Behavioural insights-led interventions to lower adolescent pregnancies and increase the adoption of family planning and birth spacing in Meghalaya.
In an effort to increase the adoption of family planning methods, the Health Department (NHM) is collaborating with Vihara Innovation Network and its partner FinalMile Consulting to implement a program that aims to lower adolescent pregnancies and increase the adoption of family planning and birth spacing in Meghalaya. It is being funded by the Gates Foundation and is using behavioral insights-led interventions.
This project focuses on developing insights-driven interventions to improve the efficacy and acceptance of both traditional and modern contraceptive methods. The broader goal is to support communities in making informed transitions toward modern family planning practices, fostering greater autonomy and well-being in reproductive health decision-making.
I was on the project from December 2024 to May 2025.
Majority of people in Meghalaya are tribal, the main tribes being the Garo, Khasi, and Jaintia.
Indicators from NFHS-5.
Parity preference refers to the desired number of children or ideal family size that individuals and couples build, often early in a relationship. The lower the preference, the stronger the intention to space.
Past economic stress builds an early and low parity preference. It is hard to shift, and often supersedes religious or clan mindsets.
Future aspirations build a mid to low parity preference, to ensure a better quality of life for future generations.
Religious and clan mindsets build a desire for open and high parity. This is hard to shift, even after urban migration or exposure, with a strong girl preference.
Cultural bias against limitingPreference for open and high parity is rooted in the belief that fertility is sacred, a natural gift that should not be restricted. This reinforces a preference for spacing methods that align with the natural rhythm of fertility, rather than permanent or long-acting methods. Women also often prefer to keep their reproductive options open, especially in fluid domestic partnerships, where relationship stability may shift over time.
Illustrative stories built from the research. The names are pseudonyms.
Fally and Aiden, facing economic stress, prefer low parity and choose traditional contraception after one daughter. Despite a failure leading to abortion, they avoid long-acting or permanent methods, reflecting cultural reluctance to limit fertility.
Pranita and Aaron, with a high parity preference and four sons, briefly used Cu-T and OCP after a health emergency, before switching to withdrawal and SDM. Despite not wanting more children as their son prepares for marriage, they remain unwilling to use limiting methods.
Our action-based research revealed that the challenges around family planning in Meghalaya are not rooted in lack of awareness alone, but in a complex interplay of cultural beliefs, emotional dynamics, and systemic silences. These factors collectively shape how individuals, especially adolescents, understand and engage with reproductive health.
Many couples express preference for larger families, influenced by pro-life beliefs rooted in tribal and religious values where life is seen as sacred, children are considered blessings from God, and abortion is viewed as a sin.
Love marriages are common, and emotional intimacy underpins them. Trust and shared moments foster emotional connection, which often leads to sex. Sex is seen as mutual pleasure and emotional intimacy. Intimate partnerships focus more on connection than planning, therefore birth spacing and contraception are rarely discussed.
Dating and sex are common among teenagers, but no one talks to them about safe sex. At the same time, pro-life beliefs normalize pregnancies, leaving teens unsupported and unjudged. This results in a significant information gap during a critical developmental stage.
Early parenthood is normalized and, in many cases, embraced. It is seen as a natural step into adulthood, with many adolescents feeling prematurely ready due to early entry into the workforce.
"Family Planning is about ensuring every child is born into love and stability."
A visual, paper-based job aid, like a flip chart, that frontline health workers (FLWs) can carry and use during counselling to guide method selection by beneficiaries. It displays information on the correct usage, pros and cons of both traditional and modern methods. I designed it end to end.
Fold 1Closed portable folderA4, folded from a full print on A2Front: cover with the basket of choice display image. Back: a brief script for counsellors to introduce the basket of choice.
Fold 2Open display tentA3Opens out into a standing display for the counselling session.
Fold 3Open tent with stacked cardsA3Front: stacked method cards for the beneficiary to pick and see. Back: a table to help the counsellor curate methods based on the beneficiary's preferences.Not the usual basket of choice, but an expanded one: it combines the modern methods suggested by health workers with the traditional methods the community already uses, 12 methods in all.
Each card has a beneficiary-facing page and a facilitator-facing page. All cards are 8.27" wide, and their heights step down from 10" to 7.5", so when they are stacked, every method's name stays visible.
Tap a card to see both its pages.
The Basket of Choice in use at a training session with health workers.
The intervention was designed for community engagement and capacity building of FLWs. Health workers moved through the orientation training module, beneficiary needs assessment and tailored counselling scripts, and then came to the expanded basket of choice.
At Vihara I worked with many stakeholders and people from different fields. To design the tool, everything had to be medically correct: it took a lot of medical research and conversations with doctors and psychologists to get the quantities, dosages, and how and when each method is taken, before presenting them in a visually interactive, engaging format.
My work as a designer was mainly the information architecture: making sure the details on every card were correct, and designing the tool itself. For the illustrations, I collaborated with an illustrator, sharing the vision of how each method is used. It was a really fun part of the project.
I handled this tool single-handedly, through many rounds of reviews: sometimes things worked, sometimes they didn't. The hardest part was taking a lot of information and medical terms about each method and bringing it down to one card, so it doesn't feel verbose but the important information still gets across.