Family Planning: Measurement, Learning and Evaluation

Phase 1: 2016-2020

In 2016, the Bill and Melinda Gates Foundation (BMGF) constituted a consortium comprising the Technical Support Units in Uttar Pradesh and Bihar– IHAT and CARE, respectively- and Research and Evaluation Partners – Population Council, ICRW, and IPE Global. The overall objective of forming the consortium was to generate evidence on the strength of the Family Planning service delivery in the states as a result of the investments made by the BMGF.

ICRW was responsible  for supporting TSUs in conducting Public Sector evaluations, conducting private sector evaluations, assessing the Public Private Partnership (PPP) Models, and doing the economic evaluation of some of the PPP models. In addition, ICRW and Population Council conducted secondary data analysis and built the capacity of individuals and institutions in both states on FP evaluation.

What did we intend to do?

• Public sector evaluation – to provide technical inputs related to FP to TSU and data analysis
• Private sector evaluation – to assess the incremental effect of the private sector investments on FP
• Economic evaluation – to understand costing and cost-effectiveness of FP investments both in the public and private sectors
• Synthesis analysis & mathematical modeling – to explain and test the proposed theory of action

How it was done:

• Secondary data analysis of large-scale data sets to generate and test new hypotheses around FP
• Need-based studies to interrogate findings and implementation questions that arise as the FP investments expand
• Institutional and individual capacity building to strengthen regional capacity for FP evaluation

Phase 2: 2020-2023

The National Family Health Survey (NFHS-5) highlighted that while the knowledge of contraceptives was almost universal across India, with 99% married women and men aware of at least one modern method of contraception, the usage remains low at 56.4%. Further, it pointed out how the onus of family planning continued to be on women, and the access to contraceptives from economically marginalized sections remained low.

Phase 2 of the grant focuses on unpacking the demand for FP services, specifically the role of key influencers such as men in family planning. In this context, a project titled “Evidence building and synthesis on the role of influencers in addressing barriers to demand for contraceptives among young and low parity women and couples” was designed. The project aims at generating demand-side evidence around key influencers of family planning for young and low-parity couples in India, especially Bihar and Uttar Pradesh.

What do we intend to do?

The second phase of the grant has the following key objectives:

• Synthesize existing evidence on the role of key influencers (KIs), particularly men and frontline health workers (ASHA/ANM/AWW), in breaking or reinforcing barriers to demand for FP and intent to use among Young and Low Parity Women and Couples (YLPWC)
• Explore pathways and strengths of KIs’ influence in different context, their barriers, motivators, and vulnerabilities, and identify platforms and opportunities to engage KIs to address barriers to demand and use FP
• Share evidence and insights with the program and MLE partners for programming and MLE activities, facilitate knowledge transfer between geographies and data use

How do we intend to do it?

• Literature Review to examine the existing evidence on key influencers in FP; Policy Review on the positioning of key influencers especially men in India’s FP policies; and Review of FP Programs to understand how they are designed and conceptualized to engage KIs towards addressing barriers to demand for FP.
• Quantitative surveys with young and low parity women and their key influencers such as husbands, mother-in-law, sister-in-law, health workers, etc. using the Egocentric Social Network Analysis approach.
• Qualitative deep dives with young and low parity women, their husbands, and their key influencers.

Support to consortium partners:

• Married Women of Reproductive Age (MWRA) survey rounds by CARE India in Uttar Pradesh and IHAT in Bihar: ICRW provided technical support in survey design, indicators, thematic analysis plan, and execution
• Male Engagement Study led by Population Council: ICRW proved support with tool development, training, analysis, and sharing of learnings
• Behaviour Change and Communication campaign work in Uttar Pradesh led by Centre for Social and Behaviour Change (CSBC), Ashoka University: ICRW led the testing of campaign messages in the districts of Aligarh and Fatehpur through group discussions with married and unmarried men.

Project Team: Abhishek Gautam, Pranita Achyut, Nitin Datta, Kakoli Borkotoky*, Falak Raza, Arpit Singh, Uttamacharya*, Tamal Reja*, Binit Jha and Aishwarya Sahay*

*Former Team member