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
- PMID: 37277837
- PMCID: PMC10243049
- DOI: 10.1186/s12978-023-01609-9
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
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.
Keywords: Adolescent fertility; Adolescent marriage; Behavior change; Contraception; Family planning; IPV; Niger; RCT.
Plain language summary
Although Niger has both the highest levels of fertility and of child marriage in the world, as well as substantial gender inequity, there have been no high-quality evaluations of public health programs aiming to increase contraceptive use or decrease intimate partner violence. In this study, we conducted a high quality, randomized controlled trial to evaluate whether the Reaching Married Adolescents public health program could increase modern contraceptive use and decrease intimate partner violence among married adolescent girls (13–19 years old) and their husbands in the Dosso region of Niger. The results of this evaluation provide evidence of the value of individual home visits for wives and their husbands in increasing modern contraceptive use, the value of small group discussions in reducing intimate partner violence, and the combined value of receiving both approaches at the same time for both increasing modern contraceptive use and decreasing intimate partner violence. The current study advances the state of evidence regarding contraceptive use and IPV among married adolescents and their husbands in Niger, highlighting the importance of engaging male partners in such public health programs, as well as of using multiple modes of delivery of programs. The success of this intervention in the high-risk context of Niger suggests that other countries in the region may benefit from testing this approach to improve the health and well-being of young wives.
© 2023. The Author(s).
Conflict of interest statement
The authors declare that they have no competing interests.
Similar articles
-
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 Dec 18;16(1):180. doi: 10.1186/s12978-019-0841-3. Reprod Health. 2019. PMID: 31852538 Free PMC article.
-
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 [Preprint]. 2023 Jan 18:2023.01.12.23284504. doi: 10.1101/2023.01.12.23284504. medRxiv. 2023. PMID: 36711886 Free PMC article. Preprint.
-
Associations of attitudes and social norms with experiences of intimate partner violence among married adolescents and their husbands in rural Niger: a dyadic cross-sectional study.BMC Womens Health. 2022 May 18;22(1):180. doi: 10.1186/s12905-022-01724-y. BMC Womens Health. 2022. PMID: 35585589 Free PMC article.
-
How does intimate partner violence affect condom and oral contraceptive Use in the United States?: A systematic review of the literature.Contraception. 2015 Jun;91(6):438-55. doi: 10.1016/j.contraception.2015.02.009. Epub 2015 Feb 21. Contraception. 2015. PMID: 25708504 Free PMC article. Review.
-
Community based reproductive health interventions for young married couples in resource-constrained settings: a systematic review.BMC Public Health. 2015 Oct 9;15:1037. doi: 10.1186/s12889-015-2352-7. BMC Public Health. 2015. PMID: 26452750 Free PMC article. Review.
Cited by
-
Impact of sexual and reproductive health interventions among young people in sub-Saharan Africa: a scoping review.Front Glob Womens Health. 2024 Apr 18;5:1344135. doi: 10.3389/fgwh.2024.1344135. eCollection 2024. Front Glob Womens Health. 2024. PMID: 38699461 Free PMC article.
References
-
- Institut National de la Statistique II. Enquête Démographique et de Santé et à Indicateurs Multiples du Niger 2012. Calverton, Maryland, USA: Institut National de la Statistique et ICF International; 2013.
-
- United Nations Children’s Fund . Ending child marriage: progress and prospects. New York: UNICEF; 2014.
Publication types
MeSH terms
Associated data
Grants and funding
LinkOut - more resources
Full Text Sources
Medical
Miscellaneous