PRACHAR: Promoting Change in Reproductive Behavior in Bihar, India

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

“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.

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

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

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.