2011 Grant Recipient 
India
PhD Program, Department of International Health, JHSPH
The Urban Health Initiative (UHI) is a five-year project funded by The Bill and Melinda Gates Foundation that focuses on reproductive health in Uttar Pradesh (UP), India. Led by Family Health International (FHI), the project seeks to increase uptake of delay and spacing methods of birth control (condoms, OCPs, injectables and implants), while promoting the use of modern methods of contraception. The project aims to increase the contraceptive prevalence rate (CPR) across the population, focusing specifically on the urban poor, and to transform the private sector into a major provider of family planning (FP) services. As part of the implementing team, CCP will support communication initiatives, including a mass media campaign and city wide programs that bring together consumers, clinics, providers, businesses, and civil society to model and support new social norms. These campaigns will be integrated so that TV game shows, radio spots, community activities, clinic materials, and interpersonal counseling messages promote a common message. JHU/CCP is conducting an evaluation of an mhealth intervention to promote family planning among low income urban couples. We hope to conduct the baseline data in April-May 2011. It will be good to have the stduent with us during this phase. The m-health intervention will begin in May 2011. It will continue until March 2012, after which an endline assessment will be conducted in the intervention and comparision cities. Personal Narrative:
My past experiences abroad at both grassroots and policy levels prepared me well for working in the capacity of research influencing program implementation. In particular, I was able to see the way in which findings can be used and translated at local, district, state and global levels though direct feedback of pretesting information into behavioral films and the development of a toolkit to share with agencies working in the same content arenas. Moreover, I gained nuanced understanding of the challenges associated with integrating research with broader programmatic goals; often constrained time and resources, work environments, fragmentation, power structures, and a series of logistic issues play a role in how smoothly integration happens. Arriving in Lucknow, I remember being filled with mixed emotions; I’d spent a few days in New Delhi, where the sheer size of the city and its immense population had been quite overwhelming. I’d felt confident about traveling in India even with my limited Hindi proficiency. It was, however, my first time alone in Uttar Pradesh and knowing my supervisor was traveling at the time of my arrival, uncertainty about my living and working situation lingered. The welcome to the city by an office colleague eased my worries a bit; though I realized from the start that self-direction would be my motto this summer. This understanding was critical given the nature of the UHI partnership. Multiple groups of people working on a diverse range of activities related to family planning under a single roof created both an exciting but also very independent work-atmosphere. This independence of groups visibly manifested in the fragmented structure which lead to a range of misunderstandings around my arrival logistics and role; for example, the local mobile that had been promised disappeared and all the data cards had “just been” allotted. My supervisor’s initial absence essentially hindered my ability to negotiate. Despite these first impressions, the willingness of some project staff to help me settle in as much as possible and introduce me to their work and Lucknowi lifestyle was comforting and refreshing. The passion that many of them showed in working with urban slum dwellers in motivating behavior change was reflected in their commitment despite their making a NGO salary and operating under complex power structures. Conversations with a number of colleagues at different job-levels illustrated how in Uttar Pradesh, hierarchy plays a large role in whose voices are heard and ideas brought forward. My time spent in Lucknow’s UHI office, in field testing of films with communities, and at informational feedback and validation meetings with government workers not only reinforced this idea of power’s relational influence, but also inspired me to consider related concepts to explore in my future dissertation work. Appreciating a range of perspectives while working within a resource-constrained, hierarchical and often unpredictable setting is important. Seeing research-in-action in this context compelled me to think critically and strategically about my future involvement in studies in global health. Over the couple months I spent in Lucknow, the warmth and hospitality shown by those I met through work, exploring the city and engaging in cultural and art-related activities was unlike any that I’d ever experienced. The pride in the city’s history and artistic heritage was contagious and expressed whenever people told me about the various sites or markets to visit. The family with which I lived welcomed me as one of their own; the opportunity to share in meals, converse about nature of social and health-related news and ideas, and participate in family occasions gave me insight into the way in which families live and experience disease and adverse events. It enabled me to better understand some of the concerns people have about quality of care generally, the cumbersome nature of dealing with bureaucracy and corruption, yet also drew my attention to the a range of coping mechanisms and support systems that are in place to mediate negative occurrences. Given my own qualitative research interest, the openness that prompted rich discussion with people I lived with, their friends and relatives, colleagues, and others gave me the chance to enhance my rapport-building and Hindi language skills. The time spent faltering through broken Hindi and communicating though hand gestures were helpful not only for this particular experience but also for establishing meaningful connections from both a personal and professional standpoint. Overall, despite some apprehension early on, my experience in Lucknow developed into a positive one that instilled in me a desire to return in the future. Photo Album:  | Pre-testing of behavioral films with urban slum-dwelling women |  | Focus group discussion with urban slum-dwelling women |  | Interviewers conducting pre-film-viewing surveys with urban slum dwelling women |  | Gateway in old Lucknow |  | ‘Bhool Bhulaiyya’, a labyrinth of hundreds of narrow stairway passages on top of the ‘Bara Imambara’, a historic site in Lucknow. |
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