DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20222797
Published: 2022-10-28

QI initiative to improve utilization of centchroman: a non-steroidal contraceptive

A. G. Radhika, Amita Suneja, Himani Malik, Rashmi Gupta

Abstract


Background: The nonsteroidal contraceptive centchroman is manufactured in India. It was included in family welfare programme in April 2016 by the Ministry of Health and Family Welfare, Government of India. However, national statistics indicated its low utilization at all levels of healthcare. Objective was to identify the reasons for underutilization of centchroman in the family planning clinic, and in the postpartum period, and to implement corrective measures to improve its utilization at a tertiary hospital.

Methods: The study was conducted in the department of obstetrics and gynecology at a tertiary care hospital from September 2019 to January 2022. A quality improvement action team was constituted to undertake root cause analysis. Important corrective factors were insufficient focused counselling for centchroman as contraceptive, insufficient sensitization of doctors and nurses, inconsistent supply of tablets, lack of clarity about side effects of centchroman among healthcare workers. Tablets were not readily available to postpartum women at home, which was also a contributing factor. There were the following changes implemented: sensitization of the healthcare workers, daily focused FP counselling of women in outpatient clinics and postnatal wards, and measures to ensure a continuous supply of tablets. At discharge, eligible postpartum women were given a three-month supply of tablets for ready access. ASHA (accredited social health activist) workers who are engaged in other governmental health initiatives were included in the loop to maintain contact and supply tablets to women initiated on centchroman.

Results: Contraceptive utilization increased from 0.5-0.7% at beginning of the study to 29% by incorporating the solutions. Failure of contraception occurred in one user. Pearl index for centchroman in our study was 0.22%.

Conclusions: Simple, practical solutions identified through quality improvement initiatives resulted in improved coverage and utilization of contraceptive. This study can be an important example for problem solving of challenges in low resource settings.


Keywords


Oral contraceptive, Ormeloxifene, Quality improvement

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References


NHFS. National Family Health Survey- Singrauli. 2016. Available from: http://rchiips.org/nfhs/ factsheet_NFHS-5.shtml. Accessed 21 July 2022.

Levi EE, Stuart GS, Zerden ML, Garrett JM, Bryant AG. Intrauterine device placement during cesarean delivery and continued use 6 months postpartum. Obstet Gynecol. 2015;126(1):5-11.

Huang YM, Merkatz R, Kang JZ, Roberts K, Hu XY, Di Donato F, et al. Postpartum unintended pregnancy and contraception practice among rural-to-urban migrant women in Shanghai. Contraception. 2012;86(6):731-8.

Lal J, Asthana OP, Nityanand S, Gupta RC. Pharmacokinetics of centchroman in healthy female subjects after oral administration. Contraception. 1995;52(5):297-300.

Vaidya R, Joshi U, Meherji P, Rege N, Betrabet S, Joshi L, Sheth A, Devi PK. Activity profile of Centchroman in healthy female volunteers. Indian Indian J Exp Biol. 1977;15(12):1173-6.

Cleland J, Bernstein S, Ezeh A, Faundes A, Glasier A, Innis J. Family planning: the unfinished agenda. Lancet. 2006;368(9549):1810-27.

Singh MM. Chhaya: the nonsteroidal, non-hormonal, once-a-week oral contraceptive pill. In: Berhardt LV, ed. Advances in Medicine and Biology. Vol. 160. Nova Science Publishers, Inc., NY; 2020.

StataCorp. (2011). Stata Statistical Software: Release 12. College Station, TX: StataCorp LP.

Kamboj VP, Ray S, Anand N. Centchroman: a safe reversible postcoital contraceptive with curative and prophylactic activity in many disorders. Front Biosci - Elit. 2018;10(1).

Kabra R, Allagh KP, Ali M, Jayathilaka CA, Mwinga K, Kiarie J. Scoping review to map evidence on mechanism of action, pharmacokinetics, effectiveness and side effects of centchroman as a contraceptive pill. BMJ Open. 2019;9(10).

Government of India. Reference manual for oral contraceptive pills. Family planning division. Ministry of health and family welfare. Available from: https://nhm.gov.in/images/pdf/programmes/ family-planing/guidelines/Reference_Manual_ Oral_Pills.pdf. Accessed 21 July 2022.

Nair HS, Jayasimhan P. A prospective study of centchroman users with special reference to its contraceptive benefit. J Evid Based Med Healthcare. 2016;3:5374-80.

Puri V, Kamboj VP. CHR of multicentric trial, Centchroman. In: Dhawan BN E, Delhi: N. Pharmacology for Health in Asia; 1988.

Doke G, Kamda J. A study of centchroman users with special reference to its contraceptive benefit. Int J Reprod Contracept Obstet Gynecol. 2019;8(11):4204-7.

India- Key Indicators. International Institute For Population Sciences. Available from: http://rchiips.org/nfhs/NFHS-5Reports/NFHS-5_INDIA_REPORT.pdf. Accessed on 31 July 2022.