Why Pathfinder Works in India
In recent years, India has experienced unprecedented economic growth and now ranks as the world's fourth largest economy. Across India, women and girls of all ages are in urgent need of quality health services. Adolescents-a critical, growing segment of the population-continue to go without reproductive health information and services. Of a total population of 1.21 billion, adolescents (ages 10-19 years) constitute 20 percent, and investments in their health, education and employment will shape the country's future for decades to come. Young girls are especially at risk due to early marriage and early first pregnancy. Without knowledge of or access to family planning education and care, an early first pregnancy often results in another pregnancy shortly thereafter—starting a cycle of reproduction that can adversely affect the health of the mother, the survival and development of their children, the economic well-being of their families and broader communities.
Pathfinder has a long history in India, from projects testing contraceptive methods in 1953 to integrating family planning into existing social welfare programs in the early 1970s. In 1999, a grant from The Bill & Melinda Gates Foundation supported the first large-scale intervention to address the sexual and reproductive health of adolescents and young adults in Delhi slums, Tamil Nadu, Madhya Pradesh, and Rajasthan. Since then, Pathfinder's work has expanded to large projects addressing reproductive health and family planning in the states of Bihar and Rajasthan; maternal and newborn health projects in Tamil Nadu, Rajasthan, Maharashtra, Bihar and Odisha; and HIV and AIDS work in Maharashtra. Pathfinder's strategy in India focuses on supporting the reproductive health and rights of underserved and vulnerable populations. Pathfinder supports the Government of India and its partners to increase demand for family planning, reproductive health, and maternal health services, while equipping and empowering health care providers and communities to better address adolescent health, maternal child health, unsafe abortion, and HIV and AIDS.
Evidence for Decision-Making
A key aspect of Pathfinder's approach to systems' strengthening is collecting evidence that enables public, private, and community partners to make informed health-related decisions. Some illustrative data from Pathfinder's work in India include:
- In PRACHAR intervention areas, 15.9 percent of young couples without children are now using a contraceptive method, as compared to 3.3 percent at the beginning of the project. In addition, between July 2010 to Sept 2011, close to 80,000 unmarried girls and boys aged 15-19 years attended training that aimed at increasing their knowledge of reproductive and sexual health issues, increasing their self-efficacy and negotiation skills, and motivating them to resist early marriage and childbirth.
- In the RAKSHA project, more than 1,100 health care workers were trained on the prevention and treatment of postpartum hemorrhage, one of the leading causes of maternal death in India.
- The MUKTA project has enabled more than 200,000 clinic consultations with at-risk populations, and approximately 33,000 members of at-risk populations have received HIV counseling and testing.
Building Capacity, Strengthening Systems
As part of its Integrated Community and Health Systems Strengthening framework, Pathfinder fosters partnerships among government sectors (e.g., health, education, and youth), the private sector, and civil society to facilitate a coordinated response to reproductive health needs. To ensure scalable, sustainable programs, Pathfinder builds government and local capacity to plan, implement, and monitor and evaluate projects. Pathfinder's partnerships with state governments and community groups foster project expansion and sustainability by:
- Training government health officials in project and supply-chain management
- Training government front-line health workers and providers to deliver quality services
- Providing technical assistance that allows health professionals to apply their acquired knowledge and skills
- Generating demand for services and foster local ownership
- Investing in monitoring and data collection tools to generate evidence for accountable planning, and for advocacy to address constraints governing India's public health system
- Advocating for sexual and reproductive rights at relevant forums and with government officials to increase efficiency and effectiveness of interventions
In undertaking these partnerships, Pathfinder encourages collective action. Together, individuals and organizations can negotiate changes in rights and norms, as well as improvements in services-changes that can promote health-seeking behaviors and ensure that people, particularly marginalized groups, have rights and access to lead a healthy sexual and reproductive life.
ANANYA aims to empower women to make informed decisions about maternal and neonatal health.
PRACHAR is an innovative program that successfully delayed age of marriage to promote healthy timing and spacing of pregnancies among young women in India.
This project serves over 25,000 female sex workers and men who have sex with men in the Indian state of Maharashtra, helping reduce their risks and vulnerabilities towards sexually transmitted infections and HIV.
Funded by the MacArthur Foundation, this project works to reduce the morbidity and mortality associated with postpartum hemorrhage in India and Nigeria.
In a year of remarkable achievement, including Pathfinder’s landmark victory at the US Supreme Court and our return to Bangladesh with a $53.8 million project, what was most exciting? The answer—integration—is the theme of Pathfinder’s 2013 Annual Report.
PRAGYA: Multisectoral, Gendered Approach to Improve Family Planning and Sexual and Reproductive Health for Young People
PRAGYA, meaning "insight" in Sanskrit, is a mixed methods study commissioned by USAID and conducted by Pathfinder India to improve understanding of the effects of Phases I and II of the PRACHAR project.
This technical brief summarizes the evolution of PRACHAR, describes the intervention model and key evaluation results that informed each phase, and highlights next steps for dissemination and advocacy based on 11 years of project learning.
The purpose of the Working Paper Series is to disseminate work in progress by Pathfinder International staff on critical issues of population, reproductive health, and development.
Pathfinder International recognises the importance of engaging with the wider community, including opening dialogues with religious leaders from different faiths as well as Hinduism. Encouraging them to advocate projects in their communities, such as Prachar which focuses on girls' reproductive health and empowerment in Haryana, they have found a shift in negative perceptions and reductions in early marriages and pregnancies.
An outstanding example of overcoming the barriers that adolescents face accessing contraception is Pathfinder International's PRACHAR project. Intended to promote change in reproductive behaviour of adolescents project in Bihar, India, events were held for newly married couples to celebrate their marriage and emphasise the benefits of delaying having children and provided couples with a small supply of oral contraceptive pills and condoms.