Use of community-based interventions to promote Family Planning use among Pastoralist women in Ethiopia: Cluster randomized controlled trial
Abstract Background: - Afar region is one of the pastoralists dominated regions in Ethiopia. The region is characterized by a low contraceptive prevalence rate (CPR) with 5.4%. Lack of awareness, husband objection, and religious influence was the reasons attributed to low CPR in the region. As objective we assessed the effect of a community-based interventions for promoting FP use among pastoralist communities of Afar region state, Ethiopia.Methods: The design was parallel, cluster randomized controlled trial (CRT) recruiting married women. It had three arms: 1) women’s education on FP, 2) male involvement in FP education and 3) control with one to one ratio. A total of 33 kebeles (lowest administrative structure) were randomized and allocated. Women’s FP education and male involvement in FP education were the interventions. It was implemented using 1) health education on FP to married women and men by faema leaders (a traditional community-based structure that serves as a social support group) 2) Video-assisted message on FP, and 3) Assisting the faema leader using health workers. The intervention was given for a total of 9 months. FP use and intentions were measured as outcome variables based on woman’s perspectives. Cluster level summaries considering a cluster effect analysis was performed. The result was presented with adjusted risks and 95% CI. A p-value <0.05 was used to declare statistically significant.Results: There was a positive change in the proportion of married women who use FP in the women’s FP education arm, absolute risk (AR) of 0.13(95% CI,0.08,0.17) and male involvement arm with AR of 0.29 (95% CI, 0.23,0.34) as compared to the control arm. In the control arm, the proportion of FP use was 4.3%, whereas it was 17.5% with women who receive FP education and 34% in the male involvement arm. Furthermore, the proportion of married women who had high intention to use FP was high in arms of women’s FP education and male involvement with AR=3.4(95% CI: 2.48,4.91) and AR=2.1 (95% CI: 1.5,2.95), respectively as compared with the control arm. Conclusion: The present study highlighted the effctienesswomen’s education on FP and male involvement in FP education brings a significant change in increasing the number of women who use FP and intention. Using the community-led support groups in the pastoralist community appears to be effective in increasing the number of women FP users and intention to use.Trial registration: NCT03450564