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Assessing the long-term impact of the PRACHAR project in India.

A new Population Council study finds that the PRACHAR project in India to improve the sexual and reproductive health of married women and increase contraceptive knowledge and use, continued to have an effect on participants' behavior long after the program concluded. This finding is groundbreaking because while most programs demonstrate promising changes in the knowledge, skills, and attitudes of participants at their immediate end, the long-term impact on reproductive health behavior has seldom been assessed. Additionally, the new study finds that this program not only had a positive long-term effect on women who had been directly exposed to program activities, but also on those indirectly exposed.

Background on the PRACHAR project

Pathfinder International implemented the Promoting Change in Reproductive Behavior of Adolescents (PRACHAR) project in three phases from July 2001 to August 2012 in Bihar, one of Northern India's least developed states. Bihar has the highest total fertility rate of any state, and a high proportion of child marriage and early childbearing.

The goals of the PRACHAR project were to delay the age of marriage, delay the birth of the first child, and promote healthy timing and spacing of pregnancy among adolescents and young couples. The intervention included multiple components: individual counseling for young women and women's group discussions about sexual and reproductive health issues; group meetings with married men, fathers, and fathers-in-law led by male counselors; "infotainment" programs for newlywed couples; and cultural programs for the broader communities. Additionally, the project displayed murals, which conveyed contraceptive information to the community, and educated health service providers about reproductive health matters, specifically focusing on how to discuss these issues with young women.

Evaluation of longer-term effects

The Population Council evaluated the longer-term effects of the PRACHAR project's Phases 1 and 2. Council researchers sought to determine whether the improvements in contraceptive awareness and use following implementation of the project were still evident four to eight years after its completion, and whether women who were having families in areas where the PRACHAR project had been implemented reported different contraceptive experiences than women in comparison areas where the program had not been implemented.

From March to April 2013, Population Council researchers interviewed 2,846 married women, focusing on four broad sets of outcomes: contraceptive awareness, age at marriage, childbearing patterns, and contraceptive use. Of this group, 2,130 women were from PRACHAR intervention areas and they were compared to a sample of 716 women (matched by age, education, migration, and marital status) from an area where PRACHAR had not been implemented. Twenty-five percent of the women interviewed from the intervention areas had been directly exposed to one or more of the intervention activities (primarily cultural programs that promoted reproductive health messages, although one-third had attended group meetings and one-third participated in youth training programs).

"We wanted to see whether there was a marked difference in contraceptive knowledge and practice, age at marriage, and childbearing patterns among married women four to eight years after the PRACHAR project took place," explained Council researcher Rajib Acharya. "We were particularly interested in assessing whether the outcomes differed between women in comparison areas and intervention areas, and between women in intervention areas who were directly exposed to the PRACHAR project and those in intervention areas who were indirectly exposed."

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Lasting results

Although researchers found that comprehensive awareness of contraception remains far from universal, contraceptive practice is limited, child marriage persists, and childbearing is initiated early and repeated rapidly among young women in Bihar, the PRACHAR project had a notable impact on women's reproductive health and choices even four to eight years after its conclusion.

Women in intervention areas were more likely to have method-specific knowledge of oral contraceptives, IUDs, condoms, and the Standard Days Method; to know that oral contraceptives and condoms are appropriate for delaying first pregnancy and that IUDs and injectables are appropriate for spacing births; to have ever used contraceptives or be using a modern method; and to have initiated contraception within three months of their first birth (but not to delay the first pregnancy). Notably, these findings were true both for women who had been directly exposed to the intervention and for women who had been indirectly exposed. Researchers also found that while differences were small, mean age at marriage was significantly higher among women in intervention areas than those in comparison areas, and higher among both directly exposed and indirectly exposed women than comparison women, but that it remained well below the legal minimum age of marriage in India.

The results of this evaluation are critical as they demonstrate for the first time that women who are exposed to reproductive health programs not only retain contraception information but also adopt health-promoting practices once married, including using contraception following the first pregnancy and afterward.

Additionally, this sustained awareness of contraceptive methods also applies to women who reside in intervention communities but who were not directly exposed to program activities. This demonstrates that multipronged interventions like PRACHAR have the ability to not only change practice in the short-term but to fundamentally change reproductive norms that could have long-term implications for marriage, childbearing, and reproductive health practices.

SOURCE

Jejeebhoy, Shireen J., Ravi Prakash, Rajib Acharya, Santosh K. Singh and Elkan Daniel. 2015, "Meeting contraceptive needs: Long-term associations of the PRACHAR Project with married women's awareness and behavior in Bihar," International Perspectives on Sexual and Reproductive Health 41(3): 115-125. doi: 10.1363/4111515.

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Title Annotation:REPRODUCTIVE HEALTH
Publication:Population Briefs
Geographic Code:9INDI
Date:Dec 1, 2015
Words:906
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