Addressing access barriers to family planning and reproductive health services in bihar, India- The ‘smart' way

Methodology: A rapid assessment was conducted in the month of February 2013 using qualitative research methods including observations of health facilities and services, key informant interviews with state and district level health functionaries (24)and focus group discussions (9), representatives from local organisations and programs(18).

Key findings: On the demand side, knowledge about contraceptives is low along with myths and misbeliefs; sterilization is most common but adopted after high parity. The demand for spacing is absent with concurrent lack of access to spacing methods. Women don't feel empowered to make decisions about their own fertility, and abortions are widely prevalent. Men are unable to discuss FP with women health workers(ASHA). On the supply side, under-resourced public facilities; paucity of trained service providers for sterilizations and IUCD; health staff unaware of health welfare schemes that they can use to motivate clients; and salaries and payments to staff are delayed, resulting in lowered motivation. Private providers are present: rural medical practitioners at the village level and qualified providers at the block level. Many have not been accredited to provide PPP services and have no or few contraceptive stocks.

Results: Cellphones, which are common in households, may be used to increase demand for health services and behavior change; large youth population needs to be reached to make ‘smart' health decisions; build new avenues for PPP; tap the vast network of informal providers for referrals; use existing entrepreneur models to reach the remotest clients with contraceptives.