Parivar Seva Sanstha provides need based affordable clinical services to the community across 11 states in the country through its 31 comprehensive Reproductive Health (RH) Care service clinics. The services are recognised by the concerned district officers in the state. Clinics are accredited and doctors empanelled for sterilization procedures. All clinics are also approved under the Medical Termination of Pregnancy Act.
In 1978, the Sanstha established its first clinic in Delhi to provide safe and affordable abortion services including post-abortion care under the ambit of the country’s Medical Termination of Pregnancy (MTP) Act, 1971 and Rules 1972 and 2003. Over the years, the clinics have expanded both in numbers and range of services and today, almost all RH care services are offered at all the clinics. All the clinics are registered/accredited as per statutory requirements and have the latest equipment, instruments and technology including competent and trained medical, nursing and paramedical staff. They offer client-centred quality services with warmth and care in a friendly atmosphere.
SERVICES OFFERED BY OUR CLINICS
Parivar Seva Sanstha provides free/subsidized services, which are affordable.
1. COUNSELLING: Counselling is the key component of service delivery provided at all the clinics through competent counsellors, based on the client’s need. It enables and assists them in making the correct choices according to their need and achieve their reproductive health goals, covering a wide range of RH care.
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Doctors counseling the clients
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Clinic Incharge informing about clinical services and the counselling process.
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The emphasis is on children by choice, birth spacing, safe sex and fertility awareness, infertility management, early detection of cancer etc.
2. GYNAECOLOGICAL CONSULTATIONS:
a) General Gynae Problems: There is a need for our young girls and women to come out of the “culture of silence” associated with women’s reproductive health issues. To manage various minor gynaecological problems associated with menstrual cycle/bleeding, pain, infection etc, consultations with experts are available in all clinics.
b) Reproductive Tract Infections (RTI) / Sexually Transmitted Infections (STI) management: Services for prevention, diagnosis and treatment of the clients (both female and male), including their follow up care is provided in the clinics.
c) Pre-menopausal & Menopausal gynae problems: Many older women may face problems associated with their menstrual cycles. Consultations are available in Special clinics for women between 40-45 years (pre-menopausal) & 46-60 years (menopausal) to manage these issues.
d) Adolescent – Sexual & Reproductive Health problems: Special clinics dedicated to adolescents and the youth with emphasis on knowledge about sexuality and reproduction, safe sex to prevent STI and unwanted pregnancy, address their Reproductive Health issues etc.
3. ABORTIONS: All the clinics provide Medical Termination of Pregnancy (MTP) safely up to 20 weeks, both medical abortion (abortion with medicines) and surgical abortion by following set standards and latest techniques, assuring full confidentiality of the clients. However, Sex Selective Abortion is not done at any of the clinics. All clinics perform abortions mostly as a day care procedure with assured privacy and confidentiality All clients opting for abortion are fully counselled, screened medically, which is then followed by the basic laboratory tests.
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The procedure is carried out by competent doctors, using the method acceptable to her and which is also appropriate. Post-procedure, clients are offered/administered the contraception of their choice which they would have voluntarily accepted prior to the procedure. Free of cost follow-up for any complaint or problem is offered to the clients for 42 days.
The various procedures by which abortions are carried out in Parivar Seva Clinics are as follows:
a) Medical Abortions: Medical Abortion, i.e. abortions with medicines, is offered under medical supervision in all Parivar Seva clinics. It is a safe procedure if done under medical supervision. It avoids surgical intervention and general anaesthesia. Medical Abortion is done within 63 days of missing a period by giving two abortion inducing drugs orally on day 1 and 3. In about 5% of cases, it may not be successful and may require evacuation by about 5% of cases, medical abortion may not be successful and the woman may require surgical aspiration (EVA). In such cases, EVA is provided by Parivar Seva clinic, free of cost.
b) Surgical Abortions: The uterus is emptied by Manual Vacuum Aspiration (MVA), a suction method or by surgical evacuation with instrument (EVA/D&E). The procedure can be done under local or sedation anaesthesia. General anaesthesia may be given in some cases. It is done as a day care procedure in almost all cases.
4 . MANAGEMENT OF INCOMPLETE ABORTIONS: Incomplete abortions, which may have occurred naturally or may be the result of a failed medical abortion initiated elsewhere, are also managed at all the Parivar Seva clinics. Incidences of incomplete abortions after women having taken pills without medical supervision, has now become rampant. All Parivar Seva Clinics currently treat a large number of women who present themselves with incomplete abortions after self initiated abortions. Often, their condition is not good. There is a need for women and their families to be aware that medical abortions done without medical supervision can have serious and life threatening consequences.
5. CONTRACEPTION: All the clinics provide a wide range of contraceptive methods depending on the need and choice of the clients, ranging from temporary methods (for spacing of a child) to a permanent one (for limiting the family) as also emergency contraceptive (for accidental/unplanned sexual intercourse) to prevent a pregnancy.
a) Reversible (temporary) methods
(i) Condoms:
Barrier method of contraception. It has the dual advantage of protecting against sexually transmitted infections and unwanted, unplanned pregnancies.
However, to be effective, it has to be used consistently and correctly. Both free products (Nirodh) supplied under NHM and socially marketed lower priced Parivar Seva brands (Sawan, Bliss and Rider) are provided in the clinics.
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Parivar Seva brands of condoms – Sawan, Bliss and Rider
(ii) Oral Contraceptive Pills (OCPs) : Two types of Hormonal and non-Hormonal OCPs are provided in Parivar Seva clinics:
Hormonal OCPs
Combined Oral Contraceptive Pills (COC): It contains small doses of female hormones (oestrogen and progesterone), which alter hormonal mechanism in the body and causes suppression of ovulation and thus provides contraceptive effect. One pill has to be taken daily, approximately at the same time of the day for effective contraception benefit. First time user should start this pill within five days of her menstrual cycle. Apart from contraceptive effect, pills have other benefits in management of dysmenorrhea, irregular/heavy bleeding, control of anaemia etc. Return to fertility is immediate on stopping pills. Some women may experience minor side effects like nausea in the initial months.
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All Parivar Seva clinics provide free pills from NHM (Mala N) as well as Parivar Seva’s socially marketed product (ECROZ) at minimal cost.
A cycle of these OCPs have 28 tablets – 21 hormonal tablets and 7 iron tablets.
Progesterone Only Pills (POP): Contains small doses of only one hormone (progesterone) and no oestrogen. They can be used by women who are breastfeeding and those who cannot use oestrogen. One pill has to be taken every day, without a break. They act by thickening the cervical mucus and prevent the release of eggs. The product is available in the commercial market and is being introduced in the public section by Government of India under the NHM (Family Planning programme).
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Non-Hormonal
Centchroman (Saheli) / Chhaya: It has been developed in India by CDRI, Lucknow, UP and is marketed only in India. It is effective if taken regularly at the scheduled date and time. For the first three months, it is to be taken two days in a week. Thereafter, it has to be taken once a week. It does not have side-effects of the hormonal contraceptives, but some women may have irregular menstrual cycles. |
(iii) Intra Uterine Contraceptive Devices (IUCD): Very effective, long acting reversible contraceptive method (LARC). IUCD is placed in the uterus and acts by causing a chemical change in the uterine cavity that damages the sperm and egg before they meet, thus preventing fertilisation.
All Parivar Seva clinics provide both IUCDs (CuT 380 A and mutiload CuT 375) at a very nominal cost. Those received from the government are provided free of cost. Also, LNG-IUS are procured and provided as required in special cases.
There are two types of IUCDs, copper bearing and hormone impregnated.
Copper Bearing
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Copper T 380A: It is a ‘T’ shaped, copper bearing device, effective for 10 years. It can be used by most women of all age groups. Heavier and prolonged bleeding associated cramps can be expected in the initial three to six months. It can be removed any time a woman desires. There is no delay in return to fertility when the method is discontinued. |
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Multiload (CuT 375): It is also a copper bearing device, in which the horizontal limb is curved (umbrella shaped) and thus has slightly reduced side-effects of bleeding and cramps, as compared to Copper T. It is effective for five years. |
Hormone Impregnated
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Levonorgestrel Intrauterine Device (LNG-IUS): It is a ‘T’ shaped device impregnated with Levonorgestrel hormone, which is slowly released in the body. It is a highly effective and reversible method. It is specially indicated for use in women with heavy menstrual bleeding. It primarily acts by suppressing the growth of the inner lining of the uterus. It may cause bleeding, changes in the form of scanty and irregular and infrequent bleeding. The product is available in the commercial market and not yet introduced in the National Family Planning programme. |
(iv) Injectables: Two types of injectables are available. Progestin only injectables, containing only progesterone (DMPA & NET EN) and combined one, containing small doses of both oestrogen and progesterone.
Depo Medroxy Progesterone Acetate (DMPA): This is a progesterone only injection in which the hormone is in microcrystal form dissolved in aqueous solution, to be administered intra muscularly every three months. It is a very effective contraception.
In most cases, the drug causes changes in the menstrual pattern in the form of irregular scanty bleeding followed by no bleeding, which is reversible and not harmful to the body. Return to fertility is, however, delayed. It may take three to six months from the last injection. It may reduce Bone Mineral Density (BMD), but changes are reversible. It has now been included in the government’s basket of contraceptive choices under NHM in the Family Planning programme. All Parivar Seva clinics are providing this method at a very nominal cost.
Norethisteroneenanthate (NET-EN): It is also a progesterone only injectable containing the hormone Norethisteroneenanthenate. It has to be given at an interval of two months. It affects the bleeding pattern less than DMPA.
(b) Irreversible (permanent) methods
Sterilisation: A permanent method of contraception to limit the family size for those who have completed their families and do not want any more children. It has the advantage of being a one time method and avoids recurrent visits to health establishments. It can be performed both on females and males.
All Parivar Seva clinics are providing sterilisation services for men and women as per technical and administrative guidelines of the Ministry of Health and Family Welfare, Government of India. In focused states, (e.g. Uttar Pradesh, Bihar, Rajasthan, Madhya Pradesh, Gujarat and Chhattisgarh) all acceptors of sterilisation are given wage compensation as per the government policy. However in non-focused states (e.g. Delhi, West Bengal, Tamil Nadu and Karnataka), only those Below Poverty Line (BPL) are offered free sterilisations with wage compensation. In these non focused states, Parivar Seva Sanstha offers sterilisation services at very nominal cost to those Above Poverty Line (APL), but in the Low income and middle income groups.
(i) Female Sterilisation: Known as tubal ligation and tubal occlusion based upon the technique involved, it is a safe procedure done under local anaesthesia (general anaesthesia can also be given, if necessary) and has minimal morbidity and mortality if done in a proper place by competent and skilled providers. Failure rate is very low. It varies between 0.5 to 1.0%.
Two methods are prevalent, Minilap Method and Laparoscopy, which is offered as a choice to clients in almost all Parivar Seva clinics. However, in some clinics, only one method may be available.
Minilap Tubal Ligation: It is done by making a small incision in the lower part of the abdomen, through which the fallopian tubes are cut and tied, under direct vision.
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Before Sterilization
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After Sterilization
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It is mostly done as day care procedure under sedation and local anaesthesia (general anaesthesia may be required in some situations).
Laparoscopic Tubal Occlusion: Done under vision through laparoscope in which both the tubal lumens are occluded using silastic rings applied on the loop of the tube. It is also a safe and quick method with minimal post procedure discomfort, mostly done under local anaesthesia.
(ii) Male Sterilisation
Non Scalpel Vasectomy: It is a no cut, no stitch technique, in which both the vasal tubes on either sides are approached through a single mid-scrotal puncture. It is one of the safest, quickest and most effective contraceptive methods.
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The man can go back to routine light work immediately after surgery. Since there is no damage to the nerves and blood vessels, there is no effect on the man’s sexual pleasure or activity and seminal discharge. However, vasectomy is not immediately effective as a contraceptive method like female sterilisation. Couples need to use condom or some other effective method of contraception for at least the first three months or until the sperm completely disappears from the semen. This is confirmed by doing a semen test at three months. The failure rate is low and ranges between 1 to 2 %.
(c) Emergency Contraception
Emergency contraception helps to prevent pregnancy in an unplanned and unprotected sexual act or following a damaged condom/leak or forgotten intake of oral pills or following sexual assault. Two types of contraceptives are available:
- EC Pills: They contain hormone Levonorgestrel 150 mcg in a single tablet. It has to be taken as early as possible but within five days of sexual act/accident. It is not an abortion pill. It should also not be used as a method of regular contraception, because regular contraception is more effective in preventing a pregnancy than emergency contraception. If the EC pill fails and a woman becomes pregnant, she can continue with the pregnancy if she desires.
All Parivar Seva clinics provide EC pills free of cost from NHM supply (E-pills) and minimally priced Parivar Seva’s brand (Ecroz).
- IUCD: Also acts as an emergency contraceptive, which can be inserted up to seven days of unprotected sexual act/assault/accident and can be continued as a long term contraceptive method.
6. INFERTILITY CARE AND MANAGEMENT: The incidence of infertility is about 10% among couples in the reproductive age group. The problems of infertility is almost equal in both men and women (about 40% in each) and the rest (20%) is unexplained. The incidence of infertility is on the rise in the community particularly in urban areas due to late marriages, lifestyle changes, food habits, environment etc. The National Family Welfare Programme has given due emphasis on handling this problem. To address this issue, all Parivar Seva clinics are providing care to the couple towards prevention, assessment and treatment including basic assisted reproduction techniques. This includes techniques such as Intra Uterine Insemination (IUI), Diagnostic D & C for endometrial biopsy, Hydrotubation and Diagnostic Laparoscopy with Chromotubation, which are offered as OPD procedures at minimal costs.
7. CANCER SCREENING / DIAGNOSIS, REFERREL AND PREVENTIVE CARE (SPECIALLY BREAST AND CERVIX): Most common cancers in women is in the breast and cervix, which can easily be identified in the initial stage and can be fully cured with proper treatment. Simple clinical assessment for breast and cervix as also screening of cervix by visual inspection with acetic acid application (VIA) and PAP smear test can easily detect early lesions. The suspicious findings in women/frank ones are referred to bigger hospitals for proper treatment. All Parivar Seva clinics regularly counsel the clients for periodic self-examination of their breasts and provide services of VIA & PAP smear tests to all high risk and suspicious women.
8. ANTE-NATAL AND POST-NATAL CARE (ANC & PNC) SERVICES are being provided in Parivar Seva Clinics to pregnant and post-delivery women, particularly in clinics based in rural areas where these services are inadequate.
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9. IMMUNISATIONS of pregnant women and children.
10. OTHER MINOR GYNAECOLOGICAL PROCEDURES:
(i) Insertion of LNG-IUD: This gynaecological treatment is available in all Parivar Seva clinics.
(ii) Diagnostic D & C-Therapeutic : This diagnostic procedure is available in all Parivar Seva Clinics.
(iii) Cryocautery: To treat some specific benign lesions in the cervix such as cervical erosion, unhealthy ulcers, white patches etccryocautery is required, which is available in Parivar Seva clinics.
(iv) Minor gynaecological surgeries: The clinics are equipped to remove vaginal cysts (Bertholene or other simple cysts), simple ovarian cysts, etc
11. TREATMENT FOR SEVERE ANAEMIA: Iron Sucrose infusion is available in some Parivar Seva Clinics.
12. MEDICHECK: Preventive general health check up with gynaecological screening. Both full medical and part medicheck services are available in all clinics.