Over one-third of sexually active women in northwest Tanzania who do not desire pregnancy report using no effective method to prevent pregnancy. In focus group discussions, we found that major barriers to acceptance of family planning by both women and men include limited knowledge and uncertainty about its compatibility with religious beliefs. Leaders and congregations were eager to receive information about family planning and to discuss its implications for their faith and for their communities. Using these focus group findings, we have developed and pilot-tested a theologically and culturally informed educational seminar about family planning for Christian church leaders in the region. We will conduct a cluster randomized trial in 24 paired villages in rural Tanzania to test the hypothesis that the 12 intervention villages whose church leaders receive this education will have an approximate three-fold increase in the uptake of family planning, as compared to 12 control villages whose church leaders do not receive this education. We will compare the percent of women aged 15-49 years seeking family planning at the village dispensary, the difference in couple-years of protection provided, and reported reasons for seeking family planning, between villages. We will also develop and pilot-test a similar contextualized curriculum about family planning for Muslim religious leaders. We estimate that our strategy could lead to ~1 million new family planning users in Tanzania alone, and will generate a curriculum and methodology that can be used to improve uptake of family planning in other areas where religion plays a major role.
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