Background
Methods
Search strategy
PubMed Search Strategy |
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Limits Activated: English, Adolescent: 15–18 years, Young Adult: 19–24 years |
#1: (((Community Health Aides [MeSH]) OR (“Aide, Community Health”) OR (“Aides, Community Health Aide”) OR (“Health Aide, Community”) OR (“Health Aides, Community”) OR (“Village Health Worker”) OR (“Health Worker, Village”) OR (“Health Workers, Village”) OR (“Village Health Workers”) OR (“Worker, Village Health”) OR (“Workers, Village Health”) OR (“Family Planning Personnel”) OR (“Personnel, Family Planning”) OR (“Planning Personnel, Family”) OR (“Family Planning Personnel Characteristics”) OR (“Barefoot Doctors”) OR (“Barefoot Doctor”) OR (“Doctor, Barefoot”) OR (“Doctors, Barefoot”) OR (“Community Workers”) OR (“Community Worker”) OR (“Worker, Community”) OR (“Workers, Community”)) |
#2: (((Community Health Services [MeSH]) OR (“Services, Community Health”) OR (“Health Services, Community”) OR (“Community Health Service”) OR (“Health Service, Community”) OR (“Service, Community Health”) OR (“Community Health Care”) OR (“Care, Community Health”) OR (“Health Care, Community”) OR (“Community Healthcare”) OR (“Community HealthCare’s”) OR (“Healthcare, Community”) OR (“HealthCare’s, Community”))))))))) |
#3: #1 OR #2 |
#4 (((“prenatal care” [MeSH]) OR (“prenatal care”) OR (“antenatal care”))) |
#5 (((“Delivery, Obstetric” [MeSH]) OR (“Deliveries, Obstetric”) OR (“Obstetric Deliveries”) OR (“Obstetric Delivery”))) |
#6 (((“Postnatal Care” [MeSH]) OR (“Care, Postnatal”) OR (“Postpartum Programs”) OR (“Postpartum Program”) OR (“Program, Postpartum”) OR (“Programs, Postpartum”) OR (“Postpartum Care”) OR (“Care, Postpartum”) OR (“Cares, Postpartum”) OR (“Postpartum Cares”))) |
#7: (Contraception [MeSH]) OR (“Contraceptive Methods”) OR (“Contraceptive Method”) OR (“Fertility Control”) OR (“Female Contraception”) OR (“Contraception, Female”) OR (“Contraception, Female”) OR (“Female Contraception”) OR (“Male Contraception”) OR (“Contraception, Male”) OR (“Contraception, Male”) OR (“Male Contraception”) OR (Family Planning Services [MeSH]) OR (“Family Planning Service”) OR (“Planning Service, Family”) OR (“Planning Services, Family”) OR (“Service, Family Planning”) OR (“Services, Family Planning”) OR (“Family Planning”) OR (“Pregnancy, Planned”) OR (“Planned Pregnancies”) OR (“Pregnancies, Planned”) OR (“Planned Pregnancy”) OR (“Family Planning Programs”) OR (“Family Planning Program”) OR (“Program, Family Planning”) OR (“Programs, Family Planning”)))) |
#8: (((((Reproductive Behavior [MeSH]) OR (“Behavior, Reproductive”) OR (“Voluntary Childlessness”) OR (“Childlessness, Voluntary”) OR (“Delayed Childbearing”) OR (“Childbearing, Delayed”) OR (Birth Intervals [MeSH]) OR (“Birth Interval”) OR (“Birth Spacing”) OR (“Birth Spacing’s”) OR (“Pregnancy Intervals”) OR (“Pregnancy Interval”) OR (“First Birth Intervals”) OR (“First Birth Interval”) OR (Abortion, Induced [MeSH]) OR (“Induced Abortion”) OR (“Abortions, Induced”) OR (“Induced Abortions”) OR (“Abortion (Induced)”) OR (“Abortions (Induced)”) |
#9: (Intrauterine Devices [MeSH]) OR (“Device, Intrauterine”) OR (“Devices, Intrauterine”) OR (“Intrauterine Device”) OR (“Contraceptive IUD”) OR (“IUD, Contraceptive”) OR (“IUDs, Contraceptive”) OR (“Contraceptive IUDs”) OR (“Contraceptive Devices, Intrauterine”) OR (“Contraceptive Device, Intrauterine”) OR (“Device, Intrauterine Contraceptive”) OR (“Devices, Intrauterine Contraceptive”) OR (“Intrauterine Contraceptive Device”) OR (“Postpartum Abstinence”) OR (“Abstinence, Postpartum”) OR (Contraceptives, Oral [MeSH]) OR (“Oral Contraceptives”) OR (“Oral Contraceptives, Phasic”) OR (Sex Education [MeSH]) OR (“Education, Sex”) OR (“Family Planning Instructors”) OR (Reproductive Health Services [MeSH]) OR (“Health Service, Reproductive”) OR (“Health Services, Reproductive”) OR (“Reproductive Health Service”) OR (“Service, Reproductive Health”) OR (“Services, Reproductive Health”))) |
#10: #4 OR #5 OR #6 OR #7 OR # 8 OR # 9 |
#11: #3 AND #10 |
Inclusion criteria
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Population: (i) Interventions focused on young married couples, defined as married or cohabiting couples in which the female partner was in the age group of 15–24 years. (ii) Studies and evaluations of initiatives carried out in resource-constrained settings, being classified as low and middle-income countries (LMICs) by the World Bank in August 2011.
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Intervention: The interventions were on: (i) pregnancy care (antenatal, birth and postnatal), contraception/family planning and abortion care, and (ii) delivered by community/frontline workers, volunteers, paramedics and health workers.
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Outcome: Measured outcomes included changes in knowledge, attitudes, skills and practices on contraceptive use, the use of safe abortion services and pregnancy care including antenatal care (ANC), delivery care and postnatal care (PNC), and health impacts in terms of reduction in maternal mortality and morbidity.
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Study Design: Studies and evaluations using experimental, quasi-experimental designs, pre-post design and controlled comparison of before and after studies.
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Language: Studies and reports, published in English.
Data collection process
Quality assessment
Results
Abbreviations of different projects | Topic | Organization |
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FP [23] | Promoting healthy timing and spacing of births in India through a community-based Approach | Population council, Lala Lajpat Rai Memorial Medical College, and (Department of Economics) Jamia Milia Islamia University |
FTP [24] | Empowering married young women and improving their sexual and reproductive health: Effect of the First-time Parents Project | Population Council, CINI and Deepak Charitable Trust |
PRACHAR [25] | The effect of community-based reproductive health communication interventions on contraceptive use among young married couples in Bihar, India | PATHFINDER INTERNATIONAL. |
ACQUIRE [26] | Mobilizing married youth in Nepal to improve reproductive health: The Reproductive Health for Married Adolescent Couples Project, Nepal, 2005-2007 | ACQUIRE Project partners Engender Health and CARE |
REWARD [27] | Determining an effective and Replicable communication-based mechanism for improving young couples’ access to and use of reproductive health information and services in Nepal-An Operations Research Study | Center for Research on Environment, Health and Population Activities |
MMM [28] | Encouraging contraceptive uptake by motivating men to communicate about family planning: The Malawi Male Motivator Project | Family Health International and Save the children |
KEM [29] | Reproductive and sexual health education, care and counseling for married adolescents in rural Maharashtra | KEM Hospital Research Centre (KEM), Pune |
FRHS [30] | Social mobilization or Government services: What influences married adolescents’ reproductive health in rural Maharashtra, India? | Foundation for Research in Health Systems, Maharashtra |
Reference/country/implementation period | Objectives | Target population | Multi component intervention | Study design and sampling technique, evaluation design | Focus of intervention | ||
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Direct intervention with young married couple | Interventions to target family members and community meetings | Interventions towards health and other welfare systems | |||||
Khan et al. 2008, [23] India, 2006–07 (FP)a | 1. To assess the feasibility and effectiveness of using community workers to promote the use of Lactation Amenorrhea Method (LAM) and post-partum contraception that are conducive to healthy spacing and timing of pregnancy which can lead towards maternal and child mortality control. | 1. Pregnant women with parity 0, 1 Age group-20-24 years | 1. Individual counselling | 1. Discussion sessions, | 1. Cascaded capacity building training of frontline health workers | 1. Quasi experimental with intervention/control area, | 1. Post-partum contraception, |
2. Husbands of pregnant women | 2. Group counselling | 2. Educational campaign | 2. Purposive and convenience sampling, | 2. Family planning | |||
3. Mother-in-Law of pregnant women | 3. Wall Paintings | 3. Comparison between intervention and control | |||||
Santhya et al. 2008, [24] India, 2003–05, (FTP)a | 1. To develop and test an integrated package of health and social interventions to improve married young women’s reproductive and sexual health knowledge and practices, | 1. Young women married for up to 2 years and not yet pregnant | 1. Individual counselling | 1. Informal interaction to provide information | 1. None | 1. Quasi experimental with intervention/control area, | 1. Antenatal care, |
2. To enhance their ability to act in their own interest and expand their social support networks. | 2. Nulliparous pregnant women; | 2. Group Formation | 2. Community Educational campaign | 2. Selection process not reported | 2. Delivery care | ||
3. First-time mothers up to 18 months postpartum | 3. Group counselling | 3. Comparison between intervention and control, and Baseline end line | 3. Post natal care | ||||
4. Contraceptive use to delay first pregnancy | |||||||
5. Decision making, mobility and couple communication | |||||||
Daniel et al.2008, [25] India 2005–07 (PRACHAR)a | 1. To improve the health and welfare of young mothers and their children by changing traditional customs of early childbearing | 1. Married women (aged 15–24) | 1. Individual counseling | 1. Community meetings | 1. Training of rural medical practitioner (RMP) | 1. Quasi experimental with intervention/control area, | 1. Delay first birth |
2. Unmarried adolescents | 2. Street Plays, | 2. BCC | 2. Purposive and convenience sampling, Comparison between baseline and follow-up with in intervention and control group | 2. Family planning | |||
3. Young couples, their guardians (parents and in laws) and influential community members | 3. Drama | 3. Group meeting | 3. Follow-up/monitoring of cohort for reproductive and sexual health | 3. RTI/STI prevention, | |||
4. Subgroups based on child status (no child, pregnant and with one child) | 4. Community educational campaign, | 4. Importance of delaying first birth, need of birth spacing, | |||||
5. Provision of basic reproductive and sexual health services | |||||||
ACQUIREb 2008, Nepal, [26] 2000–2002 (ACQUIRE Project)a | 1. To increase married adolescents’ knowledge about family planning, maternal health and HIV and STI, | 1. Married couples in which the woman was an adolescent | 1. Group training | 1. Advocacy workshop | 1. Advocacy | 1. Pre post Repeated Cross sectional surveys | 1. Use of contraception before first pregnancy, |
2. To increase community and family support for reproductive health decision making by married adolescent couples, especially related to family planning and pregnancy, delivery and post natal care | 2. Youth couples aged up to 25 years | 2. Individual counselling | 2. Discussion sessions, | 2. Cluster Sampling with Village Development Council as unit, Comparison between Baseline and End line | 2. ANC, | ||
3. Sensitization | 3. Qualitative and quantitative survey | 3. Delivery, | |||||
4. Community educational campaign | 4. PNC | ||||||
5. Street Plays | 5. HIV/AIDS, | ||||||
6. Drama | 6. Gender attitude | ||||||
CREHPAb 2004, Nepal, [27] (REWARDa Project) | 1. To improve the reproductive health need of newly married couples | 1. Young married women under 25 years | 1. Group formation Youth Communication Action Group (YCAG) and Mothers group (MG) | 1. Special events | 1. Cascaded Capacity building training of frontline health workers | 1. Quasi experimental with intervention/control area, | 1. Family planning, |
2. Capacity building of Group leaders and deputy leaders, Group (YCAG and MG) | 2. Dissemination of knowledge | 2. Advocacy | 2. Purposive and convenience sampling, | 2. ANC, | |||
3. Counselling, Linkage of Group (YCAG and MG) members to health providers | 3. Sensitisation | 3. Comparison between intervention and control groups | 3. Delivery | ||||
4. Community Educational campaign | 4. Qualitative and quantitative survey | 4 PNC, | |||||
5. Group Sensitization | 5. STI and HIV/AIDS | ||||||
6. Street Plays, Drama, Wall Paintings, Radio channels, TV channels | |||||||
Shattuck et al. 2011, [28] Malawi, 2008 (MMM)a | 1. To evaluate the effect of a peer-delivered educational intervention, the Malawi Male Motivator intervention, on couples’ contraceptive uptake | 1. Primary target: Men at least 18 years old and married to or living with female sexual partner aged not less than 25 years who was not currently pregnant or breastfeeding | 1. Information, Motivation and Behavioral skill model | 1. None | 1. None | 1. RCT | 1. Use of contraception |
2. Secondary target group: Wife/female sexual partner of those men | 2. Computer based random number list, Comparison between baseline and end line with in intervention and control group | 2. Gender norms | |||||
3. Qualitative and quantitative survey | |||||||
Pande et al. (a) 2006 [29] (KEM)a | 1. Improving the reproductive health of married and unmarried adolescents | 1. Married male and female adolescents and young adults aged: 14–25 years | 1. Identification and referral for counselling | 1. Sensitisation | 1. Training | 1. Feasibility study, House-listing survey, | 1. Sexual and Reproductive health knowledge and status and use of services |
2. Couple counselling, | 2. Baseline and end line comparison | ||||||
3. Marital counselling, and Clinical Referral | 3. Qualitative and quantitative survey | ||||||
Pande et al. (b) 2006 [30] (FRHS)a | 1. To examine the feasibility and effectiveness of providing a package of services in a rural community to improve married adolescents’ sexual and reproductive health knowledge and status, and use of services | 1. Newly married couple less than 22 years old, | 1. Group Formation and Group counselling (health education sessions), | 1. Social mobilization activities | 1. Training of health providers | 1. 2 × 2 intervention control design | 1. ANC |
2. Husbands | 2. Couple counselling | 2. House-listing survey | 2. Delivery, | ||||
3. Mothers in law. | 3. Comparison between baseline and end line with in intervention and control group | 3. PNC | |||||
4. Contraception use, | |||||||
5. Abortion, infertility and treatment of reproductive RTI |
Projects | ANC | Institutional delivery | PNC | Contraception |
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Khan et al. 2008 (FP) [23]c | 1. Proportions discussing about spacing and family planning (%) | |||
% of couples who discussed family planning methods: Exp. Group (Exp.): 61 % (N = 560); Con. Group (Con): 39 % (N = 570); Sig (p < = 0.001) | ||||
% of couples who discussed when to have next child: Exp.: 85 %, con: 85 %; Non Sig Z test, Exp. vs. Con. | ||||
2. Contraceptive use at 9 months post-partum | ||||
% of women currently using family planning (FP): Exp: 63 %, Con: 32 %; Sig (p < = 0.001) | ||||
% currently pregnant: Exp.: 10 %, Con: 16 %; Sig (p < = 0.001) Z test, Exp. vs. Con. | ||||
(Data Source: End line Survey)
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Santhya et al. 2008 (FTP) [24] | Comprehensive antenatal care received by first time mothers: | % of first time mothers who reported institutional delivery | First time mothers who reported receiving routine checkups within six weeks postpartum | 1. Use of contraceptive to delay first birth: |
Diamond Harbour (DH): | Diamond Harbour (DH): | Diamond Harbour (DH): | Diamond Harbour (DH) site: | |
Con; BL: 6.5a; EL: 7.7 (N = 244,500); Sig. | Con; BL: 61 %; EL: 70 % (N = 244,500); Sig | Con.; BL: 7 %; EL: 27 % (N = 244,500); Sig | Con.; Baseline (BL): 54 %; End-line (EL): 66 % (N = 212, 238), | |
Exp. non-intervention; | Exp. non-intervention; | Exp. non-intervention; BL: | Exp. non-interventionb; BL: 24 %; | |
BL: 6; EL: 6.9, (N = 206, 191); Sig. | BL: 43 %; EL: 49 %, (N = 206, 191); Non sig | 6 %; EL: 15 % (N = 206,191); Sig | EL: 34 % (N = 94, 281) | |
Exp. intervention; BL: 6.1; EL: 7.7 (N = 114,460); Non sig | Exp. intervention; BL: 40 %; EL: 51 % (N = 114,460); Sig | Exp. intervention; BL: 6 %; EL: 45 % (N = 114/460); Sig | Exp. intervention; BL: 28 %; EL: 39 % (N = 163, 96) | |
Vadodara (VD): | Vadodara (VD): | Vadodara (VD): | Vadodara (VD) site: | |
Con; BL: 6.3; EL: 7.9 (N = 270,314); Sig | Con; BL: 56 %; EL: 68 % (N = 270,314); Sig | Control; BL: 29 %; EL: 33 % (N = 270/314); Sig | Control; BL: 36 %; EL: 13 % (N = 259, 338); Sig | |
Exp.non-intervention; BL: 7.1; EL: 7.8 (N = 228,159); Sig | Exp. non-intervention; BL: 65 %; EL: 77 % (N = 228,159); Sig | Exp. non-intervention; BL: 26 %; EL: 49 % (N = 228/159); Sig | Exp. non-intervention; BL: 34 %; EL: 11 % (N = 176, 310); Sig | |
Exp. intervention; BL: 8.3; EL: 8.8 (N = 61,285); Non sig | Exp. intervention; BL: 71 %; EL: 70 % (N = 61,285); Non Sig | Exp. intervention; BL: 28 %; EL: 51 % (N = 61,285); Sig
Data Source: Baseline End line Survey
| Exp. intervention; BL: 18 %; EL: 21 %, Non Sig | |
Daniel et al. 2008 (PRACHAR) [25]c | 1. % of Married women aged 15–24 years who were using contraception | |||
BL; Control: 2.8 %, Intervention: 4.3 % | ||||
Follow –up period: Control: 4.7 %, Intervention: 20.7 %, Sig | ||||
Interventions vs. Control: (OR: 3.8:1.0; p < 0.001) | ||||
2. % increase in median interval (in months) between marriage and first birth: | ||||
BL; Intervention area: 21.3 months, Non-intervention areas: NA | ||||
EL- Intervention area: 24 months; Non-intervention areas: NA | ||||
(Data Source: Baseline and Follow-Up Data)
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ACQUIRE, Evaluation and Research Studies Nepal 2008 [26] | Women who attended ANC on 4 or more occasions | Decrease in proportion of home delivery: | Use of PNC increased: Use of postnatal care services by young married women | 1. Actual use of contraception to postpone first birth among young married women: |
BL: 29.4 % and EL: 49.9 % (N = NA) | BL: 75 % and EL: 67 % (N = NA) | BL: 20 % and EL: 30 % (N = 240, 269) | BL: 4.4 % and EL: 4.8 %, (N = 294, 333) | |
Note: NA = data on sample size is Not Available |
(Data Source: Baseline and End line Survey)
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CREPHA, Nepal2004 (REWARD Project) [27] | Attended 4 or more ANC visits: | % of young married women who delivered their last child in hospital: | 1. Contraceptive prevalence rate: (%) among young married women | |
MG area: BL: 24.8 %, EL: 52.9 %; Sig | YCAG area: BL-5.9 %, EL: 16.1 % | Youth Communication Action Groups (YCAG) area; BL: 26 %, EL: 28 % | ||
Control area: BL: 14.4 %, EL: 43.2 %; Sig | Control: BL-2.6 %, EL: 5.3 % | |||
Mothers’ Group (MG) area; BL: 19 %, EL: 37 % | ||||
(Data Source: Baseline and End line Survey)
| Control area; BL: 29 %, EL: 34 % | |||
2. Mean age at pregnancy among young married women | ||||
YCAG area; BL: 18.1 %, EL: 18.5 % | ||||
MG area; BL: 18.0 %, EL: 18.3 % | ||||
Control area; BL: 17.7 %, EL: 17.5 % | ||||
Shattuck et al. 2011 (MMM) [28]c | Contraceptive uptake among young men with married or co-habiting partner: | |||
OR for contraceptive uptake among young males between intervention and control groups: OR (95 % CI): 2.4 (1.45,4.03) Sig | ||||
OR for increase in communication frequency among young couples between intervention and control groups: OR (95 % CI): 0.61 (0.36, 1.02) Sig | ||||
(Data Source: Baseline and Post-Intervention Data)
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Note: OR indicates Odds Ratio | ||||
Pande et al. (a) 2006 (KEM) [29] | Knowledge regarding Regular ANC check-ups | Awareness improved with respect to condom use as a way to prevent STIs and HIV | ||
Pre: 50 %, post: 75 % | Note: Data is not available | |||
(Data Source: Pre and Post-Intervention Data)
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Pande et al. (b) 2006 (FRHS) [30] | Change in knowledge among young married women on need for ANC check-ups between baseline and end line: | Knowledge on side effects of contraceptive use has increased | ||
Note: Data is not available | ||||
Social Mobilization arm (SM) only: 24.2 %, Government Services arm (GS) only: 18.5 %, SM + GS: 12 %, Control: 18.9 % | ||||
Change in knowledge among young married women on danger signs of pregnancy between baseline and end line: | ||||
SM only: 24.4 %, GS only: 22.5 %, SM + GS: 24.2 %, control: 16.5 % | ||||
(Data Source: Baseline and End line Survey)
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Project | Explicit aim | Sample size justification | sample representative of population | Inclusion and exclusion criteria stated | Reliability and validity of measures justified | Response rate and drop out specified | Data adequately described | Statistical significance assessed | Discussion of generalizability | Ethical clearance | Score |
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Khan et al. 2008 [23] | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 10 |
Santhya et al. 2008 [24] | Yes | No | No | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 8 |
Daniel et al. 2008 [25] | Yes | No | Yes | Partly | Yes | No | No | Yes | Yes | Not reported | 5 |
ACQUIRE 2008 [26] | Yes | Partly | Yes | No | No | No | Yes | Yes | Yes | Not reported | 5 |
CREHPA Nepal 2004 [27] | Yes | Yes | Yes | No | Yes | Partly | Yes | Yes | Yes | Yes | 8 |
Shattuck et al. 2011 [28] | Yes | No | No | Yes | Yes | No | Yes | No | No | Yes | 5 |
Pande et al. (a) 2006 [29] | Yes | No | No | Yes | Yes | No | No | No | No | Not reported | 2 |
Pande et al. (b) 2006 [30] | Yes | No | No | Yes | No | No | No | No | No | Not reported | 2 |