A Reproductive Health Communication Model That Helps Improve Young Women's Reproductive Life and Reduce Population Growth: The Case of PRACHAR from Bihar, India

Using data from a project in Bihar, India, this paper shows that culturally acceptable and community-focused interventions geared to adolescents and youth can help increase age of marriage and first birth, increase contraceptive use among young couples, provide vulnerable populations with better access to reproductive health (RH) services, and reduce population growth.

Specifically, it examines an RH communication model that was developed and tested by Pathfinder International in 3 districts of Bihar during 2002-2008. Known as PRACHAR (a word that in Hindi means "to let people know" or "to disseminate"), this model provides RH information to adolescents and young couples, their parents, in-laws, and influential community members, with the aim of creating an enabling social environment conducive to innovative ideas that improve health and quality of life. Sample PRACHAR activities include: adolescent girls and boys are given a 3-day RH training and are taught communication skills to negotiate with partners and guardians in order to achieve their reproductive goals; newlywed couples are given "infotainment" parties; young married women are visited by female workers who provide information on the benefits of delaying childbearing and spacing of pregnancies; and meetings are held with young married males, parents and in-laws, and influential community members. RH information is disseminated through wall paintings, street theatre, posters, and leaflets.

The impact of PRACHAR interventions was assessed at both Phase 1 (2002-2005) and Phase 2 (2005-08) through baseline and follow-up surveys. The authors summarise the findings as follows:

• PRACHAR's effect on contraceptive use: In the intervention blocks, contraceptive use increased significantly from 4% to 21% between the baseline and follow-up period while, in the comparison blocks, it only increased from 3% to 5%. Disaggregated by the number of children, contraceptive use for women with no children increased from less than 4% to 16% and that among women with one child increased from 6% to 25%.
• PRACHAR's impact on delayed marriage and childbearing: Based on an analysis of a late 2008 study of 300 girls and 300 boys, selected from participants in the RH training course, the authors conclude that "The PRACHAR beneficiaries, having 23% fewer births, will thus have 1.5 births instead of 2.0, an impressive reduction in fertility among young women before they reach the age of 25.
• PRACHAR's impact on socioeconomically disadvantaged populations: Because no data on household wealth were collected in the baseline survey, the authors turned to education as an indicator. In comparison areas, there was no noticeable change of contraceptive use in any of the education groups. Yet, in the intervention areas, contraceptive use increased approximately 2.5 times for the groups with 1-9 years and 10 or more years of schooling. In contrast (within those same intervention areas), contraceptive use increased over 6 times for those who had no schooling. "The results show that information provision is extremely powerful in increasing contraceptive use across socioeconomic groups but the least advantaged benefit more from the information as the relative increase of contraceptive use is much higher among them than among others."

The authors then project the population of Bihar and Uttar Pradesh (UP) from 2005 to 2025 to assess the potential benefits of implementing PRACHAR interventions in addition to the government RH/FP programmes presently in place. The projection was done using a computer programme known as SPECTRUM, developed by Futures Group International (to access information about the methods and procedures of the projection, including the underlying demographic models, along with the software itself, click here). In short, the projection exercise found that implementing PRACHAR in just these 2 states could result in reduced national population growth by the amount of 64 million people.

Features of the PRACHAR model cited as being powerful in contributing to this projection outcome:

• It does not require service provision but, rather, creates demand for RH/FP services, enables the social environment to acquire healthy reproductive behaviour, and facilitates existing service delivery systems in the public and private sectors that help increase service utilisation.
• It addresses a range of issues that are crucial to reduction in population growth and improvement in maternal and child health and family well-being, including improvement of the reproductive lives of the disadvantaged.
• It has a lasting intervention effect, whereby beneficiaries continue good RH practices beyond the intervention period, well into adulthood.

"In sum, PRACHAR offers a solution to many crucial reproductive health and associated population problems in India and shows the power of simple information provision. State governments in India should consider this model of reproductive health communication to adopt in their health and family welfare programs."