Evaluation of the Impact and Effectiveness of the Contextual Reproductive Harmony Theory (CRHT) in Improving Access to and Use of Reproductive Health Services in the Districts of Lonkly and Atomey (Benin)

Introduction: Persistent gaps in reproductive health service utilization in sub-Saharan Africa are driven not only by structural barriers but also by deeply embedded socio-cultural resistance. The Contextual Reproductive Harmony Theory (CRHT) was developed to address these dynamics by promoting context-adapted, community-owned reproductive health interventions capable of disrupting the Inertial Resistance Cycle (IRC) that sustains behavioral inaction in marginalized settings. Study Design: A quasi-experimental pre-post control study was conducted from January to August 2022 in two villages of the Aplahoué commune, Couffo department, southern Benin. Lonkly village (Djikpamey district) served as the intervention site, while Atomey village served as the control. A purposive sample of 70 households (35 per village) with comparable baseline socio-demographic characteristics was selected. The intervention was delivered over eight months by trained community health workers and local leaders, using four CRHT operational tools: Social Harmony Mapping (SHM), Harmonic Engagement Circles (HEC), a Ritual and Symbolic Approach (RSA), and a Digital Harmonization Platform (DHP). The same households were assessed at baseline and endline. Key indicators included knowledge, acceptance, and utilization of modern contraceptive methods, antenatal care attendance, spousal involvement, youth participation, and community stakeholder engagement. Data were analyzed using MedCalc software; statistical significance was set at p < 0.05. Results: Post-intervention, the CRHT group showed substantial improvements across all indicators compared to both its own baseline and the control group. Knowledge of modern contraceptive methods increased from 1.89% to 67.92% (vs. 13.21% in controls, p < 0.0001), while acceptance rose from 11.32% to 32.08% (vs. 15.09%, p = 0.0403). Utilization of maternal health services increased from 6.25% to 75.00% (vs. 37.50%, p = 0.0353). Regular antenatal consultations reached 69.23% (vs. 25.00%, p = 0.0336), spousal involvement rose to 50.94% (vs. 24.53%, p = 0.0052), and youth participation reached 80.56% (vs. 12.28%, p < 0.0001). The control group exhibited minimal or no improvement across all indicators. Conclusion: These findings suggest that CRHT may significantly enhance access to and utilization of reproductive health services in socio-culturally constrained settings. Larger randomized evaluations with extended follow-up are warranted to confirm effectiveness and guide scaling.