Private doctors have begun to refer their low-income patients to the primary health center in Maharashtra, knowing that the facility can provide safe, hygienic abortion care free of cost.

Photo courtesy of the David and Lucile Packard Foundation.

Abortion is legal in India and widely available in urban areas. However, for poor women and women in rural areas, safe, compassionate abortion care is often out of reach. At the only primary health center (PHC) in the state of Maharashtra, one doctor sought to make high-quality comprehensive abortion available to the women who needed it most.

The PHC in Nirgudsar, about 80 km from the state capital of Pune, served 47,000 people in 18 villages with very few resources: no operating room, no private exam or counseling areas and a demoralized staff. Not surprisingly, the poor conditions also drove away clients. The Medical Officer in Charge, Dr. Ganesh Pawar, was constantly on the lookout for changes that could improve patient care and attract clientele.

One such opportunity came when Nirgudsar was identified to pilot an abortion services program in the state, using manual vacuum aspiration (MVA). MVA is recommended by the World Health Organization as a preferred method of uterine evacuation for an abortion, as is medication abortion. Several staff of the PHC underwent training in Comprehensive Abortion Care (CAC). The workshop had a profound impact on them.

“The training enabled us to view abortion from a woman's perspective,” Dr. Pawar reports. “It made us understand that abortion is not just a clinical service but also has equally important social and emotional dimensions.”

Through the training, the staff came to see that CAC provides important opportunities to counsel clients about contraception to avoid future unwanted pregnancies, as well as other reproductive-health services. To make it a model site for the provision of safe abortion services, the PHC's facilities needed to be upgraded. For example, with Ipas support, the PHC was able to build curtained cubicles in order to provide patients with privacy during exams.

Armed with improved facilities and well-trained staff, Dr. Pawar marketed the PHC's CAC services to the community and nearby private health-care providers. Over time, their efforts paid off. “Women who visited the local ‘dais' [traditional birth attendants] earlier now began approaching us with more faith and confidence.”

Private doctors have also begun to refer their low-income patients to the PHC, knowing that the facility can provide safe, hygienic abortion care free of cost. “Today I think of the unfortunate consequences the woman would have had to suffer, if we were not here to provide safe services,” Dr. Pawar said. “She would have gone straight to an unqualified provider at a cost to her health.”

The health center has also become adept at handling more sensitive cases. For example, two unmarried women, who would have been berated or badly treated at other centers, came to the center seeking abortions. Reports Dr. Pawar, “I was not only proud of, but was also deeply touched by the sensitive attitude of the staff towards these two young women. Not only were we able to provide them with safe abortion services but were also successful in counseling them about the legal and consent issues associated with abortion. When I see the ANMs [nurse-midwives] and the support staff handle such cases with sensitivity and respect, it makes me realize that my efforts have not been a waste.”

With the skills developed at the CAC workshop, PHC Nirgudsar has become a model of woman-centered patient care. Dr. Pawar and his team take great pride in their work, and hope their example will be adopted by other health centers, making safe reproductive health-care services available to women throughout the state.

Article courtesy of Ipas India and the Pioneer Plus Club.

---

For more information, contact media@ipas.org