23-10
How much responsibility should health workers be given?
In different programs, health workers play very different roles with respect to
family planning.
• Many larger government programs instruct health workers to encourage
people to plan their families. Most of these health workers simply refer interested
women to a family planning clinic. However, an increasing number of programs now
supply health workers with condoms and birth control pills to distribute.
• Some programs train special ‘community nurses’ to work mainly in family
planning. The nurses learn just enough other health skills so that it does not look as
though they are there only to promote family planning.
• By contrast, many community programs train health workers in a wide range
of health skills, including HIV prevention and family planning. Quite wisely, family
planning services are often linked with activities for children under 5 years old.
• Some community-based programs even train
local health workers to do sterilization operations.
In Gonoshasthaya Kendra in Bangladesh, village
women ‘paramedics’ have skillfully performed
hundreds of tubal ligations (female sterilizations,
see WTND, p. 293). The incidence of infection from
their operations is lower than the national average
for doctors. Furthermore, the percentage of women
who have chosen sterilization is much higher in the
program area than in the rest of the country. This
is probably because the operations are performed
only when asked for, by local women whom the
others know and trust.
We are not suggesting that all programs teach health workers to perform tubal
ligations. It may not be appropriate for your area. We are only pointing out that a
group of community health workers, some of whom have never attended school,
have been able to do a better job—both technically and socially—than the average
professional in their country. What makes the difference is the fact that these
women paramedics are local persons selected for their human concern, and that
they receive appropriate training and support.
In many programs, we have seen that village health workers with little formal
education can learn to prescribe birth control pills and other contraceptives carefully
and correctly. But during training, the basic information about selection, precautions,
and advice must be carefully discussed and clearly presented.
In conclusion, the problems related to family planning are more human than
technical. We feel that, in community-based programs, health workers should (1)
be able to provide the kind of advice that permits people to make intelligent,
well-informed decisions, (2) help people understand the political and
religious influences—local and international—that lead to misinformation and
abuse with regard to family planning, and (3) be taught and permitted to make
appropriate birth control methods available to those who want them.
It is women’s right to control their own bodies.