# The impact of a participatory learning and action intervention on unmet need for contraception: a cluster-randomized controlled trial in rural Bihar, India

## TL;DR

A community-based education program in rural India slightly increased contraceptive use and reduced unmet need for limiting childbirth among women.

## Contribution

This study provides empirical evidence on the effectiveness of participatory learning in improving contraceptive behavior in rural India.

## Key findings

- Contraceptive use increased by 5.8 percentage points in treatment villages.
- Unmet need for limiting childbirth decreased by 7.2 percentage points.
- No significant effect was observed on spacing childbirth.

## Abstract

Unmet need for contraception is a persistent issue in rural India. This work evaluates the impact of Gram Varta – a participatory learning and action intervention employed in women’s self-help groups in rural Bihar, India – on women’s contraceptive behavior and unmet need for contraception. Trained facilitators used an active and participatory communication approach in 20 group meetings to discuss health-related topics focusing on the improvement of communities’ knowledge and practice related to health, nutrition, water, sanitation and hygiene. One of the meetings focused on family planning measures, the benefits of various measures, and a discussion on the availability of various means of contraception through the government health system. The intervention was also meant to increase women’s empowerment.

Gram Varta was evaluated in one district of Bihar, Madhepura, with a cluster-randomized controlled trial. We used a difference-in-differences model to estimate the intention-to-treat effect of Gram Varta on women’s contraceptive behaviour and unmet need for contraception using a panel dataset with 972 observations collected in 2015 and 2016.

We find a statistically marginally significant increase in contraceptive use by 5.8 percentage points (95%-CI [0.00;0.12]) and a statistically significant reduction in unmet need for limiting childbirth by 7.2 percentage points (95%-CI [-0.14;0.00]) among women in treatment villages but no effect on spacing childbirth.

There is indicative evidence that participatory learning and action intervention increased contraception use among women of reproductive age in rural India, but the effect on unmet need was inconsistent.

The randomized controlled trial was registered with and a pre-analysis plan was submitted to 3ie before intervention roll-out. In addition, it was retrospectively registered in the AEA RCT Registry with the identification number AEARCTR-0004700 on September 16, 2019.