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

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          Abstract

          Background

          Despite 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 Findings

          A 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.

          Conclusions

          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 IPV in married couples.

          Trial Registration

          ClinicalTrials.gov NCT01593943

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          Most cited references 20

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          Contraceptive failure in the United States.

          This review provides an update of previous estimates of first-year probabilities of contraceptive failure for all methods of contraception available in the United States. Estimates are provided of probabilities of failure during typical use (which includes both incorrect and inconsistent use) and during perfect use (correct and consistent use). The difference between these two probabilities reveals the consequences of imperfect use; it depends both on how unforgiving of imperfect use a method is and on how hard it is to use that method perfectly. These revisions reflect new research on contraceptive failure both during perfect use and during typical use. Copyright © 2011 Elsevier Inc. All rights reserved.
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            Effectiveness of an integrated intimate partner violence and HIV prevention intervention in Rakai, Uganda: analysis of an intervention in an existing cluster randomised cohort.

            Intimate partner violence (IPV) is associated with HIV infection. We aimed to assess whether provision of a combination of IPV prevention and HIV services would reduce IPV and HIV incidence in individuals enrolled in the Rakai Community Cohort Study (RCCS), Rakai, Uganda.
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              Encouraging contraceptive uptake by motivating men to communicate about family planning: the Malawi Male Motivator project.

               Dominick Shattuck (corresponding) ,  Brad Kerner,  Kate Gilles (2011)
              We examined the effect of a peer-delivered educational intervention, the Malawi Male Motivator intervention, on couples' contraceptive uptake. We based the intervention design on the information-motivation-behavioral skills (IMB) model. In 2008 we recruited 400 men from Malawi's Mangochi province who reported not using any method of contraception. We randomized them into an intervention arm and a control arm, and administered surveys on contraceptive use at baseline and after the intervention. We also conducted in-depth interviews with a subset of intervention participants. After the intervention, contraceptive use increased significantly within both arms (P < .01), and this increase was significantly greater in the intervention arm than it was in the control arm (P < .01). Quantitative and qualitative data indicated that increased ease and frequency of communication within couples were the only significant predictors of uptake (P < .01). Our findings indicate that men facilitated contraceptive use for their partners. Although the IMB model does not fully explain our findings, our results show that the intervention's content and its training in communication skills are essential mechanisms for successfully enabling men to help couples use a contraceptive.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                11 May 2016
                2016
                : 11
                : 5
                Affiliations
                [1 ]Center on Gender Equity and Health, Division of Global Public Health, University of California San Diego School of Medicine, San Diego, CA, United States of America
                [2 ]National Institute for Research in Reproductive Health (NIRRH), Mumbai, India
                [3 ]Population Council, New Delhi, India
                [4 ]T N Medical College & B Y L Nair Ch Hospital, Mumbai, India
                University of Toronto Dalla Lana School of Public Health, CANADA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: AR JGS NS DB. Performed the experiments: MG MB SN VG. Analyzed the data: AR JR MB AD. Contributed reagents/materials/analysis tools: MG JR MB JGS. Wrote the paper: AR NS JR AD.

                [¤a]

                Current address: National Institute of Medical Statistics, New Delhi, India

                [¤b]

                Current address: Bill and Melinda Gates Foundation, New Delhi, India

                Article
                PONE-D-15-41310
                10.1371/journal.pone.0153190
                4864357
                27167981
                © 2016 Raj et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Figures: 1, Tables: 7, Pages: 20
                Product
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100000071, National Institute of Child Health and Human Development;
                Award ID: RO1HD61115
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100001407, Department of Biotechnology, Ministry of Science and Technology;
                Award ID: BT/IN/US/01/BD/2010
                Award Recipient :
                This study was supported by the National Institutes of Health, US (grant number: RO1HD61115); Department of Biotechnology, Government of India (grant #BT/IN/US/01/BD/2010). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Contraception
                Female Contraception
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Pregnancy
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Pregnancy
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Contraception
                Male Contraception
                Social Sciences
                Sociology
                Criminology
                Crime
                Violent Crime
                Intimate Partner Violence
                Medicine and Health Sciences
                Pharmacology
                Drugs
                Contraceptives
                Biology and Life Sciences
                Biotechnology
                Medical Devices and Equipment
                Contraceptives
                Medicine and Health Sciences
                Medical Devices and Equipment
                Contraceptives
                Social Sciences
                Sociology
                Human Families
                People and Places
                Geographical Locations
                Asia
                India
                Medicine and Health Sciences
                Public and Occupational Health
                Custom metadata
                Due to ethical restrictions regarding patient privacy, data are available upon request. Requests for these data can be made by emailing geh@ 123456ucsd.edu , and including in the subject line “request for CHARM data." Data are also available from Inter-university Consortium for Political and Social Research (ICPSR) (DOI: http://doi.org/10.3886/E65773V1).

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