Impact of Gender-Transformative Interventions on Contraceptive Use and Reproductive Autonomy in Somalia

Browse trials for

• Contraception Behavior 37

Keywords

• Family Planning Impact Lab
• Family Planning
• Family Planning Services
• Contraception
• Contraceptive Usage
• Contraceptive Method Switching
• Cost-effectiveness
• Gender Roles
• Men's Roles
• Modern Contraceptive Use
• Gender norms
• Preference-concordant contraceptive use
• Preference-aligned fertility management
• Social networks
• Somalia
• gender-transformative

Contraception Behavior

37 studies on the registry are indexed under Contraception Behavior; 14 are open to participants now.

This study's planned enrollment of 5,436 is above the median of 773 across 32 interventional studies indexed under Contraception Behavior.

Lead sponsor

Guttmacher Institute is the lead sponsor of 3 studies on the registry; 3 are open to participants now.

Study arms

• Active comparator
  Control

  Settlements in this arm will have access only to the standard family planning intervention implemented under WISH-2. This arm serves as the control.

  Behavioral: Standard Family Planning Services (WISH-2)

• Experimental
  Intensive Gender Transformative Programming

  Settlements will have access to WISH-2 services as well as an intensive gender-transformative intervention.

  Behavioral: Intensive Gender-Transformative Programming · Behavioral: Standard Family Planning Services (WISH-2)

• Experimental
  Light-touch Gender Transformative Programming

  Settlements will have access to WISH-2 services as well as a light-touch gender-transformative intervention.

  Behavioral: Light-Touch Gender-Transformative Programming · Behavioral: Standard Family Planning Services (WISH-2)

Interventions

• BehavioralIntensive Gender-Transformative Programming

  Both the intensive and light-dose programming will target the patriarchal gender norms that constrain women's reproductive autonomy in Somalia. These norms manifest in multiple forms: partner opposition to contraceptive use, women's inability to access services without male permission, reproductive coercion, intimate partner violence related to family planning decision-making, and women's limited ability to act on their fertility preferences even when services are available. The intensive version of the intervention may be implemented as a multi-component, community-embedded program built around a structured couples' curriculum supplemented by broader community norm change strategies.

• BehavioralLight-Touch Gender-Transformative Programming

  A reduced-intensity version of the gender-transformative programming, designed to test whether a less resource-intensive approach can achieve comparable effects at lower cost. The intervention package is being finalized by the IRC; this record will be updated with the final components before implementation begins.

• BehavioralStandard Family Planning Services (WISH-2)

  The IRC's standard WISH-2 family planning service delivery package, implemented by the IRC independently of the study team in all study settlements. The package strengthens facility-based family planning services through provider training, commodity availability, service integration, and community mobilization, with services delivered through static, outreach, and community-based channels.

Primary outcomes

1. Change in the proportion and number of women using preference-aligned fertility management between baseline, midline, and endline

   Change in the proportion and number of non-pregnant women aged 15-49 whose contraceptive use or non-use is aligned with their preferences, adapted from the preference-aligned fertility management indicator developed by Holt and colleagues; the study instrument elicits current use before contraceptive preference, whereas the original index elicits preference first. Users are classified as aligned if they want to be using a method, want to be using their current method, and report no other method they would prefer to use; non-users are classified as aligned if they want not to be using a method. A pre-specified sensitivity analysis classifies women reporting any pressure on their use or non-use as discordant.

   Time frame: Pre-Baseline (Month 8 pre-intervention); Baseline (Month 1 pre-intervention); Midline (Month 11 post-intervention); Endline (Month 23 post-intervention)

2. Change in men's agreement with the statement "A husband should have the final say about whether his wife uses contraception," between baseline, midline, and endline

   Married men aged 18-60 are asked whether they agree, partially agree, or do not agree with the statement: "A husband should have the final say about whether his wife uses contraception." The measure is summarized as the proportion of men in each response category. Men are sampled cross-sectionally at each wave, one man per household, from households not selected for the women's survey.

   Time frame: Pre-Baseline (Month 8 pre-intervention); Baseline (Month 1 pre-intervention); Midline (Month 11 post-intervention); Endline (Month 23 post-intervention)

3. Change in the proportion and number of women aged 15 to 49 using a modern contraceptive method (modern contraceptive prevalence) between baseline, midline, and endline

   Change in the proportion and number of women aged 15-49 who use, or whose partners use, a modern contraceptive method. Modern methods comprise female and male sterilization, copper and hormonal IUDs, implants, provider-administered and self-administered injectables, oral contraceptive pills, male and female condoms, emergency contraception, foam/jelly, the Lactational Amenorrhea Method, fertility awareness-based methods (standard days method, Billings ovulation method), and other modern methods reported through an open response (e.g., patch/ring, diaphragm). Any-method contraceptive prevalence - adding withdrawal, the rhythm method, other traditional and fertility awareness-based methods, and probe-identified users - will be reported as a pre-specified variant.

   Time frame: Pre-Baseline (Month 8 pre-intervention); Baseline (Month 1 pre-intervention); Midline (Month 11 post-intervention); Endline (Month 23 post-intervention)

Secondary outcomes

1. Change in the proportion and number of women aged 15 to 49 who have unmet need for family planning between baseline, midline, and endline

   Unmet need follows the revised DHS definition (Bradley et al. 2012), which underlies UN SDG indicator 3.7.1. A woman has unmet need if she is fecund; wants to stop childbearing, delay the next birth by at least two years, or is undecided about timing - or is pregnant or postpartum amenorrheic following a mistimed or unwanted pregnancy - and is not using any method. Unmet need for modern methods adds women using a traditional method. The headline estimate is unmet need for modern methods among all women exposed to the risk of pregnancy: currently married or in union (assumed exposed), or unmarried and sexually active (intercourse in the past 30 days). DHS-conventional variants report unmet need for any method and for modern methods, among currently married women and among all sexually active women. SDG indicator 3.7.1 (demand satisfied with modern methods) will be computed from these components and reported. Probe-identified traditional-method users are classified as users.

   Time frame: Pre-Baseline (Month 8 pre-intervention); Baseline (Month 1 pre-intervention); Midline (Month 11 post-intervention); Endline (Month 23 post-intervention)

2. Change in the proportion and number of women aged 15 to 49 with person-centered unmet need for family planning between baseline, midline, and endline

   Person-centered unmet need classifies women with unmet need (revised DHS definition, any method, as above) who report that not using contraception is not what they want - that is, women with unmet need who want to be using a contraceptive method (Senderowicz et al., Studies in Family Planning, 2023). Its mirror, unwanted family planning - women currently using a contraceptive method who report that using is not what they want - will also be reported (Gausman et al., Studies in Family Planning, 2025).

   Time frame: Pre-Baseline (Month 8 pre-intervention); Baseline (Month 1 pre-intervention); Midline (Month 11 post-intervention); Endline (Month 23 post-intervention)

3. Change in the proportion of women who report making the final decision about contraceptive use alone or jointly with their partner, between baseline, midline, and endline

   Proportion of women aged 15-49 who report that the final decision about their contraceptive use is made by themselves alone or jointly with their husband or partner, in response to a question asking who makes the final decision about the participant's use of contraception. Responses indicating that a partner, parent/guardian, in-laws, a health care provider, or another person decides alone or jointly are classified as not having decision-making autonomy.

   Time frame: Pre-Baseline (Month 8 pre-intervention); Baseline (Month 1 pre-intervention); Midline (Month 11 post-intervention); Endline (Month 23 post-intervention)

4. Change in the proportion of women reporting that their contraceptive use or non-use was entirely their own choice, between baseline, midline, and endline

   Proportion of non-pregnant women aged 15-49 who report that their current contraceptive status is entirely their own choice, free from pressure. Current users are asked whether use of their current method was their own choice, with no one having pressured or strongly encouraged them to use that particular method; non-users are asked whether not using a method is their own choice, with no one having pressured them into not using. The remaining response options indicate experiencing some pressure but agreeing, or feeling pressured. The measure operationalizes freedom from pressure as a component of contraceptive autonomy.

   Time frame: Pre-Baseline (Month 8 pre-intervention); Baseline (Month 1 pre-intervention); Midline (Month 11 post-intervention); Endline (Month 23 post-intervention)

5. Change in the level of reproductive self-efficacy as measured by the Contraceptive Self-Efficacy Scale for Sub-Saharan Africa (CSESSA) between baseline, midline, and endline

   The Contraceptive Self-Efficacy Scale for Sub-Saharan Africa (CSESSA) is a 10-item validated tool used to measure reproductive self-efficacy. The investigators will assess the level of reproductive self-efficacy among women aged 15-49 in the sample at baseline, midline, and endline.

   Time frame: Pre-Baseline (Month 8 pre-intervention); Baseline (Month 1 pre-intervention); Midline (Month 11 post-intervention); Endline (Month 23 post-intervention)

6. Change in the mean score on a nine-item self-reported women's agency measure between baseline, midline, and endline

   A nine-item self-reported measure of general agency covering decision-making over daily life, voice, capacity to act on life choices, and freedom of movement. Items ask whether the respondent can choose how to spend free time, choose which friends to spend time with, voice opinions and express views when others disagree, decide whether to go to school or to work, act on important life choices, make important decisions that change the course of life, do desired things, and go to desired places. Items were adapted from established frameworks for measuring women's and adolescent girls' agency. Each item is rated on a five-point scale from strongly agree to strongly disagree and combined into a mean score, with higher scores indicating greater agency. Administered to all women aged 15-49 at each survey wave.

   Time frame: Pre-Baseline (Month 8 pre-intervention); Baseline (Month 1 pre-intervention); Midline (Month 11 post-intervention); Endline (Month 23 post-intervention)

7. Change in women's agreement with the statement "A husband should have the final say about whether his wife uses contraception," between baseline, midline, and endline

   Women aged 15-49 are asked the same item administered to men, with response options agree, partially agree, and do not agree. The measure is summarized as the proportion of women in each response category.

   Time frame: Pre-Baseline (Month 8 pre-intervention); Baseline (Month 1 pre-intervention); Midline (Month 11 post-intervention); Endline (Month 23 post-intervention)

8. Change in the mean score on the Gender-Equitable Men (GEM) Scale among men, between baseline, midline, and endline

   Mean score on the Gender-Equitable Men (GEM) Scale items administered to men aged 18-60, with higher scores indicating more gender-equitable attitudes. Subscale and item-level results are reported descriptively.

   Time frame: Pre-Baseline (Month 8 pre-intervention); Baseline (Month 1 pre-intervention); Midline (Month 11 post-intervention); Endline (Month 23 post-intervention)

9. Change in the proportion of women and of men who report discussing family planning with their spouse or partner in the past 12 months, between baseline, midline, and endline

   Proportion of partnered women aged 15-49, and of partnered men aged 18-60, who report discussing family planning with their spouse or partner in the past 12 months. Frequency of discussion is reported descriptively.

   Time frame: Pre-Baseline (Month 8 pre-intervention); Baseline (Month 1 pre-intervention); Midline (Month 11 post-intervention); Endline (Month 23 post-intervention)

10. Change in the proportion of women reporting any reproductive coercion in the past 12 months, measured with an adapted five-item Reproductive Coercion Scale short form, between baseline, midline, and endline

    Proportion of women aged 15-49 reporting at least one reproductively coercive behavior in the past 12 months, measured with five items adapted from the short form of the Reproductive Coercion Scale: being told not to use contraception; having birth control taken away or being kept from obtaining it; being made to have unprotected sex in order to become pregnant; condom removal during sex; and deliberate condom damage. Items are adapted to ask about coercion by any person, not only an intimate partner. The three sexual-behavior items are administered only to women who have ever had sex; the two contraceptive-interference items are administered to all women. The number of coercive behaviors reported (0-5) will be summarized descriptively. Reproductive coercion is additionally monitored by arm throughout the study for participant safety.

    Time frame: Pre-Baseline (Month 8 pre-intervention); Baseline (Month 1 pre-intervention); Midline (Month 11 post-intervention); Endline (Month 23 post-intervention)

11. Change in the proportion and number of women reporting physical, emotional, sexual, or economic intimate partner violence (IPV) between baseline, midline, and endline

    Change in the proportion and number of women aged 15-49 in the study who report experiencing physical, emotional, sexual, or economic intimate partner violence in the past 12 months, as assessed using an adapted DHS domestic violence module. Intimate partner violence is additionally monitored by arm throughout the study for participant safety.

    Time frame: Pre-Baseline (Month 8 pre-intervention); Baseline (Month 1 pre-intervention); Midline (Month 11 post-intervention); Endline (Month 23 post-intervention)

Other outcomes

1. Change in the 12-month contraceptive discontinuation rate, estimated from the contraceptive calendar, between baseline, midline, and endline

   The proportion of episodes of modern contraceptive method use discontinued within 12 months of initiation, estimated from the survey's month-by-month contraceptive calendar using single-decrement life-table methods, following DHS analytic conventions. An episode ends with the first calendar month of non-use; a switch to another modern method in the same or immediately following month is treated as continued contraceptive use in the overall rate and as method-specific discontinuation in method-level rates. Overall and method-specific 12-month discontinuation rates will be reported, distinguishing discontinuation while still in need of contraception from discontinuation due to reduced need (e.g., seeking pregnancy). The calendar administered at each wave covers at least the preceding 12 months, so each assessment reflects use episodes observable in that window.

   Time frame: Pre-Baseline (Month 8 pre-intervention); Baseline (Month 1 pre-intervention); Midline (Month 11 post-intervention); Endline (Month 23 post-intervention)

2. Change in the proportion of women aged 15 to 49 with unmet need for family planning attributed to partner or family opposition, between baseline, midline, and endline

   Women with unmet need (revised DHS definition, any method) whose reported reasons for not using contraception include opposition from their husband or partner, or opposition from other family or community members.

   Time frame: Pre-Baseline (Month 8 pre-intervention); Baseline (Month 1 pre-intervention); Midline (Month 11 post-intervention); Endline (Month 23 post-intervention)

3. Change in the proportion of current contraceptive users whose husband or partner is unaware of their contraceptive use (covert use), between baseline, midline, and endline

   Among women aged 15-49 currently using a contraceptive method, the proportion who report that their husband or partner does not know they are using it.

   Time frame: Pre-Baseline (Month 8 pre-intervention); Baseline (Month 1 pre-intervention); Midline (Month 11 post-intervention); Endline (Month 23 post-intervention)

4. Change in mean scores on the Gender Norms Scale (G-NORM) between baseline, midline, and endline

   Mean scores on the Gender Norms Scale (G-NORM) items measuring perceived descriptive norms (what the respondent believes others in the community do) and perceived injunctive norms (what the respondent believes others expect) related to family planning and gender roles, reported separately by subscale and for women and men.

   Time frame: Pre-Baseline (Month 8 pre-intervention); Baseline (Month 1 pre-intervention); Midline (Month 11 post-intervention); Endline (Month 23 post-intervention)

5. Change in indicators of women's economic empowerment (economic participation, control over earnings, participation in household financial decisions, and asset ownership) between baseline, midline, and endline

   Four indicators reported separately among women aged 15-49: (1) economic participation - the proportion who did any work aside from housework in the past 12 months; (2) control over earnings - among women who earn, the proportion who decide alone or jointly with their partner how their earnings are used; (3) participation in household financial decisions - the proportion who decide alone or jointly about major household purchases; (4) asset ownership - the proportion reporting rights to use land for their own farming, business, or housing.

   Time frame: Pre-Baseline (Month 8 pre-intervention); Baseline (Month 1 pre-intervention); Midline (Month 11 post-intervention); Endline (Month 23 post-intervention)

6. Change in the proportion of men reporting participation in household tasks in the past 7 days, between baseline, midline, and endline

   Proportion of men aged 18-60 who report having cared for children, cooked, cleaned or washed clothes, fetched water or firewood, or cared for a sick household member in the past 7 days; the number of task types reported is summarized descriptively.

   Time frame: Pre-Baseline (Month 8 pre-intervention); Baseline (Month 1 pre-intervention); Midline (Month 11 post-intervention); Endline (Month 23 post-intervention)

7. Change in gender-equitable attitudes and family planning discussion within men's social networks, as reported through an egocentric network module, between baseline, midline, and endline

   Men aged 18-60 complete an egocentric social network module naming up to ten network members (alters). Measures include the proportion of named alters with whom the respondent discusses family planning, the perceived supportiveness of alters toward contraceptive use, perceived alter endorsement of the final-say norm, and (from Wave 2 onward) reported dialogue about gender roles with alters, reported descriptively by arm to examine diffusion of gender-equitable attitudes beyond direct program participants.

   Time frame: Pre-Baseline (Month 8 pre-intervention); Baseline (Month 1 pre-intervention); Midline (Month 11 post-intervention); Endline (Month 23 post-intervention)

Individual participant data

Plan to share: No