Capacity building of service providers is crucial to deliver quality family planning (FP) services to the community and reach the last mile. IHAT supports the government in enhancing capacity of service providers for provision of FP services. This is done through skill gap assessment among service providers and development & roll out of capacity building programs/activities. To bring sustainability to the approach, IHAT supports the government in developing mentoring plans for the service providers.

One of the capacity building tools that has been extensively utilized during trainings is a short animated film “Why Did Mrs X Die, Retold”. It has been produced by Hands On for Mothers and Babies. The film is a remake of the World Health Organization 1980’s film “Why Did Mrs X Die?” based on a lecture by the founder of the Safe Motherhood Movement, Prof. Mahmoud Fathalla. The film was dubbed in Hindi for easy comprehension and has been used extensively in trainings for all categories of service providers including ASHAs, Counsellors, Nurses, Doctors and Chief Medical Superintendents in hospitals. It gives the trainers an insight about the participants’ level of understanding and engagement and thus sets the pace of the training.

The film showcases the human side of the tragedy of maternal deaths in developing countries. The film explores all the different preventable causes that contributed to a situation that led to the death of Mrs X. This is a familiar story of many of the vulnerable women that are visiting the public health facilities who are struggling with paucity of resources, poor nutrition, early and excessive fertility which leads to high risk-pregnancy and life-threatening complications. The patriarchal society and gender bias limits her agency to have access to good nutrition, education and information as well as community based preventive and curative medical services. At every stage, there is an exit route, but Mrs X is denied every opportunity to take it, ultimately leading to her death and that of her unborn child. 

This story creates an immediate emotional connect with all service providers initiating the process of introspection on all the aspects that surround the issue of maternal health beyond the medical and clinical perspective. During the discussion, the trainers are able to create consensus that one of the most critical causative factors that could have prevented the death of Mrs X was spacing between pregnancies and access and information about FP to achieve it. It is emphasized that apart from the medical aspects of the case, the service providers need to deal with the situation with a gender lens that underlines the influence of social construct on the decision making ability of women on opting for family planning methods. Adequate attention to FP in countries with high birth rates can not only reduce poverty and hunger but also avert 60 per cent of maternal (Ahmed S, et al) and nearly 10 per cent of childhood deaths (Cleland J, et al), respectively. Thus, inculcating a holistic perspective in service providers can positively impact the reproductive health of women.

The film has been showcased during various outreach and training activities, including, media consultation workshops, District Family Planning Specialist orientation meetings, Chief Medical Superintendents review meeting, regional dissemination workshops on FP, counsellor trainings & cluster meetings with Front Line Workers and has always received an affirmative response in providing practical exposure to social facets of the issue of maternal deaths.  

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 “The film ’Why did Mrs. X die, retold’ shown during the training session, has had a deep impact on our head and heart. We could empathise every aspect of the film as we have seen these things happening at the grassroots. We realized how important it is to provide the right information at the right time to the community so that there aren’t any untimely deaths of pregnant women and infants. We all should strive to reach out to the community with appropriate information on family welfare and family planning at the right time”.

Garima Shukla, FP Counsellor, National Health Mission, District Hardoi (Uttar Pradesh)

“’Why did Mrs. X die, retold’ can be considered as an apt video to showcase the journey of a pregnant woman, the challenges that she faces and reasons behind her turmoil. It reiterates the significance of timely intervention leading to saving lives.”

Arun Pandey, District Family Planning Specialist, Bareilly (Uttar Pradesh)