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Peer-reviewedCC BY 4.0PLOS Global Public Health

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

  • Sarah Averbach1
  • Mohan Ghule2
  • Gennifer Kully3
  • Nicole E. Johns4
  • Madhusudan Battala5
  • Vedavati Patwardhan6
  • Anita Raj
  • Shahina Begum
6 affiliations
  1. 1Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Complex Family Planning, University of California, San Diego, La Jolla, California, United States of America
  2. 2Center on Gender Equity and Health, Department of Medicine, Division of Infectious Disease and Global Public Health, University of California, San Diego, La Jolla, California, United States of America
  3. 3Center on Gender Equity and Health, University of California, San Diego, India Office, Mumbai, Maharashtra, India
  4. 4Population Council, India, New Delhi, India
  5. 5Newcomb Institute, Tulane University, New Orleans, Louisiana, United States of America
  6. 6National Institute for Research in Reproductive and Child Health, Mumbai, Maharashtra, India
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Abstract

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.

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Cite

BibTeXRIS
BibTeX
@article{averbach2026postpartum,
  title = {{Postpartum integration of infant vaccines and contraception through gender transformative programming: A cluster randomized trial in India}},
  author = {Sarah Averbach and Mohan Ghule and Gennifer Kully and Nicole E. Johns and Madhusudan Battala and Vedavati Patwardhan and Anita Raj and Shahina Begum},
  journal = {PLOS Global Public Health},
  year = {2026},
  month = sep,
  doi = {10.1371/journal.pgph.0006403},
  url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0006403},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Postpartum integration of infant vaccines and contraception through gender transformative programming: A cluster randomized trial in India
AU  - Sarah Averbach
AU  - Mohan Ghule
AU  - Gennifer Kully
AU  - Nicole E. Johns
AU  - Madhusudan Battala
AU  - Vedavati Patwardhan
AU  - Anita Raj
AU  - Shahina Begum
PY  - 2026
DA  - 2026/09/24
JO  - PLOS Global Public Health
DO  - 10.1371/journal.pgph.0006403
UR  - https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0006403
AB  - 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.
SN  - 2767-3375
ER  -