Improving Family Planning and Gender Equity among Married Adolescent girls in Dosso, Niger
In Niger, Dr. Silverman is the principal investigator leading a four-arm clustered randomized control trial evaluating an effort led by Pathfinder International to increase healthy birth spacing and family planning use among rural married adolescents in Niger. Niger has the highest fertility rates in the world and one of the lowest rates of modern contraception use.
In the 4-arm mix-method outcome evaluation, villages in 3 districts of Dosso will be assigned to 1 of the 4 conditions: a) gender synchronized household visits, b) gender synchronized (but segregated) group-based interventions (i.e., husband groups and safe spaces groups for wives), c) both household and group-based interventions, or d) control condition.
Married adolescent girls and their husbands will be asked to complete the quantitative evaluation assessments at both baseline and 12-months follow-up to assess knowledge, acceptance and utilization of modern spacing methods of contraception, as well as gender equity regarding communication, decision-making regarding family planning, and husband and in-law violence. Ethnography and semi-structured interviews will be conducted before and after the 12-month follow-up survey to understand how participants are receiving and understanding the intervention, bring together what people say with what they do, and elucidate the "how" and the "why" around preliminary quantitative findings. In addition, a cost-effectiveness analysis, comparing each of the three interventions, will be conducted utilizing the WHO-CHOICE methodology, an internationally accepted standard of economic analysis of health programs in low resource settings, to inform decisions regarding scale-up in Niger and adaptation of these approaches elsewhere in the region. As one of very few rigorous evaluations of family planning and programming ever conducted in the region, results will be valuable for informing future public health programming and investments in the West African region.
*Funded by Bill and Melinda Gates Foundation (via collaboration with Pathfinder International)