A communications approach to improving women's health

PSI is the worlds third largest NGO. The organization began working in India in 1988 and has since extended their programs to 22 different states and union territories in India. With nearly 20% of the world’s population living in India, health disparities are abundant throughout the country. We met with representative from PSI at their India office to learn about their women’s health programs. The main goal of their program is to empower women of reproductive age (WRA) to make their own decisions. In their efforts to improve the health status of women, PSI seeks to increase the use of IUDs in WRA from 3% in 2010 to 4.1% in 2012. They also intend to increase access to medical abortion (MA) through sales of 300,000 MA kits by 2012.

By increasing the use of IUDs and MA, ultimately maternal morbidity and mortality will be reduced with a decline in the rates of unintended and unwanted pregnancies. There are several key stakeholders that PSI’s women’s health program is targeting to achieve their goals including WRA, providers, pharmacists, and opinion leaders. Their program is based on social marketing, improving access, advocacy, and managing information systems. Their approach seeks to motivate their target audience and to create an enabling environment for IUD and MA services available to WRA.

There are a variety of activities and strategies that PSI uses to target each stakeholder. It was really exciting to learn about the techniques that PSI is using to meet their objectives because many of their strategies are similar to the ones we learn about in our MPH program. One concept used by PSI is the interpersonal communicator (IPC). When we design community based programs in our classes, we often use the idea of community health educators and community mobilizers. IPCs work directly with women in the community by going into the home and discussing the use of IUD. They use a storybook depicting a happy family that has taken advantage of the benefits of IUD. Incentives are given to IPCs based on their performance. The main messages they are trying to dispel are that IUD insertion is as effective as sterilization and the side effects usually subside within 3 to 6 months. We later went out in the field to see how the IPCs work in the community. They pair off with their materials and go directly into the home. It is not uncommon for the IPC to have the discussion with both the woman and her partner as men usually have the final say in whether or not their wives get the IUD or not.

Another strategy that PSI used that I was really interested in was their use of media to promote the IUD product Freedom 5. They use media to expose both men and women. PSI showed us a YouTube video of a Freedom 5 commercial where a male and female are role playing a potential discussion a couple may have when discussing the possibility of using IUD as contraception. This link isn’t the one they showed us, but it is one example of a video used to promote Freedom 5: http://www.youtube.com/watch?v=KHXyj2Hj3NI. In the US, many health intervention programs are starting to use text messaging. Given that all over India it seems that everyone has a cell phone regardless of social class, I think it would useful for programs to begin experimenting with the utilization of telemedicine for intervention.

I also found it interesting to talk about the cultural barriers that prevent a woman from taking advantage of contraceptive methods. Mother in laws are a huge barrier for women because they want their sons wife to fulfill their duty of expanding the family and bearing a son. It is also essential that women gain endorsement from men because they need permission from their husband to leave the home. Kelly and Jenn had the opportunity to go directly into a home with two IPCs and when they reported back, they said the woman did not want to have any more kids, but that she couldn’t get an IUD because her husband wouldn’t let her. It is hard for us to imagine such pressures and barriers to individual freedom in the US, but these cultural norms are prevalent and need to be considered when designing any community based health program.

We made other site visits to a health clinic where a female OB/GYN works as one of the providers promoting PSI. We also visited a pharmacist/chemist that fills prescriptions for MA. PSI works with pharmacists because they dispense 80% of MA medications and they need to be properly educated on how to direct women to take the medication. Each group met with different chemists. The one we visited didn’t really give us any direct answers as to how many drugs he sells without a prescription so it was difficult to gauge the volume based on his response. I imagine this is because he was afraid we might report him, and he really had no reason to trust us either way.

This is just another example of many opportunities we have had on this trip to see what we learn in the classroom applied in the field and these experiences are invaluable. I really enjoyed meeting with the PSI staff. Given that PSI presence across the globe is so established, I can see why they are so successful. The models they have in place to improve health problems are creative and well thought out, and it was incredibly beneficial to see much of the theory we learn in action.