Strategic Coaching and Advocacy Expand IUCD Access and Strengthen FP Services in Bhagalpur, Bihar

With consistent coaching and availability of equipment, our Urban Primary Health Centers (UPHCs) finally became fully functional for IUCD services. Today, no woman is turned away due to lack of equipment or trained staff.”

PSI India provided tailored coaching to local officials, emphasizing the importance of offering a broad method mix to support informed, voluntary family planning choices. Through this coaching, city teams began using routine forums – such Accredited Urban Health Activists (ASHAs) and Auxiliary Nurse Midwives (ANMs) meetings, data validation meetings, and National Urban Health Mission (NUHM) reviews to strengthen service delivery and coordination.

Yet, despite progress, a major bottleneck remained: each UPHC had just one IUCD kit for Fixed-Day Static (FDS) services. As demand grew, this shortage led to long wait times, missed opportunities, and discouraged clients. Performance monitoring data helped uncover a key factor – UPHCs with a higher number of ASHAs performed better, illustrating the critical role of community health workers in generating demand and supporting access.

PSI India also identified other system barriers, such as non-functional sterilization equipment that forced facilities to rely on nearby centers – delaying procedures and reducing service quality. In response, PSI India worked with Bhagalpur’s District Program Manager to escalate the issue to the Civil Surgeon. Despite funding constraints – urban health programs lacked their own budget lines – PSI India persisted through strategic advocacy and data-backed dialogue.

By January 2025, their efforts paid off. The Civil Surgeon approved the procurement and distribution of 32 IUCD kits and 8 forceps through the District Health Society, ensuring each UPHC received four kits to maintain uninterrupted service delivery.

The results speak for themselves. IUCD insertions in Bhagalpur rose from 0 in 2021 to 526 in 2025. The number of trained ASHAs increased from none to 46, significantly enhancing community outreach and counseling. Meanwhile, 24 service providers were trained in IUCD insertion, bolstering provider capacity and service availability.

Under The Challenge Initiative (TCI), PSI India supported Bhagalpur through structured coaching, data-driven decision-making, and strategic advocacy