It takes a village: Community workers increase birth spacing knowledge and use in India

A study in Jharkhand, India, examined the relative impact of offering the Standard Days Method (SDM) through community health workers and facility level workers and compared their respective quality of services. SDM was integrated into family planning services and education programs in two blocks. First, all government physicians (40) and auxiliary nurse midwives (ANMs) (94) in the intervention area were provided a contraceptive technology update followed by SDM training. One year later, community level providers (278 animators and Anganwadi workers) were trained to expand access at the village level and reach areas underserved by health facilities. Data were collected from service statistics, baseline and end line household surveys, and simulated client visits. Provider knowledge was assessed using an observation checklist. Following SDM introduction by government workers, the number of new SDM users per quarter stayed relatively steady over time. However, training community level providers resulted in a sharp increase in new SDM users – from under 300 to over 1,800 per quarter – and a significant increase in all birth spacing users. One year after training, Anganwadi workers had a similarly high level of correct knowledge about the SDM as physicians and a higher level than ANMs. Household survey data show that both male and female community members identified Anganwadi workers as their primary source of information about SDM. Study results show involvement of community level workers increases birth spacing knowledge and use, and community level workers provide SDM services that are of equal or better quality than clinicians.