An IUCD training session at a Bhagalpur health facility.
Bhagalpur, a city in Bihar, India, is setting a powerful example of how strategic coaching, local government leadership, and targeted advocacy can transform family planning (FP) services. Since The Challenge Initiative (TCI) began its engagement in Bhagalpur in August 2022, access to intrauterine contraceptive device (IUCD) services has significantly improved, demonstrating the effectiveness of TCI’s proven model in strengthening local health systems.
This story is the subject of a new Tales of Impact, a TCI publication that highlights how cities across India and other TCI-supported countries are leveraging local leadership and data-driven decision-making to achieve sustainable improvements in reproductive health.
When TCI began supporting Bhagalpur, family planning services – especially IUCD insertions – were limited by infrastructure gaps, a lack of trained providers, and insufficient IUCD kits. To address these challenges, TCI provided tailored coaching to local officials, emphasizing the importance of offering a broad method mix to support informed, voluntary FP choices. Through this coaching, city teams began using routine forums – such as meetings between accredited urban health activists (ASHAs) and auxiliary nurse midwives (ANMs), data validation sessions, and National Urban Health Mission (NUHM) reviews – to strengthen service delivery and coordination.
Yet, despite progress, a major bottleneck remained: each Urban Primary Health Center (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 CHWs in generating demand and supporting access.
The number of IUCDs inserted in Bhagalpur rose from zero in 2022 to 526 in 2025.
TCI and local partners 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, TCI 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 – TCI 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.
