ANANYA: Shaping Demand and Practice in Bihar for Uptake of Priority Behaviors


This project transforms communities now to create long-term impact for future generations. With the power of knowledge, the women of Bihar can take control of their health and their lives.


Childbirth should not be a death sentence. For many women in Bihar, India, it often is. Bihar has one of the highest rates of maternal and infant mortality in India. People often lack knowledge and face barriers that keep them from accessing critical health care that can save their lives. This means women often don’t get the antenatal care they need to ensure a healthy pregnancy. In fact, nearly 70 percent of women give birth alone, without a skilled provider. Pathfinder is changing this.


In 2011, Pathfinder launched an ambitious strategy to empower those who currently lack knowledge to make informed decisions abut their health. Then, we motivate them to take action.

ANANYA, funded by the Gates Foundation through a consortium led by BBC World Service Trust, aims to increase demand for family health services through a combination of mass media, information communication technology, community mobilization and interpersonal communication. The project is being implemented in eight districts in Bihar, with the intention of scaling up successful interventions across the state. This project demonstrates Pathfinder’s growing ability to engage in unconventional partnerships—in this case with a social media organization—and to promote government ownership from the outset of the project.

nine healthy behaviors

To date, Pathfinder has trained 38,512 frontline health workers to support families in making healthier decisions. Visiting couples in their homes, these health workers use innovative pictorial counseling cards to promote nine healthy behaviors:

  1. Give birth in a facility, with access to basic emergency obstetric services.
  2. If you choose to give birth at home, use a skilled birth attendant and hygienic tools. Create a plan for delivery and complications.
  3. Access preventive antenatal care and practices, including early follow-up for you and your newborn.
  4. Practice “kangaroo mother care,” carrying your infant, skin-to-skin.
  5. Practice early and exclusive breast feeding during your baby’s first six months.
  6. Practice “complementary feeding,” graduating from exclusive breast feeding to family foods, when your baby is between 6-23 months old.
  7. For women who choose to space or limit future births, practice family planning.
  8. Immunize your child until she turns one.
  9. Wash your hands with water and soap before preparing food and after changing your baby.


Pathfinder goes beyond building the skills of providers. For lasting change to occur, deep-seeded beliefs need to be changed. Maternal and child health need to be prioritized by families and communities. Men and community leaders need to mobilize resources to save mothers’ lives. Mothers-in-laws, who wield tremendous influence, need to be convinced about the importance of these new behaviors. Most importantly, women must be empowered.

That is why ANANYA extends its reach outside of family homes and into Bihar’s streets. The project mobilizes communities by broadcasting radio programs and conducting sensitization workshops with local change agents. By spreading knowledge through both trusted and unconventional channels, we can have the widest reach. We incite change.



Your support is critical to ensuring our work can continue. Your gift of $25 or $50 helps women and families access contraception, maternal and newborn care services, and a range of other reproductive health services.

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