Development, Testing and Health Effects of a Multilevel Family Planning Intervention

摘要 2018年，乌干达32.6%的育龄妇女的计划生育需求未得到满足，这意味着她们 想要避免怀孕，但没有使用现代避孕方法。填补未得到满足的需求 计划生育具有重要的公共卫生影响，包括减少与怀孕有关的健康风险。 死亡和婴儿死亡率。虽然乌干达正在加大力度减少农村地区的供给侧障碍 在避孕药具社区发放等领域，夫妻双方仍面临多层次的需求方 避孕措施的使用障碍。除了错误信息和对避孕副作用的恐惧之外，关系 动态、同伴和家庭影响，以及更广泛的社区规范，促进大家庭和传统 性别角色影响计划生育。我们建议开发和试运行一个多层次的、以社区为基础的 干预，它利用变革性的社区对话来改变个人的态度和认知 不鼓励计划生育的社区规范。社区对话被传递给一群情侣 超过4次会议，以同时讨论家庭的个人和人际层面的决定因素 计划并将夫妇与计划生育服务联系起来。我们项目的目标是：1)开发一种多功能的 水平干预，让夫妇参与变革性的社区对话，以减少意外 通过增加现代避孕措施的使用来怀孕。我们将通过定性的方式开展干预 与有未得到满足需求的妇女和男子以及社区利益攸关方进行研究，并通过形成 社区干预指导委员会；目标2)进行试点准实验对照试验 夫妇(干预n=35，对照n=35)，将一个村随机分为多层次干预组(n=35 夫妇)和1个村(n=35对夫妇，注意匹配对照干预)。我们会 评估试验程序(目标2a)和干预内容(目标2b)的可接受性和可行性， 评估干预措施对避孕药具摄取和延续的潜在效果的探索性目标(2c) 和中间结果(知识、态度、感知的社区规范、合作伙伴沟通和 股权)通过6个月的跟踪调查。

Abstract In 2018, 32.6% of women of reproductive age had an unmet need for family planning in Uganda, meaning they wanted to avoid pregnancy but were not using a modern contraceptive method. Filling the unmet need for family planning has important public health implications, including reductions in pregnancy-related health risks and deaths, and infant mortality. While Uganda is scaling up efforts to reduce supply-side barriers in rural areas, such as community distribution of contraceptives, couples are still faced with multi-level demand-side barriers to contraceptive use. In addition to misinformation and fear of contraceptive side-effects, relationship dynamics, peer and family influence, and broader community norms promoting large family size and traditional gender roles influence family planning. We propose to develop and pilot test a multi-level, community-based intervention, which employs transformative community dialogues to alter individual attitudes and the perception of community norms that discourage family planning. Community dialogues are delivered to groups of couples over 4-sessions enhanced to simultaneously address individual and interpersonal-level determinants of family planning and link couples to family planning services. The aims of our project are to: Aim 1) Develop a multi- level intervention that engages couples in transformative community dialogues to reduce unintended pregnancy by increasing modern contraceptive use. We will develop the intervention through qualitative research with women and men with an unmet need and community stakeholders and through the formation of a community intervention steering committee; Aim 2) Conduct a pilot quasi-experimental controlled trial with 70 couples (intervention n=35, control n=35), randomizing one village to the multi-level intervention (n=35 couples) and one village to the control condition (n=35 couples, attention-matched control intervention). We will assess acceptability and feasibility of the trial procedures (Aim 2a) and intervention content (Aim 2b), with the exploratory aim (2c) of assessing the intervention's potential efficacy on contraceptive uptake and continuation and intermediate outcomes (knowledge, attitudes, perceived community norms, partner communication and equity) through 6-month follow up.