CHARM 2: A Gender Synchronized Family Planning Intervention for Couples in Rural India, a Cluster Randomized Trial

INTRODUCTION: Gender synchronized family planning interventions are posited to be an important means of engaging men while supporting women's reproductive agency and increasing modern contraceptive use, particularly in contexts where traditional gender norms prevail. The Counseling Husbands to Achieve Reproductive Health and Marital Equity (CHARM) intervention counsels men, women, and couples on gender equity and family planning. METHODS: This is an institutional review board (IRB)‐approved cluster randomized controlled trial evaluating the effect of the CHARM2 intervention on contraceptive use, communication and agency, pregnancy, and quality of care among married couples across 20 clusters in rural Maharashtra, India. RESULTS: We enrolled 1,201 couples. Full‐couple retention at 18 months was 90.5%. Contraceptive use was higher among intervention participants at 9 but not 18 months (adjusted ratio of odds ratio [AROR] 1.5, 95% CI 1.03‐2.3 and AROR 0.8, 95% CI 0.4‐1.4). Communication (9‐month AROR 1.9, 95% CI 1.0‐3.6; 18‐month AROR 2.7, 95% CI 1.5‐4.8) and agency (9‐month AROR 5.1, 95% CI 1.2‐22.4; 18‐month AROR 8.1, 95% CI 1.4‐48.2) improved at both times. Intervention participants had significantly higher mean Interpersonal Quality of Family Planning scale scores at both times (9‐ month intervention 3.2 vs control 2.3, P<.001; 18‐month intervention 3.2 vs control 2.8, P<.001). There was no significant difference in pregnancy between groups over the 18‐month period (AOR 0.8, 95% CI 0.7‐1.1) However, unintended pregnancy was marginally less likely among intervention participants (47% vs 19%) (P=.07). CONCLUSION: Broad implementation of the CHARM2 intervention has the potential to improve contraceptive use, communication, agency, and quality of care and to possibly decrease unplanned pregnancies in rural India.