In 2018, 32.6% of women of reproductive age had an unmet need for family planning in Uganda, meaning they wanted to avoid pregnancy but were not using a modern contraceptive method. Filling the unmet need for family planning has important public health implications, including reductions in pregnancy-related health risks and deaths, and infant mortality. While Uganda is scaling up efforts to reduce supply-side barriers in rural areas, such as community distribution of contraceptives, couples are still faced with multi-level demand-side barriers to contraceptive use. In addition to misinformation and fear of contraceptive side-effects, relationship dynamics, peer and family influence, and broader community norms promoting large family size and traditional gender roles influence family planning. We propose to develop and pilot test a multi-level, community-based intervention, which employs transformative community dialogues to alter individual attitudes and the perception of community norms that discourage family planning. Community dialogues are delivered to groups of couples over 4-sessions enhanced to simultaneously address individual and interpersonal-level determinants of family planning and link couples to family planning services.
The aims of our project are to:
Aim 1) Develop a multi- level intervention that engages couples in transformative community dialogues to reduce unintended pregnancy by increasing modern contraceptive use. We will develop the intervention through qualitative research with women and men with an unmet need and community stakeholders and through the formation of a community intervention steering committee;
Aim 2) Conduct a pilot quasi-experimental controlled trial with 70 couples (intervention n=35, control n=35), randomizing one village to the multi-level intervention (n=35 couples) and one village to the control condition (n=35 couples, attention-matched control intervention). We will assess acceptability and feasibility of the trial procedures (Aim 2a) and intervention content (Aim 2b), with the exploratory aim (2c) of assessing the intervention's potential efficacy on contraceptive uptake and continuation and intermediate outcomes (knowledge, attitudes, perceived community norms, partner communication and equity) through 6-month follow up.
This study seeks to develop and evaluate an innovative multi-level intervention to satisfy couples' unmet need for family planning in rural Uganda, which has one of the highest unmet needs for family planning and fertility rates in the world. By addressing multilevel barriers to family planning, this intervention can help couples to better space and time their pregnancies, reduce the incidence of unintended pregnancy, and ultimately reduce rates of maternal and infant morbidity and mortality.
