CHARM, a gender equity and family planning intervention for men and couples in rural India: protocol for the cluster randomized controlled trial evaluation

Abstract

BackgroundGlobally, 41 % of all pregnancies are unintended, increasing risk for unsafe abortion, miscarriage and maternal and child morbidities and mortality. One in four pregnancies in India (3.3 million pregnancies, annually) are unintended; 2/3 of these occur in the context of no modern contraceptive use. In addition, no contraceptive use until desired number and sex composition of children is achieved remains a norm in India. Research shows that globally and in India, the youngest and most newly married wives are least likely to use contraception and most likely to report husband’s exclusive family planning decision-making control, suggesting that male engagement and family planning support is important for this group. Thus, the Counseling Husbands to Achieve Reproductive Health and Marital Equity (CHARM) intervention was developed in recognition of the need for more male engagement family planning models that include gender equity counseling and focus on spacing contraception use in rural India.Methods/DesignFor this study, a multi-session intervention delivered to men but inclusive of their wives was developed and evaluated as a two-armed cluster randomized controlled design study conducted across 50 mapped clusters in rural Maharashtra, India. Eligible rural young husbands and their wives (N = 1081) participated in a three session gender-equity focused family planning program delivered to the men (Sessions 1 and 2) and their wives (Session 3) by village health providers in rural India. Survey assessments were conducted at baseline and 9&18 month follow-ups with eligible men and their wives, and pregnancy tests were obtained from wives at baseline and 18-month follow-up. Additional in-depth understanding of how intervention impact occurred was assessed via in-depth interviews at 18 month follow-up with VHPs and a subsample of couples (n = 50, 2 couples per intervention cluster). Process evaluation was conducted to collect feedback from husbands, wives, and VHPs on program quality and to ascertain whether program elements were implemented according to curriculum protocols. Fidelity to intervention protocol was assessed via review of clinical records.DiscussionAll study procedures were completed in February 2015. Findings from this work offer important contributions to the growing field of male engagement in family planning, globally.Trial registrationClinicalTrial.gov, NCT01593943

“The Financial Is the Main Issue, It’s Not Even the Child”: Exploring the Role of Finances in Men’s Concepts of Fatherhood and Fertility Intention

“…Such community-based initiatives aimed at increasing the financial stability and involvement of nonresident fathers currently exist ( “Baltimore Responsible Fatherhood Project”, n.d. ; Frey, Farrell, Cotton, Lathen, & Marks, 2014 ; Martinson & Nightingale, 2008 ), as does programming that aims to challenge hegemonic masculinities ( Yore et al, 2016 ; Raj et al, 2015 ). With the exception of Wisconsin’s Lifecourse Initiative ( Frey et al, 2014 ), which focuses on increasing the intervals between children in order to reduce preterm births, it is not always clear whether or not such community-based fatherhood initiatives assist men with family planning or contraceptive knowledge and access, but a combination of such initiatives and family planning services could prove empowering for the men involved with such programming.…”

“…Family planning services in the United States are currently primarily structured for women ( Besera et al, 2016 ; Sonfield, 2002 ). While this focus on women is understandable given that they bear children and have more extensive and effective birth control options available to them, public health efforts call for engaging men in reducing unintended pregnancy risk ( Marcell et al, 2016 ; Raj et al, 2015 ; Sonfield, 2002 ; Yore et al, 2016 ), and men themselves have family planning and contraceptive service needs ( Hardee, Croce-Galis, & Jay, 2017 ). Moreover, structuring family planning services and programming for women primarily can perpetuate gender norms that position the work of pregnancy prevention as a woman’s responsibility ( Kimport, 2017 ).…”

Spousal discordance on reports of contraceptive communication, contraceptive use, and ideal family size in rural India: a cross-sectional study

“…We analyzed baseline data from non-pregnant couples ( N  = 867) participating in the CHARM (Counseling Husbands to Achieve Reproductive Health and Marital Equity Study) intervention, a family planning evaluation study conducted in Maharashtra, India [23]. …”

Understanding Men’s Elevated Alcohol Use, Gender Equity Ideologies, and Intimate Partner Violence Among Married Couples in Rural India

“…In addition, all study staff adhered to WHO guidelines for ethical research on domestic violence ( WHO, 2001 ) to ensure safety of both study participants and research staff. Note: Details on collection of baseline data (including safety measures) and the CHARM intervention study are described in full in the study protocol paper ( Yore et al, 2016 ).…”