The Population Foundation of India has worked for close to five decades to promote just and equitable policies that ensure human dignity, rights and a better quality of life for the most vulnerable, especially women. On behalf of my colleagues on the Governing Board and myself, I would like to commend PFI on its continued engagement with critical, often contentious, issues in a timely and responsible manner.

The Government of India has taken important steps this year towards increasing access to care, towards promoting heath seeking behaviour and in recognising the importance of the social determinants of health. The release of the National Health Policy, 2017 and announcement of the Ayushman Bharat programme are welcome moves towards India’s objective of universal health coverage. PFI is positioned for a crucial role in supporting the government as it rolls out Ayushman Bharat through 150,000 health and wellness centres, and the National Health Protection Scheme providing insurance cover to 100 million families. This could well be a turning point in the quality of health care that the poor can access, provided the pledges are adequately supported with requisite financial commitment, strong governance systems, and accountability.

Raising social sector allocations by the government has been a longstanding issue, with fiscal compulsions often outweighing development needs. We continue to work on this issue by presenting best practices in resource management and programme implementation that promote equitable development, while advocating for allocations to match with policy commitments, particularly in family planning.

PFI has a strong record in reaching out to the wider community, using technology, social media and support of role models in our society. On the evening of 21 November, 2017, a 2000-strong cheering, clapping audience responded enthusiastically to Farhan Akhtar and a glittering array of film celebrities to sound the ‘Lalkaar’ – a call to end violence against women and girls. We have seen promising results in our work to promote adolescent health through projects on ground with over 200 adolescent girls’ groups in Bihar, and online with short films on sexual and reproductive health. These are indeed exciting times, especially with the possibilities of reaching out to very large numbers using digital technologies. At the same time, we must guard on how we can use technology in an ethical, socially sensitive and just manner, so that we bridge divides rather than widen them.

The 2017 United Nations Revision to its World Population Prospects clearly indicates that with one of the youngest populations in the world, half of it in the reproductive age group, India needs to step up investments to provide for adequate health, education, nutrition, and better social conditions. Investing in the young is a development imperative. As future citizens and leaders, they are important instruments of political and social transformation, and need to be recognised as such in the policy framework. Young people today are very vocal, capable of either embracing an idea fully or rejecting it outright, but also need information, guidance and an appreciation of work that has been done. We need to create the spaces where we can have dialogues with the young, listen, share, and support them in their journey into responsible adulthood.

PFI is very fortunate to continue working closely with governments, both at the central and state levels. We are mindful of the trust vested in us and the immense responsibility we therefore carry. I would like to acknowledge the support we have received from civil society partners, donors and our innumerable supporters for believing in PFI and the work it does. To them all, on behalf of the Board, I extend our grateful appreciation.

It is always a pleasant task to share my thoughts and the highlights of our work over the past year in this important publication, our annual report.

For several reasons, this has been an exciting year, not least for the fact that we undertook our visioning exercise. This was an effort on our part to be in step with the changing demography of a very young India, and to be better prepared to respond to a new set of priorities and challenges. Our exercise sought to re-align PFI's vision as well as the larger sexual and reproductive health canvas. The objective was to reposition family planning (FP) in the national development agenda as an area of priority in itself, firmly believing as we do that it is a cross-cutting issue central to achieving both national and global development goals. It reaffirmed our conviction that adolescents and youth need to be at the centre of national sexual, reproductive health and rights (SRHR) policies. While they are indeed a demographic asset, the extent to which dividends are reaped will depend very much on the enabling conditions that are put in place.

Looking back at our work, we have done well and have good reason to feel proud. Whether, it was about using behaviour change communication and advocacy, capacity building and providing technical support, or building knowledge and working with communities, we made a definite imprint. Building on its expertise in its social and behaviour change communication initiative Main Kuch Bhi Kar Sakti Hoon (MKBKSH), PFI introduced two new initiatives targeting young people and using the digital space: Sex Ki Adalat (Court of Sex) and Bas Ab Bahut Ho Gaya (BABHG or Enough is Enough). The former, a digital campaign and one of the winners of the Bill and Melinda Gates Foundation's Grand Challenge initiative, amplified a groundswell of public opinion and outcry on issues of violence against women and girls. The latter was PFI's first ever web-series, where SRHR issues considered taboo in Indian society, were tackled head-on through a court room drama format, conveying responsible information in an engaging manner.

PFI has the privilege of hosting the secretariats of two distinguished groups: the Advocating Reproductive Choices (ARC) Coalition and the Advisory Group on Community Action (AGCA). I mention them, as this year, both received extraordinary recognition. The ARC Coalition nominated as India's Civil Society Focal Point for the FP 2020, acquired a new status with the mandate to engage and advocate with the government and other key stakeholders to drive the country's progress towards meeting its FP goals. Some members of the AGCA Secretariat and PFI were awarded certificates of excellence for their contributions to the 9th, 10th and 11th Common Review Missions (CRMs) of the National Health Mission (NHM). In addition, I am pleased to report that the Community Action for Health (CAH) processes are now being implemented across twenty-three states.

PFI has made significant additions to its knowledge management resources. Two studies focusing on the analysis of fund allocations for family planning in the high focus states and the cost of inaction in family planning were commissioned to respond to gaps in policies and programmes. In addition, we produced a much-needed report on women's status, health and family planning in India, which further highlights these for the attention of policymakers. We have made significant strides in using new technologies especially social media to reach out to more people. We are engaging in dialogues with policymakers on Facebook Live and have used embedded chat bot technology in a first-of-its-kind online rapid assessment of our online campaign on ending violence against women and girls. As technology and communication become inseparable from our daily lives, PFI is exploring newer ways of engaging with people to promote a rights-based approach to family planning.

It is a fact that our achievements are as much the achievements of our partners. I take this opportunity to extend our grateful appreciation to our valued partners - the Government of India, particularly, the Ministry of Health and Family Welfare, state governments, our funding agencies and implementing partners, including civil society and research organisations. To our admirable Governing Board, Executive Committee and Advisory Council, I convey my sincere thanks for their unreserved and kind support, which we can count upon and which makes all the difference in the world.

From the

Chairperson

keshav desiraju

Chairperson, Governing Board, PFI

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From the

Executive director

poonam muttreja

Executive Director, PFI

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FAMILY planning

Promoting investments in family planning for impact on sustainable development goals

Population Foundation of India considers family planning a human right and an investment that impacts all 17 global Sustainable Development Goals (SDGs). PFI’s programmes work through multiple approaches that provide women the choice to plan their reproductive health, improve the quality of services, and promote innovations in resource mobilisation, community participation and addressing social norms. PFI continues to underline the need to include young people and men in family planning programmes.

PFI’s advocacy on family planning is based on increasing emphasis on birth spacing, expanding contraceptive choices, and increasing allocation and expenditure for family planning. Processes for planning and allocating resources for family planning (FP) by states is being supported through a convergence model of District Working Groups (DWGs) in Bihar and Uttar Pradesh. To increase demand for family planning, a cadre of community level family planning champions have been trained as ‘Advocates for Change’ (AFCs) in Darbhanga and Nawada districts of Bihar. As the Secretariat of the Advocating Reproductive Choices (ARC) coalition, PFI represents ARC as India’s civil society focal point for FP2020. ARC is now part of the Implementing Best Practices (IBP) initiative, an international partnership of over 45 member organisations dedicated to scaling up global best practices in family planning and reproductive health.

The success of PFI’s flagship transmedia Social and Behaviour Change Communication (SBCC) initiative Main Kuch Bhi Kar Sakti Hoon (MKBKSH – I, A Woman, Can Achieve Anything) continued to show results, including better knowledge and attitude of viewers the factors determining family planning decision. PFI produced a series of short films entitled ‘Reel to Real’ based on stories of change inspired by MKBKSH, which were released through social media platforms in 2017.

In addition to traditional advocacy efforts with policymakers, media and opinion leaders, PFI also developed new channels of dialogue on family planning through social media. In 2017, we conducted discussions around the national budget on Facebook Live, and adapted key messages on family planning into short videos and animated GIFs. PFI commissioned two studies in 2017to generate evidence and bolster its advocacy efforts for family planning: ‘Cost of Inaction in Family Planning in India: An Analysis of Health and Economic Implications’ and ‘A Review of Planning, Budgeting and Expenditure of Family Planning Activities Under NHM’.

PFI successfully advocated with the Bihar Mahadalit Vikas Mission (BMVM) to extend family planning services to nearly 4 million marginalised households across 38 districts of Bihar through 10,000 Vikas Mitras (frontline workers). Women opting for a spacing method of contraception increased by about three times as compared to the previous year, following PFI’s advocacy in selected facilities of the high fertility Araria district (TFR 4.3) of Bihar.

Reached more than 5.7 million social media users and got over 2 million views through PFI’s social media handles with Reel to Real

Media coverage on PFI’s family planning messages averaged at over one article a day (383) in 2017-18

sexual & reproductive health of adolescents

PFI aligns with the global focus on adolescent sexual & reproductive health (SRHR)

Every third Indian is a young person (10 - 24 years). This population needs to be equipped with the correct information, awareness of their rights and ability to make decisions to exercise their choice, take charge of their own lives, and contribute to the country’s progress. PFI has turned its focus towards adolescents and youth across programmes, by putting information and services related to sexual and reproductive health within their reach, directly and through partnerships with government, civil society organisations and youth led organisations.

India was host to the 11th World Congress of the International Association for Adolescent Health (IAAH) in October 2017. As member of the Steering Committee, PFI contributed in shaping the contours of the World Congress. We also showcased Saathiya, the identity and resource toolkit for peer educators (PE) of the Government of India’s adolescent health programme Rashtriya Kishor Swasthya Karyakram (RKSK) developed in partnership with the United Nations Population Fund (UNFPA).

Stories of a superhuman character and its journey through the challenges of adolescence in the form of comic books and games are being used in a community project for adolescent girls in two districts of Bihar. The comic books have been converted into interactive stories and are now being distributed on SD cards through a network of mobile recharge shops in the project districts. Additionally, PFI developed and released a web series of five short films titled Sex ki Adalat, dealing with topics related to sexual and reproductive health that are plagued by common myths and misinformation. The series addresses the preference for a male child, the demand for evidence of virginity from women before marriage, shaming of adolescents for masturbation, the social taboos attached to menstruation, and adolescents being driven to seek information on sexual and reproductive health through pornography.

As a result of PFI’s advocacy initiatives, adolescent sexual and reproductive health included in the Village Health and Nutrition Days (VHNDs) in Gaya district of Bihar

5.9 million people reached through social media with digital series Sex ki Adalat

community monitoring of health services

Scaling up community monitoring across India

A strong community accountability mechanism is vital for an effective health care delivery system and India’s move towards Universal Health Coverage. Community Action for Health (CAH) is a key strategy of the National Health Mission (NHM) to ensure that health service providers are accountable to communities to meet their health needs and rights. CAH is currently one of the world’s largest community-led accountability initiative, being implemented in 23 states, covering approximately 201,755 villages across 340 districts of the country.

The Advisory Group on Community Action (AGCA), with its Secretariat at PFI, was formed and supported by the Ministry of Health and Family Welfare (MoHFW) to support state governments in implementing CAH. In 2017 the AGCA scaled up community monitoring by enlisting new states, reviving the processes in flagging states, and expanding to urban areas. AGCA developed resources and provided training for the new entrants. With support from the AGCA, in December 2017 Meghalaya became the first state in India to operationalise social audits of public services under the Meghalaya Community Participation and Public Services Social Audit Act, 2017.

PFI is supporting Goa, Uttar Pradesh, Jharkhand and Sikkim in strengthening their systems of Rogi Kalyan Samitis (Patient Welfare Committees – RKSs). These committees consist of members from the local Panchayati Raj Institutions (PRIs), non-profit organisations, local elected representatives and government officials, and are invaluable in making public health facilities accountable to the community. The UP government is scaling up the initiative across 10 districts in the state. Additionally, PFI is using an Interactive Voice Response System (IVRS) for communities in two districts of Bihar to raise awareness and monitor health entitlements.

The AGCA Secretariat at PFI organised a National Consultation on Community Action for Health in New Delhi in January 2018 on behalf of the Ministry of Health & Family Welfare. With over a hundred participants and representatives, including senior state government officials from 23 states, the consultation sought to share promising practices and innovations on community action and accountability, discuss the challenges, and provide recommendations to the government on the scaling up of CAH.

Trainers’ Manual on CAH was developed to help state and district level trainers roll out CAH processes 1,900 state and district nodal officers and organisations of 16 states were trained on CAH processes; 12 states have adapted and begun using CAH resource materials

315 Jan Samwads (public hearings) conducted in 7 states for public health officials to hear and resolve grievances of the community related to access and quality of health services

Sub-health centres providing regular services in Nawada district increased by 40 per cent (17 per cent to 57 per cent) as a result of community monitoring; people receiving contraceptives regularly increased nearly three times (from 20 per cent to 59 per cent)

ending gender based violence

Young people are the champions of PFI’s work to end violence against women and girls

As a natural extension of its overarching focus on women’s rights and empowerment, PFI addressed gender based violence (GBV) with a year-long online campaign, programmes with rural communities, and by lending voice to movements sweeping through the country as well as globally. We focused on young people whose opinions are still being shaped and who will, in turn, influence social norms in the years to come. On the one hand we had film celebrity and youth icon Farhan Akhtar as an ally; on the other, we supported youth champions to amplify the movement to end violence against women and girls.

PFI recognises that gender-based violence manifests itself in many ways, and therefore needs to be acknowledged and addressed using multiple strategies. In May 2017 PFI launched a digital media campaign named Bas Ab Bahut Ho Gaya (BABHG - Enough is Enough) for ending violence against women and girls (VAWG). The objective was for men to accept that VAWG is a sign of weakness, not of strength; and for women to know that they do not, under any circumstances, deserve or should accept violence. PFI led the project in partnership with film actor Farhan Akhtar’s social initiative Men Against Rape and Discrimination (MARD) and film and theatre director Feroz Abbas Khan.

The core of the campaign was production and release of six short films on issues ranging from the need to value girls and boys equally, rape, child sexual violence, stalking, and harassment at the workplace. Apart from this, the campaign organised a celebrity concert, which was streamed on Facebook Live. The concert featured Farhan Akhtar along with other film celebrities such as Salim-Sulaiman, Sukriti-Prakriti, Armaan Malik, Harshdeep Kaur, and a surprise appearance by Hindi film superstar Shah Rukh Khan.

Bas Ab Bahut Ho Gaya reached out to college students through a promotion campaign in 600 colleges across India, and panel discussions in selected academic institutions. 1,700 entries were received for an online short film contest for students. Awards were given to three winners selected by a jury of eminent personalities and one Viewers’ Choice Award to the most popular film selected through online voting. The campaign anthem Chhulein Aasman (‘Touch the Sky’), was released on International Women’s Day, 8 March 2018 through PFI and MARD’s social media platforms.

More than 46 million users on social media reached through #BasAbBahutHoGaya.

Over 6.5 million viewers engaged with the Bas Ab Bahut Ho Gaya (Enough is Enough) campaign.

Film celebrities such as Amitabh Bachchan, Shah Rukh Khan, Shabana Azmi, Priyanka Chopra, and Aamir Khan endorse the campaign on ending violence against women and girls.

National Workshop on Mission Parivar Vikas (MPV)

PFI was a civil society representative at the workshop convened by the Ministry of Health & Family Welfare of the Government of India to prepare states for implementing schemes under MPV.

Consultative Meeting on Rights- Based Approaches in Family Planning

At the meeting organised by International Planned Parenthood Foundation, London, PFI talked about `What are learning about strengthening accountability in Family Planning programs?’ in a session that covered `Social Accountability in India’

World Congress of the International Association or Adolescent Health (IAAH)

PFI was part of the Steering Committee of the World Congress and presented its work in developing a brand and resource toolkit for peer educators under Government of India’s adolescent health programme Rashtriya Kishor Swasthya Karyakram (RKSK)

March on Gender: The Implementation Gap on International Women’s Day

PFI participated in the OECD Policy Dialogue on Women’s Economic Empowerment to discuss discriminatory intra-household gender norms and improve attitudes and behaviours towards gender equality.

National Workshop on Promotion of Male Participation in Family Planning

The meeting was convened by the Ministry of Health and Family Welfare in an effort to strengthen and revive male participation under the National Family Planning Programme. PFI participated in a panel discussion presented on `Bridging the Gender Gap – Need of the hour’.

Community of Evaluators South Asia Evaluation Conclave

PFI presented findings of the evaluation of our transmedia behaviour change communication programme Main Kuch Bhi Kar Sakti Hoon (MKBKSH – I, A Woman, Can Achieve Anything) at the meeting held in Thimpu on the theme of Gender and Equity

We the Women Summit

PFI was a partner at the Summit and participated in a panel discussion titled ‘India's Harvey Weinsteins: Breaking the Silence’, on sexual harassment at the workplace and sexual abuse at homes.

National Consultation on Community Action for Health: Deliberating Pathways for Scaling Up

As Secretariat of Advisory Group on Community Action (AGCA), PFI hosted the National Consultation on Community Action for Health with participation of government officials, representatives from 23 states and members of civil society.

High-Level Panel on Partnering for Development: the Foundation Government Dynamics in India

PFI participated as a speaker at the OECD High-Level Panel on Partnering for Development: The Foundation-Government Dynamics in India. The session was titled ‘Promoting effective collaborations between foundations and the government: the way forward’.

International conference on Integrating family planning with SDGs

In a meeting titled, ‘Enhancing the Role of Parliamentarians in the Interlinkage between Population Issues and the 2030 Agenda for Sustainable Development’, PFI presented on `Family Planning and Sexual and Reproductive Health Rights – interlinkages with SDGs and the global agenda’ in a session on `Global Compact and Sustainable Development’

2nd Asia Regional Focal Point Workshop

The workshop in Manila brought together technical experts, donors, governments, and civil society organisations to accelerate progress of rights-based family planning in the 11 countries committed to FP2020 in Asia including Afghanistan, Bangladesh, and Pakistan.