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Family Planning

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.

Our Approach

Our approach in Family Planning initiatives is to ensure that all persons in the reproductive
age group has access to the basket of choices and he/she can choose between them.

Scale of Intervention on the groundScale 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.

Innovations

1

Home visits: As part of their ongoing home visits, ASHA’s will identify newly married and nulliparous/low parity young women in their catchment areas and deliver FP counselling. This counselling will be informed by the ASHA’s social and gender norm training, as well as by the expanded FP counselling training. If young women wish to include their husband’s and/or mothers-in-law in these home-based discussions, they will be supported to do so.

2

Village Health Sanitation and Nutrition Days (VHSND): ASHAs will mobilize zero and low parity women for attendance at VHSND, where they will facilitate group based discussions focused on Sexual and Reproductive Health (SRH) communication, negotiation and life skills to build confidence and support for delaying and spacing pregnancy.

3

FP Corner in public facilities- Family planning corners are being set up in public health facilities to provide counselling to couples on the different various options of contraceptives.

4

Engender Health focused on helping the government establish regional training centers at select block hospitals across the state of Bihar. The overall strategy of the EH project was to train State ToTs and then through these Master Trainers train doctors and nurses in 200 facilities, (covering all 37 DHs, all 63 SDH and 100 selected PHCs) by August 2018. The goal was to make these facilities functional for provision of the entire FP basket of choice services.

Achievements