Celebrate Solutions: Promoting Change in Reproductive Behavior in Bihar

By: Mariko Rasmussen, Communications Specialist at Women Deliver

In Bihar, one of India’s least developed and most populous states, men and women seeking information on contraceptives have faced barriers of all kinds: cultural, financial and socio-economic. The need for action is apparent: 58 percent of the population is under age 25, the median age of marriage for women from traditional villages is 15, and 28 percent of women give birth to their first child before the age of 18. In response, Pathfinder’s Promoting Change in Reproductive Behavior (PRACHAR) Project has been working since 2001 to transform attitudes and behaviors around contraceptive use and demand, with the aim of delaying and spacing pregnancies among adolescents and newlywed couples.

Pathfinder, working with 30 NGO partners across five districts, has disseminated lifecycle-specific family planning and reproductive health communication messages to more than 650,000 people in 700 villages. PRACHAR has contributed to a four-fold increase in contraceptive use among young married couples in project areas, a one and a half year increase in the age of marriage, and a two-year increase in the age of mothers at first birth in intervention areas. The project has successfully changed beliefs, attitudes, and practices in areas where women and girls have traditionally been married young, faced extreme social and economic inequality, and been pressured by their families and communities to bear children immediately after marriage.

Phase I of PRACHAR took place from 2001 to 2005, targeting more than 90,000 adolescents and young couples between the ages of 12 to 24 in 550 villages of Bihar. 400 partner staff were trained to work as outreach workers, carrying out intensive training and public education activities in their communities. Phase II took place from 2005 to 2009, and was initiated to expand upon and evaluate lessons learned in Phase I, while targeting 70,000 adolescents and young couples in 450 new villages in the existing districts Phase I. The project tested several communication approaches to identify the most effective sets of tools and messages for engendering behavior change.

PRACHAR is now in the third phase of the project. Pathfinder is working with the Government of Bihar and civil society to scale-up the most effective strategies from the first two phases. Strategies include strengthening the Government of Bihar’s health system by investing in the capacity building of accredited social health activists, public sector community-based outreach workers, and health managers. The accredited social health activists will reach out to adolescent girls and boys age 15 to 19 and young married men and women with one or no child to promote healthy decision-making.

According to Pathfinder, by integrating the PRACHAR model into the state’s health care system, the project’s proven outcomes – increased contraceptive use, and delayed marriage and first birth – have great potential to affect population growth trajectories and help the government reach the Millennium Development Goal targets in Bihar.

PRACHAR III is connected to the PRAGYA project, a research study which seeks to evaluate the impact of a multi-sectoral gender sensitive approach on family planning and reproductive health outcomes in several domains.

Learn more about PRACHAR here.
Read a blog from Pathfinder about the project here.