Quality of Family Planning Services: Lessons from Concurrent Evaluation

Abstract

The concept of reproductive health received global recognition in the International Conference of Population and Development (ICPD) at Cairo in 1994. A reproductive health approach means: people have the ability to reproduce and regulate their fertility; women are able to go through pregnancy and child birth safely; the outcome of preg nancy is successful in terms of maternal and infant survival and wellbeing; and couples are able to have sexual relations free of the fear of pregnancy and of contracting disease. In 1995, after the Cairo conference, the Government of Rajasthan took the initiative to translate the concept of reproductive health into policies and programmes. The innovative interventions, one in Bundi district with UNFPA support, and the other in the two districts of Tonk and Dausa under the Vikalp project were imple mented, abolishing the method-specific targets. Later, in April 1996, the government abolished the targets in all districts and introduced micro district level planning in which the emphasis was laid not on numbers but on the quality of care. In the light of a target-free approach, the quality of family planning services in Rajasthan has been examined by using data from Concurrent Evaluation of Reproductive and Child Health Services. The quality framework evolved by Bruce (1990) was adopted to evaluate the total quality of care of family planning services. Nearly 86 per cent of couples were informed about three spacing methods, namely, condoms, oral pills, IUD and sterilis ation. Less than three-fifths of the users mentioned the method of their own choice. Nearly half of the couples were not informed about the side effects and risks of the methods at the time of adoption. About one-third of the female health workers did not have correct knowledge of IUD insertion. About 79 per cent women were visited by health workers three months prior to the survey. The present study concludes that there