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

基本信息

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
项目类别：
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&apos 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

项目摘要

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.

全球范围内，41% 的怀孕是意外怀孕，这增加了孕产妇和婴儿发病的风险，大多数意外怀孕是在未使用或避孕失败的情况下发生的。丈夫不支持避孕的更有可能报告不使用避孕药具，并且遭受性虐待的丈夫的女性更有可能报告避孕失败。强调需要男女都参与的计划生育 (FP) 干预措施，重点关注消除婚姻性暴力（MSV）并促进使用有效（失败风险低）的间隔避孕法包括长效可逆避孕（LARC；例如印度农村地区的宫内节育器或宫内节育器）。全球避孕率最低和婚姻暴力发生率最高的一些国家提供了测试此类干预措施的重要背景，具有该团队先前的研究成果。记录原始 CHARM 干预措施的承诺，即性别平等 (GE) FP 干预措施这项干预措施改善了避孕措施。使用 MSV 并降低其可能性，但意外怀孕的情况并没有减少；男性 (91%) 的参与度较高，但夫妻 (51%) 的参与度较低，这主要是由于女性的参与对男性提供者的不适感难以接触到女性并且仅提供短效避孕药具。（药丸、避孕套）更容易避孕失败，可能会导致意外怀孕基于这些发现，我们提出了 CHARM2，其中包括针对男性和女性的 CHARM 课程。平行的以女性为中心的 GE+FP 会议由女性提供者主持，并包含更广泛的内容避孕选择，包括 LARC 本研究旨在 a) 实施 CHARM2，b) 评估其对印度农村夫妇的避孕药具使用、意外怀孕和 MSV，以及 c) 评估其使用实施科学方法评估印度农村可持续发展的潜力。 CHARM2 根据我们感兴趣的结果，将进行一项两组随机对照试验来自农村 50 个地理集群的 N=1000 对已婚夫妇（每个集群 n=20 对夫妇）印度马哈拉施特拉邦，参与者将接受 CHARM2 或护理控制条件标准，其中涉及社区卫生工作者提供药丸/避孕套并将妇女与公共卫生诊所联系起来。通过基线妊娠测试和调查以及 9 和 18 个月的随访进行评估。将使用科学方法来评估 CHARM2 的质量、可扩展性和可复制性，以供具体来说，将进行深入访谈。 CHARM2 干预夫妇 (n=50) 和提供者 (n=20) 将与关键人物一起进行焦点小组讨论；来自州、国家和国际计划生育和农村卫生基础设施的利益攸关方水平（n = 50），我们将对CHARM2进行成本效益分析。