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ORIGINAL ARTICLES
Open Access

Increasing Contraceptive Use Among Young Married Couples in Bihar, India: Evidence From a Decade of Implementation of the PRACHAR Project

Laura Subramanian, Callie Simon and Elkan E. Daniel
Global Health: Science and Practice June 2018, 6(2):330-344; https://doi.org/10.9745/GHSP-D-17-00440
Laura Subramanian
aPathfinder International, Watertown, MA, USA. Now with Ariadne Labs, Boston, MA, USA.
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  • For correspondence: laura.sita{at}post.harvard.edu
Callie Simon
bPathfinder International, Washington, DC, USA. Now with Save the Children, Seattle, WA, USA.
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Elkan E. Daniel
cPathfinder International, New Delhi, India. Now with Swasti Health Catalyst, Bangalore, India.
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  • FIGURE 1
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    FIGURE 1

    PRACHAR Phases, Intervention Delivery Mechanisms, and Coverage

    Abbreviation: PRACHAR, Promoting Change in Reproductive Behavior of Adolescents.

  • FIGURE 2
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    FIGURE 2

    Adjusted Odds Ratios for Current Contraceptive Use Among Young Married Women Aged 15–24 (Phase I and II) and Aged 15–34 (Phase III) in PRACHAR Intervention Models

    Reference groups are comparison areas where PRACHAR was not implemented.

    Adjusted odds ratios are from multivariate logistic regressions comparing baseline-endline changes in intervention and comparison areas for each PRACHAR model. These adjusted odds ratios are from different studies/designs so direct comparison should be taken with limitations.

    *P<.05; **P<.01; ***P<.001.

    Abbreviation: PRACHAR, Promoting Change in Reproductive Behavior of Adolescents.

  • FIGURE 3
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    FIGURE 3

    Current Contraceptive Use Among Married Women Aged 15–24 (Phases I and II) and Aged 15–34 (Phase III) in PRACHAR Intervention Models

    *P<.05; **P<.01; ***P<.001.

    Abbreviation: PRACHAR, Promoting Change in Reproductive Behavior of Adolescents.

  • FIGURE 4
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    FIGURE 4

    Contraceptive Method Mix Among Young Married Contraceptive Users Aged 15–24 in the PRACHAR 5-Year Comprehensive Model (Phases I and II), and Aged 15–34 in Phase III Intervention Areas (Baseline + Endline)

    Abbreviation: PRACHAR, Promoting Change in Reproductive Behavior of Adolescents.

  • FIGURE 5
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    FIGURE 5

    Number of Home Visits Required for Contraceptive Initiation Among Young Married Contraceptive Users Aged 15–24 in PRACHAR Phase I, by Parity

    Abbreviation: PRACHAR, Promoting Change in Reproductive Behavior of Adolescents.

  • FIGURE 6
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    FIGURE 6

    Adjusted Odds Ratios for Current Contraceptive Use Among Young Married Women Aged 15–24 With 1 Child, According to Exposure to PRACHAR Phase I Interventions (Wife, Husband, or Both) (N=1779)

    Reference group: neither partner exposed.

    Odds ratios adjusted for parity, education, and standard of living index.

    *P<.05; **P<.01; ***P<.001.

    Abbreviation: PRACHAR, Promoting Change in Reproductive Behavior of Adolescents.

  • FIGURE 7
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    FIGURE 7

    Adjusted Odds Ratios for Current Contraceptive Use Among Married Women Aged 15-34 in Areas Where PRACHAR Phase I, Phase II, or Phases I + II Were Implemented 4-8 Years Earlier

    Reference group is women in comparison areas where PRACHAR was not implemented.

    Adjusted odds ratios are from multivariate logistic regressions comparing baseline-endline changes in intervention and comparison areas. Odds ratios are adjusted for age, education, caste, and wealth quintile.

    *P<.05; **P<.01; ***P<.001.

    Abbreviation: PRACHAR, Promoting Change in Reproductive Behavior of Adolescents.

  • FIGURE 8
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    FIGURE 8

    Current Contraceptive Use Among Married Women Aged 15–34 in Areas Where PRACHAR Phase I, Phase II, or Phases I + II Were Implemented 4–8 Years Earlier

    *P<.05; **P<.01; ***P<.001.

    Abbreviation: PRACHAR, Promoting Change in Reproductive Behavior of Adolescents.

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    TABLE.

    PRACHAR Activities, by Project Phase

    PRACHAR Strategies and InterventionsTarget LevelImplementer(s)Phase IPhase IIPhase III
    Comprehensive3-yearmodelComprehensive 5-yearmodel (continued for 2years beyond Phase I)Comprehensive2-year modelHomevisitsonlyVolunteersonlyTrainedcouplesonly2-yearmodel withASHAs
    Interventions with adolescents, young couples, key influencers, and communities to increase support for RH practices and use of services
    Small-group education on RH with adolescent girls (aged 12–14 years), and unmarried girls and boys aged 15–19 yearsIndividualTrainers from NGO training partnerXXX–––X
    Counseling on RH/FP and referrals to FP services through regularly scheduled home visits to married young women with no children, married young women with first pregnancy, married postpartum young women who delivered their first child, married young women with 1 childIndividualPhase I and II: Female Change Agent Phase III: ASHAXXXX––X
    Home visits to women and men (whenever possible, without a regular schedule) and referral by female and male volunteers (rather than paid change agents), respectivelyIndividualMale and female community volunteers––––X––
    Outreach to young couples by other trained young couples (rather than change agents, peer–to-peer outreach approach)Individual, young couplesMale and female members of young couples–––––X–
    Newlywed couple ceremony/infotainment partiesYoung couples, GroupNGO training partnerXX–––––
    Small-group discussion and dialogue on RH and contraception, and referrals to health services, separately to young married women and married menGroupPhase I and II: Female Change Agent, Male CommunicatorPhase III: ASHA, Male CommunicatorXXX–––X
    Orientation and training of community leaders and influencers on RH for young peopleCommunityNGO intervention partnerXXX––––
    Group meetings and infotainment programs for mothers and fathers of young married men (the mothers-in-law and fathers-in-law of young married women)CommunityNGO intervention partnerXXXXXX–
    Street theater performancesCommunityNGO intervention partnerXXX––––
    Wall paintingsCommunityNGO intervention partnerXXXXXXX
    Improving access to RH services
    Support to monthly MCH clinics by providing government ANMs with training and support, essential instruments, and recordkeeping tools.CommunityPhase I and II: NGO intervention partner, Anganwadi Worker, ANM (Government)XXXXXX–
    Training of rural health practitioners on RH and FP issuesCommunityNGO training partnerXXXXXX–
    Training of TBAs on safe delivery, counseling on postpartum contraceptives, and referral of pregnant women with complicationsCommunityNGO training partnerXXXXXX–
    Training of chemist outlets and village convenience shops on FP and connecting them with social marketing agencies to encourage regular stocks of condoms and pillsCommunityNGO intervention partnerXXXXXX–
    • Abbreviations: ANM, auxiliary nurse-midwife; AHSA, accredited health social activist; FP, family planning; MCH, maternal and child health; PRACHAR, Promoting Change in Reproductive Behavior of Adolescents; RH, reproductive health; TBA, traditional birth attendant.

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Global Health: Science and Practice: 6 (2)
Global Health: Science and Practice
Vol. 6, No. 2
June 27, 2018
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Increasing Contraceptive Use Among Young Married Couples in Bihar, India: Evidence From a Decade of Implementation of the PRACHAR Project
Laura Subramanian, Callie Simon, Elkan E. Daniel
Global Health: Science and Practice Jun 2018, 6 (2) 330-344; DOI: 10.9745/GHSP-D-17-00440

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Increasing Contraceptive Use Among Young Married Couples in Bihar, India: Evidence From a Decade of Implementation of the PRACHAR Project
Laura Subramanian, Callie Simon, Elkan E. Daniel
Global Health: Science and Practice Jun 2018, 6 (2) 330-344; DOI: 10.9745/GHSP-D-17-00440
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    • Adolescents and Youth
    • Behavior Change Communication
    • Gender
  • Health Topics
    • Family Planning and Reproductive Health
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