Postpartum integration of infant vaccines and contraception through gender transformative programming: A cluster randomized trial in India

Barriers to using contraception in India include norms that promote gender inequality by restricting mobility of women to reach health clinics. We evaluated whether PIVoT (Postpartum Integration of Vaccines and contraception through gender-Transformative programming) improves contraceptive use while enhancing autonomy in contraceptive decision-making. PIVoT delivers the full spectrum of contraceptive methods available along with gender-transformative counseling, linked with community-based infant vaccination. We conducted a cluster randomized trial; 20 Anganwadi Community centers were randomized to PIVoT or the standard-of-care. We included women 18 years and older, within 12 weeks postpartum, presenting for infant vaccination at community centers in rural Maharashtra, India. We measured contraceptive use (primary outcome) and reproductive autonomy after six months. From September 2023 to June 2024, we enrolled 293 women: 143 at intervention and 150 at control sites. Follow-up at six months was 95%. Any contraceptive use was more common for the control group at baseline (n = 57, 39.9% vs n = 93, 62.0%, p < 0.001) and for the intervention group at follow-up (n = 67, 48.9% vs n = 53, 37.3%, p = 0.051). There was a time-by-treatment effect for any contraceptive use (adjusted ratio of odds ratios 3.98, 95% CI 1.95-8.12). IUD use was slightly higher at six months in the intervention group (2.9% vs 0%, p = 0.04). Use of female-controlled methods (permanent contraception, pills, IUDs, injectables) was higher at six months among the intervention group (13.1% vs 6.3%, p = 0.04). Reproductive decision-making autonomy was higher among intervention participants at follow-up (2.02 vs 1.93, p = 0.02). The PIVoT intervention may increase contraceptive use postpartum, particularly female-controlled methods, while improving reproductive autonomy.