Implementation and evaluation of a family planning intervention engaging mothers-in-law of young women in India: a mixed methods pilot study

Despite evidence that mothers-in-law (MILs) influence daughters-in-law's (DILs) fertility and family planning decisions in South Asia, emphasizing early fertility and male grandchildren, few reproductive health interventions engage MILs directly. We assessed the feasibility, acceptability, and qualitative impact of a reproductive health and life skill-based intervention on MILs in tribal Rajasthan, India, using a mixed-methods, single-group cluster pilot study. We tested a light-touch four-session intervention delivered over 4 months to MILs of newly married women that covered MILs' health, conception, and communication with DILs and sons and addressed modern healthcare misconceptions, while challenging son preference and fertility norms. This MIL intervention was complemented by a broader 16-session curriculum for newly married women. In July 2023 and January 2024, 42 MILs participated in baseline and endline surveys. We conducted in-depth interviews with 13 MILs and 6 NGO staff members for qualitative insights and to understand barriers and facilitators to the intervention. We also analyzed the data using thematic analysis. Our results demonstrated the acceptability and feasibility of the intervention (80% attendance, 97.6% satisfaction, 97.6% retention rate). The qualitative findings revealed the impact of the intervention across multiple domains: improved reproductive health knowledge, better gender attitudes and attitudes towards modern healthcare practices, and positive changes in intergenerational relationships. Key implementation barriers included time constraints due to agricultural/household work, while family support and flexible scheduling facilitated participation. Our findings challenge conventional approaches targeting young women, suggesting the value of including influential family members, such as mothers-in-law, in reproductive health interventions, particularly in societies with extended family structures. The study is registered at ClinicalTrials.gov (NCT06320964). Registered retrospectively on 13 March 2024, https://clinicaltrials.gov/study/NCT06320964 IRB Approval number: 22 -37,173.