Grandi Byen-supporting child growth and development through integrated, responsive parenting, nutrition and hygiene: study protocol for a randomized controlled trial

BACKGROUND

Poor child growth and development outcomes stem from complex relationships encompassing biological, behavioral, social, and environmental conditions. However, there is a dearth of research on integrated approaches targeting these interwoven factors. The Grandi Byen study seeks to fill this research gap through a three-arm longitudinal randomized controlled trial which will evaluate the impact of an integrated nutrition, responsive parenting, and WASH (water, sanitation and hygiene) intervention on holistic child growth and development.

METHODS

We will recruit 600 mother-infant dyads living in Cap-Haitien, Haiti and randomize them equally into one of the following groups: 1) standard well-baby care; 2) nutritional intervention (one egg per day for 6 months); and 3) multicomponent Grandi Byen intervention (responsive parenting, nutrition, WASH + one egg per day for 6 months). Primary outcomes include child growth as well as cognitive, language, motor, and social-emotional development. The study also assesses other indicators of child health (bone maturation, brain growth, diarrheal morbidity and allergies, dietary intake, nutrient biomarkers) along with responsive parenting as mediating factors influencing the primary outcomes. An economic evaluation will assess the feasibility of large-scale implementation of the interventions.

DISCUSSION

This study builds on research highlighting the importance of responsive parenting interventions on overall child health, as well as evidence demonstrating that providing an egg daily to infants during the complementary feeding period can prevent stunted growth. The multicomponent Grandi Byen intervention may provide evidence of synergistic or mediating effects of an egg intervention with instruction on psychoeducational parenting and WASH on child growth and development. Grandi Byen presents key innovations with implications for the well-being of children living in poverty globally.

TRIAL REGISTRATION

NCT04785352 . Registered March 5, 2021 at https://clinicaltrials.gov/.

Women's perspectives on long-acting reversible contraception: a critical scoping review of qualitative research

Long-acting Reversible Contraception (LARC) has significant promise both from a public health outlook and a social justice perspective. However, if women's empowerment is to be supported, then perspectives and experiences of LARC must be considered. This scoping review assesses research about contraceptive users' perspectives and experiences of contraceptive decision-making and practices. A content analysis was conducted to identify research trends in qualitative studies of contraceptive-user perspectives (n = 54), located by means of a systematic search. Interpreting findings through a reproductive justice lens, three main limitations in the scholarship were identified, viz., (1) an instrumentalist, individual-level focus; (2) a lack of consideration for diverse perspectives; and (3) an uncritical focus on young women. While the small body of qualitative research on LARC offers some valuable insights, when viewed from a sexual and reproductive justice perspective, it is not sufficiently user-centered or grounded within the reproductive politics surrounding contraceptive care and provision. Research is needed that draws on appropriate social theory; widens its focus beyond dominant groups; and is cognizant of the multi-level power relations surrounding LARC. Such work provides a nuanced picture of the complex social and contextual factors at play and inform person-centered approaches in sexual and reproductive health policy and programming.

Women's Contraceptive Perceptions, Beliefs, and Attitudes: An Integrative Review of Qualitative Research

INTRODUCTION

Unintended pregnancy rates will remain high until researchers explore the lived experience of women's relationships with contraception. This integrative review examines the extant qualitative literature on women's contraception to illuminate common themes in women's perspectives through the lens of the feminist poststructuralist framework.

METHODS

A literature review of PubMed and CINAHL databases was completed for English-language studies conducted in the United States from January 2008 through September 2018 that qualitatively examined women's perceptions, beliefs, and attitudes regarding contraception. Reports, dissertations, mixed-methods research, and literature reviews were excluded. The sample, methods, and findings of 19 studies were reviewed. Themes were identified using the 5 major tenets of the feminist poststructuralist framework: discourse, power, language, subjectivity, and agency.

RESULTS

Themes of power imbalance between partners and health care providers; societal and communal discourses on femininity and motherhood; distrust of hormonal contraception; the ability to enhance personal agency through contraceptive decision making; and a need for open, patient-focused communication arose from the 19 studies included in the review.

DISCUSSION

Using a feminist poststructuralist framework to examine women's contraceptive perceptions illuminates and magnifies the many ways in which contraceptive beliefs and use are dependent on gender roles and power dynamics. Gaps in knowledge specific to older women and exploration of women's subjectivity should be addressed. Clinicians should evaluate the power structures inherent to their practice while providing woman-focused, evidence-based contraceptive education.