2170.0 Testing a flexible model for men's participation in a couples-based family planning intervention in Uganda: A mixed methods pilot evaluation of the family health = family wealth flexible (FH=FWflex) intervention

Session: Sexual and Reproductive Health and Family Planning

Program: International Health

Time: 5:45 - 6:00 PM

Presenter:

Trace Kershaw, PhD

Abstract

Context: Couples-based family planning (FP) services are essential to reducing the high unmet need for FP observed in low-income settings. However, men can be difficult to engage (e.g., FP disapproval, work responsibilities), and couples-based approaches can exclude women whose partners are not able or willing to participate. Thus, flexible models are needed that can accommodate couples facing barriers to men’s participation. This study aimed to gather evidence on an intervention (FH=FWflex) to engage men, and its acceptability and effects on contraceptive use.

Methods: Family Health = Family Wealth (FH=FW) is a multilevel, community-based intervention that engages couples in four facilitated group discussions to reduce barriers to contraceptive use in rural Uganda. This model was adapted to employ a flexible approach to men’s attendance (FH=FWflex), with content enhanced to strengthen women’s skills to encourage their partner to attend and engage in FP discussions at home. FH=FWflex was piloted among 12 couples with an unmet need for FP who indicated the man was not available/interested in participation at enrollment. A quantitative questionnaire at baseline and 1-month post intervention examined change in contraceptive use, and semi-structured open-ended interviews 1-month post intervention explored women’s experience with the intervention.

Results: Attendance was 100% among women and 65% among their partners. Conflict with work schedules was the main reason reported for partner non-attendance. Women reported high satisfaction with the intervention in qualitative interviews. All women said they invited their partners to attend and felt the program positively affected their partner communication. Women’s interest in the program’s content, focused on family development (e.g., economic health, relationship health), helped to spark men’s interests. From no use at baseline, 50% (n=6/12) of women reported using an effective contraceptive method at follow-up, 83% (n=5/6) of which reported discussing the decision with their partner.

Conclusions and discussion: This pilot study demonstrated the feasibility and acceptability of FH=FWflex, as well as its potential to increase contraceptive use among women with unmet need for FP. This model could have a wider reach, but similar benefits, than strict couples-based approaches, but should be tested in a fully powered trial to determine its efficacy.