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Assessment of Eligible Couple

Definition

• There are approximately 150-180 eligible couples per 1,000 population in India.
• About 20% of eligible couples fall in the 15-24 year age group.
• On average, 2.5 million couples join the reproductive group every year.
• The "Eligible Couple Register" (ECR) is the basic document for organizing family planning work and is regularly updated by the ANM/health functionary for the assigned area.

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Purpose of Assessment

1. Identify couples in need of family planning (FP) services.
2. Determine their current contraceptive status.
3. Identify unmet need for contraception.
4. Plan and deliver appropriate reproductive and child health (RCH) services.
5. Update the Eligible Couple Register for program monitoring.

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Who Performs the Assessment

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Steps in Assessment of Eligible Couple

Step 1: Identification and Registration

• ANM/ASHA conducts a house-to-house survey in the assigned area.
• Identify all currently married women aged 15-45 years.
• Record details in the Eligible Couple Register / EC Survey Register.
• Register is regularly updated to add newly married couples and delete those who are no longer eligible (wife aged >45, husband/wife deceased, permanent migration, sterilization).

Step 2: Data Collection (History Taking / Interview)

• Name of husband and wife
• Age of wife (and husband)
• Address / village / ward
• Religion and education

• Number of living children (with sex of each child)
• Number of pregnancies (gravida), live births, abortions
• Date of last delivery
• Presence of pregnancy at time of survey
• Breastfeeding status (lactational amenorrhea)

• Currently using any method? (Yes/No)
• Type of method used: sterilization (tubectomy/vasectomy), IUCD, oral contraceptive pills, condoms, injectable (MPA/DMPA), emergency contraception, natural methods
• Duration of current use
• Satisfaction with current method; side effects experienced

• Couples NOT currently using any method but who:
  • Do not want any more children (unmet need for limiting), OR
  • Want to space the next pregnancy (unmet need for spacing)
• These couples are prioritized for counseling.

• Previous method(s) used and reasons for discontinuation

• Chronic diseases: hypertension, diabetes, heart disease, liver disease, epilepsy
• Reproductive tract infections / sexually transmitted infections
• Contraindications to specific methods (using WHO Medical Eligibility Criteria - WHO MEC)

• Children's immunization status
• Antenatal/postnatal care if currently pregnant or recently delivered
• Nutrition of mother and children (screening for malnutrition)

Step 3: Classification of Couples

Step 4: Counseling

• Provide individualized, client-centered counseling on:
  • Benefits of small family norm (2-child norm)
  • Healthy timing and spacing of births (HTSB) - at least 3 years between births
  • Available contraceptive methods (their efficacy, how to use, side effects)
  • Government compensation schemes (Mission Parivar Vikas, NSV/sterilization incentives)
• Address myths and misconceptions about FP methods.
• Involve the husband in decision-making.

Step 5: Service Provision / Referral

• Distribute conventional contraceptives: condoms, oral contraceptive pills (OCPs).
• Provide IUCD insertion at sub-center (for trained ANM).
• Refer for sterilization (tubectomy/vasectomy) at PHC/CHC/FDS camp.
• Refer for management of RTI/STI, high-risk obstetric conditions.
• Link with VHSND (Village Health, Sanitation and Nutrition Day) for services.

Step 6: Follow-up

• Follow up on all contraceptive acceptors.
• Check for side effects, complications, IUCD expulsion, pill discontinuation.
• Update the EC Register after every visit.
• Ensure continuity of contraceptive supply (depot holders, ASHAs).

Step 7: Record Maintenance

• Eligible Couple Register: maintained and updated by ANM at sub-center level.
• EC Survey Register (ASHA format): maintained by ASHA at village level (S.No., name of wife/husband, age, number of children, current method, unmet need, remarks).
• Data used for:
  • Calculating Couple Protection Rate (CPR)
  • Planning FP camps and outreach
  • Reporting to PHC and district levels

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Couple Protection Rate (CPR)

• Definition: % of eligible couples effectively protected against childbirth by an approved FP method (sterilization, IUCD, condom, or OCP).
• National target: CPR >60% is required to achieve NRR = 1.
• Sterilization accounts for >60% of effectively protected couples.

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Target Couples (Within Eligible Couples)

• Newly married couples (for spacing)
• Couples with 1 child (for spacing)
• Couples with unmet need

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Key Points for Exam

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