Girls who become pregnant as adolescents can face an increased likelihood of major health risks and dropping out of school, and a reduced lifetime earning potential. This session will explore these issues and more. We will discuss how Rotary can help improve the lives of adolescent girls, reduce the risks of child marriage, provide broader access to family planning resources, and lower population growth.

1. Postpartum and post-miscarriage family
planning in Gizri Maternity Hospital, Karachi
Global Grant No. 1418936
(Maternal and Child Health)
Shahida Zaidi, FCPS
Rotary Club of Karachi Cosmopolitan (District 3271) and
Rotary Club of Ludwigshafen-Rheinschanze, Germany
(District 1860)
under
Rotarian Action Group for Population & Development

2. Why was the project carried out?
To contribute to improving maternal and newborn health
(and to controlling untrammeled population growth) in
Pakistan
• Population 160 million (PDHS* 2007)
• 180 million (PDHS 2009)
• 207 million (estimate 2016)
• 4-5 million births/year
• Total fertility rate 3.8 (PDHS 2012-13)
- Poor maternal health due to repeated
pregnancies
- 24% receive no antenatal care, 52% deliver
at home
*Pakistan Demographic Household Survey

3. Primary Contacts:
Sibte A Jafri, RC Karachi Cosmopolitan
Guenter Lang, RC Ludwighafen-Rheinschanze
Implementing partner: The Association of Mothers and
Newborns (AMAN)
Time frame: 1 year – Dec 2014 - Nov 2015
Follow-up period: 2 years – Dec 2015 - Nov 2017
Budget: $ 38,250
Project Quick facts

4. Gizri Maternity Hospital
• A secondary care public health
facility run by the city district
government
• Has heavy emergency
workload, with about 3000
deliveries each year,
• Baseline postpartum and post-
miscarriage FP method
provision: 5.1% (during 2013 -
at time of grant application)

5. Main objective
To contribute to improving maternal and newborn
health by:
• Providing an effective and appropriate family
planning (FP) method to women after delivery or
miscarriage, before their discharge from hospital
Target 30%, from 5.1% in Y 2013 (5.9 times increase)
Emphasis on IUCD insertion, with tubal ligation in appropriate
women
Short-acting/temporary methods also counselled and provided, but
not counted in this study.

6. Activities carried out
• Training of healthcare providers (details next slide)
• Purchase of equipment
- hospital supplies , office equipment, training equipment
Service delivery
– Counselling of women in family planning (FP) methods, and help
in selecting an appropriate method
• Record-keeping of FP method provided (primary outcome
indicator)
• Analysis of data to assess impact

7. Training of healthcare providers (HCPs)
1. In family planning counseling and service delivery, and
in 2 or 3 topics of emergency care to
– 43 doctors, nurses and midwives (including 7
doctors from community, and 2 visiting doctors)
2. In FP counseling to 23 Lady Health Workers
3. In Emergency Obstetric and Newborn Care (with funds
remaining) to 210 HCPs – eight one-day workshops
4. Stipend of 10 midwifery pupils of Community
Midwifery School paid for 15 months

8. A group discussion on WHO
Medical Eligibility Criteria
for contraceptive use
“Train-the-trainers"
session: presentation
by a group leader
Scenes from workshops
Participants practicing skills
on models

9. Beneficiaries of the project
1. A total of 2782 women provided family planning services (IUCD
insertion and tubal ligation) in 3 years
Baseline data
- 2013: 5.1% of women (tubal ligations during CS);
- Jan – Nov 2014: 9.3% (awareness of coming project)
Intervention year: 34.9%
Follow up year 1: 36.7%
Follow up year 2: 31.8%
TARGET OF 30% ACHIEVED IN ALL 3 YEARS

10. Further breakdown: In first 2 years, high uptake of IUCD after a
miscarriage, but decline in third year. Also uptake low <10% in
all 3 years after a normal delivery
59%
46%
27%
23% 26% 26%
After intervention

11. Financial outlay (funds recd $ 38,250)
No. Description Category Budgeted
cost (PKR)
TOTAL SPENT IN
2 YEARS
1 Honorarium for personnel Personnel 763,200.00 752,888.00
2 Facilitation fee Training 495,000.00 480,000
3 Meals/other costs: Operations
Meals (participants +facilitators + support staff) Operations 153,000.00 170,973
Hall rent + multimedia hire Operations 95,000.00
Tips Operations 5,400.00
4 Training material Training 240,000.00 314,458.00
5 Training supplies (e.g. pelvic models) Supplies 267,645.00 249,850.00
6 Training/hosp equipment Equipment 764,915.00 252,042.00
Stipend for 10 pupil midwives for 15 mo at Rs 3500/moTraining 525,000.00
7 Office equipment Equipment 240,000.00 205,286.00
8 Local travel Travel 95,786.00 90,000
9 PR / media coverage / promotion Publicity 265,000.00 149,210.00
10 Monitoring / evaluation (12 mo) M & E 380,000.00 360,000
11 Reserve/additional costs Project management 390,000.00 240,000.00
12 Bank charges 10,984.00
4,054,546.00 3,901,091.00
Amount actually received Rs 3,901,500
Remaining Rs 409 + Rs 100 with which the A/C was
opened equals Rs 509

12. Scaling Up the Project
With support from our International partner – a
second Global Grant applied for, which was
approved, work already started
• $ 46,500 (as opposed to $ 38,250)
• Work in 6 health facilities - in rural area as
well as urban Sindh, plus in Turbat in
Balochistan
– Maternity hospitals
– Family planning clinics
• Additional support to and from Population
Welfare Departments and from local Rotary
Clubs

13. Time frame: 1 year Follow-up period: 1 year
Venues 6:
4 maternity hospitals:
• Maternity Hospital in Memon Goth, Malir District, Karachi (Sindh)
• District Hospital, Mirpurkhas (Sindh)
• Peoples’ Medical College Hospital, Nawabshah (Sindh)
• District Hospital, Turbat (Balochistan)
2 Family Planning Clinics:
• Family Planning Clinic, Gadap, Karachi (Sindh),
• Family Planning Clinic, Umerkot (Sindh)
Scaling Up: GG 1861045

14. Expected beneficiaries (1)
• In the 4 selected hospitals
– about 3000 women who seek care during
pregnancy and childbirth
– 600 women who undergo management of an
incomplete miscarriage
• In 2 Family Planning Clinics
– about 2000 women who attend the clinics
• 600 provided long-acting reversible methods (IUCD and
hormonal implants) or a permanent method (tubal
ligation), and
• 1400 short-acting or temporary methods

15. Beneficiaries (2)
• About 60 doctors, nurses and midwives working
in the 4 hospitals (trained in FP counseling and
method provision, and Emergency Obstetric and
Newborn Care (EmONC),
• About 12 doctors, nurses and paramedical staff
working in the 2 selected Family Planning Clinics
• About 40 Lady Health Workers (community
workers) - trained in FP counseling and method
provision, and referral for appropriate FP
services.

16. Funds –
$ 46,500
(Rs
4,882.55)
No. Category Description
Cost in
Pak Rs
1 Personnel
Honorarium: a. Project Director at Rs
55,000/mo X 9 months
495,000
Honorarium: b. Family Planning Counsellors 8
(2 in each hospital) X Rs 20,000/pm X 3 months
480,000
2 Training Training material and supplies 121,600
Facilitation fee 640,000
3 Operations Meals and other costs incl Hall rental : 434,000
4 Equipment Hospital equipment: Beds and screens 554,064
Office: 1 desktop computer for each of 6
health facilities, UPS, printers 397,500
5 Travel
Local travel, including domestic air and road
travel in 4 cities
700,000
6 Publicity PR/media coverage/promotion 180,390
7 M & E Monitoring and evaluation 480,000
8
Project
management
Reserve/administrative cost
400,000
TOTAL 4,882,554
Cost in USD 46,500 ($1 = 105)