Information & Knowledge for Optimal Health (INFO) Project, Johns Hopkins University

Family Planning Resource Improves Care in Southern India

Updated guidance on highly-effective contraceptive methods adapted for hundreds of thousands of providers and clients across Karnataka state.


Dr. Ravi Kumar counselling his patients	Dr. Shoiba Saldanha, OB/GYN, Bangalore

More than 120 million women worldwide who wish to prevent pregnancy are not using a contraceptive method with their partners. Closely-spaced pregnancies and pregnancy among very young women place mothers at higher risk for illness and even death. In India, less than 10% of married women use contraception to space births. Many health care providers are not accustomed to informing family planning clients about the way a contraceptive method works. Only 22 percent of users of any modern method were informed of its possible side effects at the time of accepting the method. Fewer than one-half of IUD users and only 23 percent of pill users were informed of the side effects before accepting the method. Failing to communicate side effects to clients makes them more likely to abandon a method, putting them at risk for unplanned pregnancy.

In response to a need for clear and pragmatic evidence-based guidance on family planning methods as well as counseling, expressed by providers in resource-scarce regions such as India's southern state of Karnataka, USAID supported the INFO Project of the Johns Hopkins Bloomberg School of Public Health in the creation of a completely updated handbook designed to improve the quality of family planning services and maximize people's access to these services.

Family Planning: A Global Handbook for Providers translates the best available scientific evidence into practical guidance on all major family planning methods. With content reflecting the consensus of experts from the world's leading health organizations, the guide helps providers assist clients in choosing methods, supporting effective use, counseling clients about side effects, and solving clients' problems. The clear, updated information within Family Planning removes many medical obstacles to contraception and demonstrates that most people can safely use all methods.

Health care providers, researchers, and programmers from more than 180 countries have ordered the English-language guidebook, which is available at no cost to developing country readers. More than 70,000 copies were distributed in the first six months of publication, and the guide is being adapted in local settings including Ghana, Guatemala and the Philippines.

In Karnataka, where only 11% of eligible women use modern contraceptive method to space births, policymakers and healthcare managers have developed working manuals in the Kannada language using resources like the guide Family Planning: A Global Handbook for Providers. Program managers created one-page briefs for clients to illustrate the way each procedure works, to be used at more than 5000 clinics statewide. Job checklists on popular long-lasting methods, such as the IUD and sterilization, are used by some 6000 providers to select cases and as a resource to provide medically correct advice.

"The best part about the book is its conversational tone--how simple it is to understand all the complex information," said Dr. Shoiba Saldanha, a private OB/GYN in Bangalore, about Family Planning.

"The book is very friendly and the pictures [provided from the guidebook] are extremely helpful for people," said Dr. K. Ravi Kumar, Karnataka's Chief Medical Officer for Health and Welfare, "hundreds of thousands of people have received the materials."

Dr. Kumar reported that based on the book's recommendations they had already updated government policy on combined oral contraceptives. "Because the book says it is not necessary, we are not recommending a break between spells [of use]."

Johns Hopkins Bloomberg School of Public Health: The INFO Project