Use of community-based interventions to promote family planning use among pastoralist women in Ethiopia: cluster randomized controlled trial

Abstract

Background Afar region is one of the pastoralist dominated regions in Ethiopia. The region is characterized by a low contraceptive prevalence rate (CPR) of 5.4%. Lack of awareness of contraceptive use, husband objection and religious barriers are attributed to low CPR in the region. This study assessed the effect of community-based interventions for promoting family planning (FP) use among pastoralist communities in Ethiopia. Methods The study design was a three-arm, parallel, clustered randomized controlled trial (CRT). The three study arms were: (1) male involvement in family planning (FP) education; (2) women’s education on FP; and (3) control. A total of 33 clusters were randomized and allocated with a one-to-one ratio. Intervention components included (1) health education on FP to married women and men by faema leaders (a traditional community-based structure that serves as a social support group); (2) video-assisted message on FP; and (3) assisting the faema leader using health workers and health extension workers (HEWs). The intervention was given for a total of nine months. FP use and intentions were measured as outcome variables. In addition, a cluster-level summary considering a cluster effect analysis was performed. The result was presented with t.test, adjusted risks and its 95% confidence interval (CI). Results The proportion of FP use among the arms was 34% in the male involvement in FP education, 17.5% in women’s education on FP and 4.3% in the control. There was a positive change in the proportion of FP use in the male involvement in FP education and women’s education on FP arms with absolute risk (AR) of 0.29 (95% CI, 0.23,0.34) and 0.13 (95% CI,0.08,0.17), respectively, as compared to the control arm. Similarly, married women in the male involvement in FP education and women’s education on FP arms had 3.4 (2.48, 4.91) and 2.1 (1.50, 2.95) higher intention to use FP, respectively, as compared with the control arm. Conclusion The present study suggests that in such male-dominated pastoralist communities with more considerable religious barriers, the community-based health education mainly targeting males appears to be a promising strategy for improving FP use and intention to use FP. Trial registration ClinicalTrials.gov, NCT03450564, March, 2018.

Effects of continuum of care for maternal health service utilisation on intention to use family planning among pastoralist women of Ethiopia: a robust regression analysis and propensity score matching modelling

“…Women from the pastoralist community with polygamous marriage status compete with the other wives of their husbands to fulfil the demand of their husbands by increasing the number of children. Also, men were repeatedly mentioned as the main barriers to not using FP 14 25. Thus, such a collective perspective puts the pastoralist women with polygamous marital status to a situation where their intention to use FP diminishes.…”

“…Initially, three districts, namely Kori, Afambo and Mille, were selected. Next to the selection of the district, a complete list of kebeles (clusters) that contain more than 30 households was generated 25. Accordingly, a total of 33 clusters were randomly selected.…”

Effect of couple-based health education on male-partners knowledge and attitude towards maternity waiting homes in rural Ethiopia: a cluster-randomized trial

“…The Hooper and Bourke method for cluster randomization studies of parallel arms with repeated cross-sections was used to calculate the sample size 25 . The parameters used to calculate the sample size were an ICC of 0.05 26 , assumed cluster size (m) of 20, 95% CI 80% power, effect size of 0.2, a cluster autocorrelation coefficient (π) of 0.80 25 , design effect attributable to cluster randomization (dc = 1.95) [calculated], design effect due to repeated measures (dr = 0.83) [calculated], proportion of MWH use = 50% 27 , 1:1 allocation ratio of intervention to control, 10% loss to follow-up, and tabulated sample size 28 . Accordingly, 16 clusters, with a total sample size of 320, were required.…”

Lived Experiences and Perceptions of Childbirth among Pastoralist Women in North-Eastern Ethiopia: A Multimethod Qualitative Analysis to the WHO Health Systems Responsiveness Framework

“…There is low health service coverage, low access to paved roads, and low access to potable water. Maternal health services are poorly equipped and are inaccessible in terms of geographic location, security issues, linguistic barriers, and poor documentation of vital events [ 27 , 28 , 29 ]. The study was carried out in three districts (Mille, Afambo, and Kori).…”