Project Details

In 2024, 27.8% of married women of reproductive age in Uganda wanted to avoid pregnancy but were not using a modern contraceptive method—highlighting persistent barriers to reproductive autonomy. Supporting women to make informed choices on the timing and spacing of their pregnancies leads to significant public health benefits, including reductions in pregnancy-related complications, maternal deaths, and infant mortality. On the supply-side, community platforms to deliver family planning, as well as provider capacity to provide effective methods, need to be strengthened, but such efforts will not be optimized without addressing multilevel demand-side barriers to contraceptive use.

Fear of side-effects, relationship dynamics, peer and family influence, and broader community norms promoting large family size and traditional societal roles influence family planning. To address this gap, our team developed Family Health=Family Wealth (FH=FW), a multi-level, community-based intervention, which employs community dialogues to alter individual knowledge and the perception of community norms that discourage family planning alongside health system strengthening efforts. Community dialogues are delivered to groups of couples over 6-sessions enhanced to simultaneously address individual and interpersonal-level determinants of family planning and serve as a platform for community-based family planning and linkage to facility-based family planning services.

The major goal of this research study is to test the efficacy of the FH=FW intervention at increasing modern contraceptive use and reducing unintended pregnancy among couples with an unmet need for family planning through 24-months. In addition, we will explore factors affecting the implementation of the intervention in order to improve feasibility, acceptability, and the likelihood of future adoption and sustainment.

Methodology

We will test the efficacy of this intervention through a cluster randomized control trial (CRCT) implemented in 3 districts in central Uganda. We will recruit couples who are of reproductive age, where the woman reports an unmet need for family planning. Data will be collected through pregnancy tests and structured questionnaires at baseline, 8-month, 16-month and 24-month follow-up, exit focus groups and interviews with a subsample of intervention participants and key informant interviews with intervention facilitators, health workers and community partners.

Key Findings

The intervention was previously tested in a pilot trial, which demonstrated its acceptability, feasibility, and preliminary positive effects on contraceptive uptake and related family planning determinants.

1. Sileo, K. M., Muhumuza, C., Wanyenze, R. K., Kershaw, T. S., Sekamatte, S., Lule, H., & Kiene, S. M. (2023). A pilot quasi-experimental controlled trial of a community-based, multilevel family planning intervention for couples in rural Uganda: evidence of feasibility, acceptability, and effect on contraceptive uptake among those with an unmet need for family planning. Contraception, 125, 110096. https://doi.org/10.1016/j.contraception.2023.110096
2. Sileo, K. M., Muhumuza, C., Wanyenze, R. K., Kershaw, T. S., Ellerbe, B., Muñoz, S., Sekamatte, S., Lule, H., & Kiene, S. M. (2024). Effects of a community-based, multi-level family planning intervention on theoretically grounded intermediate outcomes for couples in rural Uganda: Results from a mixed methods pilot evaluation. British journal of health psychology, 29(3), 551–575. https://doi.org/10.1111/bjhp.12713