Background
Methods
Results
Profile of community health workers
Views of community health workers
CHW’s views on their current roles
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“Those (women) who miss their periods and do not want to continue (the pregnancy), they come with lot of tension… what to do, where to go? Then I take them to (ARTH) health centre if they are up to two months (of pregnancy). If (the pregnancy is) around three months, then I take them to Surajpol (urban centre).” (P3, an ASHA working in the urban area)
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“… (If) she is educated, has the information then what does she have to do with us (she doesn’t consult us). Those who live in Surat, Mumbai, they have all the information, they don’t even ask us…someone knows and has money, then they go direct to Udaipur…one who is very poor, not educated, she waits for us, she will come (to us)…” (P10, a VHW working in the rural area)
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“I do the test and tell her whether she is pregnant or not. If (she is) pregnant, then (I tell her), let us go to the hospital, let us talk to the doctor, how many months is it. I go along to the hospital, they (women) do not know the place, I go with every patient” (P1, an ASHA working in the urban area)
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“…they feel if there is someone with them, then people will see and wonder where are the two going together, therefore they do not want to be seen going out of the village with someone. Instead they ask me to meet them somewhere on the way or at the health centre…” (P5, a VHW working in the rural area)
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“A woman had got abortion done twice without asking me. This time she came to me for a third abortion, I refused, told her that you have already committed this sin twice, now you want to do it another time…” (P7, ASHA working in urban area)
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“I accompany if the time is less, if it is up to two months, then I go along. If it is three or four months, then I tell them where to go, I don’t go along…” (P2, ASHA working in urban area)
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“I did her (pregnancy) test and counselled her to go to the health centre…however, instead she took tablets from somewhere and developed complications…her mother-in-law abused me so much and held me responsible for giving her wrong medicines…” (P6, VHW working in rural area)
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“I tested a woman in the village, test was positive…she took one tablet from the health centre but did not come back for the second dose…when I met her again in the village she shouted at me that she had been given wrong tablet at the health centre and had lot of problem because of that…she said she had nearly died…” (P10, VHW working in rural area)
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“Earlier, we all used to take the women and get the surgical (abortion) done. We used to take women to the doctor who put instruments inside and took it out and cleaning was done. That is what we knew.” (P1, ASHA working in the urban area)
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“…earlier we used to discuss with each other about women who sought abortion, but in the training we learnt that we should not talk like that and keep the matter between the woman and ourselves.., speak in the way that we can win their confidence so that if they have any problem they first come and share that with us and only then take action…” (P3, ASHA working in the urban area)
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“… (Earlier, I) did not know how to calculate the exact date...now if the woman tells us in terms of the local calendar (based on the position and sighting of the moon), then we can find out the LMP using the calendar we got during training…” (P1, ASHA working in the urban area)
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“…With this (Gestational age wheel) within a second, we put the date and immediately tell how many weeks pregnant she is, while the woman is still in front of us, and without using a pen or anything” (P3, ASHA working in the urban area)
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“…immediately after the training we were made to do a practical. Most of our other trainings happen, there is no practical…then when we work in the village we remember some and forget some. But here with simultaneous practice we realized what we needed to learn more and there itself could learn and improve…” (P8, ASHA working in the rural area)
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“Many such women come to the health centre, who are told after examination that their gestation is more than three months and they cannot be provided abortion here (at that centre), then they have to go back…” (P6, VHW working in the rural area)
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“I can do this but if someone from their family is around, if a woman’s husband or mother-in-law are there, she may feel shy of them and she may not talk in front of them. Then it would be difficult, otherwise no problem, I can do it” (a VHW working in rural area)
Profile of women seeking abortion
Age (n = 24) | ||
<20 | 1 | |
20–24 | 6 | |
25–29 | 11 | |
30 & above | 6 | |
Mean age | 26 years | |
Range | 18–40 years | |
Castea (n = 24) | ||
Scheduled caste | 1 | |
Scheduled tribe | 12 | |
Other castes | 11 | |
Number of living children | ||
None | 3 | |
1 to 2 | 14 | |
3 to 4 | 6 | |
5 or more | 1 | |
Education | ||
Illiterate | 9 | |
1st to 5th | 5 | |
6th to 8th | 1 | |
9th and above | 9 | |
Marital status (n = 24) | ||
Married | 24 | |
Abortion service availed at (n = 24) | ||
Rural centre 1 | 7 | |
Rural centre 2 | 1 | |
Urban centre 1 | 16b
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Views of women seeking abortion
Do women know about community health workers?
Women’s views on current role of community health workers (ASHAs)
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“Someone comes to ask for small children but since we do not have small children so now (she) does not come to our house.” (P18, urban non-tribal woman)
Whether women sought help from CHWs in seeking abortion services?
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“If I talk to her about abortion, then she asks me to get both abortion and sterilisation done. But my husband does not agree for sterilisation…she was once taking me for sterilisation forcefully, just then my husband arrived and said that he will not let me go for sterilisation. So, we do not talk to anyone at the anganwadi about such things…” (P16, rural tribal woman)
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“… (I) do not tell her (ASHA) about this. If I tell her then she may tell someone else…things become public…so (I) do not tell anyone…” (P9, an urban non-tribal woman)
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“…I know that she does urine test, women go to her…but what if she tells someone in my family, I have two older sisters-in-law, if they come to know and tell my father or brother. That is why I am scared, so I do not talk to the ASHA about it....” (P21, rural non-tribal woman)
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“I did not know that such a thing (pregnancy test) is done at the anganwadi, now that you are telling me, I am learning about it…” (P20, an urban non-tribal woman)
Women’s views on involving CHWs in assessment of eligibility for medical abortion
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“It will be good, this is ASHAs’ daily work. Women will benefit, will go with more confidence…do not see any problem, ASHA does not take any money for it…” (P3, an urban non-tribal woman)
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“It will be beneficial, the doctor talks only main things. (I) can talk openly with the ASHA… (I) feel scared of the doctor…just answered whatever the doctor asked as yes and no, (On the other hand, I) can talk more freely with the ASHA…see no disadvantage of it, women will trust the ASHA” (P5, an urban non-tribal woman)
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“…if the woman has not gone there (to the hospital) earlier, then she will take the ASHA along and if she has gone there before, then why will she ask the ASHA? She will go to the doctor on her own…” (P1, an urban tribal woman)
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“It will be beneficial only if (I) come to the hospital. I don’t know what good (it) will be meeting her, she will only talk…” (P8, a rural tribal woman)
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“How can we tell the ASHA? She lives in the village itself, what if she tells someone else…doctor is at the health centre and will then go to her house…” (P9, a rural non-tribal woman)
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“(If ASHA does the eligibilty asessment in the village itself) The advantage is that we will not have to come so far, not spend money on travel. Yesterday both of us (me and my husband) spent the whole day on this, today too we have come and have to again come day after tomorrow…” (P6, a rural tribal woman)
Should community health workers assess the need for follow-up at home?
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“…it will be good if ASHA can tell us at home (whether follow-up visit to the centre is needed), money on travel will be saved and I can take care of household chores. Today my husband had to go to work without food, since I didn’t have time to cook in the morning…” (P 17, a rural tribal woman)
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“… (If ASHA is able to assess the need for follow-up at home, then), I would not have had to come here, will not have to take so much trouble. (Today) I used the excuse of getting my older child treated…I had to lie to my mother-in-law and father-in-law, spent so much money in travelling and also wasted time…” (P22, an urban non-tribal woman)
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“… (it) would not have been of any use…I will come for examination,…she will only talk , not do any examination, she will only say from her mouth (verbally) that your work is done but those who examine are here (in the centre)…I have to come here, here examination is done by making one lie on the bed…” (P16, a rural tribal woman)