Gender Equity-Focused, Male-Centered Family Planning for Rural India

印度农村地区注重性别平等、以男性为中心的计划生育

• 批准号: 7672884
• 负责人: Anita Raj
• 金额: $ 37.49万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7672884
• 关键词: Academia; Address; Adherence; Adolescent; Age; Attitude; Behavior; Behavioral; Boston; Child; Child health care; Clinical; Clinical Trials Design; Collaborations; Communication; Contraceptive Agents; Contraceptive Usage; Contraceptive methods; Counseling; Couples; Currently Married; Data; Decision Making; Development; Evaluation; Family Planning; Family Planning Center; Family Planning Programs; Family Sizes; Feedback; Female Sterilization; Fertility; Fertility Rates; Focus Groups; Funding; Gender; Gender Role; Goals; Government; Handheld Computers; Health; Health Personnel; Health system; Healthcare; Healthcare Systems; High Risk Woman; Hospitals; Husband; India; Infant Mortality; Institutes; Institution; Institutionalization; International; Intervention; Intervention Trial; Interview; Knowledge; Link; Maps; Marriage; Maternal and Child Health; Methods; Modeling; Mothers; Outcome; Participant; Phase; Population; Populations at Risk; Pregnancy; Pregnancy Tests; Procedures; Process; Protocols documentation; Provider; Public Health; Public Health Schools; Randomized; Randomized Controlled Trials; Recruitment Activity; Relative (related person); Reporting; Reproductive Health; Research; Research Institute; Resources; Role; Rural; Rural Health; Rural Population; Scientist; Services; Social Sciences; Son; Sterilization for infection control; Surveys; Testing; Training; Underserved Population; United Nations; Universities; Upper arm; Wife; Wife Abuse; Woman; Work; aged; base; condoms; design; efficacy trial; experience; follow-up; improved; informant; intervention effect; intimate partner violence; male; medical schools; meetings; men; neglect; pill; population based; preference; pregnant; programs; public-private partnership; reproductive; response; rural area; service utilization; social; standard of care; young mother

DESCRIPTION (provided by applicant): 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.

描述（由申请人提供）：印度实现其替代生育目标的主要障碍是城市和农村计划生育之间的巨大差异，农村年轻妇女面临着计划外和未赛车的最高风险。这些担忧被认为可以推动印度持续且无法接受的孕产妇死亡率率高。这些年轻妻子对计划生育服务的收购的主要障碍包括高男性伴侣控制生殖决策，流动性低以及在村庄中对计划生育服务的机会很低。这样的发现记录了在村庄一级提供以男性为中心的计划生育工作的需求，以更好地满足农村年轻妻子的需求。这些以男性为中心的努力必须解决男性性别角色和性别不平等意识形态和规范（例如，儿子的偏爱，妻子虐待）和婚姻交流，因为这些因素与农村年轻印度夫妇在避孕症中使用的可能性较低有关。因此，拟议的研究涉及对儿童健康和负责任的母亲（Charm）计划的发展和测试，该计划是由私人乡村健康提供商（VHPS）提供的，以男性为中心的，以男性为中心的，以男性为中心的，以男性为中心的计划（FP）计划，通过与印度农村服务的主要健康中心（PHCS）通过公共私人伙伴关系。在第1阶段，我们将进行形成性研究，包括在马哈拉施特拉邦塔那（Thane）区内对Vasai的医疗保健资源制图，以识别村庄和VHP，以纳入随后的研究和干预措施。我们还将对农村年轻丈夫（n = 30），农村年轻妻子（n = 20）和医疗保健提供者（n = 12）进行深入的采访，以及与农村年轻丈夫母亲（n = 40）的焦点小组。这些数据将用于制定魅力计划和功效试验。第2阶段将涉及魅力方案的开发和试验测试以及VHP在干预试验中的作用（第3阶段）。魅力干预措施将涉及VHP分配的GE和FP咨询和服务，并进行了3次干预课程 + 2个助推器会议。第3阶段将使用两臂随机对照试验设计进行评估。村庄（n = 50）将被随机接收魅力或控制计划（标准FP转介到村庄外的政府公共卫生中心[PHCS]），以评估治疗对间距避孕药的影响，怀孕和未满足的计划生育需求的影响。将通过与农村年轻丈夫（18-30岁）的手持计算机（PDA）收集的行为调查评估干预效果，其妻子（n = 1500对夫妻，每一个村庄30对夫妇），6,12和18个月的随访，以及在基线和18个月的妊娠测试中进行的18个月随访。将通过对研究参与者和VHP的访谈以及VHP观察和临床记录审查来进行过程评估，以评估计划的依从性，参与率，对计划的响应和易于交付。还将与来自村庄以及公共和农村卫生系统的重要线人进行深入的访谈，以评估该模型的可持续性和制度化。