Abstract
BackgroundDespite 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.Methods and FindingsA 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.ConclusionsFindings 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.Trial RegistrationClinicalTrials.gov NCT01593943
Highlights
An estimated 153 million women contend with unmet need for family planning (FP); more than one in five of these women reside in India [1]
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 intimate partner violence (IPV) in married couples
The current study evaluates CHARM [Counseling Husbands to Achieve Reproductive health and Marital equity], a three-session gender equity and family planning
Summary
An estimated 153 million women contend with unmet need for family planning (FP); more than one in five of these women reside in India [1]. Awareness of modern spacing contraceptives, i.e., contraceptives designed to impede fertility on a reversible basis, is high in India, even among young, less educated and rural women, and availability of these contraceptives at low and no cost through India’s public health care system is well understood [2]. Research from India indicates that family planning programs often attempt to reach young wives only after they reach their family size goal, despite indications that demand for contraceptive use to delay first pregnancy is high [3]. 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
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