Table 2 Intervention arm: multilevel, community-based intervention

Health-system strengthening components

Pre-intervention health worker capacity building

• Needs assessment conducted at public health facilities in intervention village to assess gaps in contraceptive knowledge and skills among health workers.

• Tailored family planning refresher training provided in partnership with the District Health Team to address training gaps.

Couples’ intervention session core components

Session 1

Gender-segregated, 180 min

• Guided discussion to identify gender-specific definitions of “family wealth,” interpersonal and community barriers to family health and wealth, and redefine group norms on a “successful” family (men and women’s groups)

Session 2

Gender-segregated, 180 min

• Physical health: contraceptive education with a midwife (women’s groups)

• Relationship health: discussion on healthy relationships and family planning (partner violence, communication, decision-making, caregiver roles, gender norms); role modeling of gender equitable couples (men’s groups)

• Economic health: business skill training with a local business expert (men and women’s groups)

Session 3

Gender-mixed, 180 min

• Physical health: contraceptive education from a midwife; provide family planning/linkages to care; create a “Family Action Plan”—setting family size and contraception goals

• Relationship health: communication skills building activities; create a Family Action Plan—setting relationship goals (take home assignment)

• Economic health: family budgeting

Session 4

Gender-mixed, 180 min

• Relationship health: communication skills building activity

• Revisit Family Action Plan goals as a couple

• Guided discussion to identify community barriers and solutions for family planning access/uptake

• Introduction to a “Community Action Plan”

• Provide family planning/linkages to care