Reproductive Health and
Quality of Care
The proponents of the teproductive health approach believe
that reproductive health is inextricably linked to the subject
of reproductive rights and freedom, and to women's status
and empowerment. This encompasses all aspects of human sexuality
and reproductive health needs during the various stages of the life
cycle. In addressing the needs of women and men, such an approach
places emphasis on development programmes that enables clients to
make informed choices, receive education and counselling services for
responsible and healthy sexuality, access to services for preventing
unwanted pregnancy, safe abortion, maternal care and child survival,
and for the prevention and management of reproductive morbidity
including reproductive tract infections, sexually transmitted diseases
including HIV/AIDS and other gynaecological problems. Reproduc-
tive health programmes are, therefore, concerned with a set of specific
health problems, identifiable clusrers of client groups, and distinctive
goals and strategies.
While some interventions can be implemented at the peripheral
levels of the health delivery system, others require more sophisticated
facilities and higher level of professional skills and can, therefore, be
implemented at the higher levels of the system. Studies have been
carried out for understanding the socio-cultural gaps between the
providers and the receivers, and a matrix has been made for providing
each of the health services from the provider's level, at the commu-
nity level, the sub-centre level, the primary health centre level and
the community health centre level and above all, availability of skilled
health manpower and equipment available at each level of facility. A
'systems approach' is taken with the assumption that the facilities at
each level are coordinated and that referral systems are established.
For that SHGs, CBOs, PRIs, NGOs have to work closely with the
community to generate demand for the health services at aJllevels.
Since reproductive health programmes are designed to address
clients' needs, an important implication for their implementation is
to ensure that the quality of services improves, particularly from the
perspective of the clients. On the one hand, the clients' perception of
quality may be influenced by social and cultural concerns. On the
other, the providers usually stress the need for technical competency,
as well as infrastructure and logistical support. A nine-element
'quality' framework for reproductive health programme can help
build a balance between supply of and demand for quality services.
Five of the generic elements, to a great extent, help in creating
service-environment, client-provider interaction, enabling the clients
to make informed choices, women's participation in management,
and integration of services. The service-specific elements focus on
access to services, equipment and supplies, maintenance of profes-
sional standards and technical competence and continuity of care.
What is required is management of referrals and reverse referrals with
the objective of providing proper quality of services to enable them to
achieve their health and reproductive goals.
Communication Studies, Ohio University,
• USA, while sharing his experience empha-
sized that communication strategies would
• work better with the continued support of
• community based organizations though
• the process may be slow. He shared with
• participants the findings of the research
work he had done on radio soap operas in
• the villages of Uttar Pradesh and Bihar.
Population Foundation of India also
• shared its strategy and methodology
• adopted in developing and bringing the
• community radio programme from air to
the ground with the community support in
• Madhya Pradesh. Dr Roshan Benjamin
• Khan, Coordinator, PFI's Community
• Radio Programme, Ujala, Indore, who
• coordinated with All India Radio, Indore
• and production of the radio programmes;
• shared with the participants how she
selected the script writers, the artists who
• gave their voices and her role as a sutradhar
: for promoting the listenership of the
• programme. Mrs Usha Agrawal, Executive
Secretary, Bharatiya Grameen Mahila Sangh
(BGMS), an NGO, explained how the
• community was motivated to listen the
programme regularly by linking with their
• other regular programme interventions on
• health and social issues in the community.
Dr Sarita Sharma, Poetess recited a
• heart-rending poem on female foeticide.
~
Population Environment Development-A Bulletin of Population Foundation of India