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

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

Longitudinal associations of intimate partner violence attitudes and perpetration: Dyadic couples data from a randomized controlled trial in rural India

“…Importantly we found a striking difference between Wave 1 and Waves 2 in the IPV acceptance scores for both men and women. IPV acceptance dropped by close to 40% for both men and women between Wave 1 and Wave 2, and while this drop was greater for the intervention group, it was significant in the control group as well (see (Raj et al, 2016) for more details on intervention versus control main effect). Notably, while the acceptability of IPV decreased across all groups between Wave 1 and Waves 2, the reported IPV almost doubled for both intervention and control (though the overall rate was significantly less for the intervention group).…”

“…Of those whose wives reported IPV in Wave 1 or Wave 2; however, there was little if any difference in Wave 3 reporting between treatment and control, suggesting that much of the utility of the intervention was in preventing new IPV as opposed to reducing existing IPV. This may be why the significance of the main effect in reducing physical IPV was just slightly less than statistically significant (Raj et al, 2016). In SA Table 5, we look at the trend in men’s IPV attitudes across waves, by treatment group, and IPV reporting category.…”

“…Data for this study was collected as part of the CHARM intervention, a randomized controlled trial evaluating a family planning plus gender equity counseling intervention for husbands and couples which has been described in detail in a previous publication (Raj et al, 2016; Yore et al, 2016). …”

“…In this paper, we use 3 waves of longitudinal data from a randomized controlled trial of married couples in rural India which tested CHARM, a family planning and gender equity counseling intervention tailored to husbands and couples in rural India (Yore et al, 2016). The trial successfully reduced men’s acceptance of IPV in the intervention compared to the control, while there was an insignificant treatment effect on women’s reports of physical IPV (Raj et al, 2016). By using longitudinal data from this study, we can begin to untangle whether attitudes of acceptance of physical IPV, for women and men, are associated with women’s reports of physical IPV, cross-sectionally and over time, and whether these associations differ across treatment and control group.…”

Collecting family planning intentions and providing reproductive health information using a tablet-based video game in India

“…We sought to reach both female and male adolescents because previous studies have shown that family planning initiatives are more successful when both males and females are involved. 8 …”