD is more preferred than interval IUCD, interval IUCD should also be more promoted to enhance the coverage.

Monthly variation of the services points that the services are not provided or received uniformly throughout the year, instead it shows increasing trend in the months of February and March (end of the assessment year) and in between the high use of some services in some month and none in some. This should be avoided and uniform availability of all services should be ensured to optimize the service utilization and effective family welfare program.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
United Nations, General Assembly. Transforming Our World: The 2030 Agenda for Sustainable Development, A/RES/70/1. October 21, 2015.Available from: http://www.un.org/ga/search/view_doc.asp?symbol=A/RES/70/1&Lang=E. [Last accessed on 2020 Nov 28].  Back to cited text no. 1
    
2.
Ministry of Health and Family Welfare. International Institute for Population Sciences (IIPS) and ICF. National Family Health Survey (NFHS-4), 2015-16: India Fact Sheet. Mumbai; 2017. Available from: http://rchiips.org/NFHS/pdf/NFHS4/India.pdf. [Last accessed on 2020 Nov 28].  Back to cited text no. 2
    
3.
Ministry of Health and Family Welfare. International Institute for Population Sciences (IIPS) and ICF. National Family Health Survey (NFHS-4), 2015-16: India. Mumbai; 2017. p. 112. Available from: http://rchiips.org/nfhs/NFHS-4Reports/India.pdf. [Last accessed on 2020 Nov 28].  Back to cited text no. 3
    
4.
Demand for Grants Analysis: Health and Family Welfare. Available from: https://www.prsindia.org/parliamenttrack/budgets/demand-grants-analysis-health-and-family-welfare. [Last accessed on 2020 Nov 28].  Back to cited text no. 4
    
5.
Ministry of Health and Family Welfare. International Institute for Population Sciences (IIPS) and ICF. National Family Health Survey (NFHS-4), India, 2015-16: State Fact Sheet, Uttar Pradesh. Mumbai; 2017. Available from: http://rchiips.org/NFHS/pdf/NFHS4/UP_FactSheet.pdf. [Last accessed on 2020 Nov 28].  Back to cited text no. 5
    
6.
International Institute for Population Sciences (IIPS) and ICF. National Family Health Survey (NFHS-4), India, 2015-16: District Fact Sheet, Uttar Pradesh, Varanasi. Mumbai: IIPS; 2017. Available from: http://rchiips.org/NFHS/FCTS/UP/UP_Factsheet_197_Varanasi.pdf. [Last accessed on 2020 Nov 28].  Back to cited text no. 6
    
7.
Couple Years of Protection (CYP). What Are the CYP Conversion Factors? Available from: https://www.usaid.gov/global-health/health-areas/family-planning/couple-years-protection-cyp. [Last accessed on 2020 Dec 15].  Back to cited text no. 7
    
8.
Mohan H, Ramappa R, Sandesh M, Akash BK. PPIUCD versus interval IUCD (380a) insertion: A comparative study in a referral hospital of Karnataka, India. Int J Reprod Contracept Obstet Gynecol 2015;4:1730-2.  Back to cited text no. 8
    
9.
Kant S, Archana S, Singh AK, Ahamed F, Haldar P. Acceptance rate, probability of follow-up, and expulsion of postpartum intrauterine contraceptive device offered at two primary health centers, North India. J Family Med Prim Care 2016;5:770-6.  Back to cited text no. 9
[PUBMED]  [Full text]  
10.
Ramya KS, Meena TS, Mothilal R. A comparative study of PPIUCD acceptANCe between primiparaous and multiparaous women in a tertiary care hospital in Tamil Nadu. Int J Reprod Contracept Obstet Gynecol 2017;6:3569-72.  Back to cited text no. 10
    
11.
Gupta A, Verma A, Chauhan J. Evaluation of PPIUCD versus interval IUCD (380A) insertion in a teaching hospital of Western U. P. Int J Reprod Contracept Obstet Gynecol 2013;2:204-8.  Back to cited text no. 11
    
12.
Harani MK, Sarkar NC, Saha MM, Paul M, Debnath A. A prospective study on PPIUCD insertion between vaginal delivery and caesarean section. J Clin Diagn Res 2019;13:12-4.  Back to cited text no. 12
    
13.
Sardar F, Balouch I, Bajari N. Intrauterine contraceptive device; effectiveness comparison of postpartum intrauterine contraceptive device (PPIUCD) versus interval IUCD. Prof Med J 2018;25:1518-24.  Back to cited text no. 13
    
14.
Daniels K, Abma JC. Current contraceptive status among women aged 15–49: United States, 2017–2019. NCHS Data Brief, no 388. Hyattsville, MD: National Center for Health Statistics. 2020.p.1.  Back to cited text no. 14
    
15.
Abdel-Salam DM, Albahlol IA, Almusayyab RB, Alruwaili NF, Aljared MY, Alruwaili MS, et al. Prevalence, correlates, and barriers of contraceptive use among women attending primary health centers in Aljouf region, Saudi Arabia. Int J Environ Res Public Health 2020;17:4-6.  Back to cited text no. 15
    
16.
Donta B, Begum S, Naik DD. Acceptability of male condom: An Indian scenario. Indian J Med Res 2014;140 Suppl: S152-6.  Back to cited text no. 16
    
17.
Muhoza P, Koffi AK, Anglewicz P, Gichangi P, Guiella G, OlaOlorun F, et al. Modern contraceptive availability and stockouts: A multi-country analysis of trends in supply and consumption. Health Policy Plan 2021:czaa197. [doi: 10.1093/heapol/czaa197].  Back to cited text no. 17
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
 
 
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