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There is an unmet need among married women in Bihar, between the ages of 15 to 24 years, for family planning, especially for spacing births. With child marriage still highly prevalent, the average age of girls who get married before hitting adulthood is 16 years, however, the median age of women who start using contraceptive is 25 years. There is a need for modern spacing methods among married girls and women between the ages of 15 to 24 years.
Our approach in Family Planning initiatives is to ensure that all persons in the reproductive age group has access to a basket of choices regarding spacing and conception to choose from.
In order to understand how to improve use of modern contraceptive among nulliparous and low parity couples, a pilot was designed to increase awareness, knowledge, and communication among couples about sexual and reproductive health (SRH) and family planning. Improvements in the quality of interactions between the project participants and frontline worker was an integral component of the pilot.
The key target population for this pilot included married, nulliparous and low parity women and girls, and their partners. The intervention is being implemented in five blocks of Gaya and East Champaran districts. Districts were selected based on low performance in family planning indicators and previous implementation of interventions on gender norms.
As part of their ongoing home visits, ASHAs identify newly married and low parity young women in their catchment areas and deliver family planning counselling. This counselling is based on the ASHAs’ social and gender norm training, as well as additional training around family planning counselling. If young women wish to include their husbands and/or mothers-in-law in these home-based discussions, the frontline workers provide the necessary support.
Directed at helping the government establish regional training centres at select district hospitals across Bihar, the overall strategy revolved around training doctors and nurses in 200 facilities. The goal was to make these facilities functional for provision of the entire family planning basket of services.
ASHAs are mobilising zero and low parity women to attend VHSND, where they facilitate group-based discussions focused on SRH communication, negotiation and life skills, to build confidence and provide support for delaying and spacing pregnancy.
Support staff (including laboratory technicians, OT assistants, cleaners, and Auxiliary Nurse Midwives) were trained in proper medical practices and provision of clients with comprehensive information on available family planning methods.
Primary health centres in Bihar are providing regular surgical family planning services. We provided technical support in many trainings conducted by the government.
Doctors have been trained and empanelled for provision of sterilisation services, conducted by the government, since November 2016.
ANMs, doctors, and ayurvedic providers trained in provision of new family planning methods.