DOI: 10.3886/e205221v1
title: CHARM2: Evaluation data from a gender synchronized family planning intervention for married couples in rural India

description: Despite calls for gender transformative family planning
interventions to increase male engagement and female reproductive agency, there
is limited research involving rigorous evaluation of the integration of these
approaches. CHARM2 (counseling Husbands and wives to Achieve Reproductive
Health and Marital Equity) builds upon a prior three-session male engagement
intervention by integrating female-focused sessions emphasizing women's choice
and agency (i.e., gender synchronization). We conducted a two-armed cluster
randomized controlled trial evaluating the effects of CHARM2 on marital
contraceptive use, communication, decision-making; women's contraceptive
agency, and pregnancy among young married couples in rural Maharashtra, India
(ClinicalTrials.gov #NCT03514914, complete). 40 geographic clusters, defined
based on the catchment areas of subcenter health facilities (the most proximal
level of community health care within India's public health system) were
randomized to control (n = 20) and intervention (n = 20). We assigned all
participants within that geographic cluster to the corresponding cluster
treatment condition; participants, investigators, and study staff were not
masked to treatment assignment. Eligibility criteria included wife aged 18–29,
couple residing together for at least six months with no plan for migration,
and neither spouse sterilized or infertile. The CHARM2 intervention included
five provider-delivered sessions on gender equity and family planning, two
delivered in parallel to husbands and wives separately by gender-matched
providers, and one final joint session, delivered within the four months
subsequent to baseline survey. We conducted surveys and pregnancy testing at
baseline and 9-month and 18-month follow-up; we additionally surveyed couples
at 36- and 48-month follow-ups, though these were after the conclusion of the
formal clinical trial. 1201 couples were recruited between September 2018 and
June 2019; 600 intervention and 601 control. Full couple retention was 90.2% (n
= 1083) at 9-month follow-up, 90.5% (n = 1087) at 18-month follow-up, 88.1% (n = 1058) at 36-month follow-up, and 86.8% (n = 1043) at 48-month follow-up.
description: Response Rates: We screened 3087 couples and identified 2411 couples eligible for inclusion in the study (78%). We then re-approached 1756 of the eligible couples for recruitment. Of the 880 couples and 876 couples approached in the intervention and control clusters, 600 (68·2%), and 601(68·6%) were enrolled; 1201 couples were included in total.
description: We randomized 20 geographic clusters within the Junnar taluka of Pune district to receive either the CHARM2 intervention or the standard of care. We created clusters based on the catchment area of subcenter health facilities, the most proximal level of community health care within India's public health system. Cluster randomization ensured that providers were consistent in offering either intervention or control services to assigned participants, reducing risk for contamination. Neither participants nor research staff were masked to the treatment assignment.
description: Young married couples residing in study area. Inclusion criteria included wife aged 18–29, couple residing together for at least six months with no plan for migration, and neither spouse sterilized or infertile.
description: face-to-face interview;