Development of

Corporate
Citizenship(DOCC)Projec
t KEY FINDINGS-Family
Planning
Priyasha Dutta
Shirsho Ghosh

Survey details
Understand barriers to using modern
methods for spacing among the most
marginalised women in the society of
age 15-24 years

Objective

Methodolog
y

Place of
survey
District- Paschim Champaran
Block- Behriya (17 panchayats)

Selection of 5
panchayats under
Behriya PHC

Interviews
In-depth interviews
Women & and their
husbands(30)

Panchayats surveyed
Aanganwadi centre

Loukariya
Toli
Tadhvanandpur
tola
Miyapur
Toli
Tunkariya

Dhuniya

One Aaanganwadi under

each panchayat

Gaha rout
Tilangari
Khalwa

Selection of families to
be surveyed from the
THR list and Pregnant
woman list at

Mother of 1 child and

pregnant
Mother of 2 children and
pregnant
Mother of more than 2
children and pregnant

Key informant
interviews(10)
Mother in laws and
sister in laws
ASHA

KEY FINDINGS
Types of
service
providers
Communica
tion process
Documentat
ion and
monitoring
Incentivisati
on

Acceptor
Service
Supply
Perception

Different
types of
products
supplied
Distribution
channels
Supply
strategy
Knowledge
Source
Decision
making
Informed
choice

Acceptor
perception
Source
Condoms:
ASHA
AWW
ANM
Local shops
PHC
OCP and ECP ASHA
AWW
ANM
PHC
Copper T and
IUCDPHC

Knowledge
Methods aware of Condoms
Copper T
ECP
OCP
Methods not aware of
IUCD
Reason:
Lack of awareness and
clarity of thought among
ASHA regarding the
methods and hence lack
of promotion of the same
Lack of trust on services
provided by government
due to past experience

Decision Making
Initiator- ASHA, AWW, ANM, Neighbours
Influencers(factors of influence)
For women:
Husbands:
Sexual relation not always consensual. Usage
depends upon the degree of pleasure and whims
of husbands.

Mother-in-laws

Old school of thoughts and influence from

neighbour that these might cause cancer and
infertility
Desire for at least two healthy male children.

Sister-in-laws
Positive influence to use if they have gained from
it but higher negative influence if any bad
experience from it

For men:
Mother: Attitude against consensual decision of
usage by the couple and want for more children
specially boy child

For both:
Society:

Men accused guilty of extramarital affair while

Acceptor
perception

Most widely used

Traditional
Withdrawal
method-

Men working outside and

visit family twice or thrice a
year. Hence perception of
lesser chance of risk and
want of pleasure prevents
them from using condoms.
Also results in
discouragement of women
to use capsules or copper T
as husbands are away most
of the time.

Traditional Rhythm
method Couples avoid intercourse 3
weeks after end of
menstrual cycle. Very
convenient in these villages
ECP(no
usage)
because women
have an
Fear
of
infertility
on usage
inherent problem
of irregular
menstrual cycle and they do

Condoms(Medium
usage)

Most convenient method to

use
Available in local shops,
hence no need to ask from
female FLW out of shyness.
Control during intercourse
remains in the hands of the
male depicting highly
patriarchal society

Reasons for not using

condoms

Lack of pleasure
Meets wife twice or thrice a
year
Inconvenience with the
sticky feeling
Shyness to buy from shops
or ask from FLW
Accused guilty of
extramarital affair
while
OCP(usage
rare)
buying
condoms
from
shops

Acidity
as
there
is
a
general
notion

Vomiting
using condoms only to
ofNausea
prevent
of

Fear oftransmission
infertility

Informed Choice
Copper T(rare
usage)
Rarely used by women who are
aware enough of the infection in
cervix due to less spaced
babies.

Reasons for not using

copper T

Bleeding
Infection in the uterine wall
and cancer
Falling of copper T out of the
body
Problem in having intercourse
Problem with the string which
hangs
Restrictions in carrying out
household chores like
carrying heavy goods
Birth of dead child or
miscarriage after removal of
copper T
Mucus discharge form vagina
Fear of device breaking inside
the path
Lack of trust on quality of

Perception of people
not using any
method

General trend of no menstrual

cycle 1year and sometimes
1.5 year after birth of a child,
then if they get pregnant
deliver baby after 9 months,
so a gap of 2-2.5 years
automatically maintained
Conceive till they have at least
two healthy boy children if the
current one is unhealthy.
Religious views mainly among
Muslim tolas to keep on
producing children till they
reach menopause.
Rejection of a method on side
effects without follow up as
lack of reasoning due to
illiteracy

Service Providers
Types of
Channels
Condoms:

ASHA
AWW
ANM
Local shops
PHC
ASHA
AWW
ANM
PHC

Copper T and IUCDPHC

Communication mainly with women

and rarely with men .Specially with
those ASHA s who are elderly, men
find it difficult to discuss. Passive
communication with males through
wives which is rare and hence
ineffective
Generate lesser motivation among
people for spacing and more for
sterilization ,primarily because they
get incentives for that and secondly
because acceptors prefer that as an
one-time solution
Only verbal Awareness about copper
T and IUCD without any visual
display resulting in lack of clarity of
thought in minds of acceptors
regarding the method
Distribution of condoms to men
through male facilitators who are
not as efficient and motivated to
work
Type of communication is very

Eligible couple list- ASHA has to keep a track of all

the eligible couples in her area and provide a list to the
PHC through the ANM to provide an estimate of the
demand. No such documentation found with ASHAs who
claimed to have submitted to ANM and neither with ANM
who claimed to submit it at ICDS office where it was not
found either

Gaps in
Communication
Process
ASHA/AWW/ANM

OCP and ECP

Documentation and
monitoring

No stock record by the ANM or ASHA

regarding the available balance of contraceptive methods
with them claiming that only PHC keep a record of the
supply, hence indicating no record and replenishment of
demand.

Weak monitoring of the skill level and

knowledge of ASHA about government
schemes. No clarity of thought about Spacing scheme
where they are entitled to get an incentive of 150.Almost
zero awareness about PPIUCD and some claims of not
having any PPIUCD facility at PHC which actually is present.

Weak monitoring of skill level of ANMs and

nurses performing Copper T installations resulting in
Incentivisation
frequent failures
.

Zero awareness about family planning insurance scheme

For distribution
of condoms,
andofOCP
, ASHA entitled
to
provided
to the acceptors
onECP
failure
operations
and
payment
from
acceptors
at
their
own
discretion.
But
no
hence zero communication to the community
payment by acceptors claiming those as free government
service. Hence zero incentives for promotion of spacing.
Also no awareness about spacing scheme.
Incentive of 200 only for sterilization which is again not
paid through cheque but sent only twice a year to bank a/c

Supply
Types of
products

PHCCondoms, ECP , OCP

provided in two
categories ASHA and
free distributed in an
approximate ratio of 4:1

Distribution
Channels

Supply Strategy
Top-down approach(Followed)
Districts provide stock
State

District

of condoms, ECP and

OCP to the PHC s at
block level once in year.
Basis of distribution is
mainly average demand
in the last three years.

Blocks(PHC)
PHC
Free- Collection from
Villages
PHC by individual
(ASHA,ANM)
acceptors targeting
Bottom-up approach(Should be)
mostly families coming
State
for deliveries and
Ideally it should be
Product category
treatment A part of it
District
distributed according to
Product name
given
to
ANM
to
the demand list
Condom
Nirodh
Blocks(PHC)
prepared by ASHA and
distribute on VHSND
OCP
Mala N
replenished time to time
ASHA- Collected by
Pregnancy Test Kit
HSC(Panchayat)
instead of one time
Copper T
ASHA facilitators for
supply in a year.
ECP
handover to ASHA for
Villages(ASHA,ANM)
Local shops
distribution at village
Condoms of commercial
level. of incentives to ASHA comes only twice a year at PHC during Holi and Diwali which is a great
Fund for payment
category like Manforce and

Key
Kohinoor.

Findi
ng in
Suppl
y

loss for such poor people

No proper record of stock at the counters from where the y are distributed at PHC.
Only a PHC at block level, HSC s at Panchayat level are very poor in infrastructure which results in a huge
pressure on PHCs.
Copper T stock hardly 2-3% of the requirement and low skill level of nurses and doctors installing copper Ts
resulting in frequent infections
Recruitment process of ASHAs, AWW and ANMs solely in the hands of gram panchayats and hence a lot of power
play without much attention to skill set .