Meeting the unique contraceptive needs of young women and their migrant husbands

Recent evidence from Bihar based on Demographic and Health Surveys suggests that migration plays a critical role in shaping contraceptive use behaviours among women. Population Council undertook a formative research study and confirmed that women with migrant husbands were less likely to use contraception than women with resident husbands. The study further observed that modern method use in a high out-migration area is lower than that in a low out-migration area. Supported by Packard Foundation, we partnered with Population Council to design innovative interventions for effective family planning programs that meet the contraceptive needs of married couples in high-migration areas of rural Bihar.

The project kicked off two weeks before the pandemic was declared. There was no knowing then how long the pandemic would last and conducting primary research with an audience with limited digital literacy was a novel challenge. We rebooted the project plan and divided the research into two parts-a broad review of existing literature and expert interviews followed by a much narrower in-depth primary research on specific problem areas.

With the help of local researchers, we conducted in-depth design research interviews in high - migration blocks across the two districts. The interviews helped us uncover behaviours and problems that were heightened or unique to migrant households. These sharp problems led to multiple innovative solutions, 11 of which were tested & iterated with users from which 4 desirable solutions were pitched to grassroots CSOs. These four solutions spanning across products, digital systems, services and marketing touch points are being taken forward for a pilot test in 2022.

Modern contraceptive method use in rural Bihar is lower among women with a migrant husband (21%) than those with a resident husband (30%). Population Council had found that women with migrant husbands:

• Are less likely to use modern contraceptives.
• More likely to stop use
• And have unmet need for contraception

Through our in-depth interviews, we learnt that for a woman with a migrant husband, the need to protect herself from unwanted pregnancy arrives with her husband and leaves with him. Therefore, instead of motivating the users to take precaution in advance, we had to enable them to protect themselves when needed. Thus, we focused on modern contraceptive methods that can help meet the sporadic contraceptive needs of women with migrant husbands.

We derived multiple insights across the users’ journey of decision-making, access and use of contraceptives. We discovered that migrant households usually belong to under-served communities are their problems and constraints are often not included in the design of public health interventions. Therefore, from the multiple problem statements generated, we prioritized and shortlisted problems unique to or heightened for migrant households instead of family planning problems that are common to all rural households.

Sexual activity is considered a must for a contraceptive need and a woman often fears that using or storing contraceptives in the absence of her migrant husband, may arise suspicion of infidelity. Therefore, contraceptives are procured and used such that they last only as long as required. This social perception further reduces the ASHA’s visit to high-migration areas which in any case belong to communities that are usually physical and socially distant from the health providers. The couple’s sporadic need of contraceptive leaves a very small window for procurement with a large scope for error. This procurement opportunity is also only available to migrant men since the woman, and young women in particular, have restricted mobility.

Here’s an example of problem unique to migrant households:

MC Aaiyna

MC Aaiyna is a wall mirror with a fertility tracker that determines the probability of pregnancy during the days of the migrant man’s visit.

Challenging optimism bias: Migrant men overestimate the probability of the efficiency of withdrawal as a contraceptive. The product highlights high-risk days to challenge the bias.

Challenging ambiguity: Couples are more likely to respond to know outcomes (high-risk and low-risk of pregnancy) over uncertainty.

Creating a habit: The action of changing dates on the product is triggered by onset of period.

Pravaasi Shopping Kendra

Pravaasi Shopping Kendra is a multipurpose stall on the train platform that sells affordable take-home gifts and commodities including a large pack of condoms.

Framing: Condoms are presented among a setting of products and gifts to carry home.

Path of least resistance: Getting condom on the railway station reduces the additional effort to go and procure condoms from the market after reaching home.

Creating a default choice: Creating a default brand and size of condom packet to simplify and trigger desired choice for migrant men.

ECP Delivery Service

ECP Delivery Service is a subscription-based emergency service that provides women with an ECP at home, within 24 hours.

Regret aversion: Post-sex, women consider the worst possible outcome and seek an option that minimizes the regret it would make them feel.

Reducing friction cost: Calling for ECP at home reduces the friction associated with a woman needing to access it.

Pre-commitment and loss aversion: More users are likely to avail ECP after they commit upfront to using it and losing the cost paid if they don’t.

ASHA Area Display

ASHA Area Display is a digital system that displays areas visited by different ASHAs in a cluster.

Creating social proof and social norms: Tap into ASHAs’ sense of identity to make them feel that other ASHAs like them are visiting each of their areas and therefore getting them to do the same.

Incentive: Designing incentives that give a sense of being socially acceptable and motivate the ASHA to visit the under-served area.

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