Counseling Husbands to Achieve Reproductive health and Marital Equity – 2 (CHARM 2)

Situation or Background
Globally, 41% of all pregnancies are unintended, increasing risk for maternal and infant morbidities and mortality. Women with husbands not supportive of contraception are more likely to report contraceptive non-use, and women with sexually abusive husbands are more likely to report contraceptive failure. Such findings highlight the need for family planning (FP) interventions that engage both women and men, focus on eliminating marital sexual violence (MSV) and promote use of effective (low failure risk) spacing contraception including long-acting reversible contraception (LARC).

Our Goal or What We’re Doing
We are assessing the impact of CHARM2, a family planning+gender equity (FP+GE) intervention, in rural Maharashtra, India.

Approach or Methodology
CHARM2 included sessions for men and parallel women-focused GE+FP sessions delivered by a female provider and inclusive of broader contraceptive options, including LARC, as well as a combined couples session. To evaluate the impact of CHARM2, a two armed cluster randomized controlled trial was conducted with N=1000 married couples from 20 geographic clusters in rural Maharashtra, India. Outcomes were assessed via pregnancy testing and surveys at baseline and 9 & 18-month and 48-mo follow-ups.

Impact and What We’re Learning
The evaluation found that modern contraceptive use was higher among CHARM2 participants at 9-month but not 18-month follow-up (9-month adjusted ratio of odds ratio [AROR] 1·5, 95% CI 1·03–2·3; 18-month AROR 0·8, 95% CI 0·4–1·4). Communication (9-month AROR 1·9, 95% CI 1·0–3·6; 18-month AROR 2·7, 95% CI 1·5–4·8) and agency (9-month AROR 5·1, 95% CI 1·2–22·4; 18-month AROR 8·1, 95% CI 1·4–48·2) both improved at both time points. Further results are available in the publication list below.

Protocol paper:
Dixit, A., Averbach, S., Yore, J., Kully, G., Ghule, M., Battala, M., … & Raj, A. (2019). A gender synchronized family planning intervention for married couples in rural India: study protocol for

“overall” Findings:

Raj, A., Ghule, M., Johns, N. E., Battala, M., Begum, S., Dixit, A., … & Averbach, S. (2022).
Evaluation of a gender synchronized family planning intervention for married couples in rural India: the CHARM2 cluster randomized control trial. EClinicalMedicine, 45.

Chatterji, S., Johns, N. E., Ghule, M., Begum, S., Averbach, S., Battala, M., & Raj, A. (2024).
Assessing the impact of CHARM2, a family planning program on gender attitudes, intimate partner violence, reproductive coercion, and marital quality in India. PLOS global public
health, 4(5), e0003220.

Contraception – Use, Negotiation, Decision making and Quality of care; ass with IPV

Dixit, A., Johns, N. E., Ghule, M., Battala, M., Begum, S., Yore, J., … & Raj, A. (2021). Male–female concordance in reported involvement of women in contraceptive decision-making and its association with modern contraceptive use among couples in rural Maharashtra, India. Reproductive Health, 18(1), 139.

Dixit, A., Ghule, M., Rao, N., Battala, M., Begum, S., Johns, N. E., … & Raj, A. (2022).
Qualitative examination of the role and influence of mothers-in-law on young married couples’ family planning in rural Maharashtra, India. Global Health: Science and Practice, 10(5).

Averbach, S., Johns, N. E., Ghule, M., Dixit, A., Begum, S., Battala, M., … & Raj, A. (2023). 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. Contraception, 118, 109907.

Chen, G. L., Silverman, J. G., Dixit, A., Begum, S., Ghule, M., Battala, M., … & Averbach, S.
(2020). A cross-sectional analysis of intimate partner violence and family planning use in rural India. EClinicalMedicine, 21.

Gender attitudes, norms

Ghule, M., Dixit, A., Johns, N. E., Battala, M., Begum, S., Averbach, S., … & Raj, A. (2024).
Examining the association between men’s gender equitable attitudes and contraceptive outcomes in rural Maharashtra, India. Dialogues in Health, 4, 100168.

Marital Quality and Couple Communications

Chatterji, S., Johns, N., Ghule, M., Begum, S., Averbach, S., Battala, M., & Raj, A. (2023). Examining the longitudinal relationship between intimate partner violence and couples’ marital quality in rural India. Journal of family violence, 38(1), 139-148.

Dixit, A., Johns, N. E., Ghule, M., Battala, M., Begum, S., Saggurti, N., … & Raj, A. (2023). Association of traditional marital practices with contraceptive decision-making, couple communication, and method use among couples in rural Maharashtra, India. Culture,
Health & Sexuality, 25(4), 521-536.

Scale Development

Johns, N. E., Dixit, A., Ghule, M., Begum, S., Battala, M., Kully, G., … & Averbach, S. (2020). Validation of the Interpersonal Quality of Family Planning Scale in a rural Indian setting. Contraception: X, 2, 100035.

Bhan, N., Johns, N. E., Chatterji, S., Thomas, E. E., Rao, N., Ghule, M., … & Raj, A. (2023). Validation of the fertility norms scale and association with fertility intention and contraceptive use in India. Studies in Family Planning, 54(1), 39-61.

COVID-19 related papers from CHARM2 datasets

Dey, A. K., Bhan, N., Rao, N., Ghule, M., Chatterji, S., & Raj, A. (2022). Factors affecting delayed and non-receipt of healthcare during the COVID-19 pandemic for women in rural Maharashtra, India: Evidence from a cross-sectional study. EClinicalMedicine, 53.

Chatterji, S., McDougal, L., Johns, N., Ghule, M., Rao, N., & Raj, A. (2021). COVID-19-related financial hardship, job loss, and mental health symptoms: Findings from a cross-sectional study in a rural agrarian community in India. International Journal of Environmental Research and Public Health, 18(16), 8647.