Women want sex Delong

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Reproductive Health volume 16Article : Cite this article.

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Metrics details. To meet the needs of married adolescents and their husbands in Niger, Women want sex Delong Reaching Married Adolescents RMA program was developed with the goal of improving modern contraceptive method uptake in the Dosso region of Niger. Intervention conditions were randomly ased across the three districts, Dosso, Doutchi, and Loga.

Within each district, eligible villages were ased 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 Women want sex Delong use were also implemented. 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 deed to provide education about modern contraception and to promote gender equity in order to increase uptake of modern contraceptive methods. 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.

Registered October - ClinicalTrials. In Niger, early marriage is common, but family planning is not generally practiced leading to ificant early childbearing and increasing the health risks for young married girls. To meet the needs of these young married girls, the Reaching Married Adolescents RMA program was deed with the goal of improving use of modern contraceptive methods.

Three districts of the Dosso region of Niger were randomly ased to receive one of three intervention approaches: 1 small group discussions, to strengthen social bonds, 2 household visits, to provide knowledge about reproductive health and family planning, or 3 a combination of small group discussions and household visits. From these three districts, 48 villages were randomly selected 12 participating in the intervention approach ased to the respective district and 4 to serve as a control.

Villages that were selected to participate in the intervention also participated in community dialogue sessions to create an environment supportive of family planning and healthy timing and spacing of pregnancy. From each village, 25 married adolescent girls ages 13—19 and their husbands were randomly selected to participate. from this study will contribute to the knowledge base regarding the utility of involving men as a strategy within community-based programs to promote modern contraceptive method use in the high need context of West Africa.

Child marriage is also associated with early childbearing and high adolescent fertility in Niger and multiple other contexts [ 345 ]. Girls who marry at younger ages in Niger are less likely than those marrying at older ages to utilize maternal health care services e. Barriers to modern contraceptive use include lack of access, lack of awareness, misinformation and lack of knowledge, and opposition to use by partners and family [ 9 ]. Multiple social norms i.

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Programs deed to combat early and frequent childbearing in these regions by promoting modern contraceptive use face the challenge of addressing these many barriers. To meet the needs of married adolescents and their husbands in Niger, Pathfinder International Pathfinder developed an intervention aimed at improving modern contraceptive method uptake in the Dosso region of Niger.

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The Reaching Married Adolescents RMA program focuses on increasing knowledge of modern contraceptive methods and changing relevant attitudes and norms that may impede use via household Women want sex Delong and small group discussions with married adolescent girls and young women AGYW and their husbands. Complementing the focus on contraceptive use, this gender-synchronized approach also engages men and women to challenge gender norms and adopt attitudes supportive of gender equity, particularly with respect to female autonomy and decision-making regarding sexual and reproductive health SRH.

Researchers from the Center on Gender Equity and Health at the University of California, San Diego UCSD [ 11 ] are carrying out a cluster randomized control Women want sex Delong of this intervention to assess its impact on both modern contraceptive use and relevant gender equity outcomes. Based on our conceptual model, we hypothesize that married AGYW that participate in any of the three intervention arms will report: 1 improvement in knowledge of modern contraceptive methods, 2 attitudes more supportive of contraceptive use and gender equity, 3 perceived norms within their communities as more supportive of contraceptive use and gender equity, 4 increased self-efficacy to use a contraceptive method, 5 intention to use a modern contraceptive method, 6 reduction in IPV, and 7 increased use of modern contraceptive methods.

Secondarily, reflective of the male engagement elements of RMA, we hypothesize that higher levels of participation of husbands of married AGYW will be associated with greater increases in modern contraceptive use and greater reductions in intimate partner violence, relative to lower levels of husband participation or no participation at all. Quantitative baseline data pre-intervention were collected from April—June using structured surveys. The RMA intervention provides education and counseling on use of modern contraceptive methods and the importance of delaying and spacing pregnancies, particularly for adolescents, alongside promotion of gender equitable attitudes towards, and norms regarding t decision-making and use of modern contraception.

Education on modern contraceptive methods, inclusive of reproductive anatomy and dispelling common misconceptions regarding contraceptives and fertility, is hypothesized to improve knowledge of, attitudes towards, and norms regarding contraceptive use.

In parallel, promotion of gender equitable attitudes and norms is hypothesized to reduce perpetration of IPV. Research has demonstrated that IPV is associated with self-efficacy around SRH [ 13 ] thus, together, these elements are hypothesized to increase self-efficacy to use modern contraceptive methods. This in turn, will increase intention to use a modern contraceptive method finally resulting in actual modern contraceptive method use.

Modern contraceptive methods promoted include intrauterine devices IUDinjectable contraceptives, contraceptive implants, oral contraceptive pills, male condoms, female condoms, emergency contraception, and lactational amenorrhea LAM. This region has five districts from which three districts, Dosso, Doutchi, and Loga, were selected for participation. Based on the logistical challenges of providing all RMA intervention approaches in each district, each Women want sex Delong was randomly ased to one of the three intervention approaches home visits alone, small groups alone, or a combinationwith controls selected across all three districts.

Based on power analyses described belowthe minimum of clusters in each of the four arms was 12, requiring inclusion of 16 villages across each of the three districts 12 intervention and 4 control. Village selection and randomization followed a multi-stage process whereby eligible villages in the three districts were first identified based on the following criteria: 1 rural i.

There were villages in Dosso, in Doutchi, and 36 in Loga that met these criteria. From the eligible villages, we then stratified villages based on three level of health service provision: 1 villages with CSIs, larger health facilities serving multiple villages where doctors, nurses, and midwives provide the full contraceptive method mix and related counseling; 2 villages with CSs, village-level facilities where community health agents provide a subset of contraceptive methods; and 3 villages with neither CSI nor CS.

In order to select a sample of villages within each district that was representative of the distribution of health facilities across the region, we randomly selected nine villages with a CS, three with a CSI, and four with neither in each of the three districts. To create a control arm representative of villages in each district, and that included representation of all levels of health facility, we randomly ased four of the total 16 villages per district to the control condition, consisting of two villages with a CS, 1 with a CSI, and 1 with neither.

The remaining 12 villages were ased to the intervention condition ased to that district see Fig. Prior to the month follow up, six intervention villages per district will be randomly ased to continue to receive supervision from Nurse Supervisors while the remaining six intervention villages in each district will continue intervention activities with no supervision. Pairwise block randomization within each intervention arm by current modern contraceptive use rate will be conducted to ensure similar distributions of modern contraceptive utilization in those villages continuing vs ceasing supervision.

All four control villages in each district will continue to serve as controls. This additional randomization will allow us to determine sustainability of the effects of the intervention without direct supervision. Power calculations for our study were conducted a priori based on our primary outcome of interest, modern contraceptive method use reported by the adolescent wives in our sample.

We used pairwise tests for time by treatment effects comparing each intervention group individually to the control group. We also chose to for the ability to detect an effect size of 2. At baseline, participants were selected for recruitment based on a complete listing of married AGYW and their husbands provided by leaders in each of the participating villages. A random numeric sequence was attached to the listing and those couples ed 1—25 were selected for recruitment. If more than one adolescent wife from a household was randomly selected for inclusion, we included only the youngest eligible wife in the study.

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In accordance with cultural norms, village guides and RAs first approached the he of household if the husbands were not the head of households in order to receive permission to approach other household members. To confirm eligibility at baseline, RAs asked the head of household to provide a household roster with relationships and ages.

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Age was then reconfirmed via surveys with individual AGYW and husbands. At all timepoints, up to three attempts are made to reach the selected participants. At baseline, if the person could not be reached after these three attempts, a replacement Women want sex Delong chosen from the original listing based on asment of the next in the sequence i.

This process continued until 25 eligible couples were enrolled in each village. At baseline, couples were recruited based on the eligibility of the adolescent wife. If either the head of household or husband does not assent to participation of both the wife and husband, the couple is determined to be ineligible.

A gender-matched RA then accompanies each member of eligible couples to a private location of their choosing to obtain consent and conduct the survey. Verbal consent is assessed after describing the study and participation requirements in detail.

In keeping with the World Health Organization guidelines for ethical conduct on research on violence against women [ 1415 ]. To ensure that married AGYW do not feel pressured or coerced to participate based on husband assent, RAs assure them that consent is truly voluntary and that they are free to decline to participate. Further, only one woman per household is recruited for participation, and questions about experiences of violence were not asked of husbands, in order to minimize any potential risk to her safety arising from her participation.

If during the course of the interview, a married AGYW reports IPV, she is offered the option for confidential psychological support to increase her safety.

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Any modifications to this protocol were reported to the both ethics committees see Additional file 1. The two primary components of the RMA intervention include: 1 household visits made by trained community health workers relaisrecruited from within the communities to provide education and promote uptake of modern contraceptives and 2 small group discussions held by mentors also trained community members to promote dialogue around delaying and spacing births, use of modern contraceptive methods, and relevant cultural and gender norms.

The de of the program is based on the socio-ecological model and deed to target the multiple levels of influence on contraceptive use among married AGYW and their husbands in the context of rural Niger. These two main intervention activities are supplemented with community dialogues held in villages across all three districts ased to any of the three intervention arms to create an enabling environment for healthy timing and spacing of pregnancy HTSP and contraceptive method use. Table 1 shows a brief description of all intervention components. Household visits are conducted by trained relais in the homes of married AGYW and their husbands and include provision of education regarding modern contraceptive methods to counter misinformation, promotion of acceptability of contraceptive use and of engagement with the health system to receive family planning FP counseling and a modern contraceptive method.

Relais are gender-matched, i. Each relais speaks to the ased Women want sex Delong for one hour each month in the home. During these visits, relais use project-developed tools and an illustrated guide that supports their delivery of the twelve educational counseling sessions focused on FP counseling.

At the first home visit, the relais meets with all interested adult family members to explain the RMA program objectives and request permission from the head of household to visit the home and conduct the RMA sessions. Households in this region of rural Niger often comprise multiple related families led by the eldest man. Relais are members of the community who are committed to providing the RMA curriculum in order to help the community. Relais were recruited during village meetings prior to implementation of RMA. In each of the intervention villages ased to receive household visits, a representative of the program met with the village chief and select community members to present the objectives of RMA, the elements of the intervention, and the selection criteria for relais.

They then propose names of those that they believe best meet the selection criteria for relais. Training of relais takes place over a seven-day period with five days of training sessions, one day for preparation, and one day for reporting. Training is conducted in collaboration with the regional public health division directors as well as health center agents. Training sessions cover modern contraceptive methods, HTSP, gender equity, and adolescent rights with a focus on how to provide education and counseling to participants around these issues. Separate small group discussions, conducted by mentors, are held with married AGYW and their husbands.

These small groups are formed in each village to foster social cohesion, to build trust, and to promote dialogue related to contraception and SRH within the community. Groups consist of 10 to 13 participants each and are hosted at a health center — twice per month for married AGYW and once per month for their husbands. A female mentor facilitates all group sessions with married AGYW, and a male mentor facilitates all group sessions with their husbands, with additional support for Women want sex Delong groups provided by health center staff and community leaders.

By collaborating with community leaders, the project hopes to transform resistance to contraception, gender inequitable attitudes, and fertility norms supportive of early and frequent childbearing. Mentors, who lead the small group discussions, are members of the community and selected by project staff with input from other community members. Selection criteria for mentors were the same as for relais.

Women want sex Delong

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