Journal Article

Cluster Randomized Controlled Trial Evaluation of a Gender Equity and Family Planning Intervention for Married Men and Couples in Rural India

Ghule, Mohan, Nair, Saritha, Dasgupta, Anindita, Balaiah, Donta, Gajanan, Velhal, Battala, Madhusudana, Saggurti, Niranjan, Ritter, Julie, Silverman, Jay G., Raj, Anita

2016

Overview

Despite ongoing recommendations to increase male engagement and gender-equity (GE) counseling in family planning (FP) services, few such programs have been implemented and rigorously evaluated. This study evaluates the impact of CHARM, a three-session GE+FP counseling intervention delivered by male health care providers to married men, alone (sessions 1&2) and with their wives (session 3) in India. A two-armed cluster randomized controlled trial was conducted with young married couples (N = 1081 couples) recruited from 50 geographic clusters (25 clusters randomized to CHARM and a control condition, respectively) in rural Maharashtra, India. Couples were surveyed on demographics, contraceptive behaviors, and intimate partner violence (IPV) attitudes and behaviors at baseline and 9 &18-month follow-ups, with pregnancy testing at baseline and 18-month follow-up. Outcome effects on contraceptive use and incident pregnancy, and secondarily, on contraceptive communication and men's IPV attitudes and behaviors, were assessed using logistic generalized linear mixed models. Most men recruited from CHARM communities (91.3%) received at least one CHARM intervention session; 52.5% received the couple's session with their wife. Findings document that women from the CHARM condition, relative to controls, were more likely to report contraceptive communication at 9-month follow-up (AOR = 1.77, p = 0.04) and modern contraceptive use at 9 and 18-month follow-ups (AORs = 1.57-1.58, p = 0.05), and they were less likely to report sexual IPV at 18-month follow-up (AOR = 0.48, p = 0.01). Men in the CHARM condition were less likely than those in the control clusters to report attitudes accepting of sexual IPV at 9-month (AOR = 0.64, p = 0.03) and 18-month (AOR = 0.51, p = 0.004) follow-up, and attitudes accepting of physical IPV at 18-month follow-up (AOR = 0.64, p = 0.02). No significant effect on pregnancy was seen. Findings demonstrate that men can be engaged in FP programming in rural India, and that such an approach inclusive of GE counseling can improve contraceptive practices and reduce sexual IPV in married couples. ClinicalTrials.gov NCT01593943.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adult / Aggression / Attitudes / Behavior / Biology and Life Sciences / Birth control / Clinical trials / Clusters / Communication / Contraceptives / Councils / Counseling / Couples / Demographic aspects / Demographics / Demography / Domestic violence / Fairness / Families & family life / Family planning / Family Planning Services / Family therapy / Female / Gender / Gender equality / Gender equity / Gender inequality / Global health / Health care / Health care industry / Health care policy / Health services / HIV / Households / Human immunodeficiency virus / Humans / Husbands / India / Intervention / Intimate partner violence / Male / Males / Marriage / Married couples / Married men / Maternal child nursing / Medical personnel / Medicine / Medicine and Health Sciences / Men / Mens health / People and Places / Physiological aspects / Population / Pregnancy / Program implementation / Public health / Randomization / Registration / Reproductive health / Rural areas / Rural Population / Social aspects / Social Sciences / Spouses / Statistical models / Surveys / Transportation services / Violence / Wives / Women / Womens health / Young Adult