Exploring Couple Dynamics with First-Time Parents in Burkina Faso and Acceptability of Couple-Focused Interventions to Improve Their Sexual and Reproductive Health

E2A's experiences in implementing FTP programs in Burkina Faso, Nigeria, and Tanzania have revealed that young parents want to discuss and address relationship issues, such as communication and conflict management. These programs had been reaching young men and women separately, rather than as a couple, but due to FTPs' high level of interest in discussing relationship topics, E2A added a couple-focused component to its Burkina Faso FTP project in 2019. Couple-focused interventions (CFIs) are a potentially valuable strategy for addressing FTPs' concerns and accelerating progress toward achieving sexual and reproductive health (SRH) goals. However, little is known or has been written about the nature, needs, and concerns of adolescent and youth couple relationships and how the relationship influences SRH decisions and behaviors. Recognizing the relative invisibility of young couples in the SRH literature and policy arena, and given our program experiences working with FTPs in Burkina Faso, E2A aimed to examine the nature of the couple dynamic among youth and further explore the potential for CFIs within the FTP framework. This study is a formative assessment using qualitative methods to gain a more in-depth understanding about FTP couples in Burkina Faso and the potential for implementing CFIs for FTPs. Specifically, in-depth interviews (IDIs) were used to examine FTP couple dynamics and explore the feasibility and acceptability of CFIs through the perspectives of first-time mothers (FTMs) enrolled in E2A's FTP program, their husbands, health facility providers, and government health officials at district and national levels in Burkina Faso. Focus group discussions (FGDs) were used with mothers-in-law (MILs) and community health workers (CHWs) to leverage group dynamics to spur conversation about social norms and practices in the community related to couple communication, decision-making, and care-seeking for reproductive health and family planning. The study was conducted in six villages in the districts of Fada and Kaya, where the E2A FTP program was implemented. The study tools used for the FGDs and IDIs were developed in French by the lead investigator based in Ouagadougou, with inputs from the E2A technical team and a gender specialist consultant. A three-day training for ten data collectors was conducted in early September 2020 to familiarize participants with the data collection tools and techniques for collecting gender-sensitive data using IDIs and FGDs. Data collection took place during the last week of September 2020, and the study team conducted 58 in-depth individual interviews and 16 focus groups with a total of 177 people. The study found that the majority of FTPs are in marriage relationships, and the study focused on couples comprising a husband and wife. However, in Burkinabe societies, some husbands have multiple wives, and the study recognized that this context is relevant to understanding couple dynamics. The study also found that participation levels were affected by security issues in some of the study sites, and that some men presented themselves as husbands even though they were actually tuteurs, or "guardians." The study team was surprised to find that in Boulyaoguin village, Zaoré and Fulfuldé are the dominant dialects spoken, which were not well understood by data collectors. The study's findings suggest that couple-focused interventions (CFIs) have the potential to address the concerns and needs of first-time parents (FTPs) in Burkina Faso. The study found that FTPs want to discuss and address relationship issues, such as communication and conflict management, and that CFIs can provide a valuable strategy for addressing these concerns. However, the study also highlighted the challenges of implementing CFIs in the context of Burkina Faso, including security issues and the need for culturally sensitive data collection tools.