At roughly 1.3 billion people, India is the second most populous country in the world, but will likely surpass China as the most populous nation within six years, reaching 1.7 billion by 2050, according to United Nations estimates.
As such, experts say family planning services in India carry extra imperative. Researchers at the University of California San Diego School of Medicine have published a rare analysis on one such program, reporting that the program's comparatively rare combination of increased male engagement and gender-equity counseling with both husband and wife improved contraceptive practices and reduced marital sexual violence among married couples in rural India. The intervention involved rural private providers partnering with the public health system to reach men as well as couples.
The findings are published in the May 11, 2016 online issue of PLOS ONE.
Roughly 153 million women in the world do not have sufficient access to family planning services. More than one in five of these women live in India, where contraception practices have tended toward female sterilization, particularly among young and rural married women, despite knowledge and access to more modern options, such as oral pills, condoms and intrauterine devices.
Previous studies have indicated Indian family planning programs often don't reach out to young wives until after they reach family size goals, that males predominantly control access to and use of contraceptives and that early, unintended pregnancies contribute to ongoing high rates of infant mortality on the subcontinent.
An international team of scientists conducted a two-armed randomized controlled trial of 1,081 couples living in rural India. Roughly half of the participants participated in CHARM, a family planning program in which both husband and wife receive counseling intervention, both as individuals and as a couple. The other half consisted of similar couples who received no family planning counseling. The study lasted 18 months, with follow-ups at the midway and end points.
The researchers found that women in the CHARM cohort were more likely to have contraceptive communication at the 9-month follow up and use modern contraceptives throughout than their control group peers. Men in the CHARM cohort were less likely than controls to report attitudes accepting of intimate partner violence and they were less likely to be sexually violent or coercive with wives. The study's first author, Anita Raj, PhD, director of the Center on Gender Equity and Health at UC San Diego School of Medicine, said it was the first study to show a significant impact on reducing risk for sexual violence in married couples. There was no significant effect on pregnancy rates in either group.
"These findings demonstrate that including men in gender equity-focused family planning counseling not only can support better contraceptive communication and use in married couples, it can support prevention of marital sexual violence," said Raj. "As the Indian government broadens it basket of contraceptive options and reach, it may benefit from gender equity and male inclusive models of family planning, such as the CHARM program, to better support its family planning goals."
Niranjan Saggurti, PhD, a study co-author and a Senior Program Officer at the Bill and Melinda Gates Foundation, adds, "CHARM is not only a demonstration that men can be effectively engaged in family planning, it also shows that private providers can support the public health family planning system to achieve India's goals to reduce unintended pregnancy at a national scale."
Co-authors include: Donta Balaiaha and Mohan Ghule, National Institute for Research in Reproductive Health, Mumbai, India; Jay Silverman, Julie Ritter, and Anindita Dasgupta, UC San Diego; Madhusudana Battala, Population Council, New Delhi, India; Velhal Gajanan, TN Medical College and BYL Nair Ch Hospital, Mumbai, India; and Saritha Nair, National Institute of Medical Statistics, New Delhi, India.
Funding for this research came, in part, from the National Institutes of Health (grant RO1HD61115) and Department of Biotechnology, Government of India (grant #BT/IN/US/01/BD/2010).