Abstract
In 2022, 29.7% of married women of reproductive age had an unmet need for family planning in Uganda,
meaning they wanted to avoid pregnancy but were not using a modern contraceptive method. Filling the unmet
need for family planning has important public health implications, including reductions in pregnancy-related
health risks and deaths, and infant mortality. On the supply-side, community platforms to deliver family
planning, as well as provider capacity to provide effective methods, need to be strengthened, but such efforts
will not be optimized without addressing multilevel demand-side barriers to contraceptive use. Misinformation
and fear of contraceptive side-effects, relationship dynamics, peer and family influence, and broader
community norms promoting large family size and traditional gender roles influence family planning. We
propose to test the Family Health=Family Wealth (FH=FW) multi-level, community-based intervention, which
employs health system strengthening efforts alongside transformative community dialogues to alter individual
attitudes and the perception of community norms that discourage family planning. Community dialogues are
delivered to groups of couples over 5-sessions enhanced to simultaneously address individual and
interpersonal-level determinants of family planning and serve as a platform for community-based family
planning and linkage to facility-based family planning services. The study aims are to: (1) In a cluster
randomized trial, compare the efficacy of the FH=FW intervention vs. a time/attention matched comparator
intervention at increasing modern contraceptive use and reducing unintended pregnancy among couples with
an unmet need for family planning through 24-months, and identify potential mediators of the intervention
effect. (2) Determine the intervention’s effect on, and determinants of, contraceptive continuation. (3) Through
a mixed-methods process evaluation, explore factors affecting the implementation of the intervention in order
to improve feasibility, acceptability, and the likelihood of future adoption and sustainment.
