Contraceptive uptake after training community health workers in couples counseling: A cluster randomized trial

Young women in Malawi face many challenges in accessing family planning (FP), including distance to the health facility and partner disapproval. Our primary objective was to assess if training HSAs in couples counseling would increase modern FP uptake among young women. In this cluster randomized co...

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Bibliographic Details
Published in:	PloS one Vol. 12; no. 4; p. e0175879
Main Authors:	Lemani, Clara, Tang, Jennifer H, Kopp, Dawn, Phiri, Billy, Kumvula, Chrissy, Chikosi, Loyce, Mwale, Mwawi, Rosenberg, Nora E
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 27-04-2017 Public Library of Science (PLoS)
Subjects:	Adult Birth control Clustering Clusters Community Health Workers Condoms Confidence intervals Contraception Correlation analysis Counseling Couples Decision making Education Family planning Family Planning Services Female Health care facilities Health surveillance Humans Malawi Male Mathematical models Medical personnel Medical tests Medicine and Health Sciences Mens health Methods Occupational health People and Places Pilot projects Program Evaluation Public health Reproductive health Research and Analysis Methods Rural Population Studies Surveillance Training Womens health Workers Young Adult North Carolina Malawi United States > US India
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Summary:	Young women in Malawi face many challenges in accessing family planning (FP), including distance to the health facility and partner disapproval. Our primary objective was to assess if training HSAs in couples counseling would increase modern FP uptake among young women. In this cluster randomized controlled trial, 30 HSAs from Lilongwe, Malawi received training in FP. The HSAs were then randomized 1:1 to receive or not receive additional training in couples counseling. All HSAs were asked to provide FP counseling to women in their communities and record their contraceptive uptake over 6 months. Sexually-active women <30 years of age who had never used a modern FP method were included in this analysis. Generalized estimating equations with an exchangeable correlation matrix to account for clustering by HSA were used to estimate risk differences (RDs) and 95% confidence intervals (CIs). 430 (53%) young women were counseled by the 15 HSAs who received couples counseling training, and 378 (47%) were counseled by the 15 HSAs who did not. 115 (26%) from the couples counseling group had male partners present during their first visit, compared to only 6 (2%) from the other group (RD: 0.21, 95% CI: 0.09 to 0.33, p<0.01). Nearly all (99.5%) initiated a modern FP method, with no difference between groups (p = 0.09). Women in the couples counseling group were 8% more likely to receive male condoms (RD: 0.08, 95% CI: -7% to 23%, p = 0.28) and 8% more likely to receive dual methods (RD: 0.08, 95% CI: -0.065, 0.232, p = 0.274). Training HSAs in FP led to high modern FP uptake among young women who had never used FP. Couples counseling training increased male involvement with a trend towards higher male condom uptake.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3 Conceptualization: CL JHT DK NR BP CK LC MM.Data curation: CL BP.Formal analysis: CL NR.Funding acquisition: JHT.Investigation: BP CK.Methodology: CL NR JHT DK.Project administration: CL JHT BP.Resources: JHT CL.Supervision: JHT CL NR DK BP CK LC MM.Writing – original draft: CL.Writing – review & editing: JHT NR DK. Competing Interests: The authors have declared that no competing interests exist.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0175879