Situation Analysis of

MTP Services: Jharkhand

MTP Services:
Jharkhand

Situation Analysis of
February-May 2011

Paramita Aich
Sushanta K. Banerjee
Tarun K. Jha
Anisha Aggarwal
Debashis Sinha

For more information, please contact:

Ms. Paramita Aich
State Program Officer - Jharkhand, Ipas India
Email: aichp@ipas.org
Ipas works globally to increase women's ability to exercise their sexual and reproductive rights
and to reduce abortion-related deaths and injuries. We seek to expand the availability, quality
and sustainability of abortion and related reproductive health services, as well as to improve the
enabling environment. Ipas believes that no woman should have to risk her life or health
Situation Analysis of

MTP Services: Jharkhand

because she lacks safe reproductive health choices.

Ipas is a registered 501(c) (3) nonprofit organization. All contributions to Ipas are tax deductible to
MTP Services:
the full extent allowed by law.
Jharkhand
For more information or to donate to Ipas:

February-May 2011

Situation Analysis of
Ipas India
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Vasant Vihar,
New Delhi 110 057, India
Phone: 91.11.4166.2006
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© 2011 Ipas.

Suggested citation: Aich Paramita, Sushanta K. Banerjee, Tarun K. Jha, Anisha Aggarwal and
Debashis Sinha 2011. Situation Analysis of MTP services in Jharkhand. New Delhi, Ipas India

Produced in India

Paramita Aich
Sushanta K. Banerjee
Tarun K. Jha
Anisha Aggarwal
Debashis Sinha
 CONTENTS ACRONYMS AND ABBREVIATIONS
Page No. ANM Auxiliary Nurse Midwife

Acronyms and Abbreviations 1 ACMO Assistant Chief Medical Officer

Introduction 2-4 CHC Community Health Centre

CAC Comprehensive Abortion Care
Background and Context 2
CMO Chief Medical Officer
The Setting: Socio Demographic Profile of Jharkhand 3
CS Civil Surgeon

Scope of the Study 5-6 DLC District Level Committee

DoHFW Department of Health and Family Welfare
Objectives 5
DPM District Program Manager
Methodology 5
DDM District Data Manager
Research Tools 5
GoI Government of India
Respondents 5
GoJ Government of Jharkhand
Implementation 5
IEC Information, Education and Communication
Data Analysis 6 IIPS International Institute for Population Sciences
Limitations and Operational Challenges 6 MA Medical Abortion
Findings 7-12 MBBS Bachelor of Medicine and Bachelor of Surgery
District Level Committee 7 MMR Maternal Mortality Ratio

Formation of DLC 7 MO Medical Officer

Record Keeping and Documentation 8 MTP Medical Termination of Pregnancy

MVA Manual Vacuum Aspiration
MTP Service Provision 8
NFHS National Family Health Survey
Service Access 8
NGO Non-Governmental Organization
MTP Caseload 9
NRHM National Rural Health Mission
Gap between Estimated and Recorded Caseloads 10
Ob-Gyn Obstetrician-Gynecologist
Record Keeping and Documentation 12
PHC Primary Health Centre
Discussions and Recommendations 13-14 PIP Program Implementation Plan
District Level Committee 13 QoC Quality of Care
Service Provision 13 RCH Reproductive and Child Health

Record Keeping 13 ToT Training of Trainers

MTP Caseload 13 UE Uterine Evacuation

WHO World Health Organization
Recommendations 14

References 15
We are grateful to The David and Lucile Packard Foundation for financial support
Annexures 16-37 to implement this program in Bihar and Jharkhand.
 INTRODUCTION
1.1 Background and Context
Unsafe abortion is a neglected women's health
issue in India and in many developing nations.
Worldwide, 40-50 million pregnancies end in
abortion each year, with 20 million of these
taking place under unsafe conditions. Nearly all
unsafe abortions (95-97%) occur in developing
countries (WHO, 2004). Globally, it is estimated
that unsafe abortions result in 47,000 deaths
annually, and approximately 13% of all maternal
deaths worldwide are attributable to unsafe
abortion (WHO, 2011).
Of the 6.4 million abortions performed in India,
3.6 million (56%) were unsafe (Duggal and
Ramachandran, 2004). In India, around 10,000-
12,000 women die each year as a consequence
of unsafe abortion while many women suffer
from long term morbidity with abortion-related
complications (Banerjee 2007). Estimates for
the contribution of unsafe abortions to maternal
death in India vary from 8-20% (Duggal et al.
2004, Chhabra et al. 1993, Dahiya et al. 2005).
Almost all abortion-related deaths are
preventable when performed by a qualified
provider using appropriate techniques under
sanitary conditions (WHO 2003). Recognizing
this fact, the Indian government passed the
Medical Termination of Pregnancy (MTP) Act in
1971 (Hirve 2004). This relatively liberal law
permits a woman to seek an abortion to save
her life, preserve her physical and mental
health, for economic or social reasons, and in
cases of rape or incest, fetal impairment, or
when pregnancy results from contraceptive
failure. Even with this liberal law, access to safe
abortion services did not change much
because of lack of trained providers and
registered health facilities. The complicated
and centralized process of site approval further
restricted the access to safe abortion services.
Subsequent amendments in 2002 and 2003
have aimed to expand safe services by
devolving abortion service regulation to the
district level, changing physical requirements
for facilities providing first trimester abortions,
and allowing medical abortion at facilities not
approved for surgical abortion (Hirve 2004).
Unfortunately, these strong policies and
subsequent amendments have not led to a
significant reduction in unsafe abortion or
related maternal mortality and morbidity in
many states of India (WHO 2010), including
Jharkhand and Bihar, primarily because of
limited utilization of the MTP Act.
To address these critical gaps, and to further
expand access to Comprehensive Abortion
Care (CAC) services with the aim of reducing
maternal mortality, Ipas has been working
closely with the state government of Jharkhand.
In coordination with the Department of Medical,
Health and Family Welfare (DOHFW), Ipas
helps in strengthening the capacity of the state
to implement CAC trainings; facilitates training
of medical doctors and nursing staff to improve
access to and quality of service provision at
different levels of public health facilities, and
advocates policy issues to ensure an enabling
environment.
As on January 2011, Ipas trained and certified
430 MBBS doctors and trained 182 Ob-Gyns in
CAC. The MBBS doctors are primarily posted at
the Primary Health Centres (PHCs) and intend
to serve rural women, while the Ob-Gyns are
placed at higher level hospitals ranging from
Community Health Centres (CHCs) to District
Hospitals (DH). Although public sector health
facilities (PHCs and above) are approved to
provide abortion services, a majority of them do
not do so mostly due to lack of trained
providers. Furthermore, given the population
size and its spatial distribution the number of
existing trained doctors at public health
facilities are not yet sufficient to meet the need
of abortion services in the state of Jharkhand.
Contrary to the public sector, accessibility of
abortion services at private sector is grossly
limited with specialized doctors (ob-gyns) who
are placed in few selected private clinics,
nursing homes and hospitals. Many of the
trained doctors who even intend to provide
abortion services often do not do so as their
sites are not approved MTP sites. At the same
time, the general physicians (MBBS doctors)
who practice at private clinics do not get
enough opportunity to undergo a 12-day CAC
training because of the limited number of
training centres which can train private
providers. As a result, women of Jharkhand still
have limited choice to opt for safe abortion
services at a location close to them. This
eventually contributes to an increase in the
incidence of unsafe abortion in the state.
Realizing the complexity of site approvals and
feasibility of monitoring the accessibility of
service provisions at the local level, the
Government of India (GoI) amended the MTP
Act in 2002. With this amendment, the authority
for ensuring site approvals has been
decentralized from the state to the district by
formation of a District Level Committee (DLC)
led by the Chief Medical Officer (CMO) as the
chairperson. The primary objective of the DLC
is to approve and/ or reject the private sites
based on minimum eligibility criteria and
maintain periodic records of all approved sites
and their service provisions. However in reality,
many of the districts are either ignorant or
apathetic to form a DLC. Even when formed,
DLCs are often non-functional.
Like some other states in India, the Government
of Jharkhand also took an initiative over the
years to set up DLCs in each district. The
districts also enthusiastically formed DLCs as
per norms stated in the MTP Act of 1971. This is
reflected in the State Project Implementation
Plan (PIP) of the year 2011-12; a separate
budget was allotted for the formation of DLCs
and approval of private facilities by the DLC in
all 24 districts. Unfortunately, there is limited
documentation on the implementation of this.
As part of the ongoing CAC program in
Jharkhand supported by The David and Lucile
Packard Foundation, Ipas, in collaboration with
the state government took an initiative to
conduct a district level situational analysis of
MTP services. This study aimed to explore the
current situation on the availability of MTP
services across the state. The study also aimed
to understand the status of DLCs formed in the
districts and how active these committees are
in terms of ensuring site approval, organizing
meetings, and keeping records. The outcome
of this study will help formulate district-specific
strategies and action plan to improve access to
quality service provision.
1.2 The Setting: Socio-Demographic
Profile of Jharkhand
Jharkhand was the 28th independent state of
India formed in November 2000 from the
erstwhile Bihar. A glance at the state map of
Jharkhand gives a glimpse of the distribution of
all the 24 districts where the survey has been
conducted. The name Jharkhand is derived
from the Sanskrit word Jharikhanda, which was
the ancient name of the dense forest of the
region. Large tract of the state is covered by
deciduous forest. Jharkhand is the storehouse
of a large number of minerals and resources. In
terms of mineral resources Jharkhand is the
richest state in India. The most unique feature of
the state is that it is inhabited by 32 tribal
groups.
Jharkhand has a population of 32.96 million,
consisting of 16.93 million males and 16.03
million females. The sex ratio is 947 females to
1000 males. The state consists of 28% of tribal
population followed by 12% of scheduled caste
and 60% others. The population density of the
state is 413 persons per square kilometer.
However, it varies from as low as 148 per square
kilometer in Gumla district to as high as 1167
per square kilometer in Dhanbad district.
Demographically, the principal indicators of
the state are well behind the national average.
Fertility in Jharkhand continues to be high with
total fertility rate of 3.3 - higher than the

national average of 2.7. Fertility in rural
areas of Jharkhand at 3.7 children per
woman is about 1.4 children higher than
the urban counterparts (2.3). The state
accounts for a low level of contraceptive
prevalence for any modern method (31%)
with high unmet need of 23 percent.
Reliable data regarding the proportion or
number of abortions taking place in the
state are not available. However, an
indirect estimation based on Crude Birth
Rate (CBR), annual live births and tempo
of abortion indicates a total of around
118,000 induced abortions every year
(Ipas 2010).
Although public sector sites are mandated to
provide abortion services, they are rarely
available at Primary Health Centres (PHCs) or
Community Health Centres (CHCs). According
to the national facility survey report, 86 percent
of PHCs in Jharkhand do not provide MTP
services (IIPS, 2005). Moreover, a few rural
health facilities that are well equipped to
provide services often do not receive women
seeking abortion services owing to lack of
awareness about the legality and availability of
abortion services (Ganatra and Banerjee,
2009). Thus, a substantial number of women
rely on informal, private providers (Ganatra and
Banerjee, 2009).
SCOPE OF THE STUDY
2.1 Objectives
The situation analysis of MTP services in
Jharkhand is focused on exploring the current
status of service provision at the district level.
The study is ascertained with the following
research objectives:
• To identify districts where a District Level
Committee (DLC) has been formed
• To explore whether the DLCs are functional
in terms of organizing regular meetings,
approving new private sites and keeping
records
• To assess MTP service provision and
caseload at public as well as private health
facilities in each district
• To assess the gap between estimated
MTPs and MTPs actually reported/
recorded in each district
2.2 Methodology
The study is an exploratory research that has
collected data through: a) interviews of key
informants; b) observation and review of office
records; c) content analysis.
2.2 (a) Research tools
Data has been collected using two sets of
structured questionnaires (Schedules A and B).
These questionnaires were pre-tested and
modified before canvasing in the field.
Schedule A focused on facility based
information on doctors providing MTP services
at various levels of health facilities – public
sector facilities (District Hospital, Sub Divisional
Hospital, Medical College); other public-sector
hospitals like CCL, BCCL, Railway and Army
Hospital and private clinics. This Schedule also
gathered detailed information on the CAC
training received by doctors, number of MTP
cases performed, frequency of reporting,
number of MTP cases reported by each
performing facility, status on the routine update
of MTP register, technology used for MTP and
gestation of the terminated pregnancy.
Schedule B collected district-level information
in two different sections. While the first section
collected macro-level information on health
facilities available in each district, the second
section dealt with DLC formation and other
details related to DLC like names of the
members, number of meetings conducted,
number of applications (Form A) submitted to
the DLC, and number of pending applications
awaiting DLC approval.
2.2 (b) Respondents
Considering the nature of this study, different
cadres of government officials who deal with
this subject and are responsible for
implementation of the CAC program at the state
and district levels were interviewed by trained
research investigators. These include Civil
Surgeons (CS), Assistant Chief Medical Officer
(ACMO), District Program Managers (DPM),
District Data Manager (DDM), and Head Clerk
of CS office. Multiple respondents were
targeted purposely as all the desired
information was not available with a single
respondent. Another purpose was to cross-
check the validity and consistency of official
information provided for this study.
2.2 (c) Implementation
Data collection was sub-contracted to an
external research agency-Research Plus
Group. A total of 12 research investigators were
trained by Ipas on the MTP Act, functions of
DLCs and different officials, methodologies
including data collection tools and techniques,
methods of Uterine Evacuation (UE), and
extraction of MTP related data from case
registers and MTP logbooks of health facilities.
Before initiation of the main survey, all trained
investigators were given support in collecting share their caseload data with the research FINDINGS
relevant records from different formats. investigators. Thus, the number of private
clinics providing MTP services and private
As a part of the study process, each 3.1 District Level Committee Table 1: Districts where DLC has been
sector contribution to total MTPs is an
investigator reviewed and collected copies of formed, Jharkhand, 2011
underestimation. In addition, reporting of MTP Understanding the need for making legal
admission registers, facility logbooks, and Name of Frequency Last meeting Number of sites
cases by private clinics has been irregular. abortion services widely available, the the District of meetings held approved
Forms A and B. Care was taken to collect
However, with available data, we have been Government of India amended the MTP Act in Garhwa Quarterly Jan 11 None
accurate information from each respondent. As Latehar Quarterly Jan11 None
able to assess the field reality regarding 2002. With the amendment, the authority for
required, doubts were clarified by cross- Khunti Quarterly Nov 10 None
formation of DLCs and approval of private approval of private clinics for provision of MTP
checking information with other officials like West Singhbhum Quarterly May 11 None
clinics by each. These figures also helped us in services has been decentralized from the state
nursing staff and office clerks. Dhanbad Half yearly 2010 None
caseload distribution between private and to the district level. It suggests formation of Gumla Half yearly Aug 10 None
The survey was conducted in all 24 districts of public sites. District Level Committee (DLC) with the Chief Bokaro Half yearly Jun 10 None

Jharkhand during February-May 2011. Medical Officer as its chairperson. The Pakur Half yearly No record None

committee has a minimum of three and a Lohardaga Half Yearly Sep 10 None
Deoghar Not initiated Not applicable None
2.2 (d) Data analysis maximum of five members including the
Sahibganj Not initiated Not applicable None
chairperson. It consists of the following
All completed questionnaires were cross- members – (1) one member needs to be a
validated before entering into a data entry gynecologist / surgeon / anesthetist; (2) other Amongst these 11 districts where DLCs were
spreadsheet. Descriptive analysis (including members should be from local medical formed, nine districts seemed to be active in
frequencies, percentages, and means) was profession, NGO and PRI of the district; (3) at terms of organizing periodic meetings.
carried out for each district and for the state as a least one member should be a woman. The However, there was no consistency in terms of
whole. DLC accounts sole responsibility of approving the frequency of the meeting. As reflected in
table 1, only four districts (Garwah, Latehar,
private health facilities to perform MTPs. Each
This study attempted to assess the gap Khunti and West Singhbhum) reported
DLC can operate for two calendar years and the
between reported MTPs and estimated MTPs conducting quarterly meetings. The rest of the
tenure of the NGO member shall not be for
in each of the 24 districts and the state. five districts (Dhanbad, Gumla, Bokaro, Pakur
more than two terms.
Unfortunately, reliable district-level abortion and Lohardaga) had organized a meeting once
rates were not available. We used abortion It is mandatory that each DLC maintains a in six months.
ratios (number of abortions/100 live births) for record in Form A and Form B. In addition, the
On the other hand, in Deoghar and Sahibganj,
the state and the districts, available through Committee should also have updated records
in spite of formation of a DLC, no meeting had
indirect estimates made from findings of the on number of sites (applied for approval) that
ever been organized. In response to a question
National Family Health Survey-2 (Mishra et al, have been rejected for approval along with
on the last meeting held, only three districts
2004). Live births for each of the 24 districts reasons for the same
were found to have had a meeting in 2011 while
were estimated from the crude birth rate (SRS
another five districts had organized a meeting
2008) and 2011 census population of the state 3.1 (a) Formation of DLC during June-November 2010.
and districts (Banerjee 2010). Finally, the
annual incidences of total number of Table 1 shows the districts where DLCs have Districts with a DLC are not even different by
abortions occurring in the state and district ever been formed, frequency of meetings divisions. As reflected in table 2, almost all five
were calculated after multiplying state including the last meeting and number of divisions were having the same status in terms
specific abortion ratios and live births. private clinics approved. of availability of a functional DLC.
Review of each district reveals that around half
2.3 Limitations and Operational of the districts (54%; 13 of 24 districts) had Table 2: Division-wise distribution of districts
Challenges that had formed a DLC, Jharkhand, 2011
never formed a DLC. The 11 districts that
The findings of this study must be viewed in light reported ever having a DLC are Garwah, North Chota South Chota Palamu Kolhan Santhal
Nagpur Nagpur Parganas
of the limitations in availability of data and Latehar, Dhanbad, Bokaro, Gumla, Khunti,
Bokaro Gumla Garwah West Pakur
completeness of the official records. Although Lohardaga, W. Singhbhum, Deoghar, Singhbhum
efforts were made to capture all cases of Sahibganj, Pakur (See Annexure A for further Dhanbad Khunti Latehar Sahibganj

abortions, many private clinics did not agree to details). Lohardaga Deoghar
3.1 (b) Record keeping and documentation from the private sector. There was a Table 3: District-wise distribution of public and private sites reported providing MTP services
preponderance of private sites over public sites and performed MTP in the past 11 months (April 2010 to February 2011), Jharkhand, 2011
No district had a system of keeping records of
providing MTP services in almost all 24 districts. Name of District Total Sites Public Sites Private Sites
DLC activities. In most of the districts,
This is when the figures of private sector
investigators tried to gather DLC-related No. of sites Caseload No. of sites Caseload
facilities were grossly understated as
information from several key officials. Garhwa 4 1 32 3 107
unapproved sites have never been reported or
Surprisingly, not a single district could share Latehar 5 1 418 4 81
accounted in state/district MIS system.
any data or official records on the last meeting Dhanbad 16 3 396 13 4365
held, number of private sites that had applied Public sector facilities who reported providing Gumla 5 1 28 4 75
for site approval and number of sites approved MTP services were mostly from the district Simdega 3 1 4 2 84
in the recent past. headquarters and urban hospitals, including Hazaribagh 5 1 - 4 75
district, sub-district, and public-undertaking Chatra 6 2 15 4 105
3.2 MTP Service Provision hospitals. Although few PHCs and CHCs also Deoghar 16 2 167 14 5987
provided MTP services in the rural areas, their Khunti 3 1 152 2 63
The study aimed to collect data and related
contributions were rarely reported at the district Ramgarh 3 1 - 2 426
information on MTP services provided by the
and state levels. This probably was the primary Saraikela Kharsawan 4 1 7 3 48
public and private sites in all 24 districts of the
reason of having only 39 public health facilities W. Singhbhum 9 2 56 7 663
state. Table 3 presents the state and district
providing MTP services for the whole state of
level aggregation of data collected from Bokaro 10 4 238 6 209
Jharkhand.
different public and private sector sites. Jamtara 5 1 20 4 385
There is no uniformity by districts in terms of Giridih 7 1 198 6 3707
In 2003, the MTP Act was amended to
availability of sites providing abortion services. Dumka 6 1 14 5 870
rationalize the criteria of infrastructure
Of the total 24 districts, only five were found to Sahibganj 5 2 24 3 80
requirements for abortion facilities, specifying
have more than 10 facilities performing MTP, Pakur 4 1 - 3 145
different criteria as appropriate for conducting
while another 13 districts accounted for 6-10 Koderma 6 1 - 5 119
first and second trimester abortions. As far as
government health facilities are concerned, facilities. Surprisingly, six districts reported to Lohardaga 5 1 54 4 221

MTP services cannot be provided at facilities have less than five sites providing MTPs for the East Singhbhum 13 2 178 11 637
below the level of a PHC. whole district. Palamu 6 3 133 3 88
Godda 5 1 4 4 785
In Jharkhand, MTP services are provided both Ranchi 16 4 1270 12 4980
in public and private sites. It may be noted that
Total 167 39 3408 128 24305
none of the private sites providing MTP services
have an approval from their DLC. and being Source: District CS office, district and sub-district hospitals and private sites agreed to share

aware of the implications of offering abortion

services from an unapproved site, many of 3.2 (b) MTP caseload
these private clinics did not share abortion data
A total of 27,713 women received MTP services
with the research investigators.
from these 167 sites during 11 months
preceding the survey. An overwhelming
3.2 (a) Service access majority of these cases (88%) were recorded at
As reflected in table 3, MTP services are private sites followed by 12% at public sites. No
provided at both public and private sites (the uniformity was seen in caseload across the
districts. While district Deogarh reported 6,154
sites where doctors agreed to share data) in all
MTP cases in the past 11 months, district
the 24 districts of the state. A total of 167 health
Saraikela Kharsawan mentioned just 55 cases
facilities were reported providing MTP services
for the same time period.
at the time of survey. An overwhelming majority
of these health facilities (77%, 128 of 167) were Public sector sites also did not show any
uniformity in terms of service provision. Even
district hospitals (the largest hospitals under
public sector) in some districts did not show
any MTP caseload for the last 11 months.
The concentration of sites, especially private
sites, providing MTP services are more in
districts with important industrial and
administrative towns. It is interesting to note
that almost 46% (77 of 167) of total sites and
82% (22,853 of 27,713) of total MTP cases were
recorded from just seven districts (see table 4).
Availability of gynecologists and accessibility of
easy transportation probably influences this access to safe and legal abortion services or Table 5: District-wise gap between estimated and reported MTP caseload, Jharkhand, 20112
biased distribution. This implies that either the majority of the sites providing MTP services do
State/District Caseload Caseload reported/ Gap between estimated and
rest of the 17 districts in the state do not have not share records of their service provision. estimated recorded reported caseload (%)
[1] [2] [3]=[2/1]*100
Table: 4 Distribution of MTP sites and caseloads in selected districts with major cities/towns Jharkhand 108305 27713 26%
Districts Public Sites Private Sites Total MTP Caseload Garhwa 4344 139 3%
(major town) sites Latehar 2384 499 21%

Ranchi (Ranchi) 4 12 16 6250 Dhanbad 8814 4761 54%

Gumla 3370 103 3%
Deoghar (Deoghar) 2 14 16 6154
Bokaro (Bokaro) 4 6 10 447 Simdega 1971 88 4%

Dhanbad (Dhanbad) 3 13 16 4761 Hazaribagh 5697 75 1%

E. Singbhum (Jamshedpur) 2 11 13 815 Chatra 3425 120 4%

Chaibasa (Chaibasa) 2 7 9 719 Deoghar 4901 6154 126%

Khunti 1743 215 12%
Giridih (Giridih) 1 6 7 3707
Ramgarh 3119 426 14%
Saraikela Kharsawan 3493 55 2%
3.2 (c) Gap between estimated and estimated and reported MTP caseload. In
West Singhbhum 4934 719 15%
recorded caseloads Deoghar, the reported cases were even 2
As MTP caseload is reported for the period of last 11 months preceding the survey, the estimated caseload is also
Bokarofor the same time period of 11
projected 6774
months 447 7%
higher than the estimated figure; implying
This section explains the gap between Jamtara 2596 405 16%
women of neighboring districts also visit
estimated and reported MTP caseload in Giridih 8034 3905 49%
Deoghar to get MTP services.
each district of Jharkhand. This gap will give Dumka 4340 884 20%
an idea of the magnitude of abortions which Sahibganj 3779 104 3%
are either unsafe or never counted. Although Pakur 2954 145 5%
the incidence of abortion in India is not known Koderma 2356 119 5%
and estimated by any large scale survey, the Lohardaga 1517 275 18%
estimated MTP caseloads are estimated East Singhbhum 7527 815 11%
here indirectly 1 using other available Palamu 6362 221 3%
demographic parameters. Godda 4308 789 18%
Table 5 depicts the total number of MTPs Ranchi 9567 6250 65%
estimated to have taken place in Jharkhand
in the last 11 months - 108,305. However, this
study captured 27,713 MTP cases, which
account for 26 percent of the total estimated
cases. Thus, around 74 percent of women
who received abortion services in the last 11
months were not reported or counted in any
official statistics.
1
Reliable district-level abortion rates are not available, however, we were able to use abortion ratios (number of
Similarly, the gap between estimated and abortions/100 live births) for the state and the districts, available through indirect estimates made from the National
reported MTPs was more pronounced at the Family Health Survey-2 findings (Mishra et al, 2004). Live births for each of the 24 districts were estimated from the crude
birth rate (SRS 2008) multiplied by 2011 census population of the state and districts. Finally, the annual incidences of
district level (see figure 1). Barring four total number of abortions occurring in the state and district were calculated after multiplying state specific abortion ratios
districts, Deoghar (126%), Ranchi (65%), and live births.
Dhanbad (54%) and Giridih (49%), all other 2
As MTP caseloads are reported for the period of last 11 months preceding the survey, the estimated caseloads are also
districts had substantial gap between projected for the same time period of 11 months
Figure 1: District-wise gap between estimated and reported MTP cases, Jharkhand, 2011
DISCUSSIONS AND RECOMMENDATIONS
Deoghar 4901
6154
Ranchi 9567 4.1 District Level Committee • Complete ignorance of private sector
6250
8814 sites: In absence of any DLC meeting,
Dhanbad 4761 The primary purpose of decentralization of
private - sector sites are not aware of the
Giridih 8034 power from the state to the district level with
3905 process and requirement of site
Latehar 2384 formation of DLCs was to increase the reach of
499 registration
Dumka 4340 safe abortion services for women, especially
884
Godda 4308 those belonging to disadvantaged
789 4.2 Service Provision
Lohardaga 1517 communities, living in difficult geographical
275
Jamtara 2596 locations, adolescent girls as well as unmarried Some major issues which emerged from this
405
4934 women. However, it is observed that this has not study are the low caseload in public sector sites
W. Singhbhum 719
materialized in Jharkhand – 13 of the 24 districts and poor record keeping and monitoring at all
Ramgarh 3119
426 do not have a DLC. Rest of the districts have no levels. In line with the MTP Act every public and
Khunti 1743
215 information even about the number of private site should maintain updated record of
E. Singhbhum 7527
815 applications received for approval. Even if abortions in the facility log book. The private
Bokaro 6744
447 DLCs are functional, official records were not sites are also required to submit caseloads to
Koderma 2356 the Civil Surgeon every month. In addition, all
119 available on the sites approved by the
Pakur 2954 sites are required to maintain an Opinion Form
145 committee.
Simdega 1971 (Form 1), Consent Form (Form C) and
88
Chatra 3425 The following inferences can be drawn from Admission Register in their concerned sites.
120
6362
these observations:
Palamu 221 Below are some possible reasons for poor
Garhwa 4344 • Lack of understanding on the purpose practices of MTP service provision:
139
Gumla 3370 and role of the DLC: Majority of districts
103
Sahibganj 3779 have not yet formed a DLC. Even in the 11 4.2 (a) Record keeping
104
S Kharsawan 3493 districts where they have been formed, the
55 • Irrespective of the facilities where abortions
Hazaribagh 5697 DLCs have failed to accomplish their
75 are performed, MTP providers are not
primary task of expanding availability of
0 2000 4000 6000 8000 10000 legal and safe abortion services aware of the mandatory requirements
imposed by the MTP Act for recording of
Estimated Reported •· Filling up of Form A and Form B: This is cases
an integral aspect of the process of
It is interesting to note the substantial gaps in especially keeping in mind its geographic approval of private sites by DLCs but has • Abortions conducted through medical
rest of the 20 districts. Around 10 districts had location and other constraints. On the contrary, methods and incomplete abortions are
not been taken up seriously by any of the
less than five percent of cases recorded. For record keeping of Simdega and Godda has grossly under reported across all facilities
existing DLCs. Poor understanding,
example, in Hazaribag and Saraikela been quite dismal. Surprisingly, no public providing abortion services
absence of regular dialogue on DLC
Kharsawan only one to two percent of the sector site reported providing any MTP during
between the state and district officials can • Abortions done at unapproved private sites
estimated MTPs of the districts are recorded the past months in Pakur, Ramgarh and
during the field visits. Koderma districts. be the probable reason for this are never reported. Data captured in this
study implies that only a fraction of the
3.2 (d) Record keeping and documentation Although reported cases by private sector • No monitoring at the state level:
estimated total induced abortions
facilities were much higher than their public Although lack of access to safe abortion
It is clear from the above section that systematic sector counterparts, the record-keeping occurring in the state are reported
has always been recognized as a
record keeping and consequent reporting of system is poor. The reported figures seem to be
significant medical and social problem, it
services was almost absent in most of the a portion of the total cases estimated to be 4.2 (b) MTP caseload
districts. Barring districts Ranchi, Dhanbad and has failed to occupy space in the priority
carried out at private health facilities.
Latehar, record keeping on MTP at the public Furthermore, there is no uniform register or list. Progress and achievement made by • Caseloads reported at public sector sites
sites was extremely poor in the state. Record logbook used by the private as well as public each DLC has seldom been reviewed at are uniformly low in all districts. In spite of
keeping of Latehar district deserves mention sector facilities. the state level the fact that medical officers of the
 government health facilities are trained to
provide safe abortion services till PHC
level, many of the providers do not provide
MTP services at public health facilities
• Even doctors who provide MTP services at
PHCs and CHCs do not report the same at
district and state levels
• There exists a substantial gap between
estimated MTP caseload and the caseload
gathered through this study. This fact infers
that illegal or unsafe or even safe abortions
at unapproved private sites continue to be
prevalent in all parts of the state
4.3 Recommendations
Based on the salient findings, below are some
recommendations to strengthen the access to
safe and legal abortion services; and improve
reporting of abortion cases in the state:
i Sensitization of officials on DLCs
There seems to be a lack of understanding
on the implementation of DLCs. Intensive
orientation and follow-up at regular intervals
would be an important intervention.
ii Strengthening review and monitoring
of DLCs
The state has to gear up review of DLC
formation from the concerned officials
regularly during the monthly meetings.
Review on number of sites approved,
meetings conducted and maintenance of
records should be given priority.
iii Linking state HMIS and DLC to improve
reporting of MTP cases
The state should establish a linkage
between DLCs and MIS department to
capture MTPs performed at private sites.
iv Special government program or
schemes
The government may take up special
programs or schemes to address DLC
formation and approval of private sites.
v Promoting messages
Print and audio media may be involved to
spread messages like – abortion is legal,
availability of safe, affordable abortion
services at public sites, legal implications
for persons doing MTP services who are
not eligible as per the Act.
vi Understanding the attitudinal and
operational bottlenecks of private
providers to initiate the process of site
approval
This will help the government to understand
the apathy of private providers to act on the
site registration.
vii Adding MTP performance as an
indicator of reporting
PHCs and CHCs do not perceive any
compulsion to report on their MTP
performance contrary to other reproductive
health and immunization performance.
Government of India has recently
introduced a reporting format (see
Annexure C) in all states of India to improve
the system of MTP record keeping at all
levels.
viii Mapping of CAC-trained providers
In addition, there is an urgent need for
mapping of CAC-trained providers in
various public and private health facilities.
REFERENCES
Banerjee S: Increasing access to safe abortion WHO: Unsafe abortion: Global and regional
services in Uttarakhand: identifying medical estimates of the incidence of unsafe abortion
termination of pregnancy (MTP) training centers. and associated mortality in 2008. --6th ed.
New Delhi: Ipas India; 2007. Geneva; 2011.
Chhabra R, Nuna S: Abortion in India: An WHO: Safe Abortion: Technical and Policy
Overview. New Delhi: Veerendra Printers; 1993. Guidance for Health Systems. Geneva; 2003.
Dahiya K, Madan S, Hooda R, Sangwan K, WHO: Trends in maternal mortality: 1990 to
Khosla AH. Evaluation of the efficacy of 2008. Geneva; 2010.
Mifepristone/Misoprostol and Methotrexate/
Misoprostol for medical abortion. Indian Journal
of Medical Sciences 2005, 59:301-306.
Duggal R, Ramachandran V: The Abortion
Assessment Project - India: Key Findings and
Recommendations. Reproductive Health
Matters 2004, 12:122-129.
Ganatra B, Banerjee SK: Expanding
Community-Based Access to Medical Abortion
in Jharkhaand: a pre-intervention baseline
survey in selected two blocks of Ranchi and
Khunti districts. New Delhi: Ipas India; 2010.
Hirve S: Abortion Law, Policy and Services in
India: A Critical Review. Reproductive Health
Matters 2004, 12 (Suppl 24):114-121.
Mishra U.S and T.R. Dilip 2004. Assessing
Potential for Induced Abortion Among Indian
Women. Abortion Assessment Project India.
CEHAT and Health Watch. Working paper:
ISBN: 81-89041-36-X. Mumbai India.
Registrar General of India 2008. SRS Bulletin.
Volume 43 No. 1. October 2008. Ministry of
Home Affairs, Government of India, New Delhi
India
WHO: The prevention and management of
unsafe abortion. Report of a Technical Working
Group. Geneva; 2002.
 ANNEXURE: A ANNEXURE: B
STATUS OF DLC FORMATION IN JHARKHAND AT A GLANCE DISTRICT-WISE MTP PERFORMANCE
JHARKHAND
Name of the DLC Formed Meeting in a year Last meeting held No. of sites
District approved
Status of District Level Committee for MTP
Garhwa Yes Quarterly January 2011 -
Name of the DLC Formed Meeting in a year Last meeting held No. of sites
District approved
Latehar Yes Quarterly January 2011 -
Garhwa Yes Quarterly January 2011 -
Dhanbad Yes Half yearly 2010 -
Latehar Yes Quarterly January 2011 -
Gumla Yes Half yearly August 2010 -
Dhanbad Yes Half yearly 2010 -
Deoghar Yes - - -
Gumla Yes Half yearly August 2010 -
Khunti Yes Quarterly November 2010 -
Simdega No - - -
W. Singhbhum Yes Quarterly May 2011 -
Hazaribagh No - - -

Bokaro Yes Half yearly June 2010 - Chatra No - - -

Sahibganj Yes - - - Deoghar Yes - - -

Pakur Yes Half yearly - - Khunti Yes Quarterly November 2010 -

Lohardaga Yes Half Yearly September 2010 - Ramgarh No - - -

Simdega No - - - Saraikela Kharsawan No - - -

Hazaribagh No - - - West Singhbhum Yes Quarterly May 2011 -

Chatra No - - - Bokaro Yes Half yearly June 2010 -

Jamtara No - - -
Ramgarh No - - -
Giridih No - - -
S. Kharsawan No - - -
Dumka No - - -
Jamtara No - - -
Sahibganj Yes - - -
Giridih No - - -
Pakur Yes Half yearly - -
Dumka No - - -
Koderma No - - -
Koderma No - - -
Lohardaga Yes Half Yearly September 2010 -
East Singhbhum No - - -
East Singhbhum No - - -
Palamu No - - -
Palamu No - - -

Godda No - - - Godda No - - -

Ranchi No - - - Ranchi No - - -
No. of sites providing MTP services and No. of Caseload 2009-2010 1. DISTRICT: GARHWA

Name of District No. of sites Type of sites Site-wise data on MTP providers and cases
Public Private Name of Sites Name of Block No. of Providers No. of MTP cases
No. MTP Reported No. MTP Reported reported
Sadar hospital Garhwa 2 -
Garhwa 4 1 32 3 107
PHC Meral Meral (Pipra Kalan) 1 -
Latehar 5 2 418 4 81 Total 3 -

Dhanbad 16 3 396 13 4365

Gumla 5 1 28 4 75 Distribution of MTP cases by site type, methods and post-abortion contraception

Simdega 3 1 4 2 84 Site No. of No. of No. of Trimester Methods Contraception

st nd
Name Sites Providers MTP 1 2 MVA/ D&C/ MMA Perm. Temp.
Hazaribagh 5 1 - 4 75 EVA D&E
DH 1 4 32 31 1 - 32 - - 15
Chatra 6 2 15 4 105
SDH - - - - - - - - - -
Deoghar 16 2 167 14 5987 MCH - - - - - - - - - -
PSU - - - - - - - - - -
Khunti 3 1 152 2 63
Private 3 7 75 53 22 - 75 - - 13
Ramgarh 3 1 - 2 426 Total 4 11 107 84 23 - 107 - - 28

Saraikela Kharsawan 4 1 7 3 48

West Singhbhum 9 2 56 7 663 2. DISTRICT: LATEHAR

Bokaro 10 4 238 6 209 Site-wise data on MTP providers and cases

Name of Sites Name of Block No. of Providers No. of MTP cases

Jamtara 5 1 20 4 385
reported
Giridih 7 1 198 6 3707 CHC Balumath Balumath 1 -
CHC Manika Manika 2 -
Dumka 6 1 14 5 870
Total 3 -
Sahibganj 5 2 24 3 80

Pakur 4 1 - 3 145 Distribution of MTP cases by site type, methods and post-abortion contraception
Koderma 6 1 - 5 119 Site No. of No. of No. of Trimester Methods Contraception
st nd
Lohardaga 5 1 54 4 221 Name Sites Providers MTP 1 2 MVA/ D&C/ MMA Perm. Temp.
EVA D&E
East Singhbhum 13 2 178 11 637 DH 1 2 418 218 200 - 418 - - -
SDH - - - - - - - - - -
Palamu 6 3 133 3 88
MCH - - - - - - - - - -

Godda 5 1 4 4 785 PSU - - - - - - - - - -

Private 4 5 81 81 - 38 43 - - 20
Ranchi 16 4 1270 12 4980 Total 5 7 499 299 200 38 461 - - 20
 3. DISTRICT: DHANBAD 5. DISTRICT: SIMDEGA

Site-wise data on MTP providers and cases Site-wise data on MTP providers and cases

Name of Sites Name of Block No. of Providers No. of MTP cases Name of Sites Name of Block No. of Providers No. of MTP cases
reported reported
PHC Govindpur Govindpur - 61 District hospital Simdega Simdega 1 25
PHC Jharia Jharia - 176 PHC Bano Bano 1 -
PHC Baghmara Baghmara - 95
PHC Jaldega Jaldega 1 11
PHC Tundi Tundi - 66
PHC Koilbera Koilbera 1 -
Total - 398
APHC Lachagarah Koilbera 1 -
Distribution of MTP cases by site type, methods and post-abortion contraception APHC Hurda Bano 1 -
PHC Kurdeg Kurdeg - 5
Site No. of No. of No. of Trimester Methods Contraception
st nd
Total 6 41
Name Sites Providers MTP 1 2 MVA/ D&C/ MMA Perm. Temp.
EVA D&E
DH - - - - - - - - - -
SDH - - - - - - - - - - Distribution of MTP cases by site type, methods and post-abortion contraception
MCH 1 9 36 36 - 36 - - 22 14
Site No. of No. of No. of Trimester Methods Contraception
PSU 2 5 360 288 72 324 - 36 180 180 st nd
Name Sites Providers MTP 1 2 MVA/ D&C/ MMA Perm. Temp.
Private 13 16 4365 3916 449 2964 1015 386 1541 2824 EVA D&E
Total 16 30 4761 4240 521 3324 1015 422 1743 3018 DH 1 1 4 4 - 4 - - 3 1
SDH - - - - - - - - - -
4. DISTRICT: GUMLA MCH - - - - - - - - - -
Site-wise data on MTP providers and cases PSU - - - - - - - - - -
Private 2 2 84 81 3 84 - - 60 24
Name of Sites Name of Block No. of Providers No. of MTP cases
reported Total 3 3 88 85 3 88 - - 63 25
District hospital Gumla Gumla 2 -
PHC Bharno 1 -
PHC Dumri 1 -
6. DISTRICT: HAZARIBAGH
PHC Palkot 1 -
PHC Kamdara 1 - Site-wise data on MTP providers and cases
PHC Basia 1 -
Total 7 - Name of Sites Name of Block No. of Providers No. of MTP cases
reported
Distribution of MTP cases by site type, methods and post-abortion contraception District hospital Hazaribagh Sadar 3 -
Site No. of No. of No. of Trimester Methods Contraception CHC Katkamsandi Katkamsandi 2 -

Name Sites Providers MTP 1st 2nd MVA/ D&C/ MMA Perm. Temp. CHC Barkatha Barkatha 2 -
EVA D&E CHC Barkagaon Barkagaon 1 -
DH 1 5 28 18 10 15 13 - 20 8 CHC Keredari Keredari 1 -
SDH - - - - - - - - - - CHC Chauparan Chauparan 2 -
MCH - - - - - - - - - - CHC Barhi Barhi 1 -
PSU - - - - - - - - - - CHC Ichak Ichak 1 -
Private 4 5 75 68 7 42 29 4 31 44 CHC Sadar Sadar 1 -
Total 5 10 103 86 17 57 42 4 51 52 Total 14 -
Distribution of MTP cases by site type, methods and post-abortion contraception Distribution of MTP cases by site type, methods and post-abortion contraception

Site No. of No. of No. of Trimester Methods Contraception Site No. of No. of No. of Trimester Methods Contraception
st nd st nd
Name Sites Providers MTP 1 2 MVA/ D&C/ MMA Perm. Temp. Name Sites Providers MTP 1 2 MVA/ D&C/ MMA Perm. Temp.
EVA D&E EVA D&E
DH 1 5 - - - - - - - - DH 1 2 13 13 - 13 - - - 13
SDH - - - - - - - - - - SDH 1 3 154 154 - - 154 - - 154
MCH - - - - - - - - - - MCH - - - - - - - - - -
PSU - - - - - - - - - - PSU - - - - - - - - - -
Private 4 6 75 - - 35 40 - - - Private 14 15 5987 5132 855 3577 2155 255 1453 3457
Total 5 11 75 - - 35 40 - - - Total 16 20 6154 5299 855 3590 2309 255 1453 3624

9. DISTRICT: KHUNTI
7. DISTRICT: CHATRA Site-wise data on MTP providers and cases

Site-wise data on MTP providers and cases Name of Sites Name of Block No. of Providers No. of MTP cases
reported
Name of Sites Name of Block No. of Providers No. of MTP cases
District hospital Khunti Khunti 1 -
reported
PHC Khunti Khunti 1 -
District hospital Chatra Chatra 2 -
PHC Murhu Murhu 2 -
Total 2 -
PHC Rania Rania 1 -
Total 5 221

Distribution of MTP cases by site type, methods and post-abortion contraception

Distribution of MTP cases by site type, methods and post-abortion contraception
Site No. of No. of No. of Trimester Methods Contraception
Site No. of No. of No. of Trimester Methods Contraception
st nd
Name Sites Providers MTP 1 2 MVA/ D&C/ MMA Perm. Temp. st nd
Name Sites Providers MTP 1 2 MVA/ D&C/ MMA Perm. Temp.
EVA D&E
EVA D&E
DH 1 - - - - - - - - -
DH 1 2 152 152 - 152 - - - -
SDH - - - - - - - - - -
SDH - - - - - - - - - -
MCH - - - - - - - - - -
MCH - - - - - - - - - -
PSU 1 3 15 15 - - 15 - - -
PSU - - - - - - - - - -
Private 4 5 105 105 - - 105 - - -
Private 2 2 63 60 3 9 54 - 14 40
Total 6 8 120 120 - - 120 - - -
Total 3 4 215 212 3 161 54 - 14 40

10. DISTRICT: RAMGARH

8. DISTRICT: DEOGHAR
Site-wise data on MTP providers and cases
Site-wise data on MTP providers and cases Name of Sites Name of Block No. of Providers No. of MTP cases
Name of Sites Name of Block No. of Providers No. of MTP cases reported
reported PHC Chitarpur Ramgarh 1 -
Govt. Sites - - 95 CHC Gola Gola 1 -
Private - - 216 CHC Patratu Patratu 1 -
Total - 305 Total 3 -
Distribution of MTP cases by site type, methods and post-abortion contraception Distribution of MTP cases by site type, methods and post-abortion contraception

Site No. of No. of No. of Trimester Methods Contraception Site No. of No. of No. of Trimester Methods Contraception
st nd st nd
Name Sites Providers MTP 1 2 MVA/ D&C/ MMA Perm. Temp. Name Sites Providers MTP 1 2 MVA/ D&C/ MMA Perm. Temp.
EVA D&E EVA D&E
DH 1 - - - - - - - - - DH 1 7 56 55 1 45 11 - 20 36
SDH - - - - - - - - - - SDH 1 1 - - - - - - - -
MCH - - - - - - - - - - MCH - - - - - - - - - -
PSU - - - - - - - - - - PSU - - - - - - - - - -
Private 2 2 426 404 22 336 35 55 - - Private 7 7 663 646 17 152 481 30 272 341
Total 3 2 426 404 22 336 35 55 - - Total 9 15 719 701 18 197 492 30 292 377

11. DISTRICT: SARAIKELA-KHARSAWAN 13. DISTRICT: BOKARO

Site-wise data on MTP providers and cases Site-wise data on MTP providers and cases

Name of Sites Name of Block No. of Providers No. of MTP cases Name of Sites Name of Block No. of Providers No. of MTP cases
reported reported
District hospital Saraikela Saraikela 2 - Refral hospital Jenamore Jaridih 1 -
PHC Kharsawan Kharsawan 1 - PHC Gomio Gomio 1 -
PHC Rajnagar Rajnagar 1 - PHC Kasmar Kasmar 1 -
PHC Gamharia Gamharia 3 - Total 3 1138
PHC Nimdih Nimdih 1 -
Total 8 - Distribution of MTP cases by site type, methods and post-abortion contraception

Site No. of No. of No. of Trimester Methods Contraception

Distribution of MTP cases by site type, methods and post-abortion contraception
st nd
Name Sites Providers MTP 1 2 MVA/ D&C/ MMA Perm. Temp.
Site No. of No. of No. of Trimester Methods Contraception EVA D&E
Name Sites Providers MTP 1st 2nd MVA/ D&C/ MMA Perm. Temp. DH - - - - - - - - - -
EVA D&E SDH 3 2 12 12 - 12 - - - 7
DH 1 1 7 7 - 7 - - - - MCH - - - - - - - - - -
SDH - - - - - - - - - - PSU 1 14 226 176 50 200 26 - - -
MCH - - - - - - - - - - Private 6 9 209 139 70 50 159 - 5 56
PSU - - - - - - - - - - Total 10 25 447 327 120 262 185 - 5 63
Private 3 3 48 48 - 10 38 - 15 33
Total 4 4 55 55 - 17 38 - 15 33 14. DISTRICT: JAMTARA
Site-wise data on MTP providers and cases
12. DISTRICT: WEST SINGHBHUM
Name of Sites Name of Block No. of Providers No. of MTP cases
Site-wise data on MTP providers and cases reported
Name of Sites Name of Block No. of Providers No. of MTP cases District hospital Jamtara Jamtara 1 -
reported PHC Jamtara Jamtara 1 -
District hospital Chaibasa Chaibasa 7 - PHC Nala Nala 1 -
PHC Goilkera Goilkera 1 - PHC Narayanpur Narayanpur 1 -
PHC Barajamuda Barajamuda 1 - PHC Kundhit Kundhit 1 -
Total 9 - Total 5 109
Distribution of MTP cases by site type, methods and post-abortion contraception Distribution of MTP cases by site type, methods and post-abortion contraception

Site No. of No. of No. of Trimester Methods Contraception Site No. of No. of No. of Trimester Methods Contraception
st nd st nd
Name Sites Providers MTP 1 2 MVA/ D&C/ MMA Perm. Temp. Name Sites Providers MTP 1 2 MVA/ D&C/ MMA Perm. Temp.
EVA D&E EVA D&E
DH 1 1 20 20 - 10 10 - 10 10 DH 1 2 14 14 - 14 - - - 14
SDH - - - - - - - - - - SDH - - - - - - - - - -
MCH - - - - - - - - - - MCH - - - - - - - - - -
PSU - - - - - - - - - - PSU - - - - - - - - - -
Private 4 4 385 385 - 115 242 28 20 190 Private 5 5 870 856 14 430 400 40 93 642
Total 5 5 405 405 - 125 252 28 30 200 Total 6 7 884 870 14 444 400 40 93 656

15. DISTRICT: GIRIDIH

Site-wise data on MTP providers and cases
17. DISTRICT: SAHIBGANJ
Site-wise data on MTP providers and cases
Name of Sites Name of Block No. of Providers No. of MTP cases
reported Name of Sites Name of Block No. of Providers No. of MTP cases
District hospital Giridih Giridih - 195 reported
PHC Tisri Tisri - 15 District hospital Sahibganj Sahibganj 1 24
Total Pvt. Clinic Giridih - 283 PHC Bhorio Bhorio - 4
Total - 493 Total - 28

Distribution of MTP cases by site type, methods and post-abortion contraception

Distribution of MTP cases by site type, methods and post-abortion contraception
Site No. of No. of No. of Trimester Methods Contraception
Name Sites Providers MTP 1st 2nd MVA/ D&C/ MMA Perm. Temp. Site No. of No. of No. of Trimester Methods Contraception
EVA D&E Name Sites Providers MTP 1 st
2 nd
MVA/ D&C/ MMA Perm. Temp.
DH 1 3 198 198 - 138 60 - 160 38 EVA D&E
SDH - - - - - - - - - - DH 1 1 24 24 - 24 - - - -
MCH - - - - - - - - - - SDH - - - - - - - - - -
PSU - - - - - - - - - - MCH - - - - - - - - - -
Private 6 7 3707 3467 240 3122 535 50 923 1577 PSU 1 - - - - - - - - -
Total 7 10 3905 3665 240 3260 595 50 1083 1615 Private 3 3 80 76 4 80 - - 15 65
Total 5 4 104 100 4 104 - - 15 65
16. DISTRICT: DUMKA
Site-wise data on MTP providers and cases
18. DISTRICT: PAKUR
Name of Sites Name of Block No. of Providers No. of MTP cases
reported Site-wise data on MTP providers and cases
District hospital Dumka Dumka - 8 Name of Sites Name of Block No. of Providers No. of MTP cases
PHC Shikaripara Shikaripara - 14 reported
Sadar PHC +PVT - - 604 District hospital Pakur Pakur 2 -
Total - 626 Total 2 -
 20. DISTRICT: LOHARDAGA

Distribution of MTP cases by site type, methods and post-abortion contraception Site-wise data on MTP providers and cases

Site No. of No. of No. of Trimester Methods Contraception Name of Sites Name of Block No. of Providers No. of MTP cases
reported
Name Sites Providers MTP 1st 2nd MVA/ D&C/ MMA Perm. Temp.
EVA D&E District hospital Lohardaga Lohardaga 2 63
DH 1 1 - - - - - - - - PHC Senha Senha 5 -
SDH - - - - - - - - - - PHC Bhandara Bhandara 2 -
MCH - - - - - - - - - - PHC Kuru Kuru 3 -
PSU - - - - - - - - - - PHC Lohardaga Lohardaga 3 -
Private 3 3 145 145 - 145 - - 11 134 PHC Kisko Kisko 2 -
Total 4 4 145 145 - 145 - - 11 134 APHC Nagjuva Bhandra 1 -
APHC Rampur Lohardaga 1 -
Total 19 63

19. DISTRICT: KODERMA

Site-wise data on MTP providers and cases Distribution of MTP cases by site type, methods and post-abortion contraception
Name of Sites Name of Block No. of Providers No. of MTP cases Site No. of No. of No. of Trimester Methods Contraception
reported st nd
Name Sites Providers MTP 1 2 MVA/ D&C/ MMA Perm. Temp.
- - - - EVA D&E
- - - - DH 1 4 54 54 - 54 - - 14 40
Total - - SDH - - - - - - - - - -
MCH - - - - - - - - - -
PSU - - - - - - - - - -
Private 4 9 221 213 8 208 5 8 114 107
Distribution of MTP cases by site type, methods and post-abortion contraception
Total 5 13 275 267 8 262 5 8 128 147
Site No. of No. of No. of Trimester Methods Contraception
Name Sites Providers MTP 1st 2nd MVA/ D&C/ MMA Perm. Temp.
EVA D&E
21. DISTRICT: EAST SINGHBHUM
DH 1 2 - - - - - - - -
SDH - - - - - - - - - - Site-wise data on MTP providers and cases
MCH - - - - - - - - - -
Name of Sites Name of Block No. of Providers No. of MTP cases
PSU - - - - - - - - - -
reported
Private 5 7 119 119 - 12 107 - - -
PHC Ghatshila Ghatshila 7 -
Total 6 9 119 119 - 12 107 - - -
PHC Jugsalai cum Golmuri Jugsalai cum Golmuri 8 -
PHC Mushabani Mushabani 1 -
PHC Potka Potka 5 -
PHC Baharagaura Baharagaura 1 -
PHC Patamda Patamda 1 -
APHC Haldipokhar Potka 1 -
APHC Manpur Potka 1 -
Total 25 -
Distribution of MTP cases by site type, methods and post-abortion contraception Distribution of MTP cases by site type, methods and post-abortion contraception

Site No. of No. of No. of Trimester Methods Contraception Site No. of No. of No. of Trimester Methods Contraception
st nd st nd
Name Sites Providers MTP 1 2 MVA/ D&C/ MMA Perm. Temp. Name Sites Providers MTP 1 2 MVA/ D&C/ MMA Perm. Temp.
EVA D&E EVA D&E
DH - - - - - - - - - - DH 1 5 133 133 133 - - 25 64
SDH 1 2 - - - - - - - - SDH 2 4 - - - - - - - -
MCH 1 13 178 178 - 178 - - - - MCH - - - - - - - - - -
PSU - - - - - - - - - - PSU - - - - - - - - - -
Private 11 11 637 634 3 225 412 - 198 419 Private 3 7 88 88 - 15 73 - - -
Total 13 26 815 812 3 403 412 - 198 419 Total 6 16 221 221 - 148 73 - 25 64

22. DISTRICT: PALAMU 23. DISTRICT: GODDA

Site-wise data on MTP providers and cases Site-wise data on MTP providers and cases
Name of Sites Name of Block No. of Providers No. of MTP cases Name of Sites Name of Block No. of Providers No. of MTP cases
reported reported
District hospital Daltonganj Daltonganj Sadar 4 - PHC Sundarpahari Sundarpahari - 69
PHC Chainpur Chinpur 4 - PHC Poriyahat Poriyahat - 5
PHC Panki Panki 3 - PHC Sadar Sadar - 93
PHC Bishrampur Bishrampur 2 - PHC Pathargama Pathargama - 24
PHC Sadar Sadar 2 - PHC Mahgama Mahgama - 54
PHC Manatu Manatu 2 - PHC Boarijor Boarijor - 7
PHC Hariharganj Hariharganj 6 - District hospital Godda Sadar - 4
PHC Patan Patan 1 - Total - 256
PHC Hussainabad Hussainabad 1 -
PHC Lesliganj Lesliganj 2 -
PHC Chhatarpur Chhatarpur 2 -
APHC Jamune Sadar 1 -
APHC Kishunpur Patan 1 - Distribution of MTP cases by site type, methods and post-abortion contraception
APHC Bansdih Chainpur 1 - Site No. of No. of No. of Trimester Methods Contraception
APHC Haidernagar 1 - st nd
Name Sites Providers MTP 1 2 MVA/ D&C/ MMA Perm. Temp.
Total 33 - EVA D&E
DH 1 2 4 4 - - 4 - 1 3
SDH - - - - - - - - - -
MCH - - - - - - - - - -
PSU - - - - - - - - - -
Private 4 4 785 765 20 555 230 - 240 220
Total 5 6 789 769 20 555 234 - 241 223
 24. DISTRICT: RANCHI ANNEXURE: C
Reporting Format of Government of India
Site-wise data on MTP providers and cases
Comprehensive Abortion Care
Name of Sites Name of Block No. of Providers No. of MTP cases State Monitoring Format (6 Monthly)
reported
Please do not modify/change (add/delete columns) the format
District hospital Ranchi Ranchi - 73
PHC Kanke Kanke - 46
Name of State/U.T: Month and Year of reporting:
PHC Lapung Lapung - 39
Number of districts in the State: Reporting period:
PHC Silli Silli - 23
PHC Angara Angara - 66
PHC Ormanjhi Ormanjhi - 18 Name of State Nodal Officer for MTP activities:
PHC Sonahatu Sonahatu - 8 Designation and Contact Number:
Email-id:
PHC Tamar Tamar - 56
PHC Ratu Ratu - 358
PHC Bundu Bundu - 119
1. DISTRICT LEVEL INDICATORS:
PHC Bero Bero - 12
PHC Chanho Chanho - 61 S. No. Indicator Numbers
Total - 879
1. Districts in which Comprehensive Abortion Care (CAC)–Training
and Service Delivery Guidelines are available

2. District Level Districts With DLCs

Distribution of MTP cases by site type, methods and post-abortion contraception Committees
(DLCs)* Districts with regular DLC meeting held in the reporting period
Site No. of No. of No. of Trimester Methods Contraception (at least one meeting/month)
Name Sites Providers MTP 1st 2nd MVA/ D&C/ MMA Perm. Temp.
EVA D&E 3. Approved a) Approved by DLCs to provide safe abortion services
DH 1 7 249 249 - 249 - - - - NGO and
Private b) Renewal certificates issued in the reporting period
SDH 1 3 - - - - - - - -
Clinics and
MCH 1 7 1005 - - 1005 - - 336 669 Hospitals
c) New certificates issued in the reporting period
PSU 1 7 16 16 - 16 - - - 16
Private 12 29 4980 - - 265 4715 - 1169 3641
d) Number of applications pending with the DLCs for one year
Total 16 53 6250 265 - 1535 4715 - 1505 4326 (at end of reporting period)

e) Number of new applications received in the reporting period

f) Number of applications out of the new applications (e)

pending with the DLCs at the end of the reporting period**

• Is MVA equipment being procured and supplied? (Y/N)...Y.............................

• Are the drugs for MMA included in the essential drug list? (Y/N)......N .....................

* As per MTP Act, Rules and Regulations 2002-2003

** Applications on which no action has been taken (as per MTP Rules)
2. CAPACITY BUILDING: 4. SUPPORTIVE SUPERVISION:

Name of the Nodal agency/ department/ any agency under PPP for training:
S. No. Indicator Remarks
1. What is the supportive supervision/ monitoring mechanism for post
S. No. Indicator Numbers
training follow up and quality of MTP service delivery?
1. Training sites Medical Colleges conducting training
2. If there is no mechanism, what is the state's plan for 1) and the
District Hospitals conducting training proposed timeline?
Any other facilities including Private Hospitals /NGO Hospitals
conducting training
2. Training Training Load (Cumulative since April 2005)
5. BIOMEDICAL WASTE MANAGEMENT:
MOs trained (Cumulative since April 2005)
MOs trained in the reporting period (six months) • What is the mechanism of disposal of products of conception?
Target for current year ·
• Is this mechanism in accordance with CAC guidelines? (Y/N).........................................
3. Master trainers trained (Cumulative since April 2005)
4. ANMs and Staff Nurses trained to provide confidential counselling for MTP and • Whether implemented in all the districts? (Y/N)..................................................
post-abortion care. (Cumulative since April 2005)
5. ANMs, and Staff Nurses trained to provide confidential counselling for MTP and
post-abortion care in the reporting period
6. ASHAs and other field functionaries trained to provide confidential counselling
for MTP and post-abortion care. (Cumulative since April 2005)
7. ASHAs and other field functionaries trained to provide confidential counselling
for MTP and post-abortion care in the reporting period

3. IEC/BCC: Does the state have an IEC/BCC plan for the following :

S. No. Subject Please specify frequency of IEC/BCC activities

1. On the legality of MTP Print: Annually and Monthly (During training)
Audio:
Video:
Any other (specify):
2. On sex determination Print:
preceding MTP as an offence Audio:
Video:
Any other (specify):
3. On mandatory requirements Print:
for approval of private/NGO Audio:
service delivery sites Video:
Any other (specify):
4. On MTP service availability at Print:
nearest facility in public and Audio:
private sector Video:
Any other (specify):
6. SERVICE AVAILABILITY AND SERVICE UTILIZATION:

S. No. Facility Availability Availability Utilization

Number of Facilities Number of Facilities Number of MTPs

performed in the
last 6 months

Total With With MTP With Having all Institutions Providing Providing Providing Up to 12 - 20
Health MTP Equipments* Trained three (MTP) providing MTPs up MTPs up to CAC Services 12 weeks
Facilities Drugs* Providers - Drugs, MTP Services to 8 weeks 12 weeks ( both < 12 weeks
in (MTP) Equipment only only weeks and
the and Trained (MVA/MMA) >12 weeks)
State Providers - EVA/MVA/
MMA

1. Medical Colleges

2. District Hospitals
including Women
and Children
Hospitals

3. Sub Divisional
Hospitals

4. CHCs (FRUs) and

other Sub District
Level Hospitals

5. 24 x 7 PHCs,
Non FRU CHCs

6. Other PHCs

7. Approved NGO
and Private Clinics
and Hospitals

*For the list of drugs and equipments refer to Chapter 8 of CAC guidelines.
NOTES