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Boyce SC, Minnis AM, Deardorff J, McCoy SI, Challa S, Johns NE, Aliou S, Brooks MI, Nouhou AM, Baker H, Silverman JG. Effect of a gender-synchronized family planning intervention on inequitable gender norms in a cluster randomized control trial among husbands of married adolescent girls in Dosso, Niger. medRxiv 2023:2023.09.28.23296292. [PMID: 37808735 PMCID: PMC10557813 DOI: 10.1101/2023.09.28.23296292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Gender inequity is pervasive globally and has severe consequences for health and well-being, particularly for women and girls in Niger. The Reaching Married Adolescents in Niger (RMA) intervention aimed to promote equitable gender norms in order to increase modern contraceptive use and reduce intimate partner violence among married adolescent girls and their husbands in Niger. Using data from a 4-arm factorial cluster randomized control trial of the RMA intervention (2016-2019), the current study assesses effects of the RMA intervention on gender norms among husbands. We used an adjusted hierarchical difference-in-differences linear regression model to assess these effects. The mean score for perceived gender inequitable norms at baseline was 4.1 (n=1,055; range: 0-5). Assignment to the RMA small groups intervention was associated with a 0.62 lower score (95% CI: -1.05, -0.18) relative to controls at follow-up, after adjusting for baseline differences. No significant effects were detected for other intervention arms. As a low-cost, simple, scalable, and transferrable intervention with rigorous evidence of being able to change such gender norms, this community health worker-based small group intervention could be valuable to the field of public health for reducing the negative impact of inequitable gender norms on health and wellbeing in similar settings.
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Boyce SC, Minnis AM, Deardorff J, McCoy SI, Challa S, Johns N, Aliou S, Brooks M, Nouhou AM, Gochyyev P, Wilson M, Baker H, Silverman JG. Measuring social norms of intimate partner violence to exert control over wife agency, sexuality, and reproductive autonomy: an item response modelling of the IPV-ASRA scale. Reprod Health 2023; 20:90. [PMID: 37316890 DOI: 10.1186/s12978-023-01632-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 06/02/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The field of violence prevention research is unequivocal that interventions must target contextual factors, like social norms, to reduce gender-based violence. Limited research, however, on the social norms contributing to intimate partner violence or reproductive coercion exists. One of the driving factors is lack of measurement tools to accurately assess social norms. METHODS Using an item response modelling approach, this study psychometrically assesses the reliability and validity of a social norms measure of the acceptability of intimate partner violence to exert control over wife agency, sexuality, and reproductive autonomy with data from a population-based sample of married adolescent girls (ages 13-18) and their husbands in rural Niger (n = 559 husband-wife dyads) collected in 2019. RESULTS A two-dimensional Partial Credit Model for polytomous items was fit, showing evidence of reliability and validity. Higher scores on the "challenging husband authority" dimension were statistically associated with husband perpetration of intimate partner violence. CONCLUSIONS This brief scale is a short (5 items), practical measure with strong reliability and validity evidence. This scale can help identify populations with high-need for social norms-focused IPV prevention and to help measure the impact of such efforts.
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Affiliation(s)
- Sabrina C Boyce
- Center on Gender Equity and Health, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
| | - Alexandra M Minnis
- Women's Global Health Imperative, RTI International, 2150 Shattuck Ave. Ste 800, Berkeley, CA, 94704, USA
| | - Julianna Deardorff
- Community Health Sciences, School of Public Health, University of California Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720-7360, USA
| | - Sandra I McCoy
- Division of Epidemiology, School of Public Health, University of California Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720-7360, USA
| | - Sneha Challa
- School of Nursing, University of San Francisco, 3333 California Street, San Francisco, CA, 94118, USA
| | - Nicole Johns
- Center on Gender Equity and Health, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Sani Aliou
- Niger Country Office, Pathfinder International, Niamey, Niger
| | - Mohamad Brooks
- Pathfinder International, 9 Galen Street, Suite 217, Watertown, MA, 02472, USA
| | | | - Perman Gochyyev
- Graduate School of Education, University of California, 2121 Berkeley Way, Berkeley, CA, 94720-1670, USA
| | - Mark Wilson
- Graduate School of Education, University of California, 2121 Berkeley Way, Berkeley, CA, 94720-1670, USA
| | - Holly Baker
- Center on Gender Equity and Health, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Jay G Silverman
- Center on Gender Equity and Health, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
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Silverman JG, Brooks MI, Aliou S, Johns NE, Challa S, Nouhou AM, Tomar S, Baker H, Boyce SC, McDougal L, DeLong S, Raj A. Effects of the reaching married adolescents program on modern contraceptive use and intimate partner violence: results of a cluster randomized controlled trial among married adolescent girls and their husbands in Dosso, Niger. Reprod Health 2023; 20:83. [PMID: 37277837 PMCID: PMC10243049 DOI: 10.1186/s12978-023-01609-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 04/10/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Niger has the highest rate of adolescent fertility in the world, with early marriage, early childbearing and high gender inequity. This study assesses the impact of Reaching Married Adolescents (RMA), a gender-synchronized social behavioral intervention designed to improve modern contraceptive use and reduce intimate partner violence (IPV) among married adolescent couples in rural Niger. METHODS We conducted a four-armed cluster-randomized trial in 48 villages across three districts in Dosso region, Niger. Married adolescent girls (ages 13-19) and their husbands were recruited within selected villages. Intervention arms included home visits by gender-matched community health workers (CHWs) (Arm 1), gender-segregated, group discussion sessions (Arm 2), and both approaches (Arm 3). We used multilevel mixed-effects Poisson regression models to assess intervention effects for our primary outcome, current modern contraceptive use, and our secondary outcome, past year IPV. RESULTS Baseline and 24-month follow-up data were collected April-June 2016 and April-June 2018. At baseline, 1072 adolescent wives were interviewed (88% participation), with 90% retention at follow-up; 1080 husbands were interviewed (88% participation), with 72% retention at follow-up. Adolescent wives had higher likelihood of modern contraceptive use at follow-up relative to controls in Arm 1 (aIRR 3.65, 95% CI 1.41-8.78) and Arm 3 (aIRR 2.99, 95% CI 1.68-5.32); no Arm 2 effects were observed. Relative to those in the control arm, Arm 2 and Arm 3 participants were significantly less likely to report past year IPV (aIRR 0.40, 95% CI 0.18-0.88 for Arm 2; aIRR 0.46, 95% CI 0.21-1.01 for Arm 3). No Arm 1 effects were observed. CONCLUSIONS The RMA approach blending home visits by CHWs and gender-segregated group discussion sessions is the optimal format for increasing modern contraceptive use and decreasing IPV among married adolescents in Niger. Trial registration This trial is retrospectively registered with ClinicalTrials.gov, Identifier NCT03226730.
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Affiliation(s)
- Jay G. Silverman
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | | | - Sani Aliou
- Pathfinder International, Watertown, USA
| | - Nicole E. Johns
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | - Sneha Challa
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | | | - Shweta Tomar
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | - Holly Baker
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | - Sabrina C. Boyce
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | - Lotus McDougal
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | - Stephanie DeLong
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
| | - Anita Raj
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, La Jolla, CA 92093 USA
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Erhardt-Ohren B, Brooks M, Aliou S, Osseni AA, Oumarou A, Challa S, Tomar S, Johns N, Silverman J. Sustained impact of community-based interventions on contraceptive use among married adolescent girls in rural Niger: Results from a cluster randomized controlled trial. Int J Gynaecol Obstet 2023; 160:468-475. [PMID: 35900221 DOI: 10.1002/ijgo.14378] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate the sustained impact of community-based family planning (FP) interventions on current modern contraceptive and long-acting reversible contraceptive (LARC) use among married adolescent girls in rural Niger. METHODS We used a cluster randomized controlled trial design following married adolescent girls and their husbands over 3 years. Villages were randomized to one of four arms: household visits, small group discussions, combined intervention, or control. For 1.5 years, couples were exposed to one intervention activity per month and 1.5 years after implementation ended, we used a multi-level mixed effects logistic regression model to evaluate changes in key FP outcomes. RESULTS We analyzed survey data from 404 married adolescent girls with data at baseline and endline. Small group discussions (+35.6%; adjusted odds ratio [aOR] 7.94, P < 0.001) and the combined intervention (+17.9%: aOR 4.53, P = 0.005) led to statistically significant increases in the odds of using modern contraceptives at endline compared with the control. The combined intervention (+14.2%; aOR 7.98, P < 0.001) and home visits (+12.6%; aOR 8.09, P < 0.001) led to statistically significant increases in odds of using LARC methods at endline compared with the control. Increase in LARC use was driven by implant use across all intervention groups. CONCLUSION This study contributes to the empirical evidence base on the sustained impact of community-based interventions on increases in FP use among married adolescent girls in low- and middle-income countries.
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Affiliation(s)
| | | | | | | | | | - Sneha Challa
- University of California, San Diego, California, USA
| | - Shweta Tomar
- University of California, San Diego, California, USA
| | - Nicole Johns
- University of California, San Diego, California, USA
| | - Jay Silverman
- University of California, San Diego, California, USA
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Boyce SC, Minnis AM, Deardorff J, McCoy SI, Goin DE, Challa S, Johns NE, Aliou S, Brooks MI, Nouhou AM, Baker H, Silverman JG. Mediating effects of inequitable gender norms on intimate partner violence and contraceptive use in a cluster randomized control trial in Niger: A causal inference mediation analysis. medRxiv 2023:2023.01.12.23284504. [PMID: 36711886 PMCID: PMC9882558 DOI: 10.1101/2023.01.12.23284504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Background Gender inequity, a deeply-rooted driver of poor health globally, is expressed in society through gender norms, the unspoken rules that govern gender-related roles and behavior. The development of public health interventions focused on promoting equitable gender norms are gaining momentum internationally, but there remain critical gaps in the evidence about how these interventions are working to change behavioral outcomes. Methods A four-arm cluster randomized control trial (cRCT) was conducted to evaluate the effects of the Reaching Married Adolescents in Niger (RMA) intervention on modern contraceptive use and intimate partner violence (IPV) among married adolescent girls and their husbands in Dosso, Niger (T1: 1042 dyads; 24 mos. follow-up: 737 dyads, 2016-2019). This study seeks to understand if changes in perceived inequitable gender norms among husbands are the mechanism behind effects on modern contraceptive use and IPV. We estimated natural direct and indirect effects via these gender norms using inverse odds ratio weighting. An intention-to-treat approach and a difference-in-differences estimator in a hierarchical linear probability model was used to estimate prevalence differences, along with bootstrapping to estimate confidence intervals. Results The total effects of the RMA small group intervention (Arm 2) is estimated to be an 8% reduction in prevalence of IPV [95% CI: -0.18, 0.01]. For this arm, the natural indirect effect through gender inequitable social norms is associated with a 2% decrease (95% CI: -0.07, 0.12), accounting for 22.3% of this total effect, and the natural direct effect with a 6% decrease (95% CI: -0.20, -0.02) in IPV. Of the total effect of the RMA household visit intervention (Arm 1) on contraceptive use (20% increase), indirect effects via inequitable gender norms were associated with an 11% decrease (95% CI: -0.18, -0.01) and direct effects with a 32% increase (95% CI: 0.13, 0.44) in contraceptive use. For the combination arm, of the total effects on contraceptive use (19% increase), indirect effects were associated with a 9% decrease (95% CI: -0.20, 0.02) and direct effects with a 28% increase (95% CI: 0.12, 0.46). Conclusion The present study contributes experimental evidence that the small group RMA intervention reduced IPV partially via reductions in perceived inequitable gender norms among husbands. Evidence also suggests that increases in perceived inequitable gender norms resulted in decreased contraceptive use among those receiving the household visit intervention component. Not only do these results open the "black box" around how the RMA small group intervention may create behavior change to help inform its future use, they provide evidence supporting behavior change theories and frameworks that postulate the importance of changing underlying social norms in order to reduce IPV and increase modern contraceptive use.
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Affiliation(s)
- Sabrina C Boyce
- Center on Gender Equity and Health, University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - AM Minnis
- Center on Gender Equity and Health, University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - J Deardorff
- Center on Gender Equity and Health, University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - SI McCoy
- Center on Gender Equity and Health, University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - DE Goin
- Center on Gender Equity and Health, University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - S Challa
- Center on Gender Equity and Health, University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - NE Johns
- Center on Gender Equity and Health, University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - S Aliou
- Center on Gender Equity and Health, University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - MI Brooks
- Center on Gender Equity and Health, University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - A-M Nouhou
- Center on Gender Equity and Health, University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - H Baker
- Center on Gender Equity and Health, University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - JG Silverman
- Center on Gender Equity and Health, University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, USA
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Tomar S, Johns N, Challa S, Brooks MI, Aliou S, Abdoul-Moumouni N, Raj A, Silverman J. Associations of Age at Marriage With Marital Decision-Making Agency Among Adolescent Wives in Rural Niger. J Adolesc Health 2021; 69:S74-S80. [PMID: 34809904 DOI: 10.1016/j.jadohealth.2021.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/30/2021] [Accepted: 08/04/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Child marriage is associated with multiple adverse health and social outcomes. Although evidence suggests that child marriage is associated with reduced participation in personal and household decisions for women, less is known about the association between age at marriage and decision-making among married adolescent girls. This study assesses associations between adolescents' age at marriage and two dimensions of decision-making (participation and satisfaction) in the high early marriage prevalence settings of Niger. METHODS Cross-sectional data from a cluster-randomized control trial of a community-level program to increase the use of modern contraceptives among married adolescents in the Dosso region of Niger were analyzed. Multiple logistic regression models were used to determine the association of age at marriage with married girls' participation in and satisfaction with decision-making processes. RESULTS More than half of married adolescents (N = 796) were married before reaching the age of 15 years. Older age at marriage was associated with adolescents' increased participation in decisions related to economics (adjusted odds ratio: 1.23; 95% confidence interval: 1.05-1.43) and health-care access (adjusted odds ratio: 1.18; 95% confidence interval: 1.01-1.40), but not with greater reported satisfaction with their control over these decisions. CONCLUSIONS The study suggests that marrying as a very young adolescent places girls in even more disadvantaged positions regarding decision-making. These findings indicate the need to design programs targeted at addressing inequitable gender norms to reduce early child marriage and increase participation in decision-making. Further study of satisfaction with participation in decision-making is recommended, including consideration of whether it is related to gender norms for participation in decisions rather than actual participation.
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Affiliation(s)
- Shweta Tomar
- Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, La Jolla California; Joint Doctoral Program, San Diego State University/University of California San Diego, San Diego, California.
| | - Nicole Johns
- Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, La Jolla California
| | - Sneha Challa
- Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, La Jolla California
| | | | | | | | - Anita Raj
- Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, La Jolla California
| | - Jay Silverman
- Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, La Jolla California
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Challa S, Shakya HB, Carter N, Boyce SC, Brooks MI, Aliou S, Silverman JG. Associations of spousal communication with contraceptive method use among adolescent wives and their husbands in Niger. PLoS One 2020; 15:e0237512. [PMID: 32776980 PMCID: PMC7416918 DOI: 10.1371/journal.pone.0237512] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 07/28/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES This study aims to examine associations between spousal communication about contraception and ever use of modern contraception, overt modern contraceptive use (with husband's knowledge), and covert modern contraceptive use (without husband's knowledge) among adolescent wives and their husbands in Niger. STUDY DESIGN Cross-sectional data, from the Reaching Married Adolescents Study, were collected from randomly selected adolescent wives (ages 13-19 years) and their husbands from 48 randomly selected villages in rural Niger (N = 1,020 couples). Logistic regression models assessed associations of couples' reports of spousal communication about contraception with wives' reports of contraception (overall, overt, and covert). RESULTS About one-fourth of adolescent wives and one-fifth of husbands reported spousal communication about contraception. Results showed couples' reports of spousal communication about contraception were positively associated with ever use of modern contraception. Couples' reports of spousal communication about contraception were negatively associated with covert modern contraceptive use compared to overt use. Wives' reports of spousal communication were marginally associated with covert use compared to no use but husbands' reports were not. CONCLUSION Among a sample of couples in Niger, spousal communication about contraception was positively associated with modern contraceptive use (compared to no use) and negatively with covert use (compared to overt use) but wives' and husbands' reports showed differential associations with covert use compared to no use. Since there is little understanding of couple communication surrounding covert contraceptive use decisions, research should focus on characterizing content and context of couple communication particularly in cases of disagreement over fertility decisions.
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Affiliation(s)
- Sneha Challa
- Center on Gender Equity and Health, University of California San Diego, La Jolla, California, United States of America
| | - Holly B. Shakya
- Center on Gender Equity and Health, University of California San Diego, La Jolla, California, United States of America
| | - Nicole Carter
- Center on Gender Equity and Health, University of California San Diego, La Jolla, California, United States of America
| | - Sabrina C. Boyce
- Center on Gender Equity and Health, University of California San Diego, La Jolla, California, United States of America
| | - Mohamad I. Brooks
- Pathfinder International, Boston, Massachusetts, United States of America
| | - Sani Aliou
- Pathfinder International, Boston, Massachusetts, United States of America
| | - Jay G. Silverman
- Center on Gender Equity and Health, University of California San Diego, La Jolla, California, United States of America
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DeLong SM, Brooks MI, Aliou S, Lundgren R, Corneliess C, Johns NE, Challa S, Carter N, Lauro G, Silverman JG. Married very young adolescent girls in Niger at greatest risk of lifetime male partner reproductive coercion and sexual violence. PLoS One 2020; 15:e0231392. [PMID: 32282817 PMCID: PMC7153890 DOI: 10.1371/journal.pone.0231392] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/23/2020] [Indexed: 11/24/2022] Open
Abstract
Objective The purpose of this analysis was to compare and contrast reproductive health (RH), gender equity attitudes, and intimate partner violence (IPV) among married very young adolescent (VYA) girls with married older adolescent girls and young women (AGYW) in rural Niger given limited literature on the topic. Methods We conducted an exploratory analysis of baseline data from the Reaching Married Adolescents Trial in Dosso region, Niger. We report counts and percents, by age group (13–14 years (VYA), 15–16 years, 17–19 years), of AGYW’s self-efficacy to use family planning (FP), accurate knowledge of FP, current use of modern FP, and unintended last pregnancy (UIP); lifetime reproductive coercion (RC), physical IPV, and sexual IPV; and gender equity attitudes. We also assess whether percents differ between VYA and older groups using Pearson’s Chi-Square and Fisher’s exact p-values. Results are stratified by parity. Finally, we use logistic regression to consider associations. Results There were 49 VYA, 248 girls aged 15–16, and 775 AGYW aged 17–19 in our sample (n = 1072). Accurate knowledge of FP, self-efficacy to use FP, current use of modern FP, and UIP increased with age; all percents between VYA and AGYW 17–19 were marginally or statistically significantly different. We also saw VYA report higher lifetime RC and sexual IPV versus older groups, with sexual IPV statistically different between VYA and girls 17–19. Parous VYA reported a significantly higher percent of lifetime RC versus older AGYW. Among 17–19 year-olds, odds of current use of FP were higher among AGYW who reported physical IPV, and odds of UIP were higher among those reporting more gender equitable attitudes, both adjusted for parity. Conclusions We observed differences in RH, RC, and sexual IPV among married VYA and older AGYW in rural Niger. VYA should be prioritized in research to confirm and further understand their RH needs.
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Affiliation(s)
- Stephanie M. DeLong
- University of California, San Diego, La Jolla, California, United States of America
- * E-mail:
| | - Mohamad I. Brooks
- Pathfinder International, Watertown, Massachusetts, United States of America
| | | | - Rebecka Lundgren
- University of California, San Diego, La Jolla, California, United States of America
| | - Caitlin Corneliess
- Pathfinder International, Watertown, Massachusetts, United States of America
| | - Nicole E. Johns
- University of California, San Diego, La Jolla, California, United States of America
| | - Sneha Challa
- University of California, San Diego, La Jolla, California, United States of America
| | - Nicole Carter
- University of California, San Diego, La Jolla, California, United States of America
| | - Giovanna Lauro
- Promundo–United States, Washington, DC, United States of America
| | - Jay G. Silverman
- University of California, San Diego, La Jolla, California, United States of America
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Challa S, DeLong SM, Carter N, Johns N, Shakya H, Boyce SC, Vera-Monroy R, Aliou S, Ibrahima FA, Brooks MI, Corneliess C, Moodie C, Nouhou AM, Souley I, Raj A, Silverman JG. Protocol for cluster randomized evaluation of reaching married adolescents - a gender-synchronized intervention to increase modern contraceptive use among married adolescent girls and young women and their husbands in Niger. Reprod Health 2019; 16:180. [PMID: 31852538 PMCID: PMC6921454 DOI: 10.1186/s12978-019-0841-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 12/03/2019] [Indexed: 11/24/2022] Open
Abstract
Background Early marriage and early childbearing are highly prevalent in Niger with 75% of girls married before age 18 years and 42% of girls giving birth between ages 15 and 18 years. In 2012, only 7% of all 15–19-year-old married adolescents (male and female) reported use of a modern contraceptive method with barriers including misinformation, and social norms unsupportive of contraception. To meet the needs of married adolescents and their husbands in Niger, the Reaching Married Adolescents (RMA) program was developed with the goal of improving modern contraceptive method uptake in the Dosso region of Niger. Methods Using a four-arm cluster randomized control design, the RMA study seeks to assess whether household visits only (Arm 1), small group discussions only (Arm 2), or a combination of both (Arm 3), as compared to controls (no intervention – Arm 4), improve modern contraceptive method use among married adolescent girls and young women (AGYW), age 13–19 years-old, in three districts of the Dosso region. Intervention conditions were randomly assigned across the three districts, Dosso, Doutchi, and Loga. Within each district, eligible villages were assigned to either that intervention condition or to the control condition (12 intervention and 4 control per district). Across the three intervention conditions, community dialogues regarding modern contraceptive use were also implemented. Data for the study was collected at baseline (April – June 2016), at 24 months post-intervention (April – June 2018), and a final round of data collection will occur at 40 months post-intervention (October – December 2019). Discussion The RMA intervention is a gender-synchronized and community-based program implemented among married adolescent girls and their husbands in the context of rural Niger. The intervention is designed to provide education about modern contraception and to promote gender equity in order to increase uptake of modern contraceptive methods. Results from this cluster randomized control study will contribute to the knowledge base regarding the utility of male engagement as a strategy within community-level approaches to promote modern contraceptive method use in the high need context of West Africa. Trial registration Registered October 2017 - ClinicalTrials.gov NCT03226730.
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Affiliation(s)
- Sneha Challa
- Center on Gender Equity and Health, University of California San Diego, San Diego, USA.
| | - Stephanie M DeLong
- Center on Gender Equity and Health, University of California San Diego, San Diego, USA
| | - Nicole Carter
- Center on Gender Equity and Health, University of California San Diego, San Diego, USA
| | - Nicole Johns
- Center on Gender Equity and Health, University of California San Diego, San Diego, USA
| | - Holly Shakya
- Center on Gender Equity and Health, University of California San Diego, San Diego, USA
| | - Sabrina C Boyce
- Center on Gender Equity and Health, University of California San Diego, San Diego, USA
| | | | | | | | | | | | | | | | | | - Anita Raj
- Center on Gender Equity and Health, University of California San Diego, San Diego, USA
| | - Jay G Silverman
- Center on Gender Equity and Health, University of California San Diego, San Diego, USA
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Fleming PJ, Shakya H, Farron M, Brooks MI, Lauro G, Levtov RG, Boyce SC, Aliou S, Silverman JG. Knowledge, attitudes, and practices related to family planning and gender equity among husbands of adolescent girls in Niger. Glob Public Health 2019; 15:666-677. [PMID: 31791194 PMCID: PMC7175468 DOI: 10.1080/17441692.2019.1692890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Despite having the highest fertility rate in the world, research on Niger men and family planning (FP) is limited. We collected survey data collected in the Dosso region of Niger in 2016 from 1136 men who are the husbands of adolescent girls. We report descriptive statistics, bivariate and multivariable logistic regression on three dichotomous outcomes: (a) knowledge of modern contraceptives, (b) beliefs that only husbands should make FP decisions, and (c) current FP use. About 56% had ever heard of the pill, 6% had ever heard of an intrauterine device, and 45% had ever heard of an injectable. In our multivariable analyses, we found: a man knowing at least one modern method was significantly associated with his age, wife’s education level, gender ideology, and wife’s say in healthcare decisions; men’s belief that men alone should make FP decisions was associated with husband’s Quranic education, gender ideology, and attitudes towards violence against women; men’s reports of adolescent wives’ current family planning use was associated with men’s Quranic education, women’s involvement in her own healthcare decisions, and belief that men alone should decide about family planning. Finding suggests that interventions should target aim to reduce gender inequities to increase family planning utilisation.
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Affiliation(s)
- Paul J Fleming
- Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Holly Shakya
- Center on Gender Equity and Health, University of California, San Diego, CA, USA
| | - Madeline Farron
- Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | | | | | - Sabrina C Boyce
- Center on Gender Equity and Health, University of California, San Diego, CA, USA
| | - Sani Aliou
- Pathfinder International, Watertown, MA, USA
| | - Jay G Silverman
- Center on Gender Equity and Health, University of California, San Diego, CA, USA
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