Journal Article

Meeting contraceptive needs: Long-term associations of the PRACHAR project with married women’s awareness and behavior in Bihar

Context
Although interventions such as the PRACHAR project in Bihar, India, have been associated with increased contraceptive knowledge and use in the short term, less is known about whether such gains are sustained years later.

Methods
Survey data, collected in 2013 from 2,846 married women aged 15–34, were used to compare contraceptive awareness and use between those who lived in areas where the PRACHAR project had been implemented in 2002–2009 and those who lived in matched comparison areas. Multivariate analyses assessed whether, after adjustment for covariates, outcomes differed between women in comparison and intervention areas, as well as between women directly exposed to the program and those who lived in intervention areas but had been only indirectly exposed.

Results
Compared with women in comparison areas, those in intervention areas were more likely to have method-specific knowledge of oral contraceptives, IUDs, condoms and the Standard Days Method (odds ratios, 1.4–1.7); to know that oral contraceptives and condoms are appropriate for delaying first pregnancy (2.3 for each) and IUDs and injectables are appropriate for spacing births (1.4 for each); to have ever used contraceptives (2.1) or be using a modern method (1.5); and to have initiated contraception within three months of their first birth (1.8). Levels of awareness and use were elevated not only among women directly exposed to the intervention but also, for many measures, among indirectly exposed women.

Conclusions
The association of multipronged reproductive health programs like PRACHAR with contraceptive awareness and practices may last for years beyond the project’s conclusion.