Female Community Health Volunteers in Nepal promote safe abortion

Ranju Sapkota, a Female Community Health Volunteer (FCHV) in rural Nepal’s Kavre District, says a two-day training on how to evaluate and refer women for safe abortion care has made a huge difference in her ability to help her community.

“Now I have learned to perform urine tests to detect pregnancy,” Ranju explains, and she can use this early pregnancy detection service to counsel women on their reproductive health-care options, such as family planning and safe abortion services offered by the Nepali government. Ranju can now add this skill to the long list of other services the government has already trained her to offer her community.

Nepal’s innovative program has been training rural women to administer basic health services and counseling for decades; there are now more than 48,000 FCHVs working throughout the country. As these volunteers are perfectly situated to advise their communities on safe abortion care, Ipas and the Family Health Division of the Nepal Ministry of Health decided in 2009 to develop a two-day training in which more than 5,400 FCHVs have now participated. The program not only taught techniques for performing urine pregnancy tests, but also the legal conditions for safe abortion in Nepal, the consequences of unsafe abortion, and how to refer women for reproductive health care.

“We didn’t know about the safe abortion law,” Ranju says. “I myself have heard about the suicide case of an unmarried girl who was pregnant,” she adds, emphasizing the importance of her work disseminating information on how to access safe abortion care.
Women in Ranju’s community are ready to listen and trust her advice on reproductive health care because she has already established herself as a well-respected community resource during her 16 years as a FCHV.

“I distribute iron pills, cotrimetazole to children for treatment of pneumonia, rehydration solution, contraceptive pills, condoms, etc,” Ranju explains. She also organizes monthly meetings for the women’s group in her community to share new health information and discuss issues raised by group members.

Women in Ranju’s community know they can trust her with their most personal problems and concerns.

“This is our main strength,” she says. “That’s why they come to us. They meet us separately if they cannot talk in group.”

The community status and respect awarded FCHVs often cultivates a strong sense of pride and long-term commitment in these women volunteers. Ranju explains that many FCHVs in her district are so devoted they resist retirement and have to be asked to step down so a younger woman can take their place. The job satisfaction for these volunteers more than compensates for the fact that it’s an unpaid position.

“They count their prestige more than money,” Ranju says.

As for Ranju’s source of inspiration to become a FCHV, she credits her mother-in-law.

“My mother-in-law was also a FCHV, and after her resignation, I joined in her place.”

Nepal’s use of FCHVs to educate women about healthy pregnancy and safe abortion services has helped to nearly halve its maternal mortality ratio in the last decade. Accompanying strategies such as increasing the legal marriage age and improving roads also helped, yielding an impressive result: the number of women who die from pregnancy-related complications dropped from 415 to 229 per 100,000 live births between 2000 and 2010. Nepal’s commitment and progress toward achievement of Millennium Development Goal 5, which pertains to improving maternal health, won the nation a Millennium Development Goal Award in 2010.

Source: http://www.ipas.org