In spite of enormous efforts by the government, the contraceptive
prevalence among Indian Rural community continues to remain very low. In
rural areas, women start their childbearing soon after early marriage,
at times much before the legal age of marriage ie 18 years. The low
literacy, poverty and lack of safety for girl children during late
adolescence are main reasons for early marriage and resultant
childbearing.
Women refuse to use contraceptives for various misbelieves surrounding
them. Male counterpart, being equally ignorant about the importance of
spacing between two pregnancies, does not use available male
contraceptives. Government has put in lot of efforts and money to
provide newer, longer acting and reversible methods of contraception in
recent times. In India, the government has adopted cafeteria approach
for promotion of contraceptives.
Short inter-conceptional periods, especially following operative
delivery, ie caesarean section, pose risk to life of the pregnant women,
due to risk of scar dehiscence and rupture uterus. Women with short
inter-conceptional period are not given trial of vaginal delivery for
the fear of scar dehiscence. This itself contributes to rising rate of
caesarean section.
Government has implemented various schemes in last decade for promotion
of institutional deliveries. Government is providing monitory
incentives, food supplements and transport facilities to pregnant women
for reaching to the hospital. Rising number of institutional deliveries
has provided more opportunities for counselling women regarding
contraception and improving utilization of available contraceptive
methods.
One of the newer methods of postpartum contraception is a reversible
long term contraception ,that is post placental intra uterine
contraceptive device, popularly named as PPIUCD. Campaign for promotion
of PPIUCD has been undertaken at Pravara Rural Hospital ,where in women
are initially counselled during pregnancy regarding benefits of PPIUCD
.Brief educational sessions are being conducted in antenatal OPD ,where
in short video clips are projected and educational pamphlets are
distributed to pregnant women ,giving them information about various
contraceptive options and benefits of PPIUCD in particular. The choice
of their contraception is obtained and recorded in the antenatal case
sheet. Women, who have expressed their willingness for PPIUCD during
antenatal period, are re counselled during early labour and written
informed consent is obtained for PPIUCD insertion.
The team of doctors has been trained in counselling techniques and
PPIUCD insertion. Government has provided two types of intrauterine
devices for insertion namely, Copper 375 and Copper 380 A. There has
been overwhelming response for acceptance of PPIUCD insertion,
especially during caesarean section. More than 300 women have been
followed up
during six months period .There has not been any major complication
during insertion or post insertion. Women are being regularly followed
up for any complications like expulsion, displacement, perforation of
uterus or failure of contraception. The method has been found to be very
effective, convenient and safe as reversible long term contraceptive for
rural women. It will help in improving the spacing between pregnancies.
It will result in reducing maternal morbidity and mortality related to
frequent childbirth and will also help in improving the child health, as
women with PPIUCD will have enough time to look after their small baby,
without having physical and psychological stress of new pregnancy and
unborn baby.