Reproductive health is a crucial part of general health and a central feature of human development. Among women of reproductive age (15-49 years), the burden of reproductive ill-health is far greater than the disease burden from tuberculosis, respiratory infections, motor vehicle injuries, homicide and violence. Women run the risks of pregnancy, childbirth and unsafe abortion, take most of the responsibility for fertility regulation and are socially and biologically more vulnerable to reproductive tract infections and sexually transmitted diseases. The National Population Policy (India), 2000, affirms the commitment of government towards voluntary and informed choice and consent of citizens while availing of reproductive health care services, and continuation of the target free approach in providing family planning services.
The Ministry of Health and Family Welfare (MOHFW), Government of India, through its National Rural Health Mission (NRHM) has introduced the rapid home pregnancy test kits (Nishchay). The Nishchay program is not a program for the promotion of the pregnancy test kit alone, but is an entry point to RCH and family planning services for women seeking quality and assured RCH and FP services.
Important key issues addressed by Nishchay are:
1. Low percent of women starting ANC in first trimester due to late detection
2. Contraceptive Provisioning (IUD/Pill) not started after ruling out pregnancy
3. High unsafe abortions due to late detection of pregnancy
The key strategies of the program are community awareness, especially among eligible couples, on Home Based Pregnancy Test Card and RCH services, increased utilization of RCH and FP services, following the test results. Important activities include capacity building of ASHAs (Accredited Social Health Activist) through resource persons with field and NGO experience, brand and logo visibility using mass media campaign, community outreach activities using mid -media campaign, and integrating the card into the monitoring system of NRHM/RCH-II.
Implementation of the program is in all Indian States and UT's. The states have been classified into high, medium and low priority groups based on the NFHS-3 data on birthrate and institutional deliveries. In the first phase, the program is launched in the following 11high priority states - Uttar Pradesh, Bihar, Madhya Pradesh, Uttarakhand, Chattisgarh, Jharkhand, Rajasthan, Assam, Meghalaya and Nagaland.
The implementation team was formulated at the central office of Hindustan Latex Family Planning Promotion Trust, comprising of a Senior Program Manager (Atul Bahl), Training Managers, Training Officers and a Communication Officer. State level consultants were hired in the states for additional support in monitoring of NGOs and on ground activities. The Senior Program Manager is assigned the responsibility of the national roll out of the program and the linked activities.
As planned, the service delivery strategy is being addressed through building capacities of ASHAs on understanding the pregnancy test card, making it easily available to all Eligible Couples in the community and tracking the outcome. Relevant training materials were conceptualized and designed for training of ASHAs. These were shared with the Ministry of Health & Family Welfare and have been printed after the approval. NGOs at district level were contacted in all the states, meetings held and the Master trainers identified by them were trained by the project implementation team. Special training materials were designed for them as well.
Demand generation is through using mass media and mid media campaign using local folk, edu - entertainment modality through mobile vans. The program has been very well received by the public and early detection of pregnancy offers many advantages for the mother and the fetus. Many medical benefits depend on early detection, including social and emotional well-being and the avoidance of medications, irradiation, and other teratogenics.
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