Skip to content

Publications

Increasing Contraceptive Use Among Young Married Couples in Bihar, India

India
Evidence From a Decade of Implementation of the PRACHAR Project

Background: Evidence on effective behavior change programming for sexual and reproductive health among married youth aged 15–24 in developing countries is lacking. To address this gap, we examined monitoring, evaluation, and special study data from the Promoting Change in Reproductive Behavior of Adolescents (PRACHAR) Project, which was implemented between 2001 and 2012 in Bihar, India, over 3 phases using 2 different implementation models (NGO- and government-led).

Methods: We conducted a synthesis of evidence from multiple PRACHAR studies to identify key findings on intervention effectiveness, scalability, and sustained effects on behaviors. Data were triangulated from quantitative population-based quasi-experimental evaluations from each project phase; the project’s performance monitoring database; and qualitative studies with beneficiaries.

Results: PRACHAR’s original comprehensive NGO-led model, which included behavior change elements and multiple overlapping communication channels (including home visits and small-group meetings), increased contraceptive use among young married couples, and these outcomes were sustained 4–8 years after project interventions ended. Several program elements were critical to the effectiveness of PRACHAR, including use of a socioecological intervention model with emphasis on behavior change efforts; use of a gender-synchronized approach that engages both male and female partners; and intensity of interventions calibrated to different moments in the life cycle of adolescents and youth. While the hybrid government-NGO model of PRACHAR implementation reached greater scale than the original NGO-led model, comparison of results suggests trade-offs in effectiveness of interventions and sustained impacts.

Conclusions: A decade of learning from the PRACHAR Project in Bihar, India, finds that comprehensive programming with gender-synchronized interventions tailored to specific life stages and aimed at different levels of the socioecological model can effectively increase contraceptive use among married young people in a conservative context. Shifting from a more intensive NGO-led model to less intensive government implementation enhances scalability but may have diminished impact on reach and long-lasting effectiveness.

View this article on Global Health: Science and Practice >

Download this Publication

Featured Stories & Perspectives

Championing Digital Solutions for Improved Health Care Delivery to Mothers and Children

The GeoST4R project, funded by the Bill & Melinda Gates Foundation, employs innovative digital strategies that contribute to data-informed decisions…

Read The Story
Featured Stories & Perspectives

Ending AIDS in Children—The Time is Now

ACE2 improves prevention, care, and treatment in three Nigerian states Despite almost halving the number of HIV infections since 2010…

Read The Story
Featured Stories & Perspectives

Health for All: Time for Action

Countries Reflection on UHC Global Monitoring Report and Actions Needed to Accelerate Progress Each year on December 12th, Universal Health Coverage…

Read The Story
Featured Stories & Perspectives

What “Country-led” Means to Pathfinder Uganda

As Pathfinder seeks to advance country-led solutions that achieve universal sexual and reproductive health and rights (SRHR) and are deeply…

Read The Story
Featured Stories & Perspectives

Kenya’s Primary Health Care Law Paves the Way Toward Universal Health Coverage

In Kenya, Pathfinder’s work to build universal health coverage is having impacts At Pathfinder, we are working toward a world…

Read The Story
Featured Stories & Perspectives

Scaling Up: Giving Adolescents More Power Through Skill Development and Peer Mentorship

“…I was thinking that when I finish school, I will find a job and become what I want to become”,…

Read The Story
Featured Stories & Perspectives

Lifelong Learning

How two Pathfinders continue to grow through a learning exchange A Global Organization With 1,200 staff in 19 countries and…

Read The Story
Featured Stories & Perspectives

Pathfinder at Gender and Inclusion Summit 2023 – Digital Resources

Thank you for your interest in our publications and resources on gender and inclusion. Find links to view and download…

Read The Story
Featured Stories & Perspectives

No More Sex for Fish: Women’s Leadership in Kenya’s Sustainable Fisheries

In Kenya, Pathfinder’s Darwin Initiative: Pairing Community Conservation Areas (CCAs) with Sustainable Aquaculture in Lake Victoria Project cultivates a new…

Read The Story
Featured Stories & Perspectives

Stories for Change 

In Mozambique, Pathfinder trains people to develop short videos to build awareness on child marriage and gender-based violence  Supervisor and…

Read The Story
Featured Stories & Perspectives

Country-led Operations at Pathfinder: Localization is Working for Us

Localization, localization, localization. It’s on everyone’s mind and is probably in the strategic plan of every company working in the…

Read The Story
Featured Stories & Perspectives

Hope and Heartbreak for Pakistan in the Era of Climate Change 

Harnessing the voices of women and youth to withstand the climate crisis My country is one of hope and heartbreak.…

Read The Story