Reaching the unreached with family planning in India

A Janani mobile family planning van registers new users in India.

This blog was first published by Impatient Optimists blog on March 13, 2015.

By the time the brightly colored family planning van pulls into the government health center in a village in northern India, a group of young women is waiting. They have come to adopt a high quality modern method of contraception. They have already been pre-screened and most have chosen either an intrauterine device (IUD) or tubal ligation but the van also offers methods like condoms, oral contraceptives, injectables and emergency contraceptives, according to their needs.

Some of them have three, four or more children, and want no more. For many of them, it is the first time they have practiced family planning. The fertility rate in the states of Bihar and Uttar Pradesh, according to the last India National Family Health Survey 2005-2006, was 4.0 and 3.82 children respectively, the highest and second highest in all of India.

Some 270 such “mobile family planning days” were conducted in 2013 and 2014 in a pilot project with one van, creating 2,800 new IUD clients, and counseling 1,600 women who came for follow-up visits. With support from The Bill & Melinda Gates Foundation — in partnership with CARE, the University of Manitoba and Marie Stopes International — this program has expanded from one to 20 outreach teams that provide IUD and sterilization services for women, and non scalpel vasectomy for men. The operation is run by Janani, an affiliate of the international social marketing organization DKT International.

The vans are necessary because these hard-to-reach places lack accessibility to quality and affordable health services. Since the services are not available where these people live, Janani brings the services to them.

Each team is made up of four to nine people depending on the services offered, including doctors, nurse/midwives, van coordinators, attendants and drivers. The vans are air-conditioned and equipped with a counseling chamber, audio-visual equipment, essential medicines and medical equipment needed for IUD insertion. The nurse/midwives are trained for counseling and IUD insertion at Janani’s state-of-the-art Surya Clinic and Training Centre in Patna, where hundreds of health professionals are trained each year.

The objective is to support the governments of Bihar and Uttar Pradesh to improve access, scale and quality of family planning by promoting clinically long-acting reversible methods (like IUDs) and permanent methods (like tubal ligation and vasectomy) in underserved public health facilities. Janani also offers a full range of quality contraceptive options, including condoms, injectables, oral contraceptives and emergency contraception.

Janani expects to serve 10-15 new clients and half that many follow-up clients per van per day of operation, through up to 15 days of visits per month. With 20 teams operating, Janani hopes to serve between 2,000 and 3,000 new clients and 1,000 and 1,500 follow-up clients each month.

"Jannai is pleased to offer this important new means of family planning service delivery,” said Don Douglas, country director of Janani. “These well-trained, well-equipped teams enable Janani to provide both limiting and spacing methods that offer protection for five or ten years, depending on which device is chosen — CuT275 or Copper-T 380 A. We offer the services at government health clinics in remote areas, and continue to follow up with those clients through regular repeat visits." 

The expansion of the mobile family planning program is the latest example of two decades of innovation and service provision by Janani, which started working in Bihar and Jharkhand in 1995. Janani, the first social franchising program in reproductive health in India and believed to be the first in the world, has become the largest private provider of clinical family planning services in India. It serves a segment of rural Indian villagers in northern and eastern India who would otherwise have difficulty accessing these services. Janani has increased the number of couple years of protection it delivers from 125,581 in 1997 to 1.75 million in 2014.

The program focuses on low-income and rural populations who have limited (or no) sources of family planning products and services in order to reach those who desire family planning options but have not been able to obtain them.