A mixed-methods evaluation of the impact of a person-centered family planning intervention for community health workers on family planning outcomes in India

Abstract

Background Person-centered quality for family planning has been gaining increased attention, yet few interventions have focused on this, or measured associations between person-centered quality for family planning and family planning outcomes (uptake, continuation, etc.). In India, the first point of contact for family planning is often the community health care worker, in this case, Accredited Social Health Activists (ASHAs). Methods In this study, we evaluate a training on person-centered family planning as an add-on to a training on family planning provision for urban ASHAs in Varanasi, India in 2019 using mixed methods. We first validate a scale to measure person-centered family planning in a community health worker population and find it to be valid. Higher person-centered family planning scores are associated with family planning uptake. Results Comparing women who saw intervention compared to control ASHAs, we find that the intervention had no impact on overall person-centered family planning scores. Women in the intervention arm were more likely to report that their ASHA had a strong preference about what method they choose, suggesting that the training increased provider pressure. However, qualitative interviews with ASHAs suggest that they value person-centered care for their interactions and absorbed the messages from the intervention. Conclusions More research is needed on how to intervene to change behaviors related to person-centered family planning. Trial registration This study received IRB approval from the University of California, San Francisco (IRB # 15–25,950) and was retrospectively registered at clinicaltrials.gov (NCT04206527).

Provider verbal disrespect in the provision of family planning in public-sector facilities in Western Kenya

“…Further, contraceptive coercion and reproductive justice have recently garnered more thoughtful attention among scholars in high-income countries, particularly in the wake of vastly increased promotion of long-acting reversible contraception over the last decade ( American College of Obstetricians and Gynecologists’ Committee on Health Care for Underserved Women, and the Contraceptive Equity Expert Work Group, 2021 ; Gomez et al, 2014 ; Gutiérrez, 2008 ; Higgins, 2014 ; Kathawa & Arora, 2020 ; Roberts, 1997 ; Roberts and Kaplan, 2016 ; Schoen, 2005 ; Silliman et al, 2004 ). Additionally, there has been some recent effort by researchers to develop and test measures of disrespect and abuse in family planning service delivery, as part of contraceptive counseling scales ( Diamond Smith et al, 2020a , 2020b ; Holt et al, 2019 ; Sudhinaraset et al, 2018 , 2017 ). Yet, there is currently no consensus on how best to measure disrespectful and rights-violating treatment in family planning ( Harris et al, 2016 ), particularly in the context of low- and middle-income countries, and very limited evidence on how to prevent and address mistreatment in family planning service delivery ( Diamond Smith et al, 2018 ).…”

Evaluation of a gender synchronized family planning intervention for married couples in rural India: The CHARM2 cluster randomized control trial

“…CHARM2 FP content for both spouses included exploration of fertility goals and counseling on contraceptive options to achieve these goals including education regarding efficacy, risks, non-contraceptive benefits, and side effects of different types of contraceptives, and skills training and practice related to contraceptive communication and joint decision-making. For women, counseling also assessed for reproductive coercion from partners or family and used a person-centered care approach 11 , 12 , 13 , 14 in which women's choice and fertility goals were central to contraceptive decision-making, including discussion about the potential for covert contraceptive use. For men, counseling emphasized the importance of male engagement and respectful communication with wives.…”

“…We use a person-centered care approach, a proven model that places women at the center of FP decision-making, relative to the provider and the male partner. 11 , 12 , 13 , 14 , 15 This approach, which borrowed from prior reproductive coercion-focused clinical interventions with women, 16 , 17 was designed to ensure that the intervention did not just emphasize male engagement but also female reproductive agency. 4 …”

Evaluation of a Gender Synchronized Family Planning Intervention for Married Couples in Rural India: The Charm2 Cluster Randomized Control Trial

“…CHARM2 FP content for both spouses included exploration of fertility goals and counseling on contraceptive options to achieve these goals including education regarding efficacy, risks, non-contraceptive benefits, and side effects of different types of contraceptives, and skills training and practice related to contraceptive communication and joint decision-making. For women, counseling also assessed for reproductive coercion from partners or family and used a person-centered care approach [11][12][13][14] in which women's choice and fertility goals were central to contraceptive decisionmaking, including discussion about the potential for covert contraceptive use. For men, counseling emphasized the importance of male engagement and respectful communication with wives.…”