Centre For Contraception Research (CCR)
Established in 2020 as a research unit of ARTH society, Centre for Contraception Research works for advancing contraception policy and practice in India through implementation-research, dissemination and advocacy. It works as an independent unit within the organization and draws on professional resources and skills as needed, to focus on implementation issues that are relevant to policy and programmes in large north Indian states like Rajasthan. The Centre has started with following objectives: A five member Research Advisory Committee (RAC) guides CCR in establishing a set of priorities along with dissemination and linkage to advocacy groups and activities. To carry credibility independent of the CCR, the RAC does not involve itself in implementation of activities. The centre has started exploring following research priorities. On the basis of need and capacity, we will explore more areas. 1. Repositioning Emergency Contraception (EC) With low levels of acceptance and use, the “emergency” label on sexual activity might aggravate stigmatisation of sexual activity and in effect discourage its use. Alternate positioning of EC as a short term option for non-users might therefore be considered. Keeping this in mind, we plan to conduct formative research and test pilot interventions on repositioning emergency contraception. To start with, we conducted pilot testing with some existing users in our area which helped us to develop the research questions and study tools accordingly. 2. Contraception among migrant and long-distance couples With a large proportion of males migrating to other cities for employment, wives of migrant husbands are left behind. There is a need for spousal communication about expectations of contraception use in situations in which husband’s visits are unplanned or might be sudden. This is quite different from the need among migrant men to use condoms to prevent STI/HIV. Keeping this in mind, conducted formative research exploring determinants of contraceptive use among young migrant couples. To understand the pattern of contraception use, we conducted test interviews in our field area, which helped us to have clearer understanding of research objectives and create study tools for the same. 3. Contraception among newly weds Family expectations to demonstrate fertility, poor spousal communication, and lack of prior knowledge and access to commodities combine to make contraception an absent part of newly wed sexual activity. To understand decision making around contraception use, we are planning to conduct formative research on determinants of contraceptive decision making and use among newly wed couples in rural-tribal settings. 4. Dissemination of Work Along with this, we planned to disseminate ARTH’s work, including enabling contraception through community health entrepreneurs, the role of pregnancy self testing in promoting women’s agency in the field of SRH, and role of the Levonorgestrel intrauterine device as a long acting reversible contraceptive option.
SAFUL Project (2012-2016)
In 2012, it was estimated that 70,000-100,000 women die every year due to consequences of unsafe abortion. A majority of these deaths occur in low-income countries where induced abortion is illegal or clandestine. Unplanned pregnancy and unsafe abortion thus place a huge burden on scarce medical resources. Any improvement in comprehensive abortion care such as increased availability and acceptability of abortion services would mean important improvements for the concerned women and their families as well as for the societies at large. Thus, ARTH commenced a research trial in Udaipur and nearby district Rajsamand with the objective to assess the effectiveness and safety of self-assessment following a medical abortion procedure as compared to routine follow up. We aimed to describe the acceptability and accuracy of home assessments of abortion outcomes among women in both rural and urban settings in Rajasthan, India and to describe contraceptive use and compliance among women prior to and post a medical abortion. The research was carried out at four of ARTH’s rural health centres and one private hospital. As part of the project two-prong strategy was adopted: Under the first strategic move, two training programs were organized in which 62 providers (32 doctors & 30 senior nurse-midwives) took part from ten districts of Rajasthan. They were trained on recent updates on abortion including the legal issues, techniques and simplified procedures. Under the second strategic move, a research trial was conducted and it led to the following findings: Further qualitative interviews with the women participating in the trial on simplified medical abortion revealed the following conclusions:
Navjeevan (2010-2012)
Impact of promoting referral for newborns with danger signs and strengthening first referral level facilities on newborn survival – a cluster randomized trial (Department of Medical, Health and Family Welfare Services in collaboration with ARTH, WHO and UNICEF) Overview The intervention provides incentives to ASHAs for helping families in the decision to accept referral recommendations, the creation of a telephone helpline and of access to a pool of vehicles to facilitate transport to referral facilities, and providing social support during stay at hospital. In addition, first referral level facilities, i.e. Community Health Centres (CHCs), are being supported for improved management of labour, provision of essential newborn care at birth and management of sick newborns. The primary impact of the intervention will be measured in terms of reduction in newborn mortality, increased utilization of CHCs and district hospitals for newborns with severe illness. Rationale for the Project Interventions to improve newborn survival can be delivered during pregnancy, during labour and childbirth, and during the newborn period. Obstetric complications, particularly in labour, are a major source of stillbirths and early neonatal deaths. Intrapartum risk factors increase the risk of perinatal or neonatal death more than pre-pregnancy or antenatal factors. Improved delivery care, with labour surveillance for early identification of complications, such as provided by the partograph, has been associated with significant reductions in newborn mortality. Studies indicated that quality of delivery care in many health facilities do not meet the standards required for their full impact on maternal or newborn survival. While the provision of newborn care at the home and first level facilities such as primary health centres is a core child health intervention that is expected to reduce newborn mortality by over 30%, newborns that are severely ill will need to be referred to a higher level facility for care. Therefore this intervention was implemented and evaluated to understand the impact of improving access to quality referral care for newborns identified with danger signs in the community. It was conducted in settings where IMNCI had been implemented both at the community and first level facility. Key partners and their roles: The study was implemented by following key partners – Department of Medical, Health & FW services, Government of Rajasthan, ARTH Udaipur, UNICEF, Rajasthan and WHO. Their roles are mentioned below: THE STUDY Primary Objectives Secondary Objectives Intervention Clusters: Description of Activities: Please click here for a detailed report on the project.
SAMPOORNA (2011-15)
Impact Of Three Feeding Regimens On Recovery Of Children From Uncomplicated Severe Acute Malnutrition (SAM) In India A Randomized Controlled Trial (2011-15) Research Agencies: Society for Applied Studies, New Delhi, in partnership with Action Research & Training for Health (ARTH), Udaipur and Christian Medical College, Vellore Trial monitored by: Department of Biotechnology (DBT), Indian Council of Medical Research (ICMR) & Ministry of Health & FW, Government of India Technical oversight by: Department of Maternal-Child & Adolescent Health & Development, World Health Organization (WHO), Geneva Ethical oversight: Institutional Ethics Committees of participating research institutions and WHO ERC Financial Support: Bill & Melinda Gates Foundation India has the largest number of children affected by malnutrition in the world. As per the National Family Health Survey of 2005-2006, among children under the age of five. This is believed to be due to a combination of socio-economic and societal factors including poverty, food insecurity, gender inequality, disease and poor access to health and developmental services. Severe acute malnutrition is an extension of this problem and is a life threatening condition for children aged between 6-59 months. While prevention is essential to deal with the problem of malnutrition, prompt and effective management of SAM is a public health priority for preventing deaths among the affected children.The Sampoorna project is an attempt to resolve this situation. It involves comparing 3 different feeding regimen for nutritional recovery among children suffering from uncomplicated severe acute malnutrition. The emphasis is on community and home based management of uncomplicated severe acute malnutrition. Study Hypothesis: Ready to Use Therapeutic Food (RUTF) produced centrally or locally will be more effective compared to home prepared foods in achieving recovery 16 weeks after initiating treatment, among 6-59 month old children suffering from severe acute malnutrition (SAM) Objective: To evaluate the impact of 3 home-based food regimens (centrally produced RUTF, locally produced RUTF and Augmented Home Prepared Foods) on recovery of children with uncomplicated severe acute malnutrition, between 6-59 months. Primary Outcome: Recovery (weight for height at least -2 SD of mean) by 16 weeks after enrolment Secondary Outcomes: Study Sites: Urban slums in the national capital region (Delhi), Rural and tribal in southern Rajasthan (Udaipur and Rajsamand districts) Rural and urban Tamil Nadu Feeding regimens for home management of SAM: Implementation strategy: A team of trained surveyors covered each village, enumerated all children aged 6 – 59 months, and after consent measured mid upper arm circumference (MUAC). Children with MUAC below a cut-off level of 13 cm were transported to a field clinic where anthropometry (height, weight, etc) was carried out and a doctor screened for illness. Children with uncomplicated SAM are enrolled after consent in the trial, those without SAM or with complications are treated and / or referred to hospital by the physician. Enrolled SAM children received food supplies (RUTF or home foods as per random allocation) each week, and daily visits by a helper (a female neighbour) to help ensure regular feeding. Project staff also visited bi-weekly for counseling support and weekly for anthropometry. After recovery from SAM for 16 weeks (whichever is earlier), the child was linked to the nearest anganwadi for further management. During screening and enrolment, all children receive free treatment, transport and referral services. Implementation of Trial: As on 12th September 2014 a total of 287 children were enrolled. Treatment phase was completed by December 2014 while sustenance phase was completed by April 2015. Progress at the Rajasthan site (as on 31 December 2014): Villages covered 62 Households covered 18,300 Population covered 81,209 6 to 59 month old children identified 6,555 Children with arm circumference (MUAC) below 13 cm 1,378 (21.02%) Children with severe acute malnutration (SAM) identified 360 (5.49%) Total no. of SAM children enrolled 287 (79.72%)
Maternal morbidity, its burden, consequences and options for interventions in a rural area in Rajasthan (2007-2010)
ARTH is conducted a study on maternal morbidity with the following objectives: The study consisted of the following components: Study area: 49 villages in two blocks of Udaipur district and in one block of Rajsamand district covering a population of 54,000. As part of this, nearly 600 women were followed up at 6 weeks, 6 months and 12 months after delivery.
Survey of abortion services in Rajasthan (2003-04)
To work towards making safe abortion services accessible in rural areas, ARTH was part of a 6-state study on the situation analysis of abortion services. The study revealed that in Rajasthan:
Home Based Management of Young Infants (2002-09)
The Home Based Management of Young Infants (HBMYI) was a research study intended to study the effectiveness of a package of home-based interventions, delivered by a village-based worker, in reducing mortality of neonates and young infants (<60 days) in rural communities through a multi-site field trial. In Rajasthan, Rajsamand district was chosen in consultation with state and district authorities as it had neonatal mortality above 40 per 1000 births and more than 70 percent of deliveries occurred at home. A baseline study undertaken at the beginning of the study helped to assess the outcome and impact of the interventions. Teenage, first-time and illiterate mothers, and those from SC/ST and OBC communities exhibited the highest NMR in the baseline study. study was undertaken across four PHC areas of the district which followed two approaches- in two PHC areas village based female workers called shishu rakshaks (SR) were employed while in other two PHC areas anganwadi workers (AWW) have been trained to provide home-based care. The SR/AWW visited the families during pregnancy, delivery and 8 times during the first postpartum month. She educated the mother & family on newborn care and feeding, detected problems and managed or referred to them. This is carried out with extensive support from ARTH, ICDS and the health department. Over four years of the HBMYI implementation period (2004-2008), NMR decreased from 77.3 to 37.7 in the intervention area. This study demonstrated the feasibility of offering home based management of young infants from locally trained women in reducing NMR in rural/low resource settings.
Integrated Management of Childhood Illness Study (2001-03)
ARTH undertook a research study to assess whether training doctors in counseling improves care-seeking behaviour in families with sick children. The study was implemented in 12 PHC areas of Udaipur district, 6 of which were intervention areas and 6 were control areas. Doctors in intervention centres were trained in counseling, communication, and clinical skills, using the integrated management of childhood illness approach. The results of the study suggested that : The intervention site physicians reported that following training, use of local terms for danger signs and pictorial cards for demonstrating these signs helped them in communicating more effectively with the families. Sustained improvement in counselling performance would probably require, in addition to training, addressing systemic factors such as crowd management and queuing, scheduling field duties and administrative work in a manner that does not affect the time-availability for OPD.
ANM: What determines her decision to reside in the work area? (2000-01)
ARTH conducted a study to understand how ANMs in Rajasthan decide about residing within their work areas and to suggest policy and programmatic changes to encourage ANMs to reside in their work areas. A key finding was that the personal, family and security needs of ANMs deeply impact their availability on the ground, and hence their productivity and efficiency. Thus, efforts to encourage ANMs to reside in their work area should aim to enhance their ease of staying as well as enforcing accountability. The study put forth the following recommendations to encourage ANMs to reside within their work areas : The study found that the ANM takes an “economic” decision about whether or not to reside within her work area. This decision is taken after weighing the “ease of staying” and the “inconvenience of not staying” in the area. The study revealed that the ANMs were more likely to stay in their sub-centre villages if they had spent their growing years in a village, and if their sub-centre village was far from a city.
Nutritional status of pre-school children in southern Rajasthan (1999-2000)
A study was conducted in five blocks across 2 districts of southern Rajasthan to estimate the prevalence of stunting, wasting, and those underweight among rural preschool children (0-35 months) and to compare the degree of stunting among beneficiaries and non-beneficiaries of ICDS supplementary nutrition. The study found that protein malnutrition was highly prevalent among rural children aged less than three years, as evidenced by high levels of wasting (19.4%), stunting (53.8%), and underweight (53.8%). It appears that a major reason for malnutrition among children under 3 years of age is difficulty in weaning. The finding that babies born at close birth intervals of less than 3 years were stunted, underscores that malnutrition may be a consequence of high and uncontrolled fertility in the area. There was no significant difference found in the prevalence of wasting or stunting between beneficiaries and non-beneficiaries of ICDS programmes. 16.8% of children aged 6 to 35 months received supplementary food from the anganwadis, which was only 43.1% of the maximum children that could have been targeted by the programme. Children born in scheduled tribes and scheduled caste households were significantly more malnourished than those born to other castes. The further a child lived from the Anganwadi, the less likely it was to receive the food supplement. Low level of routine contact with health care providers made it less likely that early malnutrition in children could be detected and treated by such providers.