A Systems-integrated Model (VIKALP) to Improve Contraceptive Uptake among Low-parity Women
Junita NirmalAbstract
Background:
Early first births and inadequate birth spacing remain major public health challenges in India. NFHS 5 (2019–21) reports that 6.8% of women aged 15–19 years were already mothers or pregnant. Although modern contraceptive use among women aged 15–49 years is 56.5%, an unmet need for spacing persists at 4.0%, reflecting gaps in informed choice, early engagement, and service continuity. These gaps are most evident between marriage and first birth and between the first and second births, underscoring the need for a systems integrated approach leveraging community, facility, and government platforms.
Objectives:
To increase uptake of modern contraceptives among low parity couples to delay first birth and ensure adequate spacing between the first and second births through a systems integrated approach leveraging government platforms.
Methods:
The project implemented a multi-level care model integrating community-based identification of newly married and low-parity couples with structured counseling through frontline workers (ASHAs, ANMs), strengthened facility readiness, and convergence with government platforms such as Saas Bahu Sammelan, Village Health Nutrition & Sanitation Days and leveraging government schemes for delaying & spacing. Capacity building and demand generation strategies are used to ensure timely follow-up, method choice, and service linkage. Partnerships with public facilities ensured method availability and continuity of care.
Results:
The model improved early identification and enlisting of eligible couples, increased informed choice of contraceptive methods, and enhanced uptake of spacing methods. Strengthened frontline worker engagement and systematic follow-up contributed to improved continuity and reduced missed opportunities. Leveraging existing government systems improved sustainability and scalability.
Conclusion:
The Vikalp model demonstrates that integrating targeted demand generation with strengthened public health platforms can ensure the right family planning services reach low-parity women at the right time and place, advancing universal health coverage goals and improving maternal and child health outcomes.