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Women waiting to receive care at the Senha Primary Health Center in Jharkhand, India.

Ipas

Just before noon on a recent Saturday, dozens of people, mostly women and children, crowded the front porch and doorway of the Senha Primary Health Center in Jharkhand, a state in southwest India. The brilliant pinks, greens and blues of the women's saris contrasted with the sienna-painted walls of the small building, the main source of health care for about 100,000 people in this primarily agricultural area.

Merrill Wolf, Ipas consultant, and I had been invited by Dr. Kiran Marandi, an obstetrician-gynecologist and one of only two doctors at the center, for a brief tour. We were visiting health sites in the Lohardaga region, talking with doctors and nurses about the reproductive health-care needs of the women they serve.

Inside, people packed the dim waiting room, seeking shelter from the midday sun and waiting their turn to see a doctor. The crowds are not unusual: about 150 people come here every day, for all kinds of health-related advice and care.

To meet that need, the health center should employ four doctors, be open 24 hours a day and have 10 patient beds, according to India's national health plan. But thanks to budget shortfalls, scarcity of qualified staff (especially those willing to serve in rural areas such as this), health-worker strikes and other factors, the reality is very different. Dr. Marandi, and her colleague are able to keep the center open for only part of each day and must refer patients requiring hospitalization to a district hospital about 15 miles away. For those receiving outpatient treatments, there is a small recovery room with six beds. Although a labor and delivery ward and additional clinic facilities are under construction behind the center, for the time being, space, supplies and other critical resources are scarce.

In this challenging context, introduction of manual vacuum aspiration, or MVA, for early abortion is helping these dedicated doctors do more with less.Since learning how to use MVA in an Ipas training in late 2007, they have offered this safe, simple outpatient procedure at the health center (abortion has been legal in India for since 1971). Dr. Marandi says that provision of MVA has eliminated the need to refer women to the hospital, where they usually were treated with D&C, or dilitation and curettage -- a method of uterine evacuation that carries much higher clinical risks and usually requires an overnight stay.

Dr. Marandi, who has lived and worked in Lohardaga for six years, told us that she values MVA not only for its safety but also for the fact that it limits the disruption to her patients's daily lives. This quality is especially important for the young, unmarried women she sees both at the health center and in her private practice. They are especially subject to the stigma that still surrounds unintended pregnancy and abortion, despite abortion’s having been legal in India for almost 40 years.

We soon said our goodbyes as Dr. Marandi was clearly needed to treat patients who continued to arrive at the center. Though Merrill and I have traveled widely as advocates for safe abortion care, it is always a special privilege to meet the health-care providers who devote their lives to providing safe care to women in their local community.

Katie Early is the director of Ipas's development unit.

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