Improving Contraceptive Use in Young First-Time Parents Highlighting the Achievements of Community Health Workers in India

This demographic faces unique challenges, including limited access to accurate information and services, structural inequalities, and health risks such as injuries, violence, and early pregnancy and childbirth. The needs of young people vary substantially by intersecting societal factors such as age, sex, stage of development, life circumstances, socio-economic status, marital status, class, region, and cultural context. India's Ministry of Health & Family Welfare created the Rashtriya Kishor Swasthya Karyakram (RKSK) program to address the critical need for adolescent reproductive and sexual health services. The program focuses on strengthening the health system to respond to adolescent health needs, with a key technical strategy of adolescent reproductive and sexual health (ARSH). RKSK identifies six strategic priorities for adolescents: nutrition, sexual and reproductive health, non-communicable diseases, substance misuse, injuries and violence, and mental health. The National Family Health Survey (NFHS 4, 2015-16) shows that the age group with the lowest contraceptive prevalence rate are married women 15-24 years of age, particularly young, married first-time parents. The survey reveals that only around a third of the demand for modern contraceptives among young, currently married women is met, due to India's social norms that expect young women to start a family as soon as they are married. NFHS 4 also found that Uttar Pradesh, a state in northern India, had a high unmet need for a birth-spacing method among married women between the ages of 15-19 (20.4%) and 20-24 (19.1%). The challenges faced by young married mothers in Uttar Pradesh and elsewhere include limited agency to negotiate contraceptive choices and decisions with their husband and family members, poor spousal communication on family planning, and the expectation to follow social norms that include bearing children as soon as they are married. Family planning is not introduced to women who have not yet given birth, especially young adolescent (15-19-year-old) married women, and they are burdened with household chores and not allowed to intermingle with older women in their communities. In 2017, The Challenge Initiative for Healthy Cities (TCIHC) started providing coaching support to local governments in Uttar Pradesh to implement evidence-based family planning programs. Five cities (Allahabad, Firozabad, Gorakhpur, Varanasi, and Saharanpur) were selected to add adolescent and youth sexual and reproductive health (AYSRH) and contraceptive use in young first-time parents (FTP) to the existing FP program in September 2018. TCIHC advocated with RKSK and presented a coaching-mentoring strategy, which included making data on first-time parents more visible, conducting values clarification exercises throughout health centers, and identifying the key influencer. The project aimed to reach 100% of first-time parents in the community who are non-users of modern contraceptive methods with information on family planning methods and connect them to FP services. Community frontline health worker Accredited Social Health Activists (ASHA) emerged as the first and natural choice to approach this cohort. The project demonstrated success by identifying a key influencer and implementing a coaching-mentoring strategy to improve the knowledge and attitudes of health facility staff to provide non-judgmental, supportive care to adolescents and youth.