Husbands were, on average about 22 years old, ranging from 18-32 (Table 2). Over half had not completed high school, while 23.2% (N=5) had completed high school and 14.6% (N=6) had education beyond high school. About 20% were still pursuing further education. The majority (87.8%, N=36) were currently employed. Most identified as Hindu (97.6%, N=40), with a significant portion belonging to the scheduled tribe (63.3%, N=26). About a third reported having no prior acquaintance with their wives before marriage (N=15, 36.6%). Qualitative interviews were conducted with a subset of these same men, roughly representing the distribution of the full sample.
Table 2: Demographics of the quantitative and qualitative samples
|
Quantitative (N=41)
|
Qualitative(n=13)
|
Age (mean, range)
|
21.9 (18-32)
|
23.1 (19-25)
|
Education
|
|
|
Less than 8th grade
|
12 (29.27)
|
0 (0%)
|
8-11th grade
|
18 (43.90)
|
3 (23.1%)
|
Completed high school (12th grade)
|
5 (12.20)
|
2 (15.3%)
|
More than high school
|
6 (14.63)
|
8 (61.5%)
|
Not currently attending any more school
|
33 (80.49)
|
0 (0%)
|
Currently working
|
36 ( 87.80)
|
13 (100%)
|
Religion (Hindu, all others Islam)
|
40 (97.56)
|
Not available
|
Caste
|
|
|
Schedule caste (SC)
|
6 (14.63)
|
5 (38.5%)
|
Schedule tribe (ST)
|
26 (63.41)
|
4 (30.8%)
|
Other backward caste (OBC)
|
5 (12.20)
|
4 (30.8%)
|
General category
|
3 (7.32)
|
0 (0.0%)
|
Did not know wife at all before marriage
|
15 (36.59)
|
Not available
|
At baseline, few husbands reported having discussed certain family planning topics with their wives. Specifically, only 12.2% (N=5) had discussed the number of children to have, 19.5% (N=8) had discussed when to have the first child, 22% (N=9) had discussed the desired gap between children, and 17.1% (N=7) had discussed using family planning methods (refer to Table 3)
Knowledge regarding family planning was also low, with half (N=21, 51.2%) saying they didn’t know the recommended gap between children, and most (N=29, 70.7%) not knowing when a woman could get pregnant. Of those who provided an answer, 19.5% (N=8) said it was right after her period, and 7.3% (N=3) said it was during her period, with only 1 person mentioning between two periods. Most thought abortion was not legal (N=30, 73.2%), 22% (N=9) did not know, and only 2 knew that it was legal (4.9%).
Knowledge of temporary family planning methods was low. When asked to say if a list of 8 temporary methods were temporary or not, the mean score was 1.78, with no participant correctly listing more than 5 methods. Additionally, almost a third (N=12, 29.3%) did not list female sterilization as a permanent method, and almost two thirds (N=27, 65.9%) did not list male sterilization as a permanent method.
Regarding family planning intentions, only one respondent expressed a desire to have a baby immediately, and only 1 wanted a baby within less than a year. Among those who provided an answer, the majority (36.6%) expressed a preference to wait 24-36 months, followed by 16.7% preferring to wait 12-18 months, and 7.32% (N=3) preferring to wait over 3 years. However, despite these intentions, only 11.8% (N=4) of respondents were currently using family planning methods.
Table 3: Baseline knowledge and practices around family planning discussions and use
Item
|
N (%)
|
Communication about family planning
|
|
Ever discussed how many children to have
|
5 (12.20)
|
Ever discussed when to have first child
|
8 (19.51)
|
Ever discussed gap between children
|
9 (21.95)
|
Ever discussed which family planning method to use
|
7 (17.07)
|
Knowledge
|
|
Don’t know recommended gap between children
|
21 (51.22)
|
Fertility window when a woman is most likely to get pregnant
|
|
Don’t know
|
29 (70.73)
|
Between two periods
|
1 (2.44)
|
Right after her period has ended
|
8 (19.51)
|
During period
|
3 (7.32)
|
Is abortion legal in India
|
|
No
|
30 (73.17)
|
Yes
|
2 (4.88)
|
Don’t know
|
9 (21.95)
|
Family planning methods
|
|
Did not know female sterilization was permanent
|
12 (29.27)
|
Did not know male sterilization was permanent
|
27 (65.85)
|
Temporary FP score (total possible 8), mean, range
|
1.78 (0-5)
|
Desires and Behaviors
|
|
Desired time between marriage and the first baby
|
|
Immediately
|
1 (2.44)
|
<1 year
|
1 2.44
|
12-18 months
|
6 (16.67 )
|
24-36 months
|
15 (36.58)
|
3+ years
|
3 (7.32)
|
Don’t know
|
15 (36.59)
|
Currently using any family planning method
|
4 (11.76)
|
- Increased knowledge
a. Increased knowledge about menstruation, birth spacing and contraceptives
Many of the husbands reported that they learned about the importance of birth spacing and using contraceptives through the TARANG sessions. They highlighted the challenges they could face if they did not have an appropriate gap between their children including not having time to focus on them, limited income, and potential health effects to their wives.
When the sir (moderator) talked about periods, I got to know. He talked about children, saying not to have them for two years. There should be a gap of four years between the first and second child because it would be challenging to manage children, not being able to focus on time, limited income, and a deficiency of blood in women. If you don't want children, use condoms, and women have to take pills. Family members should come together and make decisions about what to do and what not to do. Bringing or doing anything improves relationships. – husband 13, 24 years, 12th standard, OBC
As mentioned in the quote above and below, learning about menstruation was one of the most valuable topics to the men in the sessions, perhaps because this is something that they had never had an opportunity to learn about before (as opposed to family planning which they might have had some exposure to through friends, mass media campaigns, or health workers).
The most beneficial one was about menstruation. It openly discussed things, and I found it good. It provided a lot of information – Husband 7: 25 years, BA, ST
The moderators also described how husbands shared that no one had ever talked to them about this type of information before.
Sometimes, the husbands share that no one has told them such a thing to date - it is very useful for them. They shared that there is no one else to whom they can ask all these things – not even neighbors. It seems that they need all these things. When I was doing the second and third sessions, there was [topic of] sex determination, fertility, during the session we talked to them and it came out that all these things were not known to them. Then it seemed that it was easy to see but they did not have such information. – NGO staff
Not only did husbands report getting information for them, but the information led others in the community to seek their advice about family planning. One husband mentioned that he feels good that people come to him for information about family planning and that he can give them advice on the benefits of using it.
The benefit is that those who lack information seek advice from me; I provide them with information. I feel good that people ask me and take advice. They are understanding that using these methods should bring positive changes to their families. An example is that my friend has three children. And, when they were about to conceive their fourth child, I explained family planning methods to him. Initially, he thought it was useless, but later he agreed and started using these methods. – Husband 7: 25 years, BA, ST
c. Increased knowledge about relationships, communication, and shared decision-making
Several husbands mentioned that one of the main benefits of the TARANG program was gaining knowledge about how to build/cultivate a healthy relationship with their wives. Husbands reiterated the importance of making decisions together, especially in relation to family planning and the selection of contraceptive methods.
There are many benefits, especially regarding relationships, family, and work. It helps in decision-making and knowing what to do. Both partners should be asked when choosing contraceptive methods and it should be used after taking advice from each other. – 21-year-old husband with a BA education belonging to ST caste
Every topic is different, like, there should be consensus on anything in [our] family, and we should be able to express our views to each other, I can express my views and my wife can also express her views. About anything. About children. In the topic of family planning, there should be a gap of three years between children, it is better than that, and it is also better in parenting. It is also good for [our] health. I like that I got the knowledge that I did not have earlier, and how scientifically this all happens. – Husband 2: age 25 years, BA education, OBC
Expanding upon the value of communication, and how it helps with planning for the future, including around children, another husband explained:
There should be communication between husband and wife so that they can understand each other's point of view….There are many benefits [to receiving information as husband and wife]; it provides time to start planning for the future. Both should be on the same page about when to do it and when not to do it during this time. – 24 year-old husband with a BA education belonging to OBC caste
c. Increased knowledge about consent and healthy spousal relationships
Related to building a healthy relationship, some husbands also mentioned that the TARANG program taught them to ask their wives for consent before engaging in intercourse. They also reported that if their wife is not feeling well, they should not insist on having sex.
We build relationships only with her consent. We don't want to form relationships. If she is unwell, we shouldn't insist on meeting. It's good for our health and hers. – 21 year old husband with a BA education belonging to ST caste
Men reported that these ideas around consent were new to them.
For the first time family planning was discussed, and there should be mutual consent, not coercion, on each other. I liked this. And also to understand each other's feelings, do not impose anything. I did not hear of this concept before the session. – Husband 2: 25 years, BA, OBC
One husband discussed how even if force or violence occurs, a couple can discuss that this was wrong and work to not let that happen again.
There should be an agreement between husband and wife; nothing should be done forcibly, and there should be no violence. If a mistake happens, it should be explained once not to do it again.. – Husband 9, 23, 12th standard, SC
2. Impact
a. Increased communication between husbands and wives due to the sessions
Not only had husbands absorbed that communication, especially about family planning, was critical, but husbands reported that they talked to their wives about the information they received at the sessions and that they saw an improvement in communication. Before, either the husband or wife would feel shy to talk to one another, but now they could comfortably discuss when and how many children they want to have.
Besides information, there was also a significant health benefit. Knowing when to have a child, both information and benefits are there. Earlier, our family wasn't as understanding, there was a bit of information, but now it's fine. We discuss and share every minor and major thing by sitting together. In the evening, when going to bed, she asks where I went, and what work I did. I share the information that I had in the meeting. I got married 8-10 months ago, my wife came home three to four months ago. Either she would feel shy, or I would. Now, it's not like that. Now we can comfortably sit and share what should be done, what should not be done, and is there a need for a child or not? Our age is not suitable now; it's the age to earn money. Expenses need to be settled a bit; then we will see. For me, contraception is there and even if mistakes happen then Mala can be used by women; there are injections. We do take care of our bodies. – Husband 6: age 23, BA, SC
Participants specifically mentioned how both of them (husband and their wives) receiving information was beneficial in promoting conversation and learning.
In my personal life, there has been a significant change in communication and behaviour with my partner. They have also attended sessions, and I have too, and we have learned a lot. – husband 7: age 25 years, BA education, ST caste
Furthermore, there were instances where husbands sought their wives' assistance in comprehending topics they did not fully grasp during the sessions. This mutual learning dynamic, with women imparting knowledge to men, is less common within the patriarchal gender norms prevalent in this setting.
I didn't understand the topic of condoms, so I went home and asked my wife and she told me how to use them. We decided to use them together. We’ve talked about how many children to have two or three times. We didn't talk about it earlier, but after attending the meeting, we discussed this too. There has been a change, understanding has come, and we make decisions together. – Husband 10, age 21, 10th standard, OBC
The increased information for both husband and wife, and the fact that it led to more conversation and discussion together, was also noted to have enhanced their affection for each other. .
Benefits, such as my wife learning about the changes in her body, experiencing various aspects of living, and she is gaining information she didn't have before. We openly discuss matters related to attending sessions as per the available time. It's not forced. If there's something to discuss, we talk willingly together. We have gained a lot of information from the sessions. There is a little difference in our way of living and a slight change in love. Earlier, there used to be a bit of irritation; their mindset wasn't so open, and there was less communication. After attending sessions, she openly talks. The benefit in the family is that we use contraception, Mala-D etc. And the other benefit is that there are conversations; family members talk openly. - Husband 7: age 25, BA, ST
Furthermore, some men reported that their new prospective and knowledge around consent had positive impacts on their sexual relationships.
There has been a lot of improvement regarding physical relations. What we did not know, how to live…how to behave with them, how to live with them, do only what both of us wish to do, do not do anything as per only my wish. – Husband 5, 26 years, BA, SC
b. Male Empowerment
The combination of increased knowledge with the group format encouraging men to speak with others and in public seemed to have had larger impacts on some of the participants, providing men with a sense of empowerment. As one husband described:
By joining the group, the biggest benefit is that my power to speak increased, and my hesitation ended. I can share my thoughts in front of everyone. This has become my strength. – Husband 6: age 23, BA education, SC
Feasibility and Acceptability
Overall, the mean number of sessions attended was 2.43 (out of 4) (Table 4). Only 9 husbands (22.50%) attended all 4 sessions, 25% (N=10) 3 sessions and 25% (N=10) 2 sessions. All men were completely (47.2%) or somewhat satisfied (52.8%) and most (N=24, 60%) found it very useful (with N=16, 40% somewhat useful). Most said they were very likely (N=15, 37.5%) or somewhat likely (N=23, 57.5%) to recommend it to a friend. Themes of empowerment that arose from the qualitative data also came out in the quantitative data, with 83% (N=30) saying there were more confident than before in making decisions about family planning. Over 80% reported improvements in decision-making and communication with their wives, and all felt they learned things they could apply in their daily life to some or a great extent.
Table 4: TARANG intervention perspectives from husbands who participated in the intervention.
|
N (%) (or mean)
|
Mean number of sessions attended (range 1-4)
|
2.425
|
Proportion of participants who attended at least 50% of the sessions (primary feasibility outcome)
|
18 (43.9%)
|
How satisfied were you? (acceptability outcome)
|
|
Completely
|
17 (47.22)
|
Somewhat
|
19 (52.78)
|
How useful were the discussions and topics ? (acceptability outcome)
|
|
Somewhat useful
|
16 (40.00)
|
Very useful
|
24 (60.00)
|
How likely it is that you will recommend a friend to join?
|
|
Very unlikely
|
1 (2.50)
|
Somewhat likely
|
23 (57.50)
|
Very likely
|
15 ( 37.50)
|
Can’t say
|
1 ( 2.50)
|
How do you feel about having discussion on having children and your health after TARANG?
|
|
More confident than before
|
30 (83.33)
|
Just as confident as before
|
6 (16.67 )
|
Did you learn info from TARANG that could be applied in your daily life?
|
|
Can apply to some extent.
|
24 (60.00)
|
Can apply to a great extent.
|
16 (40.00)
|
Have you observed changes in decisions about having children after TARANG
|
|
Some positive changes
|
32 (88.89)
|
More positive changes
|
3 (8.33)
|
Can’t say
|
1 (2.78)
|
Impact of TARANG on communication with your wife about family planning?
|
|
A little negative impact
|
2 (5.00)
|
A little positive impact
|
32 (80.00)
|
A very positive impact
|
6 (15.00)
|
While the overall reception was positive, it is clear that attendance, even to four sessions, was a challenge. Interviews highlighted the challenge to find a time that all men could come together in a group and participate. The main barrier was due to work responsibilities with some men working outside the village, further complicating participation. Additionally, disruptions due to festivals and household responsibilities also contributed to attendance issues. .
The only problem is to manage time. Nothing else. There is some work pressure, as Diwali is also approaching, so people want their work to be done quickly. I was alone here. They took a session with me only. - Husband 2, 25 years, BA, OBC
As is clear from the quote above, moderators adapted and sometimes provided the session to only 1 participant, or a very small group. This had impacts on the group dynamics, as explained by one of the NGO staff below, where it was harder to lead an engaging session with few people.
With a small number [of husbands], the moderator doesn't get a sufficient environment. If two out of three husbands don't respond, it feels like our session has ended. A session doesn't become interesting with a small number, and there is a strong tendency to finish the session quickly. – NGO staff
Husbands and moderators worked together to accommodate everyone’s work schedules, as is clear from the quote below, however, it remained a challenge to find a time to hold the groups, despite everyone’s willingness and effort.
We told sir {the moderator} that every guy who attends the session has work to do so, they go in the morning and come in the evening from work. So, we suggested sir to start the meeting at 8 PM, and even if it goes till 11 PM, no one will object. Everyone is free in the evening, and it's convenient for us to attend. – Husband 6: 23 years, BA, SC