PRACHAR: Promoting Change in Reproductive Behavior in Bihar, India

Photo by Karl Grobl

Through open dialogue, PRACHAR reaches adolescents and their families with vital information about sexual and reproductive health.

Photo by Simon de Trey White

“If a girl is educated she will look after her health. Even if she does not get an opportunity to work outside her home, she will nurture a healthy family and raise children with good values.”—Adolescent trained by the PRACHAR project.

Photo by Pathfinder India

In Bihar, one of India’s least developed, most populous states, a peer educator discusses contraception with a group of captivated young men.

Photo by Simon de Trey White

In her home, a young woman learns about various contraceptive methods from an Accredited Social Health Activist or “ASHA.”

Photo by Simon de Trey White

By integrating the PRACHAR model—including male sensitization meetings like this one—into the state’s health care system, the project’s proven outcomes can have greater reach across India.

Funded by the David and Lucile Packard Foundation (with supplemental funding from UNFPA in 2009), PRACHAR, meaning "promote" in Hindi, was a twelve year innovative program which successfully changed reproductive behaviors of young couples and the social norms that pressure unmarried adolescents into early marriage, early child bearing, and inadequate child spacing in India.

Worldwide, few programs have addressed youth fertility and demonstrated results. The PRACHAR model adopted a unique approach to address youth fertility in India and was implemented across India's state of Bihar.

PRACHAR tested a government—non-governmental organization partnership model to change youth reproductive behavior through education on reproductive health and family planning by frontline government health workers.

Through the PRACHAR model, adolescents were presented with information they needed to make responsible reproductive decisions when they marry. At the same time, young couples were motivated to adopt a contraceptive method of their choice to delay their first child and to space the second child, and to continue using a contraceptive method.

Over its twelve years, PRACHAR reached approximately 960 villages, with populations totaling more than 10 million through project interventions.

Between 2009 and 2013, Pathfinder built the capacity of 994 ASHA and 176 Male Communicators to provide adolescent women and men with the thorough and accurate health information they need. 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—can have greater reach across India.

Visible Results

Young women part of PRACHAR married about 2.6 years later than women not exposed to PRACHAR. They also had their first birth 1.5 years later.

Adjusting for education, caste, and age at marriage, young women in the PRACHAR intervention area were almost five times more likely to use contraception before the first birth compared with women in the comparison area.

Even though the PRACHAR project has ended, Pathfinder has ensured that our mechanism to train and supervise ASHA is embedded in Bihar’s public health system. The government has also issued guidance that these door-to-door health workers will continue to collect data during their visits with youth, as under PRACHAR, and will continue to receive incentives for promoting birth spacing.




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.

Related Publications

May 2013

PRAGYA: Multisectoral, Gendered Approach to Improve Family Planning and Sexual and Reproductive Health for Young People

PRAGYA, meaning "insight" in Sanskrit, is a mixed methods study commissioned by USAID and conducted by Pathfinder India to improve understanding of the effects of Phases I and II of the PRACHAR project.

January 2013

PRACHAR: Advancing Young People’s Sexual and Reproductive Health and Rights in India

This technical brief summarizes the evolution of PRACHAR, describes the intervention model and key evaluation results that informed each phase, and highlights next steps for dissemination and advocacy based on 11 years of project learning.

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Driving Innovation in Sexual and Reproductive Health

In 2012, Pathfinder went where the need was greatest—the places where women, men, and young people must fight every day to defend their sexual and reproductive health and rights. This annual report explores our successes during fiscal year 2012.

January 2012

The Effect of Reproductive Health Communication Interventions on Age at Marriage and First Birth in Rural Bihar, India

This paper describes the results of a survey of participants in an adolescent education program implemented by the PRACHAR project in rural Bihar.

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