Mohan Ghule

Determinants of spacing contraceptive use among couples in Mumbai: a male perspective.

This study aimed to determine the factors influencing the use of spacing contraceptive methods in India, particularly from mens perspective. Data were obtained through a semi-structured interview schedule from 2,687 married men aged between 18 and 40 years from central Mumbai City, India, during 1999. Chi-squared tests and binary logistic regression analysis was carried out to determine the relationship between various variables and the likelihood of a couple using spacing contraceptive methods. Of the 2,687 couples, 1,395 (51.9%) were using one or other method of spacing contraceptives and 1,292 (48.1%) were not using any method at the time of survey. Male participation in contraceptive use was 23% (condom and withdrawal). The results indicate that the use of spacing contraceptive methods was significantly higher among those couples where the men desired one or two children (OR=4.3), had knowledge of five or more contraceptive methods (OR=1.9) and discussed with their wives obtaining family planning information (OR=3.2), spacing (OR=2.7) and permanent (OR=2) contraceptive methods. Age, income, desired number of children, knowledge of a greater number of contraceptive methods, inter-spouse communication regarding obtaining family planning information, spacing and permanent methods were found to be strong predictors of the use of spacing contraceptive methods. The study underlines the importance of intervention programmes aimed at promoting a small family norm, increasing the number of contraceptive choices available and encouraging inter-spouse communication. Hence, policymakers and programme managers should encourage interventions in this direction, targeting couples to enhance the use of spacing contraceptive methods.

Cluster randomized controlled trial evaluation of a gender equity and family planning intervention for married men and couples in rural India.

Background Despite ongoing recommendations to increase male engagement and gender-equity (GE) counseling in family planning (FP) services, few such programs have been implemented and rigorously evaluated. This study evaluates the impact of CHARM, a three-session GE+FP counseling intervention delivered by male health care providers to married men, alone (sessions 1&2) and with their wives (session 3) in India. Methods and Findings A two-armed cluster randomized controlled trial was conducted with young married couples (N = 1081 couples) recruited from 50 geographic clusters (25 clusters randomized to CHARM and a control condition, respectively) in rural Maharashtra, India. Couples were surveyed on demographics, contraceptive behaviors, and intimate partner violence (IPV) attitudes and behaviors at baseline and 9 &18-month follow-ups, with pregnancy testing at baseline and 18-month follow-up. Outcome effects on contraceptive use and incident pregnancy, and secondarily, on contraceptive communication and men’s IPV attitudes and behaviors, were assessed using logistic generalized linear mixed models. Most men recruited from CHARM communities (91.3%) received at least one CHARM intervention session; 52.5% received the couple’s session with their wife. Findings document that women from the CHARM condition, relative to controls, were more likely to report contraceptive communication at 9-month follow-up (AOR = 1.77, p = 0.04) and modern contraceptive use at 9 and 18-month follow-ups (AORs = 1.57–1.58, p = 0.05), and they were less likely to report sexual IPV at 18-month follow-up (AOR = 0.48, p = 0.01). Men in the CHARM condition were less likely than those in the control clusters to report attitudes accepting of sexual IPV at 9-month (AOR = 0.64, p = 0.03) and 18-month (AOR = 0.51, p = 0.004) follow-up, and attitudes accepting of physical IPV at 18-month follow-up (AOR = 0.64, p = 0.02). No significant effect on pregnancy was seen. Conclusions Findings demonstrate that men can be engaged in FP programming in rural India, and that such an approach inclusive of GE counseling can improve contraceptive practices and reduce sexual IPV in married couples. Trial Registration ClinicalTrials.gov NCT01593943

Intimate partner violence among married couples in India and contraceptive use reported by women but not husbands

To assess whether intimate partner violence (IPV) is associated with discordant reports of contraceptive use (whereby wives but not husbands report such use) among married couples in Maharashtra, India.

Age at menarche, education, and child marriage among young wives in rural Maharashtra, India.

India is home to 33% of the 720 million women worldwide who were married before the age of 18 years [1]. Menarche has historically been viewed as an indicator of a girl’s readiness to marry [2], but recent research on this issue is limited. The present study examined associations between age at menarche and age at marriage among young wives who were baseline respondents in the CHARM study—a two-armed randomized controlled trial evaluating a male engagement-focused family planning intervention in rural Maharashtra, India.

Sexual Behaviour of Rural College Youth in Maharashtra, India: An Intervention Study

Objective To promote healthy sexual behaviour among rural college youth. Methods The intervention study consisted a sample of 1 500 (800 male and 700 female) in baseline and 1 953 (1 022 male and 931 female) college going students in post intervention, in the age groups 15–24 years from 8 colleges in Thane district of Maharashtra. The interventions included dissemination of IEC (Information, Education and Communication), counselling in colleges and provision of health care services at rural health centers in the experimental area. Male and female teachers and peer leaders were trained to provide IEC. Chi-square test was carried out to find out the association between contributing factors and sexual behaviour. Results Post intervention results showed that overall any sexual experience (coital/ non-coital) increased by 2.6% and 1.0% among male students and 4.6% and 0.8% among female students in control and experimental groups respectively which suggests that in the control area physical closeness and sexual relationship has increased between sexes. A significant improvement was noted in the usage of condom during their sexual intercourse in experimental group. The provision of IEC in college settings, peer leader training and orientation to teachers helped students and teachers to initiate a dialogue on reproductive health issues. Intervention programs helped college youth to develop the skills, make informed decisions about engaging in sexual intercourse and using contraceptives in a social context that sometimes encourages risky sexual behaviour. The study found that peer interaction was exposure to erotic material; habits and working status among boys and peer interaction and place of study among girls were closely associated with their coital and non-coital sex experience. Conclusion A scientifically developed, need based and demand driven reproductive health service package for male and female students in colleges can help them to develop their knowledge, skills and attitudes for critical thinking and responsible decision making and for achieving healthy sexual life. Therefore, programs aimed at promotion of safer sex practice should be promoted at such vulnerable group.

Association between tribal status and spacing contraceptive use in rural Maharashtra, India

This study examines associations between tribal status and spacing contraception use (SCU) in rural Maharashtra, India. Cross-sectional analyses were conducted on baseline survey data from non-sterilized married couples (n = 867) participating in the CHARM family planning evaluation study. Participants were aged 18-30 years and 67.6% were tribal; 27.7% reported current SCU. Crude regression analyses indicated that tribals were less likely to use contraception (AOR = 0.04, 95% CI = 0.29, 0.54); this association was lost after adjusting for education, higher parity and desire for pregnancy, factors associated with tribal status. Findings suggest that lower SCU among tribals is driven by social vulnerabilities and higher fertility preferences.

Spousal discordance on reports of contraceptive communication, contraceptive use, and ideal family size in rural India: a cross-sectional study

BackgroundPersistent low rates of spacing contraceptive use among young wives in rural India have been implicated in ongoing negative maternal, infant and child health outcomes throughout the country. Gender inequity has been found to consistently predict low rates of contraception. An issue around contraceptive reporting however is that when reporting on contraceptive use, spouses in rural India often provide discordant reports. While discordant reports of contraceptive use potentially impede promotion of contraceptive use, little research has investigated the predictors of discordant reporting.MethodsUsing data we collected from 867 couples in rural Maharashtra India as part of a men-focused family planning randomized controlled trial. We categorized couples on discordance of men’s and women’s reports of current contraceptive use, communication with their spouse regarding contraception, and ideal family size, and assessed the levels of discordance for each category. We then ran multinomial regression analyses to determine predictors of discordance categories with a focus on women’s empowerment (household and fertility decision-making, women’s education, and women’s knowledge of contraception).ResultsWhen individuals reported communicating about contraception and their spouses did not, those individuals were also more likely to report using contraception when their spouses did not. Women’s empowerment was higher in couples in which both couples reported contraception communication or use or in couples in which only wives reported contraception communication or use. There were couple-level characteristics that predicted husbands reporting either contraception use or contraception communication when their wives did not: husband’s education, husband’s familiarity with contraception, and number of children.ConclusionsOverall there were clear patterns to differential reporting. Associations with women’s empowerment and contraceptive communication and use suggest a strategy of women’s empowerment to improve reproductive health. Discordant women-only reports suggest that even when programs interact with empowered women, the inclusion of husbands is essential. Husband-only discordant reports highlight the characteristics of men who may be more receptive to family planning messages than are their wives. Family planning programs may be most effective when working with couples rather than just with women, and should focus on improving communication between couples, and supporting them in achieving concordance in their reproductive preferences.Trial registrationClinical Trials Number: NCT01593943, registered May 4, 2012 at clinicaltrials.gov.

Understanding Men’s Elevated Alcohol Use, Gender Equity Ideologies, and Intimate Partner Violence Among Married Couples in Rural India

Qualitative evidence suggests that husbands’ inequitable gender equity (GE) ideologies may influence associations between husbands’ alcohol use and intimate partner violence (IPV) against wives. However, little quantitative research exists on the subject. To address this gap in the literature, associations of husbands’ elevated alcohol use and GE ideologies with wives’ reports of IPV victimization among a sample of married couples in Maharashtra, India, were examined. Cross-sectional analyses were conducted using data from the baseline sample of the Counseling Husbands to Achieve Reproductive Health and Marital Equity (CHARM) study. Participants included couples aged 18 to 30 years (N = 1081). Regression models assessed the relationship between husbands’ elevated alcohol use and GE ideologies (using the Gender-Equitable Men [GEM] Scale) and wives’ history of physical and/or sexual IPV victimization ever in marriage. Husbands and wives were 18 to 30 years of age, and married on average of 3.9 years (SD ± 2.7). Few husbands (4.6%) reported elevated alcohol use. Husbands had mean GEM scores of 47.3 (SD ± 5.4, range: 35–67 out of possible range of 24–72; least equitable to most equitable). Approximately one fifth (22.3%) of wives reported a history of physical and/or sexual IPV. Wives were less likely to report IPV if husbands reported greater GE ideologies (adjusted odds ratio [AOR]: 0.97, 95% CI [0.95, 0.99]), and husband’s elevated alcohol use was associated with increased risk of IPV in the final adjusted model (AOR: 1.89, 95% CI [1.01, 3.40]). Findings from this study indicate the need for male participation in violence intervention and prevention services and, specifically, the need to integrate counseling on alcohol use and GE into such programming.

Masculine Gender Ideologies, Intimate Partner Violence, and Alcohol Use Increase Risk for Genital Tract Infections Among Men

Masculine gender ideologies are thought to underlie alcohol use, intimate partner violence (IPV) perpetration, and sexual risk of HIV and other sexually transmitted infections (STIs). We extend on studies in the Indian context by examining the roles of masculine gender ideologies, alcohol use, and IPV on three outcomes of HIV risk (condom use, genital tract infection [GTI] symptoms, and GTI diagnosis). We applied logistic regression models to cross-sectional data of men and their wives in rural Maharashtra, India (n = 1,080 couples). We found that men with less masculine gender ideologies demonstrated greater odds of condom use (i.e., lower odds no condom use, odds ratio [OR] = 0.96, 95% confidence interval [CI] = [0.93, 0.98]). IPV perpetration was associated with increased odds of reporting ≥1 GTI symptom (adjusted OR [AOR] = 1.56, 95% CI = [1.07, 2.26]) and decreased GTI diagnosis (AOR = 0.28, 95% CI = [0.08, 0.97]). Moderate alcohol consumption was associated with increased odds of reporting ≥1 GTI symptom (AOR = 1.51, 95% CI = [1.01, 2.25]). Our findings have direct implications for men’s and women’s health in rural India, including targeted GTI diagnosis and treatment, integrated violence prevention in STI clinics, and targeted intervention on masculine gender ideologies.