Investigation: Family planning services unsafe in India’s Bihar state

Geeta Devi, Sumitra Devi and Mina Devi are women farmers in the Banka District of Bihar, one of the poorest districts in India. (Credit: LWR / Jake Lyell)

Clinical reproductive health services provided to women in India’s Bihar state – where few use family planning resources – are woefully insufficient, according to a new report. Problems including a lack of sanitary health facilities, too few beds for post-surgery recovery and a lack of basic tools, such as scissors, plagued both public and private health centers, according to a yearlong investigation by the International Center for Research on Women (ICRW).

“The findings highlight that in too many cases, the quality of care women receive in regards to sterilization and IUDs is inadequate,” said Pranita Achyut, lead author on the report, in an interview with Humanosphere. “A lack of a focus on women’s needs, coupled with unsafe practices highlight just how little attention has been given to ensuring women’s dignity is respected when they seek family planning services.”

Contraceptive use in India overall is growing with more than half of women using some method. However, in Bihar rates are severely lagging. Only 33 percent, or one out of every three, women use contraceptives in the state. With a fertility rate of 3.7, the provision of safe reproductive health services is all the more important for the state. The issue was recognized by the government, leading to efforts to link family planning and pregnancy services. Coupled with overall advancements in health infrastructure, the hope was the gap could be addressed. But the findings showed it was not the case and exposed larger issues with health services for women.

“The larger problem is quite often that health facilities focus more on getting women in and out of the door than providing quality services that meet their needs and meet the highest standards. This ‘assembly line’ approach fails women by not giving them the care and respect they deserve,” said Achyut.

The ICRW investigation focuses specifically on sterilization and intrauterine device (IUD) services in Bihar. Researchers looked at the services provided in five districts across the state: one district hospitals, three subdivisional hospitals, eight primary health centers and four private hospitals in each district. The facilities were evaluated and interviews with hundreds of providers and clients were conducted. Their findings were stark.

Only 14 percent of the primary health centers surveyed had beds for women following a sterilization procedure. Most were left to recover on either cotton mats or mattresses on the floor. And the support they then received was spotty at best. Worse yet were findings on the availability of post-operation drugs. Fewer than half of primary health centers (46 percent) had all of the drugs and only one of the 11 subdivisional hospitals had the drugs.

Sanitation of the facilities was a huge concern. More than 30 percent of all facilities had hospital waste, such as syringes, cotton and bandages, “scattered” about, according to the report. The conditions during the procedures were not much better. The lack of hygienic care was evident during visits to the facilities.

“While operation was going on, the staff came in and out of the theater … calling the clients one by one. One of the staff took tea and biscuits inside too,” found one of the researchers.

Such actions put patients at greater risk of infections and complications. With an average of 66 sterilization cases a week at the facilities, women are routinely put at risk. Further, one in three facilities had on-staff family planning counselors. Many went home with inadequate and sometimes no information about the procedure that was completed, for both IUD and sterilization patients.

From start to finish, the services provided to women fall well short of the very standards set out by the government of India.

“Overall, we found that the quality of women’s experiences was much lower than how health facilities’, as well as the providers’ knowledge and practices, were rated. This suggests disconnect between how the health system ranks the quality of care it provides and how women experience services within the system,” says the report.

ICRW issues a set of recommendations at the conclusion of the report. The focus is on improving the sanitary conditions every step of the way, ensuring all needed medicines are available and more support and counseling for patients before and after a procedure is completed. It also calls on better structures to ensure that clinics are delivering the services in a safe and adequate manner, such as a “district quality assurance committee.”

Safe, sanitary conditions are absolutely non-negotiable and can be achieved with very little or no heavy additional costs but will surely yield long-term dividends to establishing the credibility of these programs,” said Achyut.

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Tom Murphy

Tom Murphy is a New Hampshire-based reporter for Humanosphere. Before joining Humanosphere, Tom founded and edited the aid blog A View From the Cave. His work has appeared in Foreign Policy, the Huffington Post, the Guardian, GlobalPost and Christian Science Monitor. He tweets at @viewfromthecave. Contact him at tmurphy[at]humanosphere.org.