Most family planning programs are targeted at women, leaving men, who are usually the decision-makers, from engaging in family planning. This often reduces the effectiveness of family planning interventions. Although the global health community is making significant efforts to engage men in family planning, there is a lack of understanding of barriers and motivations of men in engaging in the process. ‘Couple Engage’ is a project that leverages evidence, literature review, and iterative design processes to help optimize, consolidate and innovate on scalable, gender equitable and couple empowering approaches to engage men and couples in family planning.
Demand Side Insights
A first of its kind grant by BMGF to understand male and couple engagement in FP. The focus is on the nuances of a couple’s relationship to comprehend the role that factors like spousal communication and decision making play in family planning.
Gaps in Service Delivery
The grant also studied deficiencies in health service providers like lack of gender-sensitivity training, knowledge gaps, and siloed services, among others to illuminate areas that need to be addressed from an intervention standpoint.
Expansive Theory of Change
A comprehensive ToC to provide the rationale for creating interventions that instigate change across the layers of individuals, couples, peers, communities, and health systems.
New Approach to Building Solutions
Partner-Embedded Prototype and Validation (PEPV) has been developed as a way to collaboratively synchronize funders, researchers, designers and implementers for achieving interventions geared towards deployability and impact.
Covid Impact
The impact of COVID-19 has been studied, and been accounted for in the project to frame multi-prong delivery approaches to de-risk the deployment of the developed interventions
Findings from Research
The Evidence Review highlights learnings on engaging men and couples in family planning in lower and middle income countries to ground the research and design process. Using a mix of peer-reviewed, programmatic and human centered design insights, the review helped build hypotheses for the project. Learnings were also drawn from interviews with technical specialists in masculinity, family planning and design research. At the end of the evidence review, a hypothesis building workshop helped refine and leverage the evidence by identifying possible opportunity areas for interventions.
Learnings from the Field
The Evidence Review highlights learnings on engaging men and couples in family planning in lower and middle income countries to ground the research and design process. Using a mix of peer-reviewed, programmatic and human centered design insights, the review helped build hypotheses for the project. Learnings were also drawn from interviews with technical specialists in masculinity, family planning and design research. At the end of the evidence review, a hypothesis building workshop helped refine and leverage the evidence by identifying possible opportunity areas for interventions.
Frameworks & Profiles
The research uncovered three primary couple profiles (or ‘typologies’) based on how the continuum of communication and decision-making between the spouses manifests itself in various domains of their marital life. These were ‘Mutuals’, ‘Functionals’ and ‘Discordant Toners’. In addition to this, an FP Uptake Pathway emerged from the findings, which essentially describes a couple’s journey in relation to FP and contraception. It captures how different couple profiles experiment with traditional and modern contraceptive methods, which, in some cases, leads to successful adoption, or more frequently in repetitive cycles of failure (unplanned pregnancies and abortions). This Pathway was a key fulcrum for identifying points of intervention, as well as designing solutions for different couple profiles.
Solutions
The insights resulting from the research were used to frame 13 Intervention Directions (IDs). These served as guides to frame and develop possible solutions. The entire process resulted in the framing of 2 concepts (1 digital, 1 non-digital) for each ID. These solutions were then clustered thematically under five headings: aspirational planning, couple-making, health and wellbeing, FLW training and mass communication. The concepts were developed on a spectrum that employed existing, future-forward, and even disruptive channels to ensure a balance between what is possible today with opportunities for the future.
Evaluation
The purpose of evaluation is to enable the interested organization to make investment decisions on whether their chosen concepts should be scaled into full-fledged interventions. It should also provide data-driven directions for altering aspects of the concepts to maximize their efficiency and effectiveness to achieve the set goal in accordance with their mandates. Keeping these in mind, it would make sense to identify the various aspects that would help them examine the potential of the selected concepts. These should encompass usability and affordance, management, supply chain and logistics and human motivation, on both service provider and beneficiary sides.
COVID Study
With the country hit by COVID-19 and the nationwide lockdown, the research team conducted a remote qualitative study to understand the impact of COVID-19 on the family planning choices, couple dynamics, sexual behaviour and demand-supply factors of contraceptives in the states of Uttar Pradesh and Bihar. Findings from this rapid research informed the intervention directions developed through the research during the project period.
Donor
Partners
The International Center for Research for Women (ICRW) is a global research institute, with regional hubs in Washington D.C., United States; New Delhi, India; Kampala, Uganda; and Nairobi, Kenya. Established in 1976, ICRW conducts research to identify practical, actionable solutions to advance the economic and social status of women and girls around the world. Our projects are focused on a range of issues such as inadequate access to education and livelihoods, adolescent empowerment, gender-based violence (GBV), masculinities and gender inequitable attitudes, HIV, and violence against women and girls (VAWG).
Vihara Innovation Network is a social impact firm dedicated to building and scaling innovations that enhance human health, well-being and social equity under the unfolding horizon of technology and climate change. Vihara's portfolio has focused on bringing rich behavioural insight, human centered design and the use of iterative and collaborative development to innovative products, services and strategies in order to increase the quality and efficacy of public health services, boost demand and coverage, improve trust between service providers and receivers and enable healthful behaviours in low resource environments.