Among married women in Bihar aged 15 to 24 years, data show that unmet need for family planning is 37%, higher than the 23% average for all women of reproductive age. Most of the unmet need is for spacing births. Although the median age of first marriage is 16 years and median age of first sex is 17 years, the median age of first contraceptive use is 25 years (2016 MWRA). There is a need for modern spacing methods among married women aged 15 to 24 years and their husbands.
Scale of Intervention on the ground
The mandate during 2010- 2013 was to engage with Health programs of the GoB to improve the coverage of a range of RMNCHN interventions at a scale of eight blocks (~28 m population), using creative yet replicable ways of improving frontline worker performance, appropriate to the challenging context: sharply defined intervention priorities, better tools, job aids, skill-building, improved last-mile supervision. It became equally clear by 2013 that the responsiveness of the FLWs and nurses to our interventions were not matched by more than a lukewarm response from the program leadership itself. Thus, the scale-up technical assistance plans evolved into a Technical Support Unit, with work under a fresh grant kicking in effectively in mid-2014 and spreading across all 38 blocks of Bihar.
In order to understand how to improve modern contraceptive use among nulliparous and low parity couples, the zero to low parity pilot was designed to increase SRH and FP knowledge and skills, increase couple communication on SRH and FP, and improve quality of frontline worker interactions with clients around delay, spacing and FP.
The key target population for this pilot is Married, nulliparous and low parity women and girls (aged 15-24) and their partners. The intervention is taking place in five blocks (two blocks in Gaya, three blocks in East Champaran). blocks were selected based on low performance on family planning indicators (East Champaran is low performing) and previous implementation of interventions on gender norms (Gaya was chosen for previous pilots as well). The husband's groups will be implemented in one block of each block.