Early Pregnancy Detection and Reproductive Health Referral by Female Community Health Volunteers in Nepal

Female community health volunteers (FCHVs) have been identified as a possible entrée for Nepali women to access timely reproductive health services, including antenatal care, comprehensive abortion care, and family planning. Between July 2008 and June 2009, 1683 selected FCHVs from six districts in Nepal were trained to implement this innovative program. FCHVs participated in district review meetings and were interviewed about their contacts with women, program successes and challenges. 1492 trained FCHVs participated in the review meetings, with 1199 reporting use of one or more urine pregnancy tests (UPTs) with women. In total, 4598 urine pregnancy tests were conducted. Among these, 2146 (47%) were negative; 985(46%) of these women received contraceptive counseling and 207(10%) were referred for contraceptive services. In addition, 436(20%) received condoms and 518(24%) received oral contraceptive pills from the FCHV. Among the 2452(53%) women with positive pregnancy tests, 1666 (68%) were referred for antenatal care and 786 (32%) referred for safe abortion services at the woman's request. FCHVs were happy with the increase in skills that arose from use of the UPT for early pregnancy detection. FCHV counseling skills and reputation were an asset for enhancing women's access to reproductive health services. Mobilizing a large number of FCHVs with the materials and supplies required for early pregnancy detection and referral is a viable method for improving access to reproductive health services at the community level in Nepal. Attention is needed to ensure service availability, UPT supply and creating viable record keeping and evaluation during scale up.