Nepal has experienced a substantial reduction in maternal mortality in recent years. Credit has been given to community health workers known as Female Community Health Volunteers (FCHVs) for this achievement. However, Nepal still has a high rate of maternal mortality at 170 deaths per 100,000 live births and unsafe abortion is one of the main causes of these deaths. This blog is aimed to promote the function of FCHVs in pregnancy testing and making referrals in villages of Nepal.
FCHVs are the first source of contact for maternal and child health services in the rural communities of Nepal. In some of the poorer villages, FCHVs are the sole source of health care. While some of these FCHVs have been providing services for the last two and half decades, others have been recruited recently. Apart from health advice and referral for antenatal care, FCHVs distribute temporary contraception such as condoms and pills to both men and women of reproductive age. This contraception is provided free along with education and referral for long-lasting or permanent methods of family planning.
Over the years, the roles of FCHVs have been extended. Currently FCHVs play an important role in undertaking urine pregnancy tests and referring women for safe abortion services if required. As a part of my PhD research I visited Dhading, a rural community. I found women contacted FCHVs if they required confirmation of their pregnancies. The pregnancy test kits were obtained by the FCHVs either from a health centre or a local pharmacy. If women were pregnant, FCHVs usually referred them for antenatal care check ups. However, if a pregnancy was unintended, then FCHVs would provide information on emergency contraceptive pills and availability of safe abortion services. Women would receive confidential services if required.
Abortion was legalized in Nepal in 2002 and was practiced from 2004. However, the abortion service was initially limited to cities. From 2009, FCHVs were enabled to inform women on safe abortion services in some communities of Nepal. FCHVs were, and still are, trusted enough to be approached by women.
FCHVs are able to be effective in delivering these services because they belong to the same community that they are serving. They are in a position to understand the needs of local women as they have experienced the same needs themselves. Information on contraception and safe abortion is shared by FCHVs whenever they meet with women: be it at work or be it at home. Besides the government health care system, almost all private health organizations also utilize FCHVs to deliver their health interventions in rural communities.
It is the availability and accessibility of information on contraception and safe abortion services in the villages by the FCHVs that has made a real difference. In my opinion, learning from these small villages can be up scaled to other villages of Nepal that lack access to information on safe abortion services. As FCHVs are highly trusted in the community, they can play an effective role in improving access to reproductive health information. For Nepal, this is the right moment to enable and support the FCHVs by training them to identify pregnancies using simple urine pregnancy test kits. It is important to ensure FCHVs have the urine pregnancy test kits and temporary contraceptive measures with them all the time so as to be able to offer services to women when required, thus helping to improve maternal health.
This post is part of the blog series “Increasing access to maternal and reproductive health supplies: Leveraging lessons learned in preventing maternal mortality,” hosted by the Maternal Health Task Force, Reproductive Health Supplies Coalition/Maternal Health Supplies Caucus, Family Care International and the USAID-Accelovate program at Jhpiego which discusses the importance and methods of reaching women with lifesaving reproductive and maternal health supplies in the context of the proposed new global target of fewer than 70 maternal deaths per 100,000 births by 2030. To contribute a post, contact Katie Millar.