The major barrier to India meeting its national goal of replacement fertility is the huge discrepancy between urban and rural family planning, with rural young women at highest risk for unplanned and unspaced pregnancies. These concerns are considered to drive the persistent and unacceptably high rates of maternal and infant mortality in India. Major impediments to these young wives' acquisition of family planning services include high male partner control over reproductive decision-making, low mobility, and very low access to family planning services in villages. Such findings document the need for male-centered family planning efforts available at the village level, to better meet the needs of rural young wives. These male-centered efforts must address male gender role and gender inequity ideologies and norms (e.g., son preference, wife abuse) and marital communication, as these factors are associated with lower likelihood of contraceptive use in rural young Indian couples. Hence, the proposed study involves development and testing of the Children's Health and Responsible Mothering (CHARM) Program, a gender equity (GE)-focused, male-centered family planning (FP) program delivered by private village health providers (VHPs), via a public-private partnership with primary health centers (PHCs) serving rural India. In Phase 1 we will conduct formative research including health care resource mapping of Vasai within the Thane district of Maharashtra to identify villages and VHPs for inclusion in subsequent research and intervention. We will also conduct in-depth interviews with rural young husbands (n=30), rural young wives (n=20), and health care providers (n=12), as well as focus groups with mothers' of rural young husbands (n=40). These data will be used to develop the CHARM program and efficacy trial. Phase 2 will involve development and pilot testing of CHARM protocols and training of VHPs for their role in the intervention trial (Phase 3). The CHARM intervention will involve VHP-delivered GE and FP counseling and services, delivered over 3 intervention sessions + 2 booster sessions. Phase 3 will involve evaluation of CHARM, using a two-armed randomized controlled trial design. Villages (N=50) will be randomized to receive either CHARM or the control program (standard FP referral to government public health centers [PHCs] located outside of villages), to assess treatment impact on spacing contraceptive use, pregnancy, and unmet family planning need. Intervention effects will be assessed via behavioral surveys collected on hand-held computers (PDAs) with rural young husbands (18-30 years) and their wives (N=1500 couples, 30 couples per village) at baseline and 6,12, and 18 month follow-up, as well as pregnancy tests from wives, conducted at baseline and 18 month follow-up. A process evaluation will be undertaken via interviews with study participants and VHPs, as well as through VHP observations and clinical record review, to assess program adherence, participation rates, response to program, and ease of delivery. In-depth interviews will also be conducted with key informants from the village and public and rural health systems to assess sustainability and institutionalization of the model.
Rural young wives in India are not obtaining contraception due to very low accessibility of family planning services in Indian villages and husbands'control of their mobility and reproductive decision-making. The proposed study seeks to address these concerns via development and testing of the CHARM Program, a gender equity (GE)-focused, male-centered family planning (FP) program delivered by private village health providers (VHPs), via a public-private partnership with primary health centers (PHCs) serving rural India. Evaluation of the CHARM intervention will involve randomization of villages (N=50) to receive either CHARM or the control program (standard FP referral to government primary health centers [PHCs] located outside the study villages), with the goal of assessing treatment impact on spacing contraceptive use, pregnancy, and unmet family planning need among young rural men aged 18-30 years and their wives (N=1500 couples, 30 couples per village), studied over 18 months.
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