Family planning and child nutrition indicators show the least improvement of health indicators across India. Historically, programs in these two sectors have focused on women, both as end-users and as providers (e.g. female community health workers). While many of these programs have seen considerable success in their outcomes, challenges have emerged in the long run:
- They place a disproportionate burden on women, both as end-users and as the ones delivering health programs.
- They reinforce the imbalanced gender norms that underlie women’s unpaid care work and time poverty and, relatedly, their mobility and workforce participation.
- Men have been further alienated from the “female” domains of family planning and nutrition.
Evidence shows positive improvements in health, nutrition, and gender outcomes when men’s engagement increases, but falls short of showing lasting behavior change at scale. To fill this gap, teams from Dalberg and Project Concern International India set out to design programs, answering the question: How might we engage men in nutrition and family planning through innovative and gender transformative programs in rural Bihar?
We developed and tested two programs over 2.5 years. We used an interdisciplinary approach anchored on human-centered design research and behavioral science, supported by literature reviews, expert interviews, rapid prototype testing and a learning pilot to design and test innovative programmatic solutions. Soon after we began ideating on potential programs, the pandemic began, prompting us to adopt a hybrid between remote and in-person research and work closely with community representatives as partners in prototyping and piloting the programs. This provided nuanced insights and shaped the programs greatly.
From 30+ program ideas, we narrowed to 2 final programs whose target audience was young, zero- or one-parity couples in rural Bihar (a state in North India). Our nutrition-focused program, called Dekh-Rekh (“Care and Nurture”), leads couples towards making more healthy, informed food choices and purchases for their children. The family planning-focused program, Hamari Shaadi, Hamare Sapne (“Our Marriage, Our Dreams”), creates a comfortable environment for couples to discuss the often taboo topics of contraception, delaying, spacing and limiting by using a financial planning course as an entry-point.
Findings from our learning pilot with 2000 households show the immense potential of these programs to change couples’ family planning and nutrition behaviors. For instance, our intervention villages saw a net 30% point increase in children’s minimum dietary diversity; and 16% point increase in modern contraceptive use. We also saw shifts in gender-related behaviors and spousal communication, including a net increase of 18% points in men’s involvement in feeding their children, a behavior typically divided by gendered, and a 16% point increase in women reporting greater support from their husbands on contraceptive use.
Lastly, our cross-disciplinary and iterative approach to designing, developing, and implementing programs could serve as a model for other sectors, while our strong gender lens provides lessons for gender-sensitive programming. Our partnerships with community members and local institutions during research and implementation offer lessons on the potential of community participatory research, and building system capacity and inter-community trust.