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THE ’1-3-2′ TOOL

The unmet need in Bihar is high as 33%, over half (57%) of all non-first births are spaced less than 24 months apart, putting women and their infants at increased risk for poor maternal and perinatal outcomes.

Field insights revealed that the concept of spacing is nonexistent, for majority, family planning is equivalent to limiting. Even though spacing has a direct correlation with the mothers and child’s health – yet health seemed a distant benefit. It was also observed that the concept of spacing was low on priority even for the frontline health workers (FLWs). Anecdotal evidences indicate that the health workers initiate discussion with selected beneficiaries with two or more parity and at least one male child rather than all married women in the reproductive age group.

During the ideation stage we delved deeper into the above insights and concluded that the answer lied in demonstrating more gap between two children to more tangible and proximal benefits.

Disruptive and clutter cutting communication around birth spacing
This led to the creation of a new language around spacing i.e 1-3-2 ‘Fayeda ka Mantar’ (Mantra of Benefits) which translates into visually demonstrating the tangible benefits the couple gains by maintaining 3 years of spacing between 2 children. The key objective of this disruptive, engaging and clutter cutting communication is to encourage spousal communication on the benefits of spacing and generating demand for adoption of contraceptives for birth spacing.

How is “1-3-2”tool used?
This tool is used in two parts; part 1 of the tool sets the context of spacing i.e. 3 year gap between 2 children. This tool is designed like an accordion to visually demonstrate the various types of benefits the couple can gain if they space between 2 children. At one end of the accordion a picture of happy family is placed with two adequately spaced children with a tag line 1-3-2 and on the other extreme a picture of a sad family without adequate spacing between children. With the help of these pictures FLW engages with the audience and asks them to spot the difference between the families and why one family is happy while the other is sad, then the FLW slowly opens the flap from one side of the tool and reveals each tangible benefit one by one and explains each one of them. This gives a lead to next part of the tool which is on the three different spacing methods: OCP, Condom and IUCD. This tool opens like a card and is divided into three sections; each section has one method and is colour coded. The FLW is expected to invite responses from the audience to pick a colour. The FLW opens the flap of the colour picked by the audience and gives all relevant information about the method including demystifying myths.
Since spacing is a new concept for them it was important to provide an aid to the FLW which is interactive, engaging, generates discussion and linked to contraceptives available at VHSND. Hence both parts of the tool have been designed with strong elements of interactivity.

Is “1-3-2” working?
A new language only exists when people adopt it, and the impact evaluation of the tool shows that 1-3-2 is a language that appeals to the people it was designed for.

  • Women exposed ‘1-3-2’ have higher intention to use, and are more likely to use contraceptives for birth spacing, than those unexposed
  • No difference in knowledge about birth spacing between exposed and unexposed groups
  • But, women exposed to 1-3-2r are 1.5 times more likely to intend to use contraception compared to unexposed groups.
  • And are 1.7 times more likely to use contraception than unexposed groups
  • Data suggests that exposure to 1-3-2 leads to an increased demand for birth spacing methods at VHSNDs

The tool has been used in Bihar for a little over a year across 8 districts at VHSNDs sites and it will soon be implemented across the state as the Government of Bihar has committed funds for the scale up.