Engaging Couples, Engaging Communities

Across India’s Bihar and Maharashtra states, married couples are joining together to reach young couples with modern contraception.

This story is part of a multi-part series on Pathfinder’s Youth Voices for Agency and Access (YUVAA) project:

• Part 1: Engaging Couples, Engaging Communities — Learn about YUVAA’s program model, and see how it works in practice
• Part 2: Meet Vaishali and Subash, Yuvaakaars for life! — Learn more about YUVAA’s social entrepreneurship component, as well as its gender-synchronized approach 
• Part 3: YUVAA’s Digital Innovations — Learn about YUVAA’s digital approaches, including specifically designed mobile apps, VR interventions, and social behavior change campaigns
• Part 4: In India, Married Couples Teach the Next Generation About Contraception and Family Planning — A ‘day in the life’ of two Yuvaakaars, as they work in their own community to bring modern contraception to married couples across

Meet Seema. Once a tailor working in Delhi, today Seema is one of 1,200 Yuvaakaars, married couples working across India’s Bihar and Maharashtra states to bring modern contraception to young married couples and first-time parents. 

For the last four years, Pathfinder’s Youth Voices for Agency and Access (YUVAA) project has worked to increase demand for, and uptake of, modern reversible contraception among young married couples and first-time parents, ages 15-24 years, in 10 districts of Bihar and Maharashtra.

When Seema and her husband decided to return to Nalanda, a village in northern Bihar state, Seema’s husband quickly took up poultry farming. But Seema worried about their future. “I was a housewife…but there was too much pressure. How was my husband going to take care of me, take care of our family, our two daughters? I wanted to help him. So, I started looking for a job.”

That’s when Seema met Shailendra Kumar, an Enterprise Leader with Dharma Life, a local partner Pathfinder works with on the YUVAA project. Shailendra’s job was to help recruit and train new Yuvaakaars, giving them the tools they needed to become changemakers in their communities. 

“Shailendra asked me how I felt about working on family planning,” says Seema. “I said, I know nothing about family planning!” Seema needed training, and she wanted to discuss this option with her husband. When she called him, he said, “Go for it!” 

Seema attended a six-day training conducted by YUVAA, where she learned about the project, products distributed by Yuvaakaars, family planning options, and how to provide referrals to local health centers. From that moment forward, Seema has worked as a Yuvaakaar to bring modern contraceptive information and methods to couples across her designated region.

The SEED Model – Supply, Enabling Environment, and Demand

SUPPLY – Increased access to youth-friendly family planning counseling and services

YUVAA works with local health centers—both private and public —to be a part of a referral network that offers quality sexual and reproductive health services to young people. At these facilities, mentors like Winnie Kamble provide trainings to nursing staff, giving them skills to counsel on contraception, as well as helping to establish ‘family planning corners’ developed to ensure client privacy.

“At first, doctors were really biased against a variety of contraceptives,” says Winnie Kamble, a mentor with the project. “Few doctors, for example, would use injections like Depo Provera, and they wouldn’t suggest these options. But over time, we saw changes, with repeated visits, and we worked to shift existing biases.”

Winnie also worked with health facilities on best practices. “Before, needles weren’t disposed of properly. We taught facilities about separating their waste. We used information, education, and communication materials and posted them in facilities.” More than that, Winnie worked to establish ‘family planning corners’ in all of the facilities she worked with. These corners provide higher levels of privacy for clients, particularly young ones referred to the facilities by Yuvaakaars. “When Yuvaakaars referred clients, they used our mobile app to refer to particular facilities. So when they submitted the referral, the doctors would know the referral was coming from YUVAA.”

Sarika Vashar, a mentee at Pishawikar Hospital, learned about family planning through YUVAA. “It’s a good program,” says Sarika. “I’ve received so much information and gained so much knowledge from the mentorship. Now, I share it with other colleagues.”

Demand – Increase informed and empowered decision-making among young married couples on family planning

YUVAA provides information about contraception and reproductive health to young married couples, increasing their understanding of both and generating demand for contraceptive services. Yuvaakaars identify and engage young couples, using gender-transformative counseling focused on the benefits of gender-equitable relationships, couples communication, shared decision-making, and family planning. Yuvakaars bring a ‘product basket’ with them on their visits that includes commonly used household goods, as well as condoms and oral contraceptive pills, and they can sell these products while providing counseling and safe spaces for conversations.

Yuvaakaars reached 649,840 individuals (more than 300,000 couples) with family planning information—couples like Shilpa Rani and Anjay Raj.“For me,” says Anjay, “family planning is about planning my future. It’s about giving us options so we can have a good life.” Through counseling with Seema, Anjay and Shilpa made a plan. “We made it together,” says Anjay. They have daughter Anika, who is nine months, but plan to wait three to four years to have their next child. “If both are small,” says Anjay, it will be hard to take care of them. One needs to grow, and then we can take care of another!”

“When I started, I was always talking to Shilpa,” says Seema. “I also talked to her mother-in-law. “First I connected with them…when we had spent some time together, and when Shilpa’s mother-in-law had developed some comfort with me, I started talking about family planning.”

While Anjay knew about family planning, Shilpa never learned about it. She learned from Seema through YUVAA’s program. Says Shilpa, “The benefit of family planning is that it gives us togetherness, and happiness. When you are with your husband, you double your happiness.”

Enabling Environment – Creating a shift in perceived gender and social norms

Finally, YUVAA works to create an enabling environment for achievement of sexual and reproductive health, one where Yuvaakaars work within their communities to address restrictive social norms related to family planning and facilitate understanding, about the dangers of early childbirth and the merits of healthy timing and spacing of pregnancies. Yuvaakaars use digital platforms, including their “Hello Safal” video series, to share messages related to gender equity and social norms. In the past year, Yuvaakaars held more than 50,000 of group meetings, reaching whole families, and sharing education materials, films, and even virtual reality interactions to reach their audience.

At one group meeting, Seema talked to a large group in a courtyard, including Pushpa and Balia Kumari, who both spoke of the changes happening over time, in terms of acceptance of family planning.

Pushpa Kumari, for one, believes thoroughly in family planning now that her and her community have more information about it. Married at 14, she didn’t have reproductive autonomy. “Ten to fifteen years before,” she says, “there was no knowledge about family planning.  “I myself have eight children—six daughters and two sons. I had another son who died.”

Balia Kumari also had a large family—four sons and two daughters. “My younger son also has six children, three daughters, and three sons.” But both feel family planning is critical. Says Balia, “Our neighbors are happy with fewer children.” Pushpa adds that the cost of living has increased, and having large families is difficult. “Small family, happy family,” she laughs.

Pushpa and Balia weren’t the only ones reached that day. One four-generation family was also attending: Ramsakhiya Devi, a great grandmother and over 100 years old, had worked as a health service provider when she was younger. With her that day were also her daughter, Mina Kumari, Mina’s daughter, Ranjan, and Ranjan’s daughter, Anchal. Ransakhiya had a very large family, but today, her granddaughter, Ranjan, plans for a smaller one.

Achievements and sustainable platforms for progress

Despite the challenges faced from COVID-19 restrictions, YUVAA has made an impact. In order to create sustainability, YUVAA collaborated with local partners and state governments, and built out digital platforms to support increased access to quality health care in project communities. With the Indian Society of Perinatology and Reproductive Biology, YUVAA created a knowledge-exchange platform for private-sector providers in Maharashtra and Bihar. YUVAA advocated with state governments, implementing a Memorandum of Understanding with the State Health Society of Maharashtra, which allowed local authorities to issue letters of support for the project. At primary health centers, local medical officers supported data exchange between medical workers and Yuvaakaars. Finally, YUVAA built digital platforms to provide users with content on FP. As the YUVAA project comes to a close, the learnings continue. Today, Pathfinder is working to implement its digital innovations alongside the State Health Society of Bihar, integrating YUVAA’s approaches into the State’s larger livelihoods program.