Contraceptive uptake after a couples counseling intervention with community health workers: a cluster randomized trial

Abstract

Objectives: We aimed to evaluate whether training health surveillance assistants (HSAs) in couples counseling would increase contraceptive uptake among young women. Methods: In this cluster randomized controlled trial, 30 HSAs based at Area 25 Health Center in Lilongwe, Malawi, received training in family planning, including provision of condoms, pills and the injectable. They were then randomized to receive or not receive additional training in couples counseling for family planning. All HSAs were asked to provide family planning counseling to sexually active young women who had never used family planning and record their contraceptive uptake. Generalized estimating equations with an exchangeable correlation matrix to account for clustering by HSA were used to estimate risk differences (RDs) and 95% confidence intervals (CIs). Results: Some 808 women received family planning counseling from the HSAs; 430 (53%) from the 15 HSAs who received couples counseling training and 378 (47%) from the 15 HSAs who did not. Some 115 (26%) women from the couples counseling group had male partners present during their first visit, compared with only 6 (2%) from the other group (RD: 0.21; 95% CI, 0.09–0.33; p<.01); 796 women (98%) received a short-term contraceptive method, with no significant difference between the two groups (p=.25). Women in the couples counseling group were 8% more likely to accept condoms (95% CI, −7 to 23%; p=.20) Conclusions: Training HSAs in family planning led to high contraceptive uptake among young women who had never used family planning. Couples counseling training increased male involvement with a trend toward higher condom uptake.