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

基本信息

批准号：
7937692
负责人：
Anita Raj
金额：
$ 37.38万
依托单位：
BOSTON UNIVERSITY MEDICAL CAMPUS
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-09-30 至 2011-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7937692
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 Surveys Testing Training Underserved Population United Nations Universities Wife Wife Abuse Woman Work aged arm 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

项目摘要

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）：印度实现替代生育国家目标的主要障碍是城乡计划生育之间的巨大差异，农村年轻妇女意外怀孕和不间隔怀孕的风险最高。这些担忧被认为是导致印度孕产妇和婴儿死亡率持续居高不下的原因。这些年轻妻子获得计划生育服务的主要障碍包括男性伴侣对生育决策的高度控制、流动性低以及村庄中获得计划生育服务的机会很少。这些调查结果证明，需要在村一级开展以男性为中心的计划生育工作，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、性别不平等意识形态和规范（例如重男轻女、虐待妻子）和婚姻沟通，因为这些因素与印度农村年轻夫妇使用避孕药具的可能性较低有关。因此，拟议的研究涉及儿童健康和负责任母亲（CHARM）计划的开发和测试，这是一个由私人乡村卫生服务提供者（VHP）提供的注重性别平等（GE）、以男性为中心的计划生育（FP）计划，通过与为印度农村地区服务的初级卫生中心 (PHC) 建立公私合作伙伴关系。在第一阶段，我们将进行形成性研究，包括绘制马哈拉施特拉邦塔那地区 Vasai 的医疗保健资源图，以确定村庄和 VHP 纳入后续研究和干预。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）进行深入访谈，并对农村年轻丈夫的母亲进行焦点小组（ n=40）。这些数据将用于开发 CHARM 计划和功效试验。第二阶段将涉及 CHARM 协议的开发和试点测试，以及对 VHP 在干预试验（第三阶段）中的作用进行培训。 CHARM 干预将涉及 VHP 提供的 GE 和 FP 咨询和服务，提供超过 3 个干预疗程 + 2 个加强疗程。第三阶段将涉及使用双臂随机对照试验设计对 CHARM 进行评估。村庄 (N=50) 将被随机分配接受 CHARM 或控制计划（标准 FP 转诊至位于村庄外的政府公共卫生中心 [PHC]），以评估治疗对间隔避孕药具使用、怀孕和未满足的计划生育的影响需要。干预效果将通过手持电脑（PDA）上收集的农村年轻丈夫（18-30岁）及其妻子（N=1500对夫妇，每个村庄30对夫妇）在基线和6,12和18上收集的行为调查来评估一个月的随访，以及妻子的妊娠测试，在基线和 18 个月的随访中进行。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，以评估计划的遵守情况、参与率、对计划的反应以及实施的难易程度。还将对村庄和公共卫生系统的主要知情人进行深入访谈，以评估该模式的可持续性和制度化。