Coaching and mentoring ASHAs is an important step towards elevation / visibility of young first-time parents, so that FTPs are seen and served at UPHCs with the right, appropriate service including contraceptive methods.

ASHAs must to be coached to:

1. Update population register: The importance of updating her survey record or population register, specifically section-2 of UHIR (ASHA diary), termed as ‘slum/gram survey’ periodically. An updated survey reveals the total number of population to be served by an ASHA.
2. Develop a priority list of FTPs: Once the ASHA updates her UHIR, she then updates/completes section 8 of the UHIR, which is an aggregation of all eligible couples in the community. From this section, the ASHA can extract number of FTPs in the population she serves. Further, segregation of lists of FTP women based on age and user/non-user, helps frame a priority list of young first-time non-user parents for counseling.
3. Prioritize visit to FTP (listing of FTP and integration in routine contact plan): When an ASHA extracts FTP list from her existing eligible couple (EC) section of the UHIR, it gives her a clear picture of potential women who are in high need of contraception for spacing between children. The list is shared with Anganwadi workers for better coordination. ASHAs precedence to this list during household visits.  Also, the list is categorized into users and non-users; the ASHA is encouraged to devise a plan with her supervisor to meet non-users first and refer them to FDS. As for users, she provides continuation support including both reassurance counseling, and also resupply of commodities such as condom and pills.
4. Leverage benefits of government schemes related to their work: ESB is a government scheme to promote spacing between births. It is important that an ASHA feels motivated to work for FP for first-time parents. Hence it is important to coach ASHA on this scheme, specifically on how to fill the form, when to claim, what are the criteria on which this incentive is given and where it is to be deposited (Refer to ESB scheme).
5. Follow up: To ensure retention of the adopted method by the client, ASHAs must follow up with clients in the proposed interval.

In many communities, it is still a taboo for a 20-22-year-old woman to adopt a family planning method (Hall, Stephenson, Juvekar, 2008). Therefore, ASHA must sensitize both FTPs and key influencers on the benefits of contraception for a young mother (and child), and this could include:

• Counsel FTPs on one-on-one basis to explain the benefits of spacing. IEC material may be used, if available.
• Educate influencers of FTPs including mother-in-law, sister-in-law, husband and, peers on the benefits of contraception for a young mother.
• Conduct meeting of FTPs where non-users can seek inspiration from the users and where couples can interact and discuss family planning amongst themselves.

You hold such an important position in the family and it is your decisions that have helped your children make wise choices. Family planning is important for the health of your daughter-in-law and your grandchildren, as well as for the financial situation of your family. The best thing you can do is to make the right decision for your son’s family.” — Laxmi, an ASHA in Ramnagar, Firozabad sensitizing the mother-in-law of a young woman who did not want her daughter-in-law to adopt family planning.

To mitigate provider bias if any caused by inadequate knowledge on methods or the latest medical guidelines about them, it is critical to conduct ‘whole-site orientation’ of all staff working at the UPHCs on specific needs for FTP and the importance of offering them all methods and support them to choose a method of their choice.

Fixed day static/Family planning day (FDS)/Antaral diwas (spacing day) approach assures quality family planning services at a pre-fixed time known to the community. To demonstrate demand for family planning among first-time parents, the Chief Medical Officer (CMO) may decide to designate one of the routine FDS day from the FDS calendar to be marked as special FDS for FTP. Following this ASHA mobilizes FTPs, announcing the day and timing specially reserved for them to avail family planning services at the nearest UPHC. To highlight the special day, facility staff may provision counseling corners, display IEC materials on FP and create a visual enhancement of the facility.

In facility readiness, it must be ensured that counseling services are offered in person to maintain confidentiality. As demand for services among this group improves, the special FDS cycle maybe discontinued and services can merge with regular weekly FDS.

Learn more about how to organize FDS.

In a new facility or a city where a ‘Special FDS for first-time parents’ if is being done for the first time then getting this inaugurated from the Chief Medical Officer (CMO) can garner attention from neighboring facilities, local media and boost the morale of that particular UPHC staff.