Years ago, in a tribal area of Madhya Pradesh, Rajni witnessed the death of a 15-year-old girl who had just given birth  for the second time.

"I was just 22 years old myself and had completed only one year in my job as an ANM. Upon the death of the young mother, all of us were very sad. And, I still recall that the doctor had said family planning could have prevented this young woman's death."

Forever etched in her mind, this sad memory motivates her to promote family planning.

"I am committed to offering family planning services to both men and women as a way to save lives. While providing family planning services, I ensure screening clients properly by checking weight, blood pressure, hemoglobin and ruling out pregnancy. I orient and counsel male group meetings in slum areas to increase knowledge and change mindsets related to family planning. As a result, I have motivated three men for non-scalpel vasectomy."

Rajni is trained in providing the full range of contraceptive methods, including intrauterine contraceptive device (IUCD) insertion and injectable contraceptives (Antara). She conducts regular meetings with Accredited Social Health Activists (ASHAs) in her area and coaches them to better plan household visits by first properly filling out their registers and using them to prioritize visits and deliver tailored counseling messages. Rajni and the ASHAs she coaches follow a systematic approach to ensure that all eligible couples in the community receive family planning information and have access to their methods of choice. She explains:

"With the help of ASHAs, we keep a record of couples that are newlyweds and those who have one child, and approach them on a priority basis for family planning counseling. Whenever an ASHA faces any challenge, I accompany her during the home visit and support in family planning counseling."

Rajni firmly believes that family planning is key to the health and well-being of the entire population. Her passion and commitment towards promotion of family planning was acknowledged by the Indore government on Aug. 15, 2019, when she was recognized as the best performing ANM.

For reading this story on TCI University please visit: https://tciurbanhealth.org/tcihc-urban-tales-creating-family-planning-coaches-within-the-health-system-in-indore/ You can read all previous stories also at https://tciurbanhealth.org/topics/india-urban-tale/.

PSI-TCIHC works with city governments to advance the cause of family planning. To know more about our work, visit https://tciurbanhealth.org/india-toolkit/ and https://tciurbanhealth.org/topics/india/.

Anita works as an Accredited Social Health Activist (ASHA) in the Asalatpura slum in Moradabad, Uttar Pradesh. One day during household visits, she noticed a short, thin, barefooted girl playing with a six-month-old baby near a sewage drain. Anita asked the young girl to call the mother of the baby. She was surprised when she found out the young girl named Rubina was in fact the mother of the child.

Anita visited Rubina's cramped house where she lived with her husband Rashid and their child, along with four more families. Rubina told her that she got married at 16, has never been to school and works as a rag picker.

Rashid joined the conversation and Anita began counseling the couple on contraceptive methods, but Rubina interrupted her and said, "My Bhabhi (sister-in-law) has told me that I am too young for adopting any contraceptive method." The couple had a strong belief that family planning is not for them as young first-time parents.

Anita was not surprised to hear this myth and was prepared to counsel Rubina and her husband on the benefits of contraceptives, especially given that Rubina is young and just experienced a labor and delivery six months earlier. Rubina described what Anita shared with her: "Anita didi used to bring pictorial leaflets to sometimes explain about personal hygiene, nutritious diet, breastfeeding, immunization, family planning, etc. She explained how a mother's health affects a child's health. This made us rethink our decision to adopt a family planning method. Finally, one day, I visited the nearby urban primary health center with my husband, where the doctor explained the importance of birth spacing and its implications on the health of a young mother and a child. That day, we realized that for many months we have been listening to similar things from Anita didi. As a result, we decided to opt for a long-acting reversible contraceptive method. Also, I started practicing self-care by following the things I learned from Anita didi."

Given such situations, it is important that ASHAs are equipped to provide informed-choice counseling and services to young first-time parents. And, given the importance of key community gatekeepers, such as husbands and other family members, it is critical that they are engaged so that myths and misperceptions do not continue to persist in families and communities in India.

For reading this story on TCI University please visit: https://tciurbanhealth.org/tcihc-urban-tales-ashas-in-moradabad-help-dispel-myths-with-young-first-time-parents/ You can read all previous stories also at https://tciurbanhealth.org/topics/india-urban-tale/.

PSI-TCIHC works with city governments to advance the cause of family planning. To know more about our work, visit https://tciurbanhealth.org/india-toolkit/ and https://tciurbanhealth.org/topics/india/.

Dr. Rajeev Niga left early one morning back in June 2020 for his job as Nodal Officer for Family Planning & Immunization in Muzaffarnagar city, Uttar Pradesh. On his way, he looked out at the deserted road from his car and thought about how COVID-19 had made life an emergency drill for medics and community health workers in his city, throughout India and around the world. These thoughts left him feeling overwhelmed but also renewed his focus and commitment to the health care staff in his city.

He shared his reflections from that morning recently with The Challenge Initiative for Healthy Cities (TCIHC):
"Although services had resumed at the urban primary health centers (UPHCs), the safety of the service providers, field-level workers and community is still a big challenge. The situation could be overwhelming to think about but then I remind myself that COVID-19 is a shared challenge. And, I'm proud that I can be of service to my community in this time of need."

When he reached the Sarwat UPHC in Muzaffarnagar city, he felt an immediate need to motivate his staff as he felt that they must be experiencing similar feelings. He later mentioned this concern to the TCIHC team, who coached him on the benefits of holding monthly review meetings with facility staff, including monthly meetings with Auxiliary Nurse Midwife (ANMs) and Accredited Social Health Activists (ASHAs). These monthly meetings are a TCIHC best practice that have been adopted by the Uttar Pradesh state government. Dr. Nigam immediately put this best practice into action: "We conducted UPHC level meetings with facility staff, ANMs and ASHAs. We told them that this is the time when the community needs us the most. We have to provide services to everyone by taking all safety measures as we do not know whether someone is infected or not. We reinforced the importance of using face masks during their service hours, avoiding touching one's face, washing hands frequently with soap and maintaining two meters distance at all times while dealing with clients in the UPHC."

During a recent ASHA-ANM meeting, he continued to reiterate and reinforce COVID-19 prevention strategies: "During household visits, [ASHAs should] inform people that their safety is our priority and that all safety measures are being implemented in the UPHCs towards ensuring safe health care services, including safe IUCD and Antara services."

Dr. Nigam concluded that meeting by distributing reusable masks, gloves and soap to ASHAs and ANMs provided by TCIHC. These regular ASHA-ANM meetings ensure that everyone is not only counseling the community on safety measures but also modeling the behavior that they wish to see. Dr. Nigam explained:

"All service providers wear face masks, gowns, gloves and cover their head while providing clinical family planning services - IUCD insertion and dispensing Antara injectable. In case of any doubts about a patient being infected or not (with COVID-19), the service provider conducts a rapid antigen test and provides clinical services while awaiting the results of the test, which come back within half an hour."

Dr. Nigam believes strongly that family planning services cannot be stopped during COVID-19 when they are needed the most. In fact, he has reminded his staff to inform clients who want permanent methods that they are still available in the district hospital, and can be performed after testing for COVID-19.

Dr. Nigam's commitment to his staff's safety and the safety of the community is commendable. He understands the value of holding regular meetings with staff at the UPHC to truly listen and hear their concerns and encourage them to remain steadfast in adhering to the safety measures. Due to the combined efforts of Dr. Nigam and his team, the four TCIHC-supported UPHCs of Muzaffarnagar continue to regularly provide family planning services, including clinical methods.

For reading this story on TCI University please visit: https://tciurbanhealth.org/urban-tales-prioritizing-health-care-workers-and-clients-safety-in-muzaffarnagar-up-during-covid-19/ You can read all previous stories also at https://tciurbanhealth.org/topics/india-urban-tale/.

PSI-TCIHC works with city governments to advance the cause of family planning. To know more about our work, visit https://tciurbanhealth.org/india-toolkit/ and https://tciurbanhealth.org/topics/india/.