Enhancing male participation in interventions to prevent unintended pregnancy

加强男性参与预防意外怀孕的干预措施

• 批准号: 9547690
• 负责人: Anita Raj
• 金额: $ 54.03万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-01 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9547690
• 关键词: Academia; Clinic; Collaborations; Community Health Aides; Community Outreach; Contraceptive Agents; Contraceptive Usage; Contraceptive methods; Cost Effectiveness Analysis; Counseling; Couples; Evaluation; Evaluation Research; Failure; Family Planning; Female; Focus Groups; Funding; Geography; Government; Health; Health Personnel; Health Planning; Health system; Healthcare Systems; Husband; India; Injectable; International; Intervention; Intervention Studies; Interview; Intrauterine Devices; Light; Link; Methods; Modeling; Modernization; Neonatal; Nurse Midwives; Nurses; Nurses' Aides; Oral Contraceptives; Outcome; Participant; Population; Pregnancy Outcome; Pregnancy Tests; Provider; Public Health; Publications; Randomized Controlled Trials; Reporting; Research; Research Infrastructure; Resources; Risk; Risk Factors; Rural; Rural Health; Safety; Sexual Health; Surveys; Testing; USAID; United States National Institutes of Health; United States Public Health Service; Woman; Work; World Health; arm; base; condoms; cost; effective intervention; follow-up; gender equity; implementation science; improved; infant morbidity/mortality; innovation; interest; male; male health; marital violence; maternal morbidity; men; pill; preference; prevent; reproductive; reproductive health intervention; reversible contraceptive; sex; sexual violence; standard of care; success; trial comparing; unintended pregnancy; uptake; young woman

Globally, 41% of all pregnancies are unintended, increasing risk for maternal and infant morbidities and mortality. Most unintended pregnancies occur in the context of contraceptive non-use or failure. Women with husbands not supportive of contraception are more likely to report contraceptive non-use, and women with sexually abusive husbands are more likely to report contraceptive failure. Such findings highlight the need for family planning (FP) interventions that engage both women and men, focus on eliminating marital sexual violence (MSV) and promote use of effective (low failure risk) spacing contraception including long-acting reversible contraception (LARC; e.g. intrauterine device or IUD). Rural India, with some of the lowest rates of contraception and highest rates of marital violence globally, offers an important context in which to test such interventions, with global implications. Prior research from this team documents promise of the original CHARM intervention, a gender equity (GE) FP intervention engaging men and delivered by male health providers over three months. This intervention improved contraceptive use and reduced likelihood of MSV, but demonstrated no reduction in unintended pregnancy; additionally, it demonstrated good participation from men (91%) but less from couples (51%), largely due to women’s discomfort with a male provider. Poor reach to women and provision of only short-acting contraceptives (pill, condom) more vulnerable to contraceptive failure, likely compromised unintended pregnancy outcomes. Based on these findings, we propose CHARM2, which will include CHARM sessions for men AND parallel women-focused GE+FP sessions delivered by a female provider and inclusive of broader contraceptive options, including LARC. This study seeks a) to implement CHARM2, b) to evaluate its impact on contraceptive use, unintended pregnancy, and MSV with rural couples in India, and c) to assess its potential for sustainability in rural India, using implementation science methods. To evaluate the impact of CHARM2 on our outcomes of interest, a two armed cluster randomized controlled trial will be conducted with N=1000 married couples from 50 geographic clusters (n=20 couples per cluster) in rural Maharashtra, India. Participants will receive CHARM2 or the standard of care control condition, which will involve community health workers offering pills/condoms and linking women to public health clinics. Outcomes will be assessed via pregnancy testing and surveys at baseline and 9&18-month follow-ups. Implementation science methods will be used to assess the quality, scalability, and replicability of CHARM2 for uptake by rural health care systems (i.e., sustainability). Specifically, in-depth interviews will be conducted with CHARM2 intervention couples (n=50) and providers (n=20); focus groups will be conducted with key stakeholders from the family planning and rural health infrastructures at state, national and international levels (n=50), and we will implement a cost-effectiveness analysis of CHARM2.

在全球范围内，所有妊娠中有41％是意外的，增加了生物和婴儿病毒的风险 死亡。大多数意外怀孕发生在避孕不使用或失败的背景下。女性 由于丈夫不支持避孕，更有可能报告避孕不使用，并且 有性虐待丈夫的妇女更有可能报告避孕失败。这样的发现 强调需要与男女互动的计划生育（FP）干预措施的需求 消除婚姻暴力（MSV）并促进使用有效的（低失败风险）间距的使用 包括长效可逆违反（LARC；例如宫内装置或宫内节育器）。印度农村，有 全球避孕速度最低和最高的婚姻暴力率最低，提供了一个 在全球影响中测试这种干预措施的重要背景。该团队的事先研究 文件承诺原始魅力干预，性别平等（GE）FP干预参与 男性并由男性健康提供者在三个月内交付。这种干预改善了避孕药 使用和降低MSV的可能性，但表现出意外怀孕没有降低；此外， 它表现出了男性的良好参与（91％），但夫妻却少得多（51％），这主要是由于女性 男性提供者不适。妇女的范围不佳，仅提供短效避孕药具 （药丸，避孕套）更容易遭受避孕失败，可能会损害意外怀孕 结果。根据这些发现，我们提出了Charm2，其中包括男人的魅力会议和 由女性提供者提供的，以女性为中心的GE+FP会话，包括更广泛 避孕选择，包括LARC。这项研究旨在a）实施Charm2，b）评估其对 避孕药使用，意外怀孕和与印度粗糙夫妇的MSV，以及c）评估其 使用实施科学方法，印度农村可持续发展的潜力。评估 Charm2关于我们感兴趣的结果，将进行两次武装集群随机对照试验 n = 1000对已婚夫妇，来自50个地理集群（每个集群n = 20对夫妇） 印度马哈拉施特拉邦。参与者将获得Charm2或护理控制条件的标准，这将涉及 提供药丸/避孕套并将妇女与公共卫生诊所联系起来的社区卫生工作者。结果会 在基线和9个月的随访中通过妊娠测试和调查进行评估。执行 科学方法将用于评估Charm2的质量，可伸缩性和可复制性以吸收 农村卫生保健系统（即可持续性）。具体而言，将与 Charm2干预夫妇（n = 50）和提供者（n = 20）;焦点小组将以关键进行 州，国家和国际的计划生育和粗糙健康基础设施的利益相关者 水平（n = 50），我们将对Charm2进行成本效益分析。