Interpretations of Population Policy by Community Health Workers In Alwar, Rajasthan

Background/Significance: In India, rural public health workers called Auxiliary Nurse Midwives (ANMs) are often the key providers and promoters of sensitive contraceptive techniques and technologies to village women whom otherwise have minimal access to such information/services.

Objective/Purpose: This paper explores ANM's perceptions of changing contraception policies and practices post the 1994 Cairo International Conference on Population and Development. ,

Methods: A qualitative study consisting of tape-recorded unstructured and semi-structured interviews and participant observation was carried out over five months with 15 urban-dwelling ANMs who serve in subcentres in the predominantly Meo-Muslim communities in the Alwar District, Rajasthan. Nurses were recruited from a government list and selected based on interest and Alwar residency. Interviews were primarily conducted in the nurse's homes, occasionally with their children/other family members present. Prior to the interview, nurses were administered written informed consent.

Results: Nurses noted recent incorporation of vaccinations and maternal health measures into family planning. They also cited benefits from the addition of community-based “paid volunteers”. Yet, nurses also reported a system of contraceptive “targets” that were developed from ANM surveys of their communities, but often “corrected” by government bureaucrats. Religious differences in beliefs regarding child-bearing and sterilization were reported by 87% of ANM'and seen to negatively affect their work.

Discussion/Conclusions: Post Cairo, ANM's perceived an increase in the quality of reproductive services. A more comprehensive survey, with a more representative sample of ANM's is needed to better understand attitudes and practices as it relates to the quality of healthcare in Rajasthan.