Objective="Improving reproductive health status of youth."
Details for Reform Option "Promoting Change in Reproductive Behaviour of Youth, Bihar"
The health survival and well being of families, mothers and their infants are adversely affected by the social customs of early marriage, too frequent and early child bearing with inadequate space between children. By delaying the first child until the age of 21 and spacing subsequent children by three to five years, communities could benefit from a significant drop in maternal and infant mortality rates. Family planning interventions that delay the first child and space subsequent children by at least 36 months have a proven value in improving maternal health and child survival. Addressing youth fertility can deliver multiple benefits like: health, demographic, economic which in turn would benefit both family and country. Changing the reproductive behaviour of youth requires that both individual beliefs and wider social norms are addressed and changed. Targeting youth alone cannot change youth reproductive behaviour.
PRACHAR Project of Pathfinder International has, since 2001, supported a group of 30 Non Governmental Organisations to promote change in reproductive behaviour of adolescents and youth in Bihar. This project was run in five districts of Bihar namely Nalanda, Nawada, Patna, Gaya and Shiekhpura covering a population of 6, 36,803 (22%) in 552 villages.
Each NGO partner worked in a cluster of 30 villages with a population of approximately 30,000. They conducted community based programs to reach the community at large with standard messages promoting the value of delaying and spacing births.
The community was segmented into specific primary and secondary target groups of unmarried adolescents, young married couples, parents and influential adults. These groups were reached with life stage specific information and communication that promoted the messages of delaying and spacing children and adopting safe sexual and reproductive behaviour to remain free of unwanted pregnancy and infection.
Standardized information and messages on these subjects were communicated through a combination of training programs, home visits, group meetings and infotainment events to all target groups, ensuring high coverage (between 60-80%) of each target group:
* Adolescent girls between 12-14 years of age received training about puberty, menstruation, personal hygiene, and nutrition.
* Adolescent girls and boys between 15-19 years of age were trained and received age appropriate information about reproductive health, family planning, sexually transmitted infections (STIs), HIV/AIDS prevention and the importance of delaying childbirth and spacing subsequent children.
* Through home visits and group meetings, newly wed couples, who had not yet had a child, received information about delaying and spacing children, as well as responsible planning for family life.
* Young couples with only one child, received information about spacing subsequent children.
* Families of young couples, especially the mothers-in-law, received messages about the health and economic benefits for young couples who delay first births and space subsequent children.
* Respected elders and community leaders with influence received messages similar to those directed at families of couples.
All communication material, training curricula and agenda for meetings were developed by Pathfinder and these standard materials were used by all partners, who were trained in using this material to maximum effect.
Highly structured and standardized monitoring and reporting systems were designed and partner staff trained to use them for reporting and reviewing progress of their own work. Monitoring data was received on a monthly basis and computerized, permitting sophisticated analysis of results.
The program was widely accepted in the 552 villages where it was implemented. The rigorous monitoring system tracked the frequency and effectiveness of project activities and interventions, as well as key family events such as births, deaths, marriages and pregnancies. It also enabled measurement of changes in contraceptive use. Extensive project data reveals:
i) The project has reached more than 90,000 adolescents and young adults with information on key issues in Reproductive Health (RH) and Family Planning (FP).
ii) More than 100,000 parents and other community adults received similar messages aimed at building wide social acceptance for the ideas of delaying and spacing children.
iii) The percentage of the population (all respondents) who believe that contraception is both necessary and safe increased from 38.3% to 80.8 %. Among unmarried adolescents, this figure increased from 45.3 % to 90.5 %.
iv) The percentage of newlyweds who use contraceptives to delay their first child more than tripled, from 5.3 % to 19.9 %.
v) The percentage of newlywed adopters who began using contraception within the first three months of the consummation of marriage increased dramatically, from 0.1 % to 20.8 %.
vi) The percentage of first time parents who used contraception to space their second child increased from 14 % to 33 %.
vii) 30 local NGOs in Bihar were provided with extensive training, supervision, and resources to attain new levels of capacity and sustainability, particularly in maintaining and developing programs in RH/FP.
viii) Basic RH/FP training of 1,398 traditional birth attendants (dais) and 447 rural medical practitioners.
The cost of intervention per 30,000 population for over four years was INR 8,289,474 (The cost per head is calculated by dividing the total cost of project by size of the population or that of primary group served. The cost is not calculated by any specific individual or combination of individuals). However, if the cost of reaching the primary target group is commuted (adolescents and young married men and women) it is INR 1,428 per head for over four years. This includes the cost of the grants for community mobilization and training, all communication support, all monitoring, evaluation, technical support and supervision.
The total grant from the Packard Foundation to Pathfinder for the four year Project was $ 3.5 million.
This project covered five districts in Bihar namely Nalanda, Nawada, Patna, Gaya and Sheikhpura.
One year for Pathfinder (to recruit its staff, identify partners, conduct baseline studies, and work out strategies, help partners to develop proposals and to make awards to partners).
Three months for NGO Partners (for staff recruitment and orientation, preparing beneficiary lists and for being trained in Pathfinder’s monitoring systems before starting systematic intervention activities in the community).
Large coverage: Prachar is one of the few innovative programs for youth that have attained scale. Prachar demonstrated that even in resource poor rural settings, scale can be attained with carefully constructed implementation structures, development of human capacity and close program monitoring.
Effective Model: The model has also been tested and found effective by Pathfinder in other states of India (Rajasthan, Delhi and Tamil Nadu) in both rural and urban slum settings.
Quick Impact: It is capable of bringing about significant levels of behaviour change in a relatively short period of two years.
Government Involvement: The Prachar approach changes social norms and builds demand for RH/FP services. It has been a challenge to involve the government system in effectively providing essential RH/FP services in outreach mode through the primary health care setting, to local communities who need affordable services close to home.
Partnership with local community based NGOs; the provision of strong central technical support; capacity building for implementing NGOs; and rigorous monitoring of NGO programs.
Who needs to be consulted
*Pathfinder International team in Patna and in New Delhi.
*Partner NGOs of Prachar.
Behavioural changes were brought about in the target population. The adoption of new behaviour continues to grow even after project inputs have ceased.
Chances of Replication
Project methodologies are so standardized that the project can easily be replicated. The methodology has been developed and tested in a variety of states and sites- urban as well as rural and has shown similar results, proving its effectiveness and replicability.
The “Prachar model” is open for various national, international government and non-government organisations, academicians, researchers, planners and policy makers to visit, examine, adopt, adapt the community based youth focused RH/FP program.
Prabha Sati, Research Consultant, ECTA, New Delhi, September 2006.