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      Gender-transformative Bandebereho couples’ intervention to promote male engagement in reproductive and maternal health and violence prevention in Rwanda: Findings from a randomized controlled trial

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          Abstract

          Background

          Rigorous evidence of the effectiveness of male engagement interventions, particularly on how these interventions impact relationship power dynamics and women’s decision-making, remains limited. This study assessed the impact of the Bandebereho gender-transformative couples’ intervention on impact on multiple behavioral and health-related outcomes influenced by gender norms and power relations.

          Methods

          We conducted a multi-site randomised controlled trial in four Rwandan districts with expectant/current fathers and their partners, who were randomised to the intervention (n = 575 couples) or control group (n = 624 couples). Primary outcomes include women’s experience of physical and sexual IPV, women’s attendance and men’s accompaniment at ANC, modern contraceptive use, and partner support during pregnancy. At 21-months post-baseline, 1123 men and 1162 partners were included in intention to treat analysis. Generalized estimating equations with robust standard errors were used to fit the models.

          Findings

          The Bandebereho intervention led to substantial improvements in multiple reported outcomes. Compared to the control group, women in the intervention group reported: less past-year physical (OR 0.37, p<0.001) and sexual IPV (OR 0.34, p<0.001); and greater attendance (IRR 1.09, p<0.001) and male accompaniment at antenatal care (IRR 1.50, p<0.001); and women and men in the intervention group reported: less child physical punishment (women: OR 0.56, p = 0.001; men: OR 0.66, p = 0.005); greater modern contraceptive use (women: OR 1.53, p = 0.004; men: OR 1.65, p = 0.001); higher levels of men’s participation in childcare and household tasks (women: beta 0.39, p<0.001; men: beta 0.33, p<0.001); and less dominance of men in decision-making.

          Conclusions

          Our study strengthens the existing evidence on male engagement approaches; together with earlier studies our findings suggest that culturally adapted gender-transformative interventions with men and couples can be effective at changing deeply entrenched gender inequalities and a range of health-related behavioral outcomes.

          Trial registration

          ClinicalTrials.gov NCT02694627

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          Most cited references16

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          Undoing Gender

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            The impact of including husbands in antenatal health education services on maternal health practices in urban Nepal: results from a randomized controlled trial.

            Observational studies suggest that including men in reproductive health interventions can enhance positive health outcomes. A randomized controlled trial was designed to test the impact of involving male partners in antenatal health education on maternal health care utilization and birth preparedness in urban Nepal. In total, 442 women seeking antenatal services during second trimester of pregnancy were randomized into three groups: women who received education with their husbands, women who received education alone and women who received no education. The education intervention consisted of two 35-min health education sessions. Women were followed until after delivery. Women who received education with husbands were more likely to attend a post-partum visit than women who received education alone [RR = 1.25, 95% CI = (1.01, 1.54)] or no education [RR = 1.29, 95% CI = (1.04, 1.60)]. Women who received education with their husbands were also nearly twice as likely as control group women to report making >3 birth preparations [RR = 1.99, 95% CI = (1.10, 3.59)]. Study groups were similar with respect to attending the recommended number of antenatal care checkups, delivering in a health institution or having a skilled provider at birth. These data provide evidence that educating pregnant women and their male partners yields a greater net impact on maternal health behaviors compared with educating women alone.
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              Effectiveness of an integrated intimate partner violence and HIV prevention intervention in Rakai, Uganda: analysis of an intervention in an existing cluster randomised cohort.

              Intimate partner violence (IPV) is associated with HIV infection. We aimed to assess whether provision of a combination of IPV prevention and HIV services would reduce IPV and HIV incidence in individuals enrolled in the Rakai Community Cohort Study (RCCS), Rakai, Uganda.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: Project administrationRole: Writing – original draft
                Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: Writing – original draft
                Role: ConceptualizationRole: Funding acquisitionRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: ValidationRole: Writing – review & editing
                Role: Formal analysisRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Project administrationRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                4 April 2018
                2018
                : 13
                : 4
                : e0192756
                Affiliations
                [1 ] Promundo-US, Washington, DC, United States of America
                [2 ] Gender Innovation Lab, World Bank, Washington, DC, United States of America
                [3 ] Milken Institute School of Public Health, The George Washington University, Washington, DC, United States of America
                [4 ] Rwanda Men’s Resource Center, Kigali, Rwanda
                [5 ] Maternal, Child and Community Health Division, Rwanda Ministry of Health, Rwanda Biomedical Center, Kigali, Rwanda
                [6 ] HIV and AIDS Program, Population Council, Washington, Washington, DC, United States of America
                [7 ] Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States of America
                [8 ] Institute for Reproductive Health, Georgetown University, Washington, DC, United States of America
                TNO, NETHERLANDS
                Author notes

                Competing Interests: Kate Doyle, Shamsi Kazimbaya and Anicet Nzabonimpa participated in the development of the curriculum. Shamsi Kazimbaya and Anicet Nzabonimpa monitored the implementation of the intervention, but did not have access to the data. Kate Doyle, Ruti Levtov, and Shamsi Kazimbaya were involved in the supervision of data collection but did not directly collect any data. No other authors have any conflict of interest to declare.

                [¤]

                Current address: Promundo-US, Washington, DC, United States of America

                Author information
                http://orcid.org/0000-0002-7030-8786
                Article
                PONE-D-17-42401
                10.1371/journal.pone.0192756
                5884496
                29617375
                d17c78a5-9386-4e4c-9c7c-53de23fab559
                © 2018 Doyle et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 2 December 2017
                : 18 January 2018
                Page count
                Figures: 1, Tables: 4, Pages: 17
                Funding
                Funded by: Anonymous Donor
                Award ID: 5669
                Funded by: Dutch Ministry of Foreign Affairs
                Award ID: 24935
                Funded by: funder-id http://dx.doi.org/10.13039/100000870, John D. and Catherine T. MacArthur Foundation;
                Award ID: 13-103720-000-INP
                Funding was received from: Anonymous donor (No.5669); Dutch Ministry of Foreign Affairs (No.24935), https://www.government.nl/ministries/ministry-of-foreign-affairs; John D. and Catherine T. MacArthur Foundation (#13-103720-000-INP), https://www.macfound.org/. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology and Life Sciences
                Neuroscience
                Cognitive Science
                Cognitive Psychology
                Decision Making
                Biology and Life Sciences
                Psychology
                Cognitive Psychology
                Decision Making
                Social Sciences
                Psychology
                Cognitive Psychology
                Decision Making
                Biology and Life Sciences
                Neuroscience
                Cognitive Science
                Cognition
                Decision Making
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Antenatal Care
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Contraception
                Female Contraception
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Contraception
                Male Contraception
                Medicine and Health Sciences
                Public and Occupational Health
                Traumatic Injury Risk Factors
                Violent Crime
                Intimate Partner Violence
                Social Sciences
                Sociology
                Criminology
                Crime
                Violent Crime
                Intimate Partner Violence
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Pregnancy
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Pregnancy
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Biology and Life Sciences
                Behavior
                Custom metadata
                Due to ethical restrictions, data are available upon request. Per our ethical approval protocol, the authors have committed to sharing the data underlying for this study upon request from qualified researchers, with priority to Rwandan researchers. Individuals can contact Promundo-US by email to request data ( research@ 123456promundoglobal.org ).

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