The Pragati games were implemented in 30 Village Development Committees across five districts from January 2017 to March 2018. In two municipalities in Rupandehi, Roving Auxiliary Nurse Midwives also conducted Pragati games.
Among the 78,373 unique points of contact, (66%) identified as a member of a marginalized community in their district (i.e.; Janijati, Dalit, Muslim, Chhetri).
The games transcended their original mode of delivery, health mother’s groups, to platforms such as saving and credit groups, youth groups, child clubs, schools, madrasas (Muslim schools), ward citizen forums, forest users’ groups, adolescents boys and girls groups, individuals in open spaces, etc. This extension of implementation maximized the impact of social networks to reach a “tipping point” within four districts.
Participants and health care providers expressed their appreciation for the games as a way to challenge the taboos of discussing reproductive health within a safe space. The fun and communal nature of game-play also provided opportunities to engage men and youth.
“I have very positive thoughts about these games. It has made it a lot easier for us health workers to bring forward these messages…. I’ve learned things that I hadn’t learnt in my 10 years as a Female Community Health Volunteer, and that makes me very happy.”
RADHA THAPA, FEMALE COMMUNITY HEALTH VOLUNTEER
More than 90% of participants who played games recalled the inclusion of fertility awareness messages in the games.
Additionally, there was a positive association between the number of games played and higher fertility awareness scores.
When compared with those in other communities, Pragati communities were 3.0 times [CI: 1.9-4.7; p<0.001] more likely to have a high fertility awareness score.
"I didn’t know before that I was supposed to use temporary methods if I have intercourse between 8th to 19th days. If we don’t use it, there will be a possibility of conceiving. After playing the game, I learned these things."
MARRIED WOMAN WITH MIGRANT HUSBAND, SIRAHA
In the Pragati communities, women had a higer rate of family planning use than women in the control communities, increasing from 31% at baseline to 35% at endline.
Fertility awareness and acceptance of FP norms were positively associated with increased current use of FP . Analyses revealed that individuals with a high fertility awareness score were 1.7 times [CI: 1.0-2.6; p<0.05] more likely to be currently using a FP method; women with a high acceptability of FP score were 2.1 times [CI: 1.1-4.0; p<0.05] more likely to be currently using a FP method.
Acceptance of FP was also related to women’s intention to use FP. Women with high acceptability of FP scores were 3.6 times [CI: 2.0-6.6; p<0.001] more likely to use an FP method in the next 6 months.
"When I taught these games to other women, I saw improvements in them too. They discuss these matters — like the number of babies they want and birth spacing — with their husbands. They also come to discuss with me and use the devices suitable for them."
FEMALE COMMUNITY HEALTH VOLUNTEER, SIRAHA
Pragati game-playing activities established a supportive environment for FP by improving determinants of family planning use, including attitudes toward FP, son preference, and attitudes toward couple communication.
Women in communities where Pragati was implemented were 1.9 times more likely than women in control communities to report positive attitudes towards family planning use and 1.5 times more likely to view communication between couples positively.
Among married women, those in communities where Pragati was implemented felt 1.4 times less pressure from their families and community to have a son.
“When the menstruation cycle game was played, I started listening carefully…The issues mentioned in the game were related to my daily life and the messages changed my traditional thoughts and practices. Unlike before, I am now very careful and use pad and clean piece of cotton cloth during menstruation.”
UMKALA, PRAGATI PARTICIPANT
Springboarding from the success of the Pragati games, the FACT Team will increase the impact of gameplay in Nepal by launching three mobile app versions of the Pragati games in early 2019. The three apps will be coupled with MoHiM, a successful menstrual hygiene management game. All games will be available for free download on Android based smartphones in Nepali and English. Together, the suite of apps will transcend traditional social-behavior change activities and offer adolescents and their parents with new ways to learn about their reproductive health.