Title : The functioning of Anganwadi centers in urban slums of Delhi.

Year : 2004

Authors : Dr Anuradha Davey and Dr. Utsuk Datta

Specific Objectives : 1.To assess the organization, available infrastructure & logistics at Anganwadi Centers. 2.To find out the knowledge of Anganwadi workers in performing their job activities. 3.To assess the coverage, content and quality of the services under Anganwadi centers in 2002- 2003. 4.To identify the existing gaps in the services delivery under Anganwadi centers so as to suggest appropriate measures for improvement, if any. Delhi has the third largest slum population of the country. A magnet of urban jobs and economic opportunity is continuously drawing all classes of people, especially the poor. ICDS scheme, in such scenario of health, occupies a significant place as an intervention in the socially and economically disadvantaged class of the society. Packages of the services in the ICDS are aimed to raise the nutritional status of children before and after birth till the age 6, thereby decreasing the morbidity due to anemia and mortality among the children as well as building the capacity of the mothers to look after their children. The main pivot of these services deliveries to the community is the Anganwadi worker; because of the fact that she is the central figure in helping the community to identify and meet the needs of their children and women. Quality of her work depends not only on the logistics available but also on her knowledge to deliver the services; thereby changing the perception and continuously motivating the community. Therefore, this study seeks to evaluate the functioning of Anganwadi centers in the urban slums of Delhi. Infra structure and logistics at selected ICDS projects: CDPOs offices of the all selected projects had basic office furniture and telephone facility. Typewriter was available in 2 CDPO offices. But none of them had facility of vehicle for their mobility. 55% of the AWCs were running in rented house and 40% in helper's house. 85% AWCs had pucca building and were electrified. 60% of AWCs had availability of fan for the children. Source of safe drinking water (tap water) was present in 75% of AWCs. 70% of AWCs had sanitary latrines, but facilities were not allowed for the children to use in any of them. 75% of the AWCs had food storing space in proper conditions (protected from seasonal variations like rain), whereas sufficient space to store ration of one month was available in 60% of AWCs. For pre school activities, half of the selected AWCs had sufficient space, while for play activities space was available in only 10% of AWCs.For logistics support to run the AWCs, all of them had regular supply of adequate ration for their registered beneficiaries. 90% AWCs had registers for record keeping, 80% had functioning weighing scale, 75% had nutrition and health education material and growth cards. Pre school education material was received by 55% of the AWCs after the gap of 4 years. But none of them had received medicine kit and Iron and folic acid since the last 4 years. Knowledge of AWWs regarding their job activities: For screening of malnourished children by Mid Upper Arm Circumference strip (MUAC strip), 50% AWWs knew about 3 colours (red, yellow and green) of MUAC strip, whereas 35% AWWs were able to mention regarding the action to be taken according to interpreted colours. Regarding the knowledge of growth chart, 90% of AWWs were able to interpret growth chart correctly. But all of them mentioned that they are providing supplementary nutrition to those children also who are below grade II malnutrition (i.e. grade I malnutrition and no malnutrition). Severely malnourished children were provided double diet at AWCs. For interpretation of growth lines, 75% AWWs were able to tell that flattened growth line indicates no weight gain by the child and falling growth line as reduced nutritional state of the child, whereas raising growth line for a healthy child was told by 80% of AWWs. Only 40% of the AWWs mentioned that correct estimation of the age of the children is essential for growth monitoring and malnourished children should be weighed monthly.For the diseases prevented through vaccination, all of them knew about polio, followed by measles (80%), diphtheria, pertussis, tetanus and tuberculosis through DPT and BCG (70-75%). 60% of the AWWs knew that night blindness can be prevented by administrating Vitamin A syrup to the children. Regarding identification of high risk among pregnant women, 60% AWWs knew about anemia, followed by history of high blood pressure / swelling in the feet (30%), history of bleeding during pregnancy and primi pregnancy (15% each).At high risk among children, severe malnutrition was known to 75% of the AWWs, followed by chronic diarrhea (30%), whooping cough (25%) and low birth weight (10%). Regarding the age of weaning of infants, 60% of AWWs mentioned as 4-6 months. Whereas 15% of the AWWs said after the age of 6 months and 25% said as even before 4 months. Selected AWCs were providing ready to eat food to their beneficiaries like Chana murmura, Bread, Biscuits, Sattu. Distributed food was taken to their home by the beneficiaries. Double diet was given to severe malnourished children (grade III and IV malnourished children). All the sampled AWCs of the selected four zones were not getting supply of iron, folic acid and Vitamin A since last four years. Therefore, beneficiaries were guided by the AWWs to receive the medicines from the attached health centers. In 80% of the selected AWCs, immunization services were provided at health centers located in the area. Immunization camps were organized at only 2 AWCs, one was 6 months back and other was one year back. In all the selected four zones (combined), coverage of the BCG was 82.5%; DPT/OPV I dose was 75.7%; DPT/OPV II dose was 71%; DPT/OPV III dose was 65.6% and measles was 60.4% among the children between the age of 12-23 months. Coverage on IInd dose of Tetanus toxoid among pregnant women was 70.2%. Pre school education in the sampled AWCs of the four zones was not being provided regularly. Children coming for pre school education were not staying at the centers for full time. Their main motive to attend AWC was to collect supplementary nutrition. All the AWWs were imparting nutrition and health education to the women between the ages of 15-45 years on every alternate Saturday. Discussion held in the session was on the subjects like breast-feeding, weaning, hygiene, sanitation, immunization and family planning. Though, all the AWWs were referring the high risks pregnant women and children, but no records of referrals were maintained by any of them. 30% of AWWs were making referral slips, but lack of due attention given to the referred patient was the main problem faced by AWWs. Regarding source of awareness of the respondents for AWCs running in the area, 37.5% came to know by themselves, 23% from their mother in law and 20% from neighbours. Only 5% respondents came to know about AWCs through AWWs. Regarding visits made by AWWs to them, 89% respondents said that AWWs had visited them for at least once in last one year. 51.7% respondents said that their frequency of approach was once in 3 months and 29.7% said once in 6 months. Regarding utilization of services for the children, all the mothers mentioned that they do receive nutrition from the AWCs. 56.6% mothers mentioned about growth monitoring of their children for at least once in last 6 months and 15.9% had utilized immunization services at AWCs. For children between the age of 3-6 years, 42.3% mothers mentioned the utilization of services for pre school education from the AWCs. For utilization of services by the pregnant women and lactating mothers, 94.5% of them mentioned about supplementary nutrition from the AWCs. 23.6% women said that they were told about health & nutrition education and 5.5% said for the immunization services. But none of the pregnant women and lactating mother had ever received tablets of iron and folic acid and had never been examined for ANC/ PNC care at AWCs. Regarding the satisfaction of the respondents for the services provided through the AWCs, 47.5% respondents said that they are satisfied with services of AWCs where as 52.5% mentioned about their dissatisfaction. Out of dissatisfied respondents, 68.6% mentioned their non-accessibility to AWCs and space to run the centers is less. 66.7% respondents said about poor quality of supplementary nutrition distributed, 57.1% said about irregular pre school education. 42.9% respondents wanted frequent change in the recipe and immunization camp at AWCs.

Policy Implications : It seems that AWCs are not that much popular as expected. One of the reasons for this might be poor rapport between AWW and community members. Therefore it is essential to develop good rapport between AWWs and community members. Supervision of AWW is another factor, which was lacking in all the AWCs. Therefore, It is suggested that supervision at all level from CDPO to Supervisor has to be improved by enhancement of supervisory skills of project functionaries through conduction of regular meetings, arrangement of ‘on the spot’ job training of AWWs and provision of timely, on the spot guidance and solution of the problems faced by the AWWs. They should do periodical survey to assess community’s needs and formulate their own indicators for the assessment. This also helps in the development of rapport between AWW and community. To achieve cent percent goal of AWCs, an effective intersectoral coordination particularly between Department of Health & Family Welfare and Department of Women & Child Development is required at all levels. Much of the trust among the community through joint provision of services such as ANC, immunization, nutritional status assessment of children could be achieved. It also helps in better functioning of AWCs in long run.

Keyword : Anganwadi centers

Title : Low Birth Weight and Associated Maternal Factors – A Hospital-Based Study (Dr. Mithila Dayanithi, Dr. M.C. Kapilashrami and Prof. K. Kalaivani)

Year : 2004

Authors : Dr. Mithila Dayanithi, Dr. M.C. Kapilashrami and Prof. K. Kalaivani

Specific Objectives : (i) To determine the prevalence of low birth weight; (ii) To identify the maternal factors associated with low birth weight; and (iii) To suggest measures, if any, for improvement in birth weight.

Policy Implications : Adequate emphasis should be given on ‘ante-natal care’; including the checking of maternal height and weight, blood pressure, haemoglobin, fundal height and abdominal girth, which could help identify risk factors for low birth weight babies.

Keyword : Birth,Weight,Maternal,Factors,Hospital

Title : A Study of School Health Services Provided by the Municipal Corporation of Delhi

Year : 2004

Authors : Dr.P.K.Sakthidharan, Dr.S.Vivek Adhish M.D & Dr.Y.L.Tekhre PhD

Specific Objectives : (i)To describe the organizational setup and implementation of school health services provided by the Municipal Corporation of Delhi; (ii)To assess the coverage, content and quality of school health services provided; (iii) To determine the awareness and attitudes of parents, teachers and head masters in relation to the services provided; and (iv)To identify the gaps in the provision of services and suggest measures for improvement. The area under Municipal Corporation of Delhi is divided into twelve zones for administrative purposes. This study was carried out in the area covered by the school health division of the Municipal Corporation of Delhi (MCD). Najafgarh zone, South zone, Shadhara south zone and Rohini zones of MCD were randomly selected after dividing all the twelve zones into four groups according to their geographical distribution and selecting one zone from each group randomly. One school was selected randomly, comprising both morning shift (girls) and evening shift (boys) from each of the zones. The study population comprised of health personnel from the zonal school health clinics viz. Deputy Health Officers (Schools), Medical Officers (M.O) and Public Health Nurses (P.H.N); Head masters/Head mistresses and Teachers of the primary schools; Parents of children studying in the primary schools. Half the teachers were selected randomly from each school for the purpose of this study. 100 parents were selected randomly from each school. All the doctors and public health nurses were included in the study. Secondary data was collected from the monthly reports of the zonal clinics to find out the number of children examined and the pattern of morbidity in the study zones. Data regarding the content of various services provided viz. preventive, promotive, curative, referral and rehabilitative services were obtained from the monthly reports and separate reports maintained for rehabilitative services. Discussions were made using checklists with the Deputy Health Officer (Schools) and information regarding the manpower status, monitoring, drugs supply, vaccines storage and any other special activities in various zones were collected. In depth interviews of parents and teachers were conducted using semi structured interview schedules to obtain information pertaining to their awareness and opinion regarding various services provided by the school health teams. Focus Group Discussions using check lists were conducted with the teachers to obtain qualitative information about the services provided by the school health teams. Medical Officers and Public Health Nurses were interviewed using semi structured interview schedules in order to assess the time spent on each child, physical infrastructure available for the examination of children, aids used for health education and the co operation of the school personnel during the examination of children. The data generated by various interviews, record studies and focus group discussions were tabulated and analyzed as per the objectives of the study. The Organizational setup is well structured and most of the sanctioned posts in the zones under study were filled except for GDMO posts in Najafgarh and Public Health Nurse posts in Najafgarh and South zones. While the corporation has sanctioned one doctor for every 12,000 students and one PHN for every 7,000 students the actual number of students covered by one doctor varies from 13,491 in South zone to 37,000 students in Najafgarh zone. Similarly, the number of children covered by a PHN varies from 7200 in Rohini zone to 14,800 in Najafgarh zone. A careful redistribution and filling the vacant posts in order to achieve an optimum number of children per doctor and nurse will decrease the burden on them. Discussions held with the DHO(s) and pharmacists of various zones revealed that there is shortage of drugs and their supply is delayed, irregular and not appropriately timed. It is noted that no zone under study has a functional power back up to be used in case of shortage of power supply. Transport facilities in all the four zones are functional with all the drivers in position. The services are provided through two types of clinics, namely (i) central clinics organized at the zonal level and (ii) school clinics conducted in each school of the MCD. Medical, eye, ENT and dental OPDs are conducted in the central clinics. The school clinics are conducted by the medical officers who are assisted by the public health nurses. The services provided to children include health appraisal, eye screening, dental check up and immunization. These services are provided in such a manner that all the children are covered by at-least one of the services in a year. Overall, 78.43% of children were examined in all the four zones. Najafgarh, with the maximum number of children (109538) examined 74% of them compared to 84% coverage of south zone with only 67,456 children. The percentage of children covered in Shadhara south and Rohini zones were 79 and 81% respectively. Approximately three fourths of the children in first standards were vaccinated with DT. Rohini has the maximum coverage for both DT and TT vaccines at 96.39% and 105.15% respectively. In other zones coverage of fifth standard students for TT vaccination was just above than 50%, which is of concern. Discussions with the teachers revealed that prior information to parents and educating children to allay the fear of injections could help to increase coverage. 86% of the total children were given health education during the health talks regarding nutrition, personal and dental hygiene, immunisation, prevention of vector borne diseases like malaria & dengue and about environmental sanitation. Rehabilitative services viz. spectacles and orthotic appliances were provided to the children. Though children were referred, regular follow up and their reporting is not done in a regular manner. Nearly two thirds of the doctors did not inform the schools before visiting them. This is a matter for concern as prior information makes the school staff prepared by ensuring attendance of all the children. The time spent in examining each child ranged between 2 to 10 minutes. Majority of the doctors spend 4 – 6 minutes in examining each child. 42% of nurses spend 4 – 6 minutes while another 42% of nurses spend more than 6 minutes for each child. Only 60% of them filled the health cards after examination. Various constraints faced by them in filling the health cards include shortage of cards, non-availability of storage facility and not getting co operation from teachers. While 13% clearly categorically ruled out any co operation from teachers, 20% opined that they don’t get full co operation in all the schools. Adequate physical infrastructure is essential for medical check up of the children. 83% of health personnel responded that there is a lack of adequate physical infrastructure in the schools during medical examination. 79% of them responded that there is lack of separate room for medical examination. Usually medical examination is carried out either in open space in the verandah or in the head master’s room. According to health teams, none of the schools had examination table for medical examination and 34% of the respondents reported lack of proper lighting facilities. The leading cause of morbidity among the children who were examined in school and central clinics of the four zones under study was worm infestation. The prevalence of worm infestation among the school children was found to be 7.85%. This was followed by anaemia with an overall prevalence of 6.4%. Other major causes of morbidity were dental disorders, avitaminosis and eye disorders with a prevalence of 6.32%, 3.8% and 2.41% respectively. The prevalence of malnutrition was 2.40%. These problems are critical in Najafgarh zone where 16% of the children suffer from worm infestation and 13% suffer from anaemia. The prevalence of other diseases is comparatively less than other studies on morbidity in primary school children. Majority of the respondents (83.49%) had heard about the school health services provided to their children. Children were the major source of knowledge (91.92%) in all the zones. Among those who have ever heard about the school health services, the awareness regarding health education, rehabilitative services and maintenance of health records of their children were present only in about 4 –5% of the respondents. The awareness about SHS was lowest amongst the illiterate respondents (72.67% as compared to other groups with 85 to 95%). Only 47% of the respondents whose children had been examined knew the correct frequency of health check ups as once a year. Nearly 37% of the respondents were not aware of the person who did the medical examination of their children. Informing the parents about the health check ups is very important to gain their confidence and to get their support. Around 44% of the respondents categorically stated there was no any prior information regarding the health check up of their children. Though 44% of the respondents did not get any prior information regarding the health check ups, almost all of them (99%) had indicated that they would like to know about the examination of their children well in advance, 90% of them would like to be present during the health appraisals. But, only one-fifth of the parents took interest in contacting some one after knowing about the health checkups underwent by the children. About one third of the parents were not at all satisfied with the school health services. Nearly half of them were moderately satisfied. While 10% were poorly satisfied a very little number of parents were highly satisfied. The present study found all the teachers to be aware of the school health services. Their contribution to improve the health of children is mainly through health education, which most of the teachers give to their students. Only 27% of the teachers had undergone in service training in health education and detection of major illnesses in school children. Almost all the teachers (97%) communicate with the parents after the examination. This was done mainly (85%) by verbal messages through children. More than one third responded that the time spent during medical examination was not adequate. Regarding the content of health education, majority (90%) of them felt that the content was adequate and appropriate for the primary school children. The impact of health education in making the children discuss health issues was found to be encouraging in the present study. 93% of the children had discussed something about health talks at home. Around 74% had told their siblings regarding brushing habits, cleanliness and washing hands. 44% had discussed with their mother regarding washing hands while cooking and keeping the utensils clean. One fifth of the children asked their elders or neighbours to stop smoking. However, 72% of the children did not brush in the evening, rest of them do it sometimes or other. It is discouraging to note that only 37% of the children wash their hands before eating food. Only 40% regularly cut their nails and keep them clean. Half of the children cut their nails irregularly, while 10% never cut their nails. Children buy candies, ice cream and locally made food items in front of the schools and eat them in unhygienic conditions. More than half of the parents said that their children had eaten those foods sometimes or other.

Policy Implications : Based on the study findings, discussion and summary of the study, it is found that though there is a proper set up for implementation of the school health services yet there are few lacunae which need to be filled for effective delivery of health care services to the school children. Optimal distribution of children among the doctors and public health nurses need attention. More detailed reporting system for dental, eye and ENT disorders and appropriate feedback to doctors and nurses at the zonal level to follow the referred cases need to be implemented. Awareness need to be generated among the parents regarding the preventive and promotive services. Their involvement which was found to be lacking in this study is very important to increase the coverage and also to reinforce the health messages given to the children. There is a great potential for involving teachers after they are given adequate training in detecting the illnesses of school children and health education.

Keyword : School Health Services; Parents’ and teachers’ attitude; coverage, content and quality.

Title : Study of the Functioning of Senior Citizens’ Clinics run by the hospitals of Government of Delhi.

Year : 2004

Authors : Dr. Ravindra Prakash Arya, Dr J.K. Das & Dr A. M. Khan

Specific Objectives : 1. To study the organizational setup of these clinics. 2. To study the services provided by these clinics 3. To assess the expectations of the beneficiaries attending these clinics 4.To identify gaps if any , 5. To suggest measures for improvement. The problem of inadequacy of the existing geriatric health care services have found a place all the recent policy documents. Elderly like all others may receive medical assistance in any of the general hospital or dispensary run by the government. But to receive medical assistance is not easy. One has to wait and jostle for hours to get the attention. Taking these problems of the elderly into consideration, in September 1998 the Govt. of Delhi launched a scheme to provide basic medical health care facilities for the elderly through special Sunday clinics to be called as Senior Citizens clinic in selected Delhi government hospitals. The present study on the functioning of Senior Citizens’ Clinics was undertaken in the five hospitals run by Govt. of Delhi using a descriptive study design with the following objectives. The functioning was studied under organization set up, functional set up, the services provided by these clinics, their utilization pattern and the expectations of the beneficiaries. Apart from record study, data were gathered from patients and providers. In all data was collected from 261 patients. A semi structured interview schedule was used as the main tool to obtain the information from patients and the providers. Similarly another semi structured interview schedule was used to obtain the information from the providers to know their perspectives. It was observed that there was no uniform pattern of services existed across these clinics. large variation in the services provided by Senior Citizens’ Clinic (SCCs) in each of these hospitals. Only if test was very urgent to be done the patients were send to the casualty where the test was done otherwise for routine investigations the patients needed to come on a working day. Utilization of the services was the maximum by the age group of 60 to 65 years and minimum above the age of 75 years. After cost, distance seems to be second most important determinant for seeking treatment in case of elderly patients, as 2/5th of the patients choose the clinic for the reason that it is nearby. Only about a sixth considered that provision of good treatment in the clinic was the reason for their choice of the clinic. A great majority of patients (over 75%) found them better than routine OPDs in terms of being less crowded. Majority of the patients found the clinic day, time and location to be highly convenient to them and their caretakers as well. With convenience a very high percentage of elderly were satisfied. They also thought that the waiting time in these clinics is far less then the routine OPDs and they saved about 50% of the time in opting for treatment in SCCs. More than a half of the patients were dissatisfied with the thoroughness of the examination by the doctor. Nine out of ten elderly patients expressed that they would like the doctor to spent more time with them . Over 3/4th of the patients felt that they get more than 50% of the medicines from the clinic, it is redeeming to note that none said that he or she did not received any medicine. Nearly 4/5th of the patients expressed the view that in the present set up they are required to revisit the hospital again on a working day for various reasons. 2/5th said they need to revisit for collecting their remaining medicines, nearly a 3rd needed a visit for their investigations, the remaining who needed a revisit did so to consult senior doctors or consult other departments. Despite the limited scale of services that continue to exists in these clinics, over ½ of the patient felt that the services provided through SCCs to be adequate to take care of their needs. Nearly 2/3rd felt behavior and courtesy of the Doctor as good, This is highly important as their exists a high degree of relationship between behavior of the Doctor and overall satisfaction of the patients. More than 2/3rd had their expectations partially fulfilled while a quarter felt that expectation have been fully met. Only about a 1/6th felt that their expectations have not been met at all. Patients whose expectations were fully met were the patients who reported a higher degree of satisfaction. Over 50% were satisfied with the services of SCCs. 40% were somewhat satisfied and only 10% were dissatisfied. Regarding suggestions more than 2/3rd suggested that all medicines should be available in the clinic and they should be issued medicines for more days. The Departments they are referred for different ailments should also remain open on Sundays. Addition of Physiotherarpy, Laboratory services, addition of Gyane, Dental Services, ENT services and presence of Senior Doctors was suggested by most of the patients. None of the categories of providers had received any training in geriatric care or dealing with the elderly. Majority of them felt that such a training is necessary. In their opinion in the SCCs, the patients only got more medicine and a little more attention than routine OPDs. As far as any advantage of consultation with the senior doctors was concerned only a small number of doctors working in SCCs agreed with it. Most of them also did not subscribe to the view that all the health problems of the elderly were attended to in the SCCs. Over all nearly half of the providers dealing with elderly patients felt that it is difficult to deal with elderly patients. The reason they felt, were they did not understand easily or they did not comply, they were hard of hearing and they lacked patience. Majority of the doctors felt that the day of the clinic, as Sunday was not suitable to them. Considering the constraints of the providers it appears that the clinics could not be developed as alternatives of OPDs for the senior citizens. Neither these could be developed as specialized clinics. Most providers has agreed to the perception of the patient, that the services were not complete and does not reduce the revisit, which the patients are anyway required to make for lack of comprehensive services. It should be ensured that these clinics does become just extension counters of the dispensaries. It is essential therefore, that both consultation and investigation services should be provided, as they ought to be provided in hospital settings. Around 60% of the total attendance of patients were reporting to the Medicine department, therefore the number of doctors should be increased, in Medicine department. To popularize the clinics a good rapport needs to be build with community readers who may disseminate information about existence of these clinics to increase the utilization of SCCs. Since distance is one of the main criteria of health seeking behaviour among elderly and SCCs cannot be opened everywhere, it is suggested therefore that the elderly population may be covered with the help of some mobile dispensaries.

Policy Implications : There is need to spread awareness about the existence and availability of these services for the elderly patients. Apart from curative, emphasis may be given to preventive and health education aspect of the health care in the Senior Citizens’ Clinic. There is also need to provide training to doctors and other categories of staff in dealing with elderly patients. The services provided by the Senior Citizens’ Clinics should be comprehensive in nature so that the elderly need not make repeated visits. There is an urgent need to develop policy guidelines regarding provision of health care for the elderly.

Keyword : Senior Citizens’ Clinics

Title : Contraceptive Practices in an Urban Slum of Delhi.

Year : 2004

Authors : Dr. Madhumita Mukherjee.,Dr. M. C. Kapilashrami & Dr. K. Kalaivan

Specific Objectives : 1.To describe the profile of contraceptive users and nonusers. 2.To estimate the unmet need for contraception and reasons for nonuse. 3.To determine the pattern of continuation of temporary contraceptives. 4.To find out the source of contraceptives among users. 5.To ascertain type and extent of follow-up services available in the area. 6.To suggest suitable measures for improvement. The study is “cross-sectional and descriptive “in nature which was done in “Motilal Nehru Camp” slum of South-Delhi. All currently married women aged 15 to 49 years available in the slum were interviewed. Data collected on specific contraceptive behaviour of the women were analyzed by using SPSS software. Slums in large metro cities like Delhi are vulnerable areas with poor health indices as the people are usually migrants, mostly unskilled and semiskilled laborers with low educational level and poor socio-economic status. Age at marriage and age at first cohabitation with husband has increased only marginally while age at first child-birth has decreased over a time period of 30-35 years. Hence high risk teen-age pregnancies and child births are to be taken care off. Contraceptive use for this study population was 51.3% (201/392). Current use was nil among nulliparas. Adoption of permanent contraception became more common than temporary ones only after having three children and then peaked after having five children. Use of spacing methods at one child was only 9.4%(5/53).For each number of living children , women with more no. of sons were more likely to use a contraceptive than with no or less no. of living sons. Reason for using temporary contraceptive, even after completing family size was welfare of the children till 5 years. Current use was significantly higher among working women ( p < 0.001). Continuation of temporary contraceptives was only 35% after one year. Mismatch of choice of contraceptive and actual use was virtually nil. Role of Follow-up services in continuation of temporary contraceptives could not be assessed fully as the Respondents used to go for follow-up only once at 7 or 15 days after first visit or they did not availed Follow-up at all. Main source of IUDs and permanent sterilization was public health sector, for condoms and oral pills however, chemists and private doctors were preferred. Unmet need for contraception was high (total need 21.15%) was high showing poor health status as well as health services provision in the slum. Desire for more children was the prime cause of non-use, next to that was fear of complications.

Policy Implications : The following recommendations to improve contraceptive practices in the urban slums were made according to the findings : To Increase Contraceptive Acceptance Appropriate to Age and Parity, to increase Child Survival Measures, special Care for Adolescent Pregnancies and Child Births, to Delay the Age at First Child Birth, proper Care and Follow up of Temporary Contraceptive users to prevent Unwanted Pregnancies and Unsafe Abortions and an Outreach Plan for each Urban Health Centre focussing on the Most Vulnerable Slum Communities with Poor Health Indices Should be Developed. Participation from Community Leaders and Non-Governmental organizations are highly desirable.

Keyword : Current use, unmet need, continuation of temporary contraceptives, source, follow-up, non-use, Delhi slum