Evaluation of a gender synchronized family planning intervention for married couples in rural India: The CHARM2 cluster randomized control trial

Raj, Anita; Ghule, Mohan; Johns, Nicole E.; Battala, Madhusudana; Begum, Shahina; Dixit, Anvita; Vaida, Florin; Saggurti, Niranjan; Silverman, Jay G.; Averbach, Sarah

doi:10.1016/j.eclinm.2022.101334

Cited by 8 publications

(21 citation statements)

References 33 publications

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“…The full intervention was received by 87.5% of participants, and an additional 7.3% of women and 5.3% of men received the intervention in part (See Fig 1 ). Further details on the study rationale, setting, methods, sampling, and intervention are available elsewhere [ 21 , 22 ].…”

Section: Methodsmentioning

confidence: 99%

“…Sessions were 20–40 minutes. More details on the intervention are available elsewhere [ 21 , 22 ]. Two sessions of the CHARM2 intervention (one session each for men and women) had content on sexual violence.…”

Section: Methodsmentioning

confidence: 99%

“…These include baseline measures of religion, wife living in the same household as her mother-in-law, wife and husband age, wife age at marriage, wife parity, having a living son, scheduled tribe/scheduled caste designation, and poverty status. More details are available in the primary trial paper [ 22 ]. We used Stata 17 [ 29 ] for data analysis, and all comparisons were assessed at the 5% significance level.…”

Section: Methodsmentioning

confidence: 99%

“…CHARM2 added two female-only counselling sessions (delivered by female health providers) in parallel to the two male-only sessions provided in the original CHARM intervention, followed by a joint session for the couples [ 21 ]. In a cluster randomised controlled trial, CHARM2 increased modern contraceptive use, communication, and contraceptive agency [ 22 ]. This study assesses the impact of CHARM2 on GE-related indicators, including IPV, RC, women’s and men’s attitudes towards physical violence, women’s and men’s self-reported marital quality, and men’s attitudes towards gender norms.…”

Section: Introductionmentioning

confidence: 99%

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Assessing the impact of CHARM2, a family planning program on gender attitudes, intimate partner violence, reproductive coercion, and marital quality in India

Chatterji,

Johns,

Ghule

et al. 2024

PLOS Glob Public Health

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Using a two-armed cluster randomised controlled trial, CHARM2 (Counselling Husbands to Achieve Reproductive health and Marital equity), a 5-session gender equity and family planning intervention for couples in rural India, showed an impact on family planning outcomes in primary trial analyses. This study examines its effects on gender-equitable attitudes, intimate partner violence, reproductive coercion, and marital quality. We used multilevel mixed-effects models to assess the intervention impact on each outcome. Both male (aIRR at 9 months: 0.64, C.I.: 0.45,0.90; aIRR at 18 months: 0.25, C.I.: 0.18,0.39) and female (aIRR at 9 months: 0.57, C.I.: 0.46,0.71; aIRR at 18 months: 0.38, C.I.: 0.23,0.61) intervention participants were less likely than corresponding control participants to endorse attitudes accepting physical IPV at 9- and 18-month follow-ups. Men in the intervention, compared to those in the control condition, reported more gender-equitable attitudes at 9- and 18 months (ß at 9 months: 0.13, C.I.: 0.06,0.20; ß at 18 months: 0.26, C.I.: 0.19,0.34) and higher marital quality at the 18-month follow-up (ß: 0.03, C.I.: 0.01,0.05). However, we found no effects on women’s experiences of IPV, reproductive coercion, or marital quality. CHARM2 shows promise in improving men’s and women’s attitudes towards gender equality and male perceptions of marital quality. Still, IPV and reproductive coercion reductions may require more intensive programming than that provided within this 5-session model focused on family planning.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Assessing the impact of CHARM2, a family planning program on gender attitudes, intimate partner violence, reproductive coercion, and marital quality in India

Chatterji,

Johns,

Ghule

et al. 2024

PLOS Glob Public Health

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“…Details on the original study are available elsewhere (Raj et al. 2022). Our research team asked participants of the CHARM2 18‐month follow‐up survey if they would be open to participation in additional studies in the future, and 90 percent of them agreed to participate in future studies.…”

Section: Methodsmentioning

confidence: 99%

Validation of the Fertility Norms Scale and Association with Fertility Intention and Contraceptive Use in India

Bhan

Johns

Chatterji

et al. 2023

Studies in Family Planning

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Social norms related to fertility may be driving pregnancy desire, timing and contraceptive use, but measurement has lagged. We validated a 10‐item injunctive Fertility Norms Scale (FNS) and examined its associations with family planning outcomes among 1021 women and 1020 men in India. FNS captured expectations around pronatalism, childbearing early in marriage and community pressure. We assessed reliability and construct validity through Cronbach's alpha and exploratory factor analysis (EFA) respectively, examining associations with childbearing intention and contraceptive use. FNS demonstrated good reliability (α = 0.65–0.71) and differing sub‐constructs by gender. High fertility norm among women was associated with greater likelihood of pregnancy intention [RRR = 2.35 (95% CI: 1.25,4.39); ARRR = 1.53 (95% CI: 0.70,3.30)], lower likelihood of delaying pregnancy [RRR = 0.69 (95% CI: 0.50,0.96); ARRR = 0.72 (95% CI: 0.51,1.02)] and greater ambivalence on delaying pregnancy [RRR = 1.92 (95% CI: 1.18,3.14); ARRR = 1.99 (95% CI: 1.21,3.28)]. Women's higher FNS scores were also associated with higher sterilization [RRR = 2.17 (95% CI: 1.28,3.66); ARRR = 2.24 (95% CI: 1.32,3.83)], but the reverse was noted for men [RRR = 0.61 (95% CI: 0.36,1.04); ARRR = 0.54 (95% CI: 0.32,0.94)]. FNS indicated better predictive value among women compared to men for key reproductive outcomes. This measure may be useful for social norms‐focused evaluations in family planning and warrants cross‐contextual study.

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Understanding quality of contraceptive counseling in the CHARM2 gender-equity focused family planning intervention: Findings from a cluster randomized controlled trial among couples in rural India

Averbach¹,

Johns²,

Ghule³

et al. 2023

Contraception

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Evaluation of a gender synchronized family planning intervention for married couples in rural India: The CHARM2 cluster randomized control trial

Cited by 8 publications

References 33 publications

Assessing the impact of CHARM2, a family planning program on gender attitudes, intimate partner violence, reproductive coercion, and marital quality in India

Assessing the impact of CHARM2, a family planning program on gender attitudes, intimate partner violence, reproductive coercion, and marital quality in India

Validation of the Fertility Norms Scale and Association with Fertility Intention and Contraceptive Use in India

Understanding quality of contraceptive counseling in the CHARM2 gender-equity focused family planning intervention: Findings from a cluster randomized controlled trial among couples in rural India

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