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

• 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
• DOI: 10.1371/journal.pone.0175879
• EISSN: 1932-6203

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.