Raj Anita, Johns Nicole, Vaida Florin, Ghule Mohan, Rao Namratha, Silverman Jay G
Newcomb Institute, Tulane University, New Orleans, LA, USA.
Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA.
Dialogues Health. 2025 Apr 19;6:100218. doi: 10.1016/j.dialog.2025.100218. eCollection 2025 Jun.
Effective family planning interventions may have inadvertent effects on births of girls given son preference in India. We conducted 36 and 48-month follow-ups to our CHARM2 family planning study to determine long-term intervention effects on births and sex of children.
Our non-blinded two-armed cluster RCT randomized young married couples ( = 1201 couples) from 20 geographic clusters (60-61 couples per cluster) into either the CHARM2 intervention or control (referral to local care) condition. CHARM2 offers 5-session gender-synchronized family planning and gender equity counseling delivered by trained local medical providers. Data were collected at baseline in September 2018-June 2019 and then follow-ups at 9, 18, 36 and 48 months, up to September 2023. We retained 88 %-91 % of women across follow-ups with no difference in retention by treatment group. We used adjusted mixed-effects logistic regression models examining sex composition of births at each follow-up and over the total 48-month follow-up to assess differences in all births of boys and girls by treatment group. We adjusted for treatment condition, cluster, and relevant demographics in adjusted models.
We saw no treatment effects on total births or boy births, but lower likelihood of a girl birth was seen at 9-month follow-up and for the total 48-month follow-up period. We found at 9-month follow-up a girl birth was less likely for intervention compared with control participants (7.1 % vs. 10.3 %, respectively, = 0.06), and the male to female sex ratio of births born between baseline and 9-month follow-up was also significantly higher for intervention vs. comparison participants (1.50 [95 % CI 1.00-2.26] vs. 0.83 [95 % CI 0.56-1.21], = 0.04). We conducted a sensitivity analysis to determine treatment effects on boy births and girl births over the 48-month follow-up and again found no effects on boy births, but a significantly lower likelihood of a girl birth for the intervention group (22 % vs 29 %, = 0.03).
The CHARM2 family planning intervention, previously demonstrating significant effects on contraceptive use and women's reproductive agency in rural India, resulted in lower likelihood of girl births over time, suggesting that family planning programs can contribute to sex ratio imbalances if broader social changes eliminating son preference and improving value of a girl child do not occur.
National Institutes of Health, Grant R01HD084453 Bill and Melinda Gates Foundation. INV002967. The funders had no role in the design and conduct of the study, collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. [ClinicalTrials.gov Identifier: NCT03514914.].
在印度，由于存在重男轻女的观念，有效的计划生育干预措施可能会对女孩出生产生意外影响。我们对CHARM2计划生育研究进行了36个月和48个月的随访，以确定干预措施对儿童出生及性别的长期影响。
我们的非盲双臂整群随机对照试验将来自20个地理区域（每个区域60 - 61对夫妇）的1201对年轻已婚夫妇随机分为CHARM2干预组或对照组（转介至当地医疗机构）。CHARM2由经过培训的当地医疗服务提供者提供为期5节的性别同步计划生育和性别平等咨询。数据于2018年9月至2019年6月基线期收集，随后在9个月、18个月、36个月和48个月进行随访，直至2023年9月。在各次随访中，我们保留了88% - 91%的女性，各治疗组的保留率无差异。我们使用调整后的混合效应逻辑回归模型，在每次随访以及整个48个月的随访期间检查出生的性别构成，以评估治疗组男孩和女孩所有出生情况的差异。在调整模型中，我们对治疗条件、区域以及相关人口统计学因素进行了调整。
我们未发现干预措施对总出生数或男孩出生数有影响，但在9个月随访时以及整个48个月随访期内，女孩出生的可能性较低。我们发现在9个月随访时，与对照组参与者相比，干预组女孩出生的可能性较小（分别为7.1%和10.3%，P = 0.06），并且在基线期至9个月随访期间出生的婴儿中，干预组的男女出生性别比也显著高于对照组（1.50 [95%置信区间1.00 - 2.26] 对0.83 [95%置信区间0.56 - 1.21]，P = 0.04）。我们进行了敏感性分析，以确定在48个月随访期间干预措施对男孩和女孩出生的影响，再次发现对男孩出生数无影响，但干预组女孩出生的可能性显著较低（22%对29%，P = 0.03）。
CHARM2计划生育干预措施此前在印度农村地区对避孕使用和妇女的生殖自主权显示出显著效果，但随着时间推移导致女孩出生的可能性降低，这表明如果不发生消除重男轻女观念和提高女孩价值的更广泛社会变革，计划生育项目可能会导致性别比例失衡。
美国国立卫生研究院，资助编号R01HD084453；比尔及梅琳达·盖茨基金会。INV002967。资助者在研究的设计与实施、数据的收集、管理、分析和解释；稿件的准备、审核或批准；或决定提交稿件发表等方面均未发挥作用。[ClinicalTrials.gov标识符：NCT03514914]
