Explore the vast range of titles available.

This study aims to examine associations between spousal communication about contraception and ever use of modern contraception, overt modern contraceptive use (with husband's knowledge), and covert modern contraceptive use (without husband's knowledge) among adolescent wives and their husbands in Niger. Cross-sectional data, from the Reaching Married Adolescents Study, were collected from randomly selected adolescent wives (ages 13-19 years) and their husbands from 48 randomly selected villages in rural Niger (N = 1,020 couples). Logistic regression models assessed associations of couples' reports of spousal communication about contraception with wives' reports of contraception (overall, overt, and covert). About one-fourth of adolescent wives and one-fifth of husbands reported spousal communication about contraception. Results showed couples' reports of spousal communication about contraception were positively associated with ever use of modern contraception. Couples' reports of spousal communication about contraception were negatively associated with covert modern contraceptive use compared to overt use. Wives' reports of spousal communication were marginally associated with covert use compared to no use but husbands' reports were not. Among a sample of couples in Niger, spousal communication about contraception was positively associated with modern contraceptive use (compared to no use) and negatively with covert use (compared to overt use) but wives' and husbands' reports showed differential associations with covert use compared to no use. Since there is little understanding of couple communication surrounding covert contraceptive use decisions, research should focus on characterizing content and context of couple communication particularly in cases of disagreement over fertility decisions.

Background Niger has the highest rate of adolescent fertility in the world, with early marriage, early childbearing and high gender inequity. This study assesses the impact of Reaching Married Adolescents (RMA), a gender-synchronized social behavioral intervention designed to improve modern contraceptive use and reduce intimate partner violence (IPV) among married adolescent couples in rural Niger. Methods We conducted a four-armed cluster-randomized trial in 48 villages across three districts in Dosso region, Niger. Married adolescent girls (ages 13–19) and their husbands were recruited within selected villages. Intervention arms included home visits by gender-matched community health workers (CHWs) (Arm 1), gender-segregated, group discussion sessions (Arm 2), and both approaches (Arm 3). We used multilevel mixed-effects Poisson regression models to assess intervention effects for our primary outcome, current modern contraceptive use, and our secondary outcome, past year IPV. Results Baseline and 24-month follow-up data were collected April–June 2016 and April–June 2018. At baseline, 1072 adolescent wives were interviewed (88% participation), with 90% retention at follow-up; 1080 husbands were interviewed (88% participation), with 72% retention at follow-up. Adolescent wives had higher likelihood of modern contraceptive use at follow-up relative to controls in Arm 1 (aIRR 3.65, 95% CI 1.41–8.78) and Arm 3 (aIRR 2.99, 95% CI 1.68–5.32); no Arm 2 effects were observed. Relative to those in the control arm, Arm 2 and Arm 3 participants were significantly less likely to report past year IPV (aIRR 0.40, 95% CI 0.18–0.88 for Arm 2; aIRR 0.46, 95% CI 0.21–1.01 for Arm 3). No Arm 1 effects were observed. Conclusions The RMA approach blending home visits by CHWs and gender-segregated group discussion sessions is the optimal format for increasing modern contraceptive use and decreasing IPV among married adolescents in Niger. Trial registration This trial is retrospectively registered with ClinicalTrials.gov, Identifier NCT03226730 Plain language summary Although Niger has both the highest levels of fertility and of child marriage in the world, as well as substantial gender inequity, there have been no high-quality evaluations of public health programs aiming to increase contraceptive use or decrease intimate partner violence. In this study, we conducted a high quality, randomized controlled trial to evaluate whether the Reaching Married Adolescents public health program could increase modern contraceptive use and decrease intimate partner violence among married adolescent girls (13–19 years old) and their husbands in the Dosso region of Niger. The results of this evaluation provide evidence of the value of individual home visits for wives and their husbands in increasing modern contraceptive use, the value of small group discussions in reducing intimate partner violence, and the combined value of receiving both approaches at the same time for both increasing modern contraceptive use and decreasing intimate partner violence. The current study advances the state of evidence regarding contraceptive use and IPV among married adolescents and their husbands in Niger, highlighting the importance of engaging male partners in such public health programs, as well as of using multiple modes of delivery of programs. The success of this intervention in the high-risk context of Niger suggests that other countries in the region may benefit from testing this approach to improve the health and well-being of young wives.

The purpose of this analysis was to compare and contrast reproductive health (RH), gender equity attitudes, and intimate partner violence (IPV) among married very young adolescent (VYA) girls with married older adolescent girls and young women (AGYW) in rural Niger given limited literature on the topic. We conducted an exploratory analysis of baseline data from the Reaching Married Adolescents Trial in Dosso region, Niger. We report counts and percents, by age group (13-14 years (VYA), 15-16 years, 17-19 years), of AGYW's self-efficacy to use family planning (FP), accurate knowledge of FP, current use of modern FP, and unintended last pregnancy (UIP); lifetime reproductive coercion (RC), physical IPV, and sexual IPV; and gender equity attitudes. We also assess whether percents differ between VYA and older groups using Pearson's Chi-Square and Fisher's exact p-values. Results are stratified by parity. Finally, we use logistic regression to consider associations. There were 49 VYA, 248 girls aged 15-16, and 775 AGYW aged 17-19 in our sample (n = 1072). Accurate knowledge of FP, self-efficacy to use FP, current use of modern FP, and UIP increased with age; all percents between VYA and AGYW 17-19 were marginally or statistically significantly different. We also saw VYA report higher lifetime RC and sexual IPV versus older groups, with sexual IPV statistically different between VYA and girls 17-19. Parous VYA reported a significantly higher percent of lifetime RC versus older AGYW. Among 17-19 year-olds, odds of current use of FP were higher among AGYW who reported physical IPV, and odds of UIP were higher among those reporting more gender equitable attitudes, both adjusted for parity. We observed differences in RH, RC, and sexual IPV among married VYA and older AGYW in rural Niger. VYA should be prioritized in research to confirm and further understand their RH needs.

Objective Niger has among the highest rates of child marriage and lowest rates of modern contraceptive use in the world. This study analyzes the association between contraceptive decision-making and contraceptive use among married adolescent girls in rural Niger, including multiple assessments of decision-making and consideration of overt vs. covert contraceptive use. Methods We analyzed cross-sectional survey data collected from married adolescent females (n = 823) participating in the third round of data collection (October–November 2019) for the cluster-randomized controlled trial of a family planning intervention study. Contraceptive decision-making measures assessed participants’ (a) participation in contraceptive decision-making, (b) final say in decision-making in case of spousal disagreement, and (c) satisfaction with participation in decision-making. Outcomes include contraceptive use ever categorized based on whether use was overt (with husband’s knowledge) or covert (without husband’s knowledge). Adjusted multinomial logistic regression models were used to test the associations between each decision-making item and each type of contraceptive use. Results Over half of participants reported ever using a contraceptive (59%) and that their husbands were the sole decision-makers regarding contraceptive use (60%). Adolescents’ participation in decision-making was negatively associated with overt contraceptive use (ARRR = 0.41; 95%CI = 0.19–0.91) and positively associated with covert contraceptive use (ARRR = 8.76; 95%CI = 2.45–31.30). Women reporting joint decision-making were more likely to report covert use vs. no use (ARRR = 3.20; 95%CI = 1.14–8.99). Women having final say in contraceptive decision-making in case of disagreements were more likely to report covert contraceptive use over no use (ARRR = 9.14; 95%CI = 3.17–26.40). Women’s satisfaction with decision-making was positively associated with contraceptive use ever (AOR = 2.72; 95%CI = 1.80–4.16), and overt (ARRR = 2.68; 95%CI = 1.75–4.01) and covert contraceptive use (ARRR = 10.9; 95%CI = 2.16–54.80). Conclusion Male control over decision-making and female satisfaction with decision-making are associated with greater contraceptive use. Findings indicate that women’s control over decision-making, and its relation to contraceptive use, is complex and requires more nuanced understanding for married adolescents. Plain language summary Niger is a country with one of the highest prevalence of child marriage in the world, with three in four girls marrying before the age of 18 years. Use of modern contraceptives remains low in this context with little known about the role of married adolescents in decisions regarding such use, or their control over or satisfaction with these decisions. In this study, we analyze data from a large representative sample of married adolescent girls in the Dosso region of Niger to access their participation in contraceptive decision-making, whether they or their husbands have the final say over such decisions in cases of disagreement, and how satisfied they are with the level of control they have over these decisions. In addition to describing agency regarding contraceptive use, we also assessed whether these aspects of decision-making are related to married adolescent girls’ reports of contraceptive use, and whether this use was with or without the knowledge of their husband. The results show that girls who participated in contraceptive decision-making alone or with their husbands, who had the final say in decision-making in cases of disagreement, and who reported being satisfied with their level of control over these decisions were more likely to use a contraceptive than others, but to do so without their husbands’ knowledge. The findings highlight the complexity of married adolescent girls’ reproductive autonomy in this context and indicate that measuring multiple aspects of contraceptive decision-making may advance a more nuanced understanding of their agency regarding these critical decisions.

Background The field of violence prevention research is unequivocal that interventions must target contextual factors, like social norms, to reduce gender-based violence. Limited research, however, on the social norms contributing to intimate partner violence or reproductive coercion exists. One of the driving factors is lack of measurement tools to accurately assess social norms. Methods Using an item response modelling approach, this study psychometrically assesses the reliability and validity of a social norms measure of the acceptability of intimate partner violence to exert control over wife agency, sexuality, and reproductive autonomy with data from a population-based sample of married adolescent girls (ages 13–18) and their husbands in rural Niger ( n  = 559 husband-wife dyads) collected in 2019. Results A two-dimensional Partial Credit Model for polytomous items was fit, showing evidence of reliability and validity. Higher scores on the “challenging husband authority” dimension were statistically associated with husband perpetration of intimate partner violence. Conclusions This brief scale is a short (5 items), practical measure with strong reliability and validity evidence. This scale can help identify populations with high-need for social norms-focused IPV prevention and to help measure the impact of such efforts. Plain language summary Long-term prevention of gender-based violence, like intimate partner violence and reproductive coercion, requires efforts to change the social environment that facilitates violence against women, yet limited research is available on how to change social environments. One reason is that there are few tools to accurately measure social environments, including social norms, which are the unspoken rules about what behavior is acceptable and what behavior is not. The present research assessed a new social norms measurement tool on the acceptability of intimate partner violence to exert control over wife agency, sexuality, and reproductive autonomy using data from a population-based sample of married adolescents and their husbands in rural Niger ( n  = 559 husband-wife dyads) collected in 2019. We found that this scale had strong reliability and validity, and that the group of questions about challenging husband authority were related to husband perpetration of intimate partner violence against his wife. This brief scale is a short (5 questions), practical measure with strong reliability and validity evidence that can help identify populations with high-need for social norms-focused prevention and to help measure the impact of such efforts. This evidence strengthens the current set of measurement tools on social norms available to researchers and practitioners.

Background Early marriage and early childbearing are highly prevalent in Niger with 75% of girls married before age 18 years and 42% of girls giving birth between ages 15 and 18 years. In 2012, only 7% of all 15–19-year-old married adolescents (male and female) reported use of a modern contraceptive method with barriers including misinformation, and social norms unsupportive of contraception. To meet the needs of married adolescents and their husbands in Niger, the Reaching Married Adolescents (RMA) program was developed with the goal of improving modern contraceptive method uptake in the Dosso region of Niger. Methods Using a four-arm cluster randomized control design, the RMA study seeks to assess whether household visits only (Arm 1), small group discussions only (Arm 2), or a combination of both (Arm 3), as compared to controls (no intervention – Arm 4), improve modern contraceptive method use among married adolescent girls and young women (AGYW), age 13–19 years-old, in three districts of the Dosso region. Intervention conditions were randomly assigned across the three districts, Dosso, Doutchi, and Loga. Within each district, eligible villages were assigned to either that intervention condition or to the control condition (12 intervention and 4 control per district). Across the three intervention conditions, community dialogues regarding modern contraceptive use were also implemented. Data for the study was collected at baseline (April – June 2016), at 24 months post-intervention (April – June 2018), and a final round of data collection will occur at 40 months post-intervention (October – December 2019). Discussion The RMA intervention is a gender-synchronized and community-based program implemented among married adolescent girls and their husbands in the context of rural Niger. The intervention is designed to provide education about modern contraception and to promote gender equity in order to increase uptake of modern contraceptive methods. Results from this cluster randomized control study will contribute to the knowledge base regarding the utility of male engagement as a strategy within community-level approaches to promote modern contraceptive method use in the high need context of West Africa. Trial registration Registered October 2017 - ClinicalTrials.gov NCT03226730.

Background The Republic of Niger has the highest rate of early marriage and adolescent fertility in the world. Recent global health initiatives, such as Family Planning 2020, have reinvigorated investments in family planning in low- and middle-income countries (LMICs). As part of this initiative, Niger has implemented ambitious plans to increase contraceptive prevalence through policies designed to increase coverage and access to family planning services. One strategy involves the deployment of volunteer community health workers ( relais communautaires ) in rural settings to improve access to family planning services, especially among adolescents and youth. The objective of this article is to determine if visits by relais are associated with increased use of modern contraception among young married women in rural Niger. Methods Cross-sectional data from a household survey were collected from young married women between the ages of 13 and 19 in three rural districts in the region of Dosso, Niger from May to August 2016. Multivariate logistic regression was conducted to assess the odds of married female youth reporting current use of modern contraceptive methods based on being visited by a relais in the past three months. Results A total of 956 young married women were included in the final analysis. Among study participants, 9.3% reported a relais visit to discuss health issues in the past three months and 11.4% reported currently using a modern method of contraception. Controlling for socio-demographic variables, the odds of current use of modern contraceptive methods were higher among young married women who were visited by a relais in the last three months compared to those not visited by a relais during this period (AOR = 1.94[95% CI 1.07–3.51]). In this study setting, relais were less likely to visit nulliparous women and women that worked in the past 12 months. Conclusion Young married women visited by relais were more likely to use modern contraceptive methods compared to those not visited by a relais . These results are consistent with similar family planning studies from sub-Saharan Africa and suggest that relais in Niger may be able to provide access to essential family planning services in rural and hard-to-reach areas. Additional efforts to understand the contraceptive barriers faced by nulliparous women and working women should be a key research priority in Niger. Trial registration Clinical trial registration number 2016–1430 ; registered on October 7, 2016 (retrospectively registered).

Abstract Contexte La République du Niger a le taux le plus élevé de mariages précoces et de fécondité des adolescentes du monde. Les récentes initiatives mondiales pour la santé, telles que Planification Familiale 2020 (FP2020), ont redynamisé les investissements dans la planification familiale dans les pays à revenu faible ou intermédiaire. Dans le cadre de cette initiative, le Niger a mis en œuvre des plans ambitieux pour accroître la prévalence de la contraception par le biais de politiques conçues pour accroître la couverture et l’accès aux services de planification familiale. Une des stratégies consiste au déploiement d’agents de santé communautaires volontaires (relais communautaires) en milieu rural pour améliorer l’accès aux services de planification familiale, en particulier chez les adolescents et les jeunes. L’objectif de cet article est. de déterminer si les visites à domicile conduites par des relais sont associées à une utilisation accrue de la contraception moderne chez les jeunes femmes mariées des zones rurales du Niger. Méthodes Les données transversales d’une enquête-ménages ont été collectées auprès de jeunes femmes mariées âgées de 13 à 19 ans dans trois districts ruraux de la région de Dosso, au Niger, de Mai à Août 2016. Une régression logistique multivariée a été menée pour évaluer la probabilité que les jeunes femmes mariées déclarant utiliser actuellement des méthodes contraceptives modernes après avoir été visitées par un relai au cours des trois derniers mois. Résultats Au total, 956 jeunes femmes mariées ont été incluses dans l’analyse finale. Parmi les participants à l’étude, 9,3% ont signalé une visite de relais pour discuter de problèmes de santé au cours des trois derniers mois et 11,4% ont déclaré utiliser actuellement une méthode de contraception moderne. En tenant compte des variables sociodémographiques, les probabilités d’utilisation actuelle de méthodes contraceptives modernes étaient plus élevées chez les jeunes femmes mariées visitées par un relai au cours des trois derniers mois par rapport à celles qui n’avaient pas été visitées par un relai au cours de cette période (AOR = 1,94 [95% IC 1,07-3,51]). Dans cette étude, les relais étaient moins susceptibles de rendre visite aux femmes nullipares et aux femmes ayant travaillé au cours des 12 derniers mois. Conclusion Les jeunes femmes mariées visitées par les relais étaient plus susceptibles d’utiliser des méthodes de contraception modernes que celles qui n’étaient pas visitées par les relais. Ces résultats concordent avec ceux d’études similaires sur la planification familiale menées en Afrique subsaharienne et suggèrent que les relais au Niger pourraient donner accès à des services essentiels de planification familiale dans les zones rurales et difficiles d’accès. Des efforts supplémentaires pour comprendre les barrières contraceptives rencontrées par les femmes nullipares et les travailleuses devraient constituer une priorité de recherche essentielle au Niger.