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ID 11

Addressing service provider biases that push responsibilities on uptake of FP on women alone, restrict women’s access to full and free method choice or receive sub-optimal quality services, by building understanding of gender issues including gender power relation and ability to use gender lens during community mobilization and delivery of FP information and services. This understanding will enable them to position FP as a couple’s responsibility and capacitate to engage men and couples in equitable and empowering ways.

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Key Design Challenges

Enabling health systems to engage men and low parity women through their FP journey pathway, by interjecting at multiple points: providing full and free basket of method choice to match couple’s needs with appropriate contraceptive methods, hand holding through experimentation to manage side effects and finally, adherence to desired spacing. Achieving all this by working on their own gender biases and navigating community biases as well.

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Research

The FLWs and HSAs are community members as well and hence are not free from the norms that dictate a community setting, especially when it comes to engaging men on sensitive topics like FP. This results in them placing the burden of adopting FP on women. In many cases, they also do not reach out to newly married or zero parity women as they also put high premium on motherhood and perceive that contraceptive is to be undertaken after at least having one child. Functioning within their own biases and limited knowledge, policy structures, including targets and payments, lead them to focus on few methods. For instance, female sterilization is one method which has been pushed and normalized to use. Several studies have documented skewed power relation between HSAs and women, particularly those coming from poor and marginalized communities, and its effect on equity, access and quality of services.

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Key Design Decisions

The design needs to influence the pre-held perspectives and assumptions in a demonstrative manner instead of a theoretical or instructional one. It needs to be in the format of a narrative that they could relate to and encourage them to introspect and question prevailing norms and practices, with practical advice on dealing with scenarios that they have either already faced or are most likely to face.

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Digital Concept

A tool to visualize, examine and challenge existing discriminatory and stigmatizing behaviour for both parties, the FLWs and the couple, through immersive role-play with narratives interspersed in the form of images, prompts, video clips, within their training protocols. To ease the HSAs, especially the ASHAs, they will be provided with tools and aids to help them engage the community and take ownership of the VHSND event. The observations and learnings from these activities will help the ASHAs guide the couples into taking beneficial steps in their own family plan and development. This tool can be included in in-person training or as follow-up material for self-learning.

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Physical Concept

A training program for HSAs that focuses on building gender perspectives and provides requisite skills and tools to question their own thinking and biases around family planning. The training will also build skills and provide tools to engage women and men individually and as couples on family planning. The relevant tools and learning materials, including a ‘how to’ guide will be shared during these sessions to aid them carry out their responsibilities.

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Assumptions

Digital 

  • This training tool is integrated in the existing training calendar with fewer additional days.

  • FLWs/HSAs have sufficient time available to attend the training programs.

  • FLWs/HSAs possess a smartphone, and have at least one of the following social media accounts: Facebook, WhatsApp, Instagram, TikTok or YouTube (Google).

  • FLWs/HSAs are familiar with using at least one of these accounts, which includes the skills of accessing the platform, along with sending, consuming, and forwarding messages/content.

  • FLWs/HSAs possess basic literacy skills in the regional language.

  • FLWs/HSAs have the intent to effectively converse with couples and men, especially around sensitive topics.

  • For training protocols, stakeholder involvement at various levels of the government will be needed.  

  • Since FLWs are an integral part of the community, community buy-in will be needed for this concept.

  • The concepts will enable the HSAs to challenge their own thinking and develop the capacity to talk to men. 

  • The concept will capacitate the HSAs to counsel couple more thoroughly

Assumptions for non-digital concept – all assumptions except those related to access to smart phone and digital account are applicable for non-digital concept

  • This training tool is integrated in the existing training calendar with fewer additional days.

  • e the HSAs to counsel couple more thoroughly

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Risks

  • Further overburdening HSAs and increasing the number of training programs for them.

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  • HSAs may be prone to potential backlash from the community on account of their increased visibility and promoting FP for young couples

  • Men may not like the HSAs talking to them about FP or know more than them

  • If not conducted in a highly sensitized manner, keeping in mind the normative structures of community, the HSAs may run the risk of losing access to young women

  • HSAs are also women and have similar familial dynamics and norms within their own households, they may not be able to negotiate for the same in their own family

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Potential

Contextually Sensitive

This concept has a lot of potential as it accounts for all the stakeholders in the community while engaging deeply with the HSAs.  The concept has the potential to affect change from a top-down approach wherein a change in the ASHA’s perspective could affect change at the grassroots level, and negotiating with the structural aspects in a steady and sustained manner.


Gender Transformative

This concept takes gender transformative approach. The training content (description, activities, scenarios, alternatives) and processes are directed towards building gender perspective and skills to critical thinking and cognizant of implications of discrimination and biases among HSAs.
An ASHA with gender perspective and skills is likely to be more sensitive and aware of power dynamics between woman and her husband, role and power of family members, pressure of early child bearing and other related issues, can take necessary steps towards engaging women and men on family planning ensuring their rights are protected and demands are met within available structure and resources. She can help women and men negotiate with their family members and community. It may initiate the process of making informed and collaborative decisions.

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ID 11

ID 11 - Gender Transformation Orientation for Health System Actors 

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ID 12

ID 12 - Breaking Patterns of Stigmatizing Behaviours 

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ID 13

ID 13 -  Facilitating Pathways to Safely Exit Experimentatio