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Wallace AS, Ryman TK, Privor-Dumm L, Morgan C, Fields R, Garcia C, Sodha SV, Lindstrand A, Nic Lochlainn LM. Leaving no one behind: Defining and implementing an integrated life course approach to vaccination across the next decade as part of the immunization Agenda 2030. Vaccine 2024; 42 Suppl 1:S54-S63. [PMID: 36503859 PMCID: PMC10414185 DOI: 10.1016/j.vaccine.2022.11.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 10/12/2022] [Accepted: 11/17/2022] [Indexed: 12/13/2022]
Abstract
Strategic Priority 4 (SP4) of the Immunization Agenda 2030 aims to ensure that all people benefit from recommended immunizations throughout the life-course, integrated with essential health services. Therefore, it is necessary for immunization programs to have coordination and collaboration across all health programs. Although there has been progress, immunization platforms in the second year of life and beyond need continued strengthening, including booster doses and catch-up vaccination, for all ages, and recommended vaccines for older age groups. We note gaps in current vaccination programs policies and achieved coverage, in the second year of life and beyond. In 2021, the second dose of measles-containing vaccine (MCV2), given in the second year of life, achieved 71% global coverage vs 81% for MCV1. For adolescents, 60% of all countries have adopted human papillomavirus vaccines in their vaccination schedule with a global coverage rate of only 12 percent in 2021. Approximately 65% of the countries recommend influenza vaccines for older adults, high-risk adults and pregnant women, and only 25% recommended pneumococcal vaccines for older adults. To achieve an integrated life course approach to vaccination, we reviewed the evidence, gaps, and strategies in four focus areas: generating evidence for disease burden and potential vaccine impact in older age groups; building awareness and shifting policy beyond early childhood; building integrated delivery approaches throughout the life course; and identifying missed opportunities for vaccination, implementing catch-up strategies, and monitoring vaccination throughout the life course. We identified needs, such as tailoring strategies to the local context, conducting research and advocacy to mobilize resources and build political will. Mustering sufficient financial support and demand for an integrated life course approach to vaccination, particularly in times of COVID-19, is both a challenge and an opportunity.
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Affiliation(s)
- A S Wallace
- Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - T K Ryman
- Bill and Melinda Gates Foundation, Seattle, WA, United States
| | - L Privor-Dumm
- Johns Hopkins Bloomberg School of Public Health, International Vaccine Access Center, Baltimore, MD, United States
| | - C Morgan
- Jhpiego, the Johns Hopkins University affiliate, Baltimore, MD, United States
| | - R Fields
- John Snow Inc., Arlington, VA, United States
| | - C Garcia
- Johns Hopkins Bloomberg School of Public Health, International Vaccine Access Center, Baltimore, MD, United States
| | - S V Sodha
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - A Lindstrand
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - L M Nic Lochlainn
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
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Gage AJ, Wood FE, Gay R, Akilimali P. Effects of the Momentum project on postpartum family planning norms and behaviors among married and unmarried adolescent and young first-time mothers in Kinshasa: A quasi-experimental study. PLoS One 2024; 19:e0300342. [PMID: 38547207 PMCID: PMC10977807 DOI: 10.1371/journal.pone.0300342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 02/26/2024] [Indexed: 04/02/2024] Open
Abstract
This study evaluated the effect of Momentum-an integrated family planning, maternal and newborn health, and nutrition intervention-on postpartum family planning norms and behaviors among ever married and never-married first-time mothers age 15-24 in Kinshasa, Democratic Republic of the Congo. Using data collected in 2018 and 2020, we conducted an intent-to-treat analysis among 1,927 first-time mothers who were about six-months pregnant at enrollment. Difference-in-differences models were run for panel data and treatment effects models with inverse-probability weighting for endline-only outcomes. Average treatment effects (ATE) were estimated. Momentum had positive effects on partner discussion of family planning in the early postpartum period (ever married 15-19: ATE = 0.179, 95% CI = 0.098, 0.261; never married 15-19: ATE = 0.131, 95% CI = 0.029, 0.232; ever married 20-24: ATE = 0.233, 95% CI = 0.164, 0.302; never married 20-24: ATE = 0.241, 95% CI = 0.121, 0.362) and discussion with a health worker, and on obtaining a contraceptive method in the early postpartum period, except among never married adolescents. Among adolescents, intervention effects on modern contraceptive use within 12 months of childbirth/pregnancy loss were larger for the never married (ATE = 0.251, 95% CI = 0.122, 0.380) than the ever married (ATE = 0.114, 95% CI = 0.020, 0.208). Full intervention exposure had consistently larger effects on contraceptive behaviors than partial exposure, except among ever married adolescents. Momentum had no effect on normative expectations about postpartum family planning use among adolescents, and on descriptive norms and personal agency among those who were never married. Results for normative outcomes and personal agency underscored the intersectionality between young maternal age and marital status. Future programs should improve personal agency and foster normative change in support of postpartum family planning uptake and tailor interventions to different age and marital status subsets of first-time mothers.
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Affiliation(s)
- Anastasia J. Gage
- Department of International Health and Sustainable Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Los Angeles, United States of America
| | - Francine E. Wood
- Department of Medicine, Center on Gender Equity and Health, University of California, San Diego, La Jolla, California, United States of America
| | - Rianne Gay
- Tulane International, LLC, Kinshasa, Democratic Republic of the Congo
| | - Pierre Akilimali
- Department of Biostatistics and Epidemiology, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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Asmamaw DB, Belachew TB, Fetene SM, Addis B, Amare T, Kidie AA, Endawkie A, Zegeye AF, Tamir TT, Wubante SM, Fentie EA, Negash WD. Postpartum long-acting reversible contraceptives use in sub-Saharan Africa. Evidence from recent demographic and health surveys data. PLoS One 2023; 18:e0291571. [PMID: 37812616 PMCID: PMC10561849 DOI: 10.1371/journal.pone.0291571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/31/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND In developing countries, most women want to avoid pregnancy for two years after giving birth. However, 70% do not use contraceptives during this time. Unintended pregnancies may occur for couples who delay contraceptive use during the postpartum period. The most effective form of contraceptive methods for postpartum women is long-acting reversible contraceptive (LARC). Therefore, this study aimed to assess long-acting reversible contraceptive use and associated factors among postpartum women in Sub-Saharan Africa. METHODS Secondary data analysis was performed using the recent Demographic and Health Surveys (DHS). Stata version 14 was used to analyze the data. A multilevel mixed-effect logistic regression model was used to identify factors associated with long-acting reversible contraceptive use. Variables with a p-value < 0.05 in the multilevel mixed-effect logistic regression model were declared significant factors associated with long-acting reversible contraceptives. RESULTS The magnitude of long-acting reversible contraceptive use among postpartum women was 12.6% (95% CI: 12.3, 12.8). Women primary (aOR = 1.51; 95% CI: 1.41, 1.63) and secondary education (aOR = 1.62; 95% CI: 1.32, 1.71), media exposure (aOR = 1.73; 95% CI: 1.51, 1.85), place of delivery (aOR = 1.54; 95% CI: 1.43, 1.67), number of ANC visit; 1-3 (aOR = 2.62; 95% CI: 2.31, 2.83) and ≥4 (aOR = 3.22; 95% CI: 2.93, 3.57), received PNC (aOR = 1.34; 95%CI: 1.13, 1.58), and income level; low middle income (aOR = 2.41; 95% CI: 2.11, 2.88) and upper middle income (aOR = 1.83; 95% CI: 1.56, 1.24) were significantly associated with long-acting reversible contractive use. CONCLUSION Nearly one in 10 postpartum women used long-acting reversible contraceptives. Hence, we suggest that the concerned bodies should promote family planning messages in mass media and give the well-documented benefits of postpartum long-acting contraceptive use. Promote the integration of postpartum LARC methods into maternal health care services and give better attention to postpartum women living in low-income countries and uneducated women.
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Affiliation(s)
- Desale Bihonegn Asmamaw
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadele Biresaw Belachew
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Samrawit Mihret Fetene
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Banchlay Addis
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tsegaw Amare
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Atitegeb Abera Kidie
- School of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Abel Endawkie
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Science, Wollo University, Dese, Ethiopia
| | - Alebachew Ferede Zegeye
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Tarik Tamir
- Department of pediatric and child health nursing, school of nursing, College of medicine and health sciences, University of Gondar, Gondar, Ethiopia
| | - Sisay Maru Wubante
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Elsa Awoke Fentie
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Wubshet Debebe Negash
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Asratie MH, Tesema GA, Chilot D, Aragaw FM, Merid MW, Belay DG. Socio-demographic and antenatal care-related factors associated with early post-partum family planning use in Ethiopia: evidence from Ethiopian Demographic and Health Survey 2016 data. Front Glob Womens Health 2023; 4:1131143. [PMID: 37727741 PMCID: PMC10505931 DOI: 10.3389/fgwh.2023.1131143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 07/20/2023] [Indexed: 09/21/2023] Open
Abstract
Introduction Initiation of family planning in the early post-partum period is a strategic move to reduce maternal, neonatal, and child mortality due to the negative consequences of short interbirth interval and the complications of unintended pregnancy. Antenatal care (ANC) is the noteworthy predictor of scaling up early initiation of post-partum family planning (PPFP) and preventing unintended pregnancy before menses resume. Despite the great role of ANC, information is scant about the effect of content, timing, and the number of ANC visits on the early initiation of PPFP in Ethiopia. Objective This study aimed to assess the association of ANC services with the early initiation of PPFP in Ethiopia. Methods The study was based on Ethiopian Demographic and Health Survey 2016 data, which was a cross-sectional survey from 18 January 2016 to 27 June 2016. A total weighted sample size of 2,920 post-partum women was included. A multilevel logistic regression model was used because of the hierarchical data, and variables with a p-value of ≤0.2 in the bivariable multilevel analysis were taken to multivariable multilevel analysis. An adjusted odds ratio with a 95% confidence interval (CI) was used to declare both the direction and strength of the association, and variables with a p-value of <0.05 were considered as statistically significant for the outcome variable. Results The early initiation of PPFP was 20.4%. Women with at least four ANC visits [adjusted odds ratio (AOR) = 1.31; CI 1.12-2.32], women who started ANC within the first trimester (AOR = 1.25; CI 1.10-2.23), complete routine ANC (AOR = 1.11; CI 1.01-2.03), post-natal care (AOR = 1.45; CI 1.19-1.87), resumption of menses (AOR = 1.67; CI 1.18-1.93), urban residency (AOR = 2.14; CI 1.18-2.51), and high community women's education (AOR = 1.71; CI 1.51-2.11) were variables significantly associated with the early initiation of PPFP. Conclusion The early initiation of PPFP in Ethiopia was very low. Attention needs to be given to the quality of ANC, post-natal care, resumption of menses, residency, and community-level education of women to increase the prevalence of the early initiation of PPFP in Ethiopia. Therefore, the government should design a program targeting the quality of ANC in rural communities, considering women without menses and scaling up the education of women at the community level to the culture of the early initiation of PPFP in order to achieve reduced maternal, neonatal, and child mortality.
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Affiliation(s)
- Melaku Hunie Asratie
- Department of Women’s and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dagmawi Chilot
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDTAfrica), Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
- Department of Human Physiology, University of Gondar, College of Medicine and Health Science, School of Medicine, Gondar, Ethiopia
| | - Fantu Mamo Aragaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mehari Woldemariam Merid
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Daniel Gashaneh Belay
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Human Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Calhoun LM, Winston J, Beňová L, Speizer IS, Delvaux T, Shiferaw S, Seme A, Karp C, Zimmerman L, van den Akker T. The more, the better: influence of family planning discussions during the maternal, newborn and child health continuum of care on postpartum contraceptive uptake and method type among young women in Ethiopia. Gates Open Res 2023; 7:67. [PMID: 37426595 PMCID: PMC10323130 DOI: 10.12688/gatesopenres.14626.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 07/11/2023] Open
Abstract
Background: This study examines the association between family planning (FP) discussions with health professionals during contact points on the maternal, newborn and child health continuum of care and timing of modern contraceptive uptake and method type in the one-year following childbirth in six regions of Ethiopia among adolescent girls and young women (AGYW). Methods: This paper uses panel data of women aged 15-24 who were interviewed during pregnancy and the postpartum period between 2019-2021 as part of the PMA Ethiopia survey (n=652). Results: Despite the majority of pregnant and postpartum AGYW attending antenatal care (ANC), giving birth in a health facility, and attending vaccination visits, one-third or less of those who received the service reported discussion of FP at any of these visits. When considering the cumulative effect of discussions of FP at ANC, pre-discharge after childbirth, postnatal care and vaccination visits, we found that discussion of FP at a greater number of visits resulted in increased uptake of modern contraception by one-year postpartum. A greater number of FP discussions was associated with higher long-acting reversible contraceptive use relative to non-use and relative to short-acting method use. Conclusions: Despite high attendance, there are missed opportunities to discuss FP when AGYW access care.
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Affiliation(s)
- Lisa M. Calhoun
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, 27516, USA
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, North Holland, The Netherlands
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jennifer Winston
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, 27516, USA
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Ilene S. Speizer
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, 27516, USA
- Department of Maternal and Child Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Thérèse Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Solomon Shiferaw
- School of Public Health, Addis Ababa University, Addis Ababa, Addis Ababa, Ethiopia
| | - Assefa Seme
- School of Public Health, Addis Ababa University, Addis Ababa, Addis Ababa, Ethiopia
| | - Celia Karp
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Linnea Zimmerman
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Thomas van den Akker
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, North Holland, The Netherlands
- Department of Obstetrics and Gynecology, Universiteit Leiden Medical Center, Leiden, South Holland, The Netherlands
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Tesfaye T, Mamo E, Teshome A, Kebede B, Abrham T, Solomon A, Seid S. Effect of Package of Interventions on the Use and Quality of Postpartum Family Planning Services at Yekatit 12 Hospital Medical College (Y12HMC), Addis Ababa, Ethiopia. Health Serv Insights 2023; 16:11786329231160017. [PMID: 36923261 PMCID: PMC10009055 DOI: 10.1177/11786329231160017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 02/09/2023] [Indexed: 03/13/2023] Open
Abstract
Background Postpartum Family Planning (PPFP), which aims to prevent high risk unintended and closely spaced pregnancies during the first year following childbirth, is one of the highest impact interventions to avoid increased risk of premature birth, low birth weight, fetal and neonatal death, and adverse maternal health outcomes. This study aimed to assess the combined effect of a package of interventions on the use and quality of PPFP services at Y12HMC, Addis Ababa Ethiopia. Method Cross-sectional study design was conducted to evaluate the effect of the package of chosen interventions: creating a private counseling space near the postpartum ward and providing training for health care providers on the WHO decision tool kit and Long Acting Contraceptive Methods (LACM). Interviews were conducted with 470 women (235 before and 235 after the intervention). Frequency tables and graphs were used to describe the study variables and statistical significance between pre and post intervention indicators was declared at P value <.05. Results From 470 participants, 421 respondents participated which makes response rate of 90%. The majority of the participants were in the age category 20 to 29 years, married/lived together, completed at least primary education and had more than one child both at baseline and post intervention. The proportion of women who chose PPFP increased from 55.8% at baseline to 69% after the intervention. The most preferred contraceptive method was implant. The overall service satisfaction level of the study participants was 95.4% post intervention, significantly higher than at baseline (78%, P < .05). Providers indicated that clients are satisfied with the service and that the institutional structure is appropriate for delivering integrated services following the intervention. Conclusion This study demonstrated that quality improvement interventions like creating a private counseling space and providing training using WHO decision tool kit can achieve significant improvement on satisfaction of clients and PPFP uptake.
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Affiliation(s)
- Tatek Tesfaye
- Obstetrics and Gynaecology Department, Y12HMC, Addis Ababa, Ethiopia
| | - Ephrem Mamo
- Public Health Department, Y12HMC, Addis Ababa, Ethiopia
| | - Ayele Teshome
- Obstetrics and Gynaecology Department, Y12HMC, Addis Ababa, Ethiopia
| | - Birhanu Kebede
- Obstetrics and Gynaecology Department, Y12HMC, Addis Ababa, Ethiopia
| | - Tizita Abrham
- Obstetrics and Gynaecology Department, Y12HMC, Addis Ababa, Ethiopia
| | - Ananya Solomon
- Obstetrics and Gynaecology Department, Y12HMC, Addis Ababa, Ethiopia
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Tougri H, Yameogo ME, Compaoré R, Dahourou D, Belemsaga DY, Meda B, Kpebo D, Ndour M, Kouanda S. Gaps and opportunities for the integrated delivery of mother-child care, postpartum family planning and nutrition services in Burkina Faso, Côte d’Ivoire and Niger. JOURNAL OF GLOBAL HEALTH REPORTS 2022. [DOI: 10.29392/001c.57370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Maternal and infant deaths can be prevented through integrated service delivery during pregnancy, postpartum, and early childhood. Our study analyses the gaps and opportunities associated with integrating maternal, newborn, and child health (MNCH) services with postpartum family planning (PPFP) and nutrition services at different points of contact in health facilities in a preintervention context in west Africa. Methods We conducted a qualitative study from June to July 2018 in Burkina Faso, Côte d’Ivoire and Niger. The points of contact studied at the health facility level were the prenatal care, postpartum care and immunisation/growth monitoring services. Individual in-depth interviews were used to collect data from key informants (providers, community health workers and mother-child health programme managers). To measure the degree of service integration, we used the dimensions and indicators included in the Integra Initiative framework concerning four aspects of integration: physical (the availability of multiple services in the health facility), temporal (the availability of care more than one day per week), provider level, and functional (the receipt of integrated services by the client). Results The findings of this study show that the integrated delivery of MNCH, PPFP, and nutrition services is configured in similar ways in Burkina Faso, Côte d’Ivoire and Niger and is insufficient at all points of contact. Physical integration is high. However, the study found important gaps in temporal, functional and provider-level integration. The main barriers to integrated service delivery are the shortage of providers, the lack of training in integrated service delivery, and insufficient service organisation. However, the availability of multiple services throughout the week, the multiple points of contact between the mother-child pair and the health system, and the multiple skills of providers represent opportunities for functional integration through the establishment of a formal referral system between the different care units with follow-up and feedback among service providers. Conclusions The provision of training and the development of a well-organised referral system in different health facilities, taking into account the specific characteristics of each health facility (urban/rural, primary health facility/district hospital), can improve the delivery of integrated MNCH, PPFP, and nutrition care to the mother-child pair.
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Affiliation(s)
- Halima Tougri
- Institut de recherche en sciences de la santé (IRSS), Ouagadougou, Burkina Faso
- Ecole doctorale sciences, santé et technologies (ED/2ST) de l’Université Saint Thomas d’Aquin (USTA), Ouagadougou, Burkina Faso
| | - Maurice E. Yameogo
- Institut de recherche en sciences de la santé (IRSS), Ouagadougou, Burkina Faso
- Institut africain de santé publique (IASP), Ouagadougou, Burkina Faso
| | - Rachidatou Compaoré
- Institut de recherche en sciences de la santé (IRSS), Ouagadougou, Burkina Faso
- Ecole doctorale sciences, santé et technologies (ED/2ST) de l’Université Saint Thomas d’Aquin (USTA), Ouagadougou, Burkina Faso
| | - Désiré Dahourou
- Institut de recherche en sciences de la santé (IRSS), Ouagadougou, Burkina Faso
| | | | - Bertrand Meda
- Institut de recherche en sciences de la santé (IRSS), Ouagadougou, Burkina Faso
| | - Denise Kpebo
- Ecole doctorale sciences, santé et technologies (ED/2ST) de l’Université Saint Thomas d’Aquin (USTA), Ouagadougou, Burkina Faso
- École de médecine d'Abidjan, Côte d'Ivoire
- Institut national de santé publique, Abidjan, Côte d'Ivoire
| | - Marguerite Ndour
- IntraHealth International, bureau regional, Ouagadougou, Burkina Faso
| | - Seni Kouanda
- Institut de recherche en sciences de la santé (IRSS), Ouagadougou, Burkina Faso
- Ecole doctorale sciences, santé et technologies (ED/2ST) de l’Université Saint Thomas d’Aquin (USTA), Ouagadougou, Burkina Faso
- Institut africain de santé publique (IASP), Ouagadougou, Burkina Faso
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Goyomsa GG, Geleta LA, Debela SA, Reshid N, Ogeto Luke A, Lamaro Abota T, Girma D, Dejene H. Quality of family planning counseling and associated factors among women attending family planning clinics at selected health centers in Akaki Kality sub-city, Addis Ababa, Ethiopia. Front Glob Womens Health 2022; 3:939783. [DOI: 10.3389/fgwh.2022.939783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 11/04/2022] [Indexed: 12/03/2022] Open
Abstract
BackgroundEthiopia has achieved a remarkable improvement in the provision of family planning. The modern contraceptive prevalence rate has shown a fivefold increment in the last two decades, yet the family planning service in the country is still deficient and characterized by poor counseling quality.ObjectiveThe aim of the study is to assess the quality of family planning counseling provided and the associated factors at selected health centers in Akaki Kality sub-city, Addis Ababa, Ethiopia.MethodA cross-sectional study was conducted among 678 randomly selected women attending family planning services at health centers in Addis Ababa, Ethiopia. Multivariable logistic regression analysis was performed to identify factors associated with the quality of family planning counseling.ResultA total of 678 women participated in the study. About 29.1% [95% confidence interval (CI): 25.7%–32.6%] of the respondents were adequately counseled. Age groups 37–49 [adjusted odds ratio (AOR) = 2.7; 95% CI: 1.1–6.6], being in marital union (AOR = 2.8; 95% CI: 1.2–6.7), attaining secondary education (AOR = 1.9; 95% CI: 1.1–3.6) or higher education (AOR = 2.2; 95% CI: 1.2–4.3), and visit status (AOR = 1.6; 95% CI: 1.1–2.4) were significantly associated with good counseling.ConclusionLess than one in three women was counseled adequately. Health professionals should give due attention to younger women, single clients, and clients with their first presentation to the health facility. It also indicates that promoting education among Ethiopian women is crucial for a positive outcome of family planning counseling.
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Cohen MA, Kumar S, Hathaway M. Global Preconception and Contraception Care. Obstet Gynecol Clin North Am 2022; 49:647-663. [DOI: 10.1016/j.ogc.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Kpebo D, Coulibaly A, Yameogo WME, Bijou S, Hamidou Lazoumar R, Tougri H, N’dour M, Kouanda S. Effect of integrating maternal and child health services, nutrition and family planning services on postpartum family planning uptake at 6 months post-partum in Burkina Faso, Cote d’Ivoire and Niger: a quasi-experimental study protocol. Reprod Health 2022; 19:181. [PMID: 35987637 PMCID: PMC9391637 DOI: 10.1186/s12978-022-01467-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 06/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Although several interventions integrating maternal, neonatal, child health and nutrition with family planning have been implemented and tested, there is still limited evidence on their effectiveness to guide program efforts and policy action on health services integration. This study aims to assess the effectiveness of a service delivery model integrating maternal and child health services, nutrition and family planning services, compared with the general standard of care in Burkina Faso, Cote d'Ivoire, and Niger. Methods This is a quasi experimental study with one intervention group and one control group of 3 to 4 health facilities in each country. Each facility was matched to a control facility of the same level of care that had similar coverage on selected reproductive health indicators such as family planning and post-partum family planning. The study participants are pregnant women (up to 28 weeks of gestational age) coming for their first antenatal care visit. They will be followed up to 6 months after childbirth, and will be interviewed at each antenatal visit and also during visits for infant vaccines. The analyzes will be carried out by intention to treat, using generalized linear models (binomial log or log Poisson) to assess the effect of the intervention on the ratio of contraceptive use prevalence between the two groups of the study at a significance level of 5%, while taking into account the cluster effect and adjusting for potential confounding factors (socio-demographic characteristics of women unevenly distributed at inclusion). Discussion This longitudinal study, with the provision of family planning services integrated into the whole maternal care continuum, a sufficiently long observation time and repeated measurements, will make it possible to better understand the timeline and the factors influencing women’s decision-making on the use of post-partum family planning services. The results will help to increase the body of knowledge regarding the impact of maternal and child health services integration on the utilization of post-partum family planning taking into account the specific context of sub-Saharan Africa French speaking countries where such information is very needed. One strategy to improve the utilization of health services by mothers and their children is the integration of maternal and child health services. For instance, a pregnant woman coming for an antenatal care visit would also receive counseling on post-partum family planning services and maternal nutrition. Similarly, a woman coming for her infant’s vaccines would be offered counseling on post-partum family planning, maternal nutrition and breastfeeding. Although several interventions have been implemented and tested, there is still limited evidence on the conditions and factors required for successful maternal and child health services integration strategies. This study aims to assess the effectiveness of an intervention integrating maternal and child health services, nutrition and family planning services. For the purpose of the evaluation, 2 distincts groups of health facilities will be selected in each country, one group of 3 or 4 health facilities where the intervention will be implemented, and another group of 3 or 4 health facilities with the general standard of care. The study participants are pregnant women (up to 28 weeks of gestational age), coming for their first antenatal care visit, who will be followed up to 6 months after childbirth.The analyzes will be carried out to assess the effect of the intervention on contraceptive use prevalence between the two groups of health facilities. This study will make it possible to better understand the timeline and the factors influencing women’s decision-making on the use of post-partum family planning services.
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11
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The causal effect of a family planning intervention on women's contraceptive use and birth spacing. Proc Natl Acad Sci U S A 2022; 119:e2200279119. [PMID: 35609202 PMCID: PMC9295775 DOI: 10.1073/pnas.2200279119] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
SignificanceImproving access to family planning may promote contraceptive use after childbirth and reduce the likelihood of closely spaced high-risk births; however, empirical evidence for these claims is limited. We present findings from a field experiment that examines the causal impact of a broad-based family-planning intervention on postpartum contraceptive use and fertility over a 2-y period, which allows us to assess impact on high-risk short pregnancy intervals. Our findings demonstrate that the benefits of family planning extend beyond contraceptive use to improve fertility and healthy birth spacing. Evidence from this study will contribute to the design of effective family-planning programs and to informing the ongoing policy debate about how such programs impact longer-term health and development more broadly.
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12
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Mruts KB, Tessema GA, Gebremedhin AT, Scott J, Pereira G. The effect of family planning counselling on postpartum modern contraceptive uptake in sub-Saharan Africa: a systematic review. Public Health 2022; 206:46-56. [PMID: 35366579 DOI: 10.1016/j.puhe.2022.02.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 02/02/2022] [Accepted: 02/14/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Family planning counselling at different contact points of maternal health services has been recommended for increasing the uptake of modern contraceptive methods. However, studies from sub-Saharan Africa (SSA) demonstrated inconsistent findings. The aim of this systematic review was to synthesise the available current evidence for the association between family planning counselling and postpartum modern contraceptive uptake in SSA. STUDY DESIGN This is a systematic review of the SSA literature. METHODS On 11 February 2021, we searched six electronic databases for studies published in English. We included quantitative observational and interventional studies that assessed the effects of family planning counselling on contraceptive uptake among women who gave birth in the first 12 months. We used Joanna Briggs Institute critical appraisal tools to evaluate study quality. The protocol for this systematic review was registered in PROSPERO (CRD42021234785). RESULTS Twenty-seven studies with 26,814 participants comprising 18 observational and nine interventional studies were included. Family planning counselling during antenatal care, delivery, postnatal care, and antenatal and postnatal care was associated with postpartum contraceptive uptake. Moreover, the newly implemented family planning counselling interventions improved postpartum modern contraceptive uptake. CONCLUSION Overall, the evidence suggests that family planning counselling during the different maternal health service delivery points enhances contraceptive uptake among postpartum women. SSA countries should promote and strengthen family planning counselling integrated with maternal health services, which will play a significant role in combating unintended and closely spaced pregnancies.
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Affiliation(s)
- K B Mruts
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia; School of Public Health, College of Health Science, Debre Berhan University, Debre Berhan, Ethiopia.
| | - G A Tessema
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia; School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - A T Gebremedhin
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia; Wesfarmers Centre of Vaccine and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia
| | - J Scott
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - G Pereira
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia; Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway; enAble Institute, Curtin University, Perth, Western Australia
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Calik-Ksepka A, Stradczuk M, Czarnecka K, Grymowicz M, Smolarczyk R. Lactational Amenorrhea: Neuroendocrine Pathways Controlling Fertility and Bone Turnover. Int J Mol Sci 2022; 23:ijms23031633. [PMID: 35163554 PMCID: PMC8835773 DOI: 10.3390/ijms23031633] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 02/06/2023] Open
Abstract
Lactation is a physiological state of hyperprolactinemia and associated amenorrhea. Despite the fact that exact mechanisms standing behind the hypothalamus-pituitary-ovarian axis during lactation are still not clear, a general overview of events leading to amenorrhea may be suggested. Suckling remains the most important stimulus maintaining suppressive effect on ovaries after pregnancy. Breastfeeding is accompanied by high levels of prolactin, which remain higher than normal until the frequency and duration of daily suckling decreases and allows normal menstrual function resumption. Hyperprolactinemia induces the suppression of hypothalamic Kiss1 neurons that directly control the pulsatile release of GnRH. Disruption in the pulsatile manner of GnRH secretion results in a strongly decreased frequency of corresponding LH pulses. Inadequate LH secretion and lack of pre-ovulatory surge inhibit the progression of the follicular phase of a menstrual cycle and result in anovulation and amenorrhea. The main consequences of lactational amenorrhea are connected with fertility issues and increased bone turnover. Provided the fulfillment of all the established conditions of its use, the lactational amenorrhea method (LAM) efficiently protects against pregnancy. Because of its accessibility and lack of additional associated costs, LAM might be especially beneficial in low-income, developing countries, where modern contraception is hard to obtain. Breastfeeding alone is not equal to the LAM method, and therefore, it is not enough to successfully protect against conception. That is why LAM promotion should primarily focus on conditions under which its use is safe and effective. More studies on larger study groups should be conducted to determine and confirm the impact of behavioral factors, like suckling parameters, on the LAM efficacy. Lactational bone loss is a physiologic mechanism that enables providing a sufficient amount of calcium to the newborn. Despite the decline in bone mass during breastfeeding, it rebuilds after weaning and is not associated with a postmenopausal decrease in BMD and osteoporosis risk. Therefore, it should be a matter of concern only for lactating women with additional risk factors or with low BMD before pregnancy. The review summarizes the effect that breastfeeding exerts on the hypothalamus-pituitary axis as well as fertility and bone turnover aspects of lactational amenorrhea. We discuss the possibility of the use of lactation as contraception, along with this method's prevalence, efficacy, and influencing factors. We also review the literature on the topic of lactational bone loss: its mechanism, severity, and persistence throughout life.
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Affiliation(s)
- Anna Calik-Ksepka
- Department of Gynaecological Endocrinology, Medical University of Warsaw, Karowa 2, 00-315 Warsaw, Poland; (M.G.); (R.S.)
- Correspondence:
| | - Monika Stradczuk
- Student’s Academic Association, Department of Gynecological Endocrinology, Faculty of Medicine, Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland; (M.S.); (K.C.)
| | - Karolina Czarnecka
- Student’s Academic Association, Department of Gynecological Endocrinology, Faculty of Medicine, Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland; (M.S.); (K.C.)
| | - Monika Grymowicz
- Department of Gynaecological Endocrinology, Medical University of Warsaw, Karowa 2, 00-315 Warsaw, Poland; (M.G.); (R.S.)
| | - Roman Smolarczyk
- Department of Gynaecological Endocrinology, Medical University of Warsaw, Karowa 2, 00-315 Warsaw, Poland; (M.G.); (R.S.)
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Roy N, Adhikary P, Kabra R, Kiarie J, Mburu G, Dhabhai N, Chowdhury R, Mazumder S. Postpartum contraceptive practices among urban and peri-urban women in North India: a mixed-methods cohort study protocol. BMC Pregnancy Childbirth 2021; 21:820. [PMID: 34893054 PMCID: PMC8662907 DOI: 10.1186/s12884-021-04294-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postpartum family planning (PPFP) helps women space childbirths, increase exclusive breastfeeding and prevent unintended pregnancies, leading to reduction in maternal, infant and child morbidities and mortality. Unmet need of family planning is highest among women in the postpartum period due to lack of knowledge, cultural and religious barriers, access barriers and low antenatal care service utilization. However, in spite of low prevalence of postpartum family planning practices, birth-to-birth interval is reportedly high in Delhi, India. This study explores the postpartum contraception practices and the relationship between use of postpartum contraception and subsequent child linear growth. METHODS This is a mixed method cohort study on PPFP and is nested within an ongoing "Women and Infants Integrated Interventions for Growth Study" (WINGS). Married women aged 18-30 years who have delivered a live baby are recruited for quantitative interviews at 6 weeks, 6, 12, and 24 months postpartum. In-depth interviews are conducted with a randomly selected sub-sample of women at each of the four time points, 35 husbands and 20 local service providers to understand their perspectives on PPFP practices. DISCUSSION The findings from the study will provide useful insights into couples' contraception preferences and choice of contraception, modern and traditional, initiation time and the effect of birth spacing and contraception use on subsequent linear growth of the child. This knowledge will be of significant public health relevance and will help in designing appropriate interventions for appropriate postpartum contraception use and delivery strategies. The study aims to work address the Sexual and Reproductive Health and Rights goal of promoting reproductive health, voluntary and safe sexual and reproductive choices for women. TRIAL REGISTRATION Trial registration number: CTRI/2020/03/023954 .
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Affiliation(s)
- Nivedita Roy
- Centre for Health Research and Development, Society for Applied Studies, 45 Kalu Sarai, New Delhi, 110016, India
| | - Priyanka Adhikary
- Centre for Health Research and Development, Society for Applied Studies, 45 Kalu Sarai, New Delhi, 110016, India
| | - Rita Kabra
- World Health Organization, Geneva, Switzerland
| | | | - Gitau Mburu
- World Health Organization, Geneva, Switzerland
| | - Neeta Dhabhai
- Centre for Health Research and Development, Society for Applied Studies, 45 Kalu Sarai, New Delhi, 110016, India
| | - Ranadip Chowdhury
- Centre for Health Research and Development, Society for Applied Studies, 45 Kalu Sarai, New Delhi, 110016, India
| | - Sarmila Mazumder
- Centre for Health Research and Development, Society for Applied Studies, 45 Kalu Sarai, New Delhi, 110016, India.
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15
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Mickler AK, Karp C, Ahmed S, Yihdego M, Seme A, Shiferaw S, Zimmerman L. Individual and facility-level factors associated with women's receipt of immediate postpartum family planning counseling in Ethiopia: results from national surveys of women and health facilities. BMC Pregnancy Childbirth 2021; 21:809. [PMID: 34865633 PMCID: PMC8645155 DOI: 10.1186/s12884-021-04278-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Immediate postpartum family planning (IPPFP) helps prevent unintended and closely spaced pregnancies. Despite Ethiopia's rising facility-based delivery rate and supportive IPPFP policies, the prevalence of postpartum contraceptive use remains low, with little known about disparities in access to IPPFP counseling. We sought to understand if women's receipt of IPPFP counseling varied by individual and facility characteristics. METHODS We used weighted linked household and facility data from the national Performance Monitoring for Action Ethiopia (PMA-Ethiopia) study. Altogether, 936 women 5-9 weeks postpartum who delivered at a government facility were matched to the nearest facility offering labor and delivery care, corresponding to the facility type in which each woman reported delivering (n = 224 facilities). We explored women's receipt of IPPFP counseling and individual and facility-level characteristics utilizing descriptive statistics. The relationship between women's receipt of IPPFP counseling and individual and facility factors were assessed through multivariate, multilevel models. RESULTS Approximately one-quarter of postpartum women received IPPFP counseling (27%) and most women delivered government health centers (59%). Nearly all facilities provided IPPFP services (94%); most had short- and long-acting methods available (71 and 87%, respectively) and no recent stockouts (60%). Multivariate analyses revealed significant disparities in IPPFP counseling with lower odds of counseling among primiparous women, those who delivered vaginally, and women who did not receive delivery care from a doctor or health officer (all p < 0.05). Having never used contraception was marginally associated with lower odds of receiving IPPFP counseling (p < 0.10). IPPFP counseling did not differ by age, residence, method availability, or facility type, after adjusting for other individual and facility factors. CONCLUSION Despite relatively widespread availability of IPPFP services in Ethiopia, receipt of IPPFP counseling remains low. Our results highlight important gaps in IPPFP care, particularly among first-time mothers, women who have never used contraception, women who delivered vaginally, and those who did not receive delivery care from a doctor or health officer. As facility births continue to rise in Ethiopia, health systems and providers must ensure that equitable, high-quality IPPFP services are offered to all women.
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Affiliation(s)
- Alexandria K Mickler
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, USA
| | - Celia Karp
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, USA.
| | - Saifuddin Ahmed
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, USA
| | - Mahari Yihdego
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Assefa Seme
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Shiferaw
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Linnea Zimmerman
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, USA
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Adofo E, Dun-Dery EJ, Kotoh AM, Dun-Dery F, Avoka JA, Ashinyo ME. Fear of infertility limits contraceptive usage among first-time mothers in Ghana: A cross-sectional study. SAGE Open Med 2021; 9:20503121211021256. [PMID: 34158936 PMCID: PMC8182170 DOI: 10.1177/20503121211021256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 05/04/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES This study aimed to determine postpartum modern contraceptive use among first-time young mothers attending child welfare clinics in the Eastern Region of Ghana and explore factors that influence family planning uptake after the first delivery, including fear of infertility. METHODS This facility-based, cross-sectional study used interviewer-administered structured questionnaires. The study recruited 422 first-time young mothers aged 15-24 years, with 6- to 18-month-old babies attending child welfare clinics. RESULTS Overall, less than half (44%) of first-time mothers used modern contraceptives within 18 months after delivery. Fear of infertility after contraceptive use (56%) is the main barrier reported as the reason for women's non-use of modern contraceptives. Mothers with tertiary education have higher odds of using postpartum contraceptives (adjusted odds ratio =1.6, 95% confidence interval: 0.4-2.0). Compared to mothers with younger children, those with children older than 6 months have higher odds of postpartum contraceptive use (adjusted odds ratio = 1.3, 95% confidence interval: 0.3-1.7). Nonspousal communication (adjusted odds ratio = 0.1, 95% confidence interval: 0.1-0.3) as compared to communication among partners about contraception and those in formal employment (adjusted odds ratio = 0.3, 95% confidence interval: 0.1-0.7), were less likely to use postpartum contraceptives. CONCLUSION Considering that there is low postpartum contraceptive utilization, mostly due to concerns about fear of infertility after use, it is paramount to intensify education on actual side effects and reformulate policies that address specific concerns of infertility among mothers and contraceptive use.
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Affiliation(s)
| | - Elvis J Dun-Dery
- Department of Population, Family and
Reproduction Health, School of Public Health, College of Health Sciences, University
of Ghana, Accra, Ghana
- Department of Population and Health
Research, Research Web Africa, Sunyani, Ghana
| | - Agnes M Kotoh
- Department of Population, Family and
Reproduction Health, School of Public Health, College of Health Sciences, University
of Ghana, Accra, Ghana
| | - Frederick Dun-Dery
- Heidelberg Institute of Global Health,
Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
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Coulibaly A, Baguiya A, Garanet F, Tran NT, Millogo T, Yaméogo WME, Meda IB, Thieba B, Kouanda S. Yam Daabo interventions' effects on postpartum family planning use in Burkina Faso at 24 months after childbirth. BMC Public Health 2021; 21:946. [PMID: 34006237 PMCID: PMC8132432 DOI: 10.1186/s12889-021-10964-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/30/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction After testing the interventions for improving the prevalence of contraceptive use, very few studies have measured the long-term effects thereafter the end of the implementation. This study aimed to measure Yam Daabo interventions’ effects on contraceptive use in Burkina Faso at twelve months after completion of the intervention. Methods Yam Daabo was a two-group, multi-intervention, single-blind, cluster randomized controlled trial. Interventions comprised refresher training for the provider, a counseling tool, supportive supervision, availability of contraceptive services 7 days a week, client appointment cards, and invitation letters for partners. We used generalized linear mixed-effects models (log Poisson) to compare the modern contraceptive prevalence at 12 months post-intervention in the two groups. We collected data between September and November 2018. We conducted an intention-to-treat analysis and adjusted the prevalence ratios on cluster effects and unbalanced baseline characteristics. Results Twelve months after the completion of the Yam Daabo trial, we interviewed 87.4% (485 out of 555 women with available data at 12 months, that is, 247/276 in the intervention group (89.5%) and 238/279 in the control group (85.3%). No difference was observed in the use of hormonal contraceptive methods between the intervention and control groups (adjusted prevalence ratio = 1.21; 95% confidence interval [CI] = [0.91–1.61], p = 0.191). By contrast, women in the intervention group were more likely to use long-acting reversible contraceptives (LARC) than those in the control group (adjusted prevalence ratio = 1.35; 95% CI = [1.08–1.69], p = 0.008). Conclusion Twelve months after completion of the intervention, we found no significant difference in hormonal contraceptive use between women in the intervention and their control group counterparts. However, women in the intervention group were significantly more likely to use long-acting reversible contraceptives than those in the control group. Trial registration The trial registration number at the Pan African Clinical Trials Registry is PACTR201609001784334. The date of the first registration is 27/09/2016. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10964-w.
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Affiliation(s)
- Abou Coulibaly
- Unité de Surveillance Démographique et de Santé (Kaya-HDSS), Institut de Recherche en Sciences de la Santé (IRSS), 03 B.P. 7047, Ouagadougou, 03, Burkina Faso. .,Ecole doctorale Sciences de la Santé, Université Joseph KI-ZERBO, 03 B.P. 7021, Ouagadougou, 03, Burkina Faso.
| | - Adama Baguiya
- Unité de Surveillance Démographique et de Santé (Kaya-HDSS), Institut de Recherche en Sciences de la Santé (IRSS), 03 B.P. 7047, Ouagadougou, 03, Burkina Faso
| | - Franck Garanet
- Unité de Surveillance Démographique et de Santé (Kaya-HDSS), Institut de Recherche en Sciences de la Santé (IRSS), 03 B.P. 7047, Ouagadougou, 03, Burkina Faso
| | - Nguyen Toan Tran
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology, PO Box 123, Sydney, NSW, 2007, Australia
| | - Tieba Millogo
- Ecole doctorale Sciences de la Santé, Université Joseph KI-ZERBO, 03 B.P. 7021, Ouagadougou, 03, Burkina Faso.,Institut Africain de Santé Publique, 12 B.P, Ouagadougou, 199, Burkina Faso
| | | | - Ivlabèhirè Bertrand Meda
- Institut de Recherche en Sciences de la Santé (IRSS), 03 B.P. 7047, Ouagadougou, 03, Burkina Faso
| | - Blandine Thieba
- Unité de formation et de recherche en sciences de la santé, Université Joseph KI-ZERBO, 03 B.P. 7021, Ouagadougou, 03, Burkina Faso
| | - Séni Kouanda
- Institut Africain de Santé Publique, 12 B.P, Ouagadougou, 199, Burkina Faso.,Institut de Recherche en Sciences de la Santé (IRSS), 03 B.P. 7047, Ouagadougou, 03, Burkina Faso
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Eva G, Gold J, Makins A, Bright S, Dean K, Tunnacliffe EA, Fatima P, Yesmin A, Muganyizi P, Kimario GF, Dalziel K. Economic Evaluation of Provision of Postpartum Intrauterine Device Services in Bangladesh and Tanzania. GLOBAL HEALTH, SCIENCE AND PRACTICE 2021; 9:107-122. [PMID: 33795364 PMCID: PMC8087427 DOI: 10.9745/ghsp-d-20-00447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 02/10/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Postpartum family planning is an effective means of achieving improved health outcomes for women and children, especially in low- and middle-income settings. We assessed the cost-effectiveness of an immediate postpartum intrauterine device (PPIUD) initiative compared with standard practice in Bangladesh and Tanzania (which is no immediate postpartum family planning counseling or service provision) to inform resource allocation decisions for governments and donors. METHODS A decision analysis was constructed to compare the PPIUD program with standard practice. The analysis was based on the number of PPIUD insertions, which were then modeled using the Impact 2 tool to produce estimates of cost per couple-years of protection (CYP) and cost per disability-adjusted life years (DALYs) averted. A micro-costing approach was used to estimate the costs of conducting the program, and downstream cost savings were generated by the Impact 2 tool. Results are presented first for the program as evaluated, and second, based on a hypothetical national scale-up scenario. One-way sensitivity analyses were conducted. RESULTS Compared to standard practice, the PPIUD program resulted in an incremental cost-effectiveness ratio (ICER) of US$14.60 per CYP and US$91.13 per DALY averted in Bangladesh, and US$54.57 per CYP and US$67.67 per DALY averted in Tanzania. When incorporating estimated direct health care costs saved, the results for Bangladesh were dominant (PPIUD is cheaper and more effective versus standard practice). For Tanzania, the PPIUD initiative was highly cost-effective, with the ICER (incorporating direct health care costs saved) estimated at US$15.20 per CYP and US$18.90 per DALY averted compared to standard practice. For the national scale-up model, the results were dominant in both countries.Conclusions/implications: The PPIUD initiative was highly cost-effective in Bangladesh and Tanzania, and national scale-up of PPIUD could produce long-term savings in direct health care costs in both countries. These analyses provide a compelling case for national governments and international donors to invest in PPIUD as part of their family planning strategies.
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Affiliation(s)
- Gillian Eva
- Independent consultant, Washington, DC, USA.
| | - Judy Gold
- Independent consultant, Melbourne, Australia
| | - Anita Makins
- International Federation of Gynecology and Obstetrics, London, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department Women's and Reproductive Health, Oxford University, Oxford, UK
| | - Suzanna Bright
- International Federation of Gynecology and Obstetrics, London, UK
| | - Katherine Dean
- International Federation of Gynecology and Obstetrics, London, UK
| | | | - Parveen Fatima
- Obstetrical and Gynaecological Society of Bangladesh, Dhaka, Bangladesh
| | - Afroja Yesmin
- Obstetrical and Gynaecological Society of Bangladesh, Dhaka, Bangladesh
| | | | | | - Kim Dalziel
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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Sheahan KL, Orgill-Meyer J, Speizer IS, Curtis S, Paul J, Weinberger M, Bennett AV. Development of integration indexes to determine the extent of family planning and child immunization services integration in health facilities in urban areas of Nigeria. Reprod Health 2021; 18:47. [PMID: 33622376 PMCID: PMC7903768 DOI: 10.1186/s12978-021-01105-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 02/10/2021] [Indexed: 11/21/2022] Open
Abstract
Background Integrating family planning into child immunization services may address unmet need for contraception by offering family planning information and services to postpartum women during routine child immunization visits. However, policies and programs promoting integration are often based on insubstantial or conflicting evidence about its effects on service delivery and health outcomes. While integration models vary, many studies measure integration as binary (a facility is integrated or not) rather than a multidimensional and varying continuum. It is thus challenging to ascertain the determinants and effects of integrated service delivery. This study creates Facility and Provider Integration Indexes, which measure capacity to support integrated family planning and child immunization services and applies them to analyze the extent of integration across 400 health facilities. Methods This study utilizes cross-sectional health facility (N = 400; 58% hospitals, 42% primary healthcare centers) and healthcare provider (N = 1479) survey data that were collected in six urban areas of Nigeria for the impact evaluation of the Nigerian Urban Reproductive Health Initiative. Principal Component Analysis was used to develop Provider and Facility Integration Indexes that estimate the extent of integration in these health facilities. The Provider Integration Index measures provider skills and practices that support integrated service delivery while the Facility Integration Index measures facility norms that support integrated service delivery. Index scores range from zero (low) to ten (high). Results Mean Provider Integration Index score is 5.42 (SD 3.10), and mean Facility Integration Index score is 6.22 (SD 2.72). Twenty-three percent of facilities were classified as having low Provider Integration scores, 32% as medium, and 45% as high. Fourteen percent of facilities were classified as having low Facility Integration scores, 38% as medium, and 48% as high. Conclusion Many facilities in our sample have achieved high levels of integration, while many others have not. Results suggest that using more nuanced measures of integration may (a) more accurately reflect true variation in integration within and across health facilities, (b) enable more precise measurement of the determinants or effects of integration, and (c) provide more tailored, actionable information about how best to improve integration. Overall, results reinforce the importance of utilizing more nuanced measures of facility-level integration.
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Affiliation(s)
- Kate L Sheahan
- The Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), (CIN 13-410) at the Durham VA Health Care System, Durham, NC, USA.
| | | | - Ilene S Speizer
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Siân Curtis
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - John Paul
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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20
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Gahungu J, Vahdaninia M, Regmi PR. The unmet needs for modern family planning methods among postpartum women in Sub-Saharan Africa: a systematic review of the literature. Reprod Health 2021; 18:35. [PMID: 33568180 PMCID: PMC7877117 DOI: 10.1186/s12978-021-01089-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa has the highest fertility rate in the world, with the highest unmet need for family planning (FP). Yet, there is a lack of knowledge about the determinants for non-utilisation of modern contraceptive methods among women of reproductive age. This systematic review of literature assessed factors affecting the unmet need and reasons for non-utilisation of modern contraceptive methods during the postpartum period in Sub-Saharan African women. METHODS An online literature search was conducted in several databases: MEDLINE, Cochrane Review, PubMed, Elsevier's Science Direct and Web of Science. The search was completed by hand searching. Data were extracted and summarised using the Arksey and O'Malley methodology. RESULTS In total, 19 studies were included; one qualitative study, seventeen quantitative, and one used a mixed-methods approach. Studies were conducted in Ethiopia (n = 11), Nigeria (n = 3), Kenya (n = 2), Malawi (n = 2) and Uganda (n = 1). Factors affecting the unmet need for modern contraceptive methods were described at three levels: (a) individual; (b) household; and (c) healthcare facility level. Reasons for non-use of FP included: fear of side effects; husband's disapproval; the absence of menses; abstinence; and low perception of risk of pregnancy. CONCLUSION Unmet needs in postpartum FP in women from Sub-Saharan Africa were associated with health-system and socio-demographic determinants. We suggest that there is a need to improve the awareness of modern contraceptive methods through effective interventions. Further research is needed for under-studied countries in this continent.
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Affiliation(s)
| | - Mariam Vahdaninia
- Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Pramod R Regmi
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth Gateway Building, 10 St Paul's Ln, BH8 8AJ, Bournemouth, UK
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21
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Wu WJ, Tiwari A, Choudhury N, Basnett I, Bhatt R, Citrin D, Halliday S, Kunwar L, Maru D, Nirola I, Pandey S, Rayamazi HJ, Sapkota S, Saud S, Thapa A, Goldberg A, Maru S. Community-based postpartum contraceptive counselling in rural Nepal: a mixed-methods evaluation. Sex Reprod Health Matters 2020; 28:1765646. [PMID: 32546070 PMCID: PMC7887993 DOI: 10.1080/26410397.2020.1765646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Unmet need for postpartum contraception in rural Nepal remains high and expanding access to sexual and reproductive healthcare is essential to achieving universal healthcare. We evaluated the impact of an integrated intervention that employed community health workers aided by mobile technology to deliver patient-centred, home-based antenatal and postnatal counselling on postpartum modern contraceptive use. This was a pre–post-intervention study in seven village wards in a single municipality in rural Nepal. The primary outcome was modern contraceptive use among recently postpartum women. We performed a multivariable logistic regression to examine contraceptive use among postpartum women pre- and one-year post-intervention. We conducted qualitative interviews to explore the implementation process. There were 445 postpartum women in the pre-intervention group and 508 in the post-intervention group. Modern contraceptive use increased from 29% pre-intervention to 46% post-intervention (p < 0.0001). Adjusting for age, caste, and household expenditure, time since delivery and sex of child in the index pregnancy, postpartum women one-year post-intervention had twice the odds (OR 2.3; CI 1.7, 3.1; p < 0.0001) of using a modern contraceptive method as compared to pre-intervention. Factors at the individual, family, and systems level influenced women’s contraceptive decisions. The intervention contributed to increasing contraceptive use through knowledge transfer, demand generation, referrals to healthcare facilities, and follow-up. A community-based, patient-centred contraceptive counselling intervention supported by mobile technology and integrated into longitudinal care delivered by community health workers appears to be an effective strategy for improving uptake of modern contraception among postpartum women in rural Nepal.
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Affiliation(s)
- Wan-Ju Wu
- Assistant Professor, Possible, New York, NY, USA; Boston Medical Center, Department of Obstetrics and Gynecology, Boston, MA, USA; Boston University School of Medicine, Department of Obstetrics and Gynecology, Boston, MA, USA
| | - Aparna Tiwari
- Research Analyst, Nyaya Health Nepal, Kathmandu, Nepal
| | - Nandini Choudhury
- Delivery Science Analyst, Possible, New York, NY, USA; Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, USA
| | - Indira Basnett
- Health Advisor, Ministry of Health and Population, Nepal Health Sector Support Programme, Kathmandu, Nepal
| | - Rita Bhatt
- Community Health Nurse, Nyaya Health Nepal, Kathmandu, Nepal
| | - David Citrin
- Director of Evidence to Policy, Possible, New York, NY, USA; Departments of Global Health and Anthropology, Henry M Jackson School of International Studies, University of Washington, Seattle, WA, USA
| | - Scott Halliday
- Senior Implementation Research Manager, Possible, New York, NY, USA; Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, US; Department of Global Health, Henry M Jackson School of International Studies, University of Washington, Seattle, WA, USA
| | - Lal Kunwar
- Independent Consultant, Nyaya Health Nepal, Kathmandu, Nepal
| | - Duncan Maru
- Senior Advisor, Possible, New York, NY, USA; Icahn School of Medicine at Mount Sinai, Departments of Internal Medicine and Pediatrics, Arnhold Institute for Global Health, New York, NY, USA
| | - Isha Nirola
- Doctoral Candidate, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sachit Pandey
- Mobile Systems Engineer, Nyaya Health Nepal, Kathmandu, Nepal
| | | | - Sabitri Sapkota
- Director of Implementation Research, Nyaya Health Nepal, Kathmandu, Nepal
| | - Sita Saud
- Community Health Programme Associate , Nyaya Health Nepal, Kathmandu, Nepal
| | - Aradhana Thapa
- Director of Healthcare Design, Nyaya Health Nepal, Kathmandu, Nepal
| | - Alisa Goldberg
- Associate Professor, Brigham and Women's Hospital, Department of Obstetrics, Gynecology and Reproductive Biology, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Planned Parenthood League of Massachusetts, Boston, MA, USA
| | - Sheela Maru
- Assistant Professor, Possible, New York, NY, USA; Icahn School of Medicine at Mount Sinai, Department of Obstetrics, Gynecology, and Reproductive Science, Arnhold Institute for Global Health, New York, NY, USA
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22
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Tran NT, Seuc A, Coulibaly A, Landoulsi S, Millogo T, Sissoko F, Yameogo WME, Zan S, Cuzin-Kihl A, Kiarie J, Gaffield ME, Thieba B, Kouanda S. Post-partum family planning in Burkina Faso (Yam Daabo): a two group, multi-intervention, single-blinded, cluster-randomised controlled trial. LANCET GLOBAL HEALTH 2020; 7:e1109-e1117. [PMID: 31303298 DOI: 10.1016/s2214-109x(19)30202-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 04/09/2019] [Accepted: 04/24/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Post-partum family planning services can prevent maternal and child morbidity and mortality in low-resource settings. We assessed the effect of a family planning intervention package on modern contraceptive use at 12 months post partum in predominantly rural Burkina Faso. METHODS Yam Daabo was a two group, multi-intervention, single-blinded, cluster randomised controlled trial. Primary health-care centres were randomly allocated to intervention or control clusters in a 1:1 ratio with only data analysts masked to the allocation assignment. Interventions comprised refresher training for the provider, a counselling tool, supportive supervision, availability of contraceptive services 7 days a week, client appointment cards, and invitation letters for partners. The primary outcome was modern contraceptive prevalence at 12 months, and secondary outcomes were modern contraceptive prevalence at 6 weeks and 6 months post partum. Analysis was by modified intention to treat. Prevalence ratios were adjusted for cluster effects and baseline characteristics. This study was registered with the Pan-African Clinical Trials Registry (PACTR201609001784334). FINDINGS From July 27-Oct 17, 2016, eight clinics were randomised and 571 women were enrolled and allocated: 286 to four intervention clusters and 285 to four control clusters. Of these, 523 completed the 12-month study exit interview (260 in the intervention group, 263 in the control group) and 523 were included in the intention-to-treat analysis. At 12 months, modern contraceptive prevalence was 55% among women who received the package and 29% among those who received routine care in control clusters (adjusted prevalence ratio 1·79, 95% CI 1·30-2·47). Significant differences in modern contraceptive prevalence were also seen between intervention and control groups at 6 weeks (42% and 10%, respectively; adjusted prevalence ratio 3·88, 95% CI 1·46-10·35) and 6 months (59% and 24%, respectively; 2·31, 1·44-3·71). INTERPRETATION A package of six low-technology interventions, aimed at strengthening existing primary health-care services and enhancing demand for these services, can effectively increase modern contraceptive use for up to a year post partum in rural settings in Burkina Faso and has the potential to be suitable in similar settings in this country and others. FUNDING Government of France.
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Affiliation(s)
- Nguyen Toan Tran
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland; Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology, Sydney, Australia.
| | - Armando Seuc
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Abou Coulibaly
- Institut de Recherche en Sciences de la Santé and Institut Africain de Santé Publique, Ouagadougou, Burkina Faso
| | - Sihem Landoulsi
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Tieba Millogo
- Institut de Recherche en Sciences de la Santé and Institut Africain de Santé Publique, Ouagadougou, Burkina Faso
| | - Fatou Sissoko
- Institut de Recherche en Sciences de la Santé and Institut Africain de Santé Publique, Ouagadougou, Burkina Faso
| | - Wambi Maurice E Yameogo
- Institut de Recherche en Sciences de la Santé and Institut Africain de Santé Publique, Ouagadougou, Burkina Faso
| | - Souleymane Zan
- World Health Organization Country Office in Burkina Faso, Ouagadougou, Burkina Faso
| | - Asa Cuzin-Kihl
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - James Kiarie
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Mary Eluned Gaffield
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Blandine Thieba
- Unité de Formation et de Recherche en Sciences de la Santé, Ouagadougou University, Ouagadougou, Burkina Faso
| | - Seni Kouanda
- Institut de Recherche en Sciences de la Santé and Institut Africain de Santé Publique, Ouagadougou, Burkina Faso
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Pearson E, Senderowicz L, Pradhan E, Francis J, Muganyizi P, Shah I, Canning D, Karra M, Ulenga N, Bärnighausen T. Effect of a postpartum family planning intervention on postpartum intrauterine device counseling and choice: evidence from a cluster-randomized trial in Tanzania. BMC WOMENS HEALTH 2020; 20:102. [PMID: 32398077 PMCID: PMC7218519 DOI: 10.1186/s12905-020-00956-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 04/16/2020] [Indexed: 11/30/2022]
Abstract
Background The World Health Organization recommends postpartum family planning (PPFP) for healthy birth spacing. This study is an evaluation of an intervention that sought to improve women’s access to PPFP in Tanzania. The intervention included counseling on PPFP during antenatal and delivery care and introducing postpartum intrauterine device (PPIUD) insertion as an integrated part of delivery services for women electing PPIUD in the immediate postpartum period. Methods This cluster-randomized controlled trial recruited 15,264 postpartum Tanzanian women aged 18 or older who delivered in one of five study hospitals between January and September 2016. We present the effectiveness of the intervention using a difference-in-differences approach to compare outcomes, receipt of PPIUD counseling and choice of PPIUD after delivery, between the pre- and post-intervention period in the treatment and control group. We also present an intervention adherence-adjusted analysis using an instrumental variables estimation. Results We estimate linear probability models to obtain effect sizes in percentage points (pp). The intervention increased PPIUD counseling by 19.8 pp (95% CI: 9.1 – 22.6 pp) and choice of PPIUD by 6.3 pp (95% CI: 2.3 – 8.0 pp). The adherence-adjusted estimates demonstrate that if all women had been counseled, we would have observed a 31.6 pp increase in choice of PPIUD (95% CI: 24.3 – 35.8 pp). Among women counseled, determinants of choosing PPIUD included receiving an informational leaflet during counseling and being counseled after admission for delivery services. Conclusions The intervention modestly increased the rate of PPIUD counseling and choice of PPIUD, primarily due to low coverage of PPIUD counseling among women delivering in study facilities. With universal PPIUD counseling, large increases in choice of PPIUD would have been observed. Giving women informational materials on PPIUD and counseling after admission for delivery are likely to increase the proportion of women choosing PPIUD. Trial registration Registered with clinicaltrials.gov (NCT02718222) on March 24, 2016, retrospectively registered.
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Affiliation(s)
| | - Leigh Senderowicz
- University of Wisconsin - Madison School of Medicine and Public Health, Madison, WI, USA
| | | | - Joel Francis
- Department of Family Medicine and Primary Care, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Projestine Muganyizi
- Association of Gynaecologists and Obstetricians of Tanzania (AGOTA), Dar es Salaam, Tanzania.,Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Iqbal Shah
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - David Canning
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Nzovu Ulenga
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Till Bärnighausen
- Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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Dagnew GW, Asresie MB, Fekadu GA, Gelaw YM. Modern contraceptive use and factors associated with use among postpartum women in Ethiopia; further analysis of the 2016 Ethiopia demographic and health survey data. BMC Public Health 2020; 20:661. [PMID: 32398123 PMCID: PMC7216498 DOI: 10.1186/s12889-020-08802-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/29/2020] [Indexed: 11/10/2022] Open
Abstract
Background The postpartum period is a critical time to improve maternal and child health. It is a time for accessing contraceptives to prevent short inter-pregnancy intervals. More than 95% of postpartum women do not want to get pregnant within 12 months. However, many women in Ethiopia experience an unintended pregnancy, and there is low information about postpartum contraceptive use among women who have family planning demand. Therefore, this study aimed to estimate the prevalence of postpartum contraceptive use and its predictors among women who give birth 12 months before the survey in Ethiopia. Methods We used the 2016 Ethiopia demographic health survey data for this analysis. The survey was a community-based cross-sectional study conducted from January 18 to June 27, 2016. The survey employed a two-stage stratified cluster sampling technique. A total of 2304 postpartum women were included. Bivariate and multivariable logistics regressions were done to identify factors associated with postpartum contraceptive use. A p-value < 0.05 was used to declare statistical significance. Results About 23.7% (23.7, 95% CI: 20.7–27.0%) of postpartum women were using modern contraceptives. Women who were urban residents (AOR = 2.18; 95%CI: 1.34–3.55), those who attended secondary or higher education (AOR = 1.79; 95%CI: 1.04–3.10), women who attended 1–3 (AOR = 2.33; 95%CI:1.27–4.25) or 4 or more ANC visits (AOR = 2.59; 95%CI:1.43–4.69) and women who delivered at a health facility (AOR = 1.86; 95%CI: 1.23–2.81) had higher odds of modern contraceptive use during the postpartum period. Similarly, women who reported the last child was no more wanted (AOR = 1.83; 95%CI: 1.01–3.31), women who decided for contraceptive use (AOR = 2.03; 95%CI: 1.13–3.65) and women whose recent child was male (AOR = 1.38; 95%CI: 1.01–1.88) had higher odds of modern contraceptive use. Conclusion Postpartum contraceptive use was low in Ethiopia. Strengthening health facility delivery, promoting girls’ education and encouraging women’s participation in deciding for contraceptive use would improve the uptake of modern contraceptives use during the postpartum period.
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Affiliation(s)
- Gizachew Worku Dagnew
- Department of Reproductive Health and population studies, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Melash Belachew Asresie
- Department of Reproductive Health and population studies, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gedefaw Abeje Fekadu
- Department of Reproductive Health and population studies, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yared Mulu Gelaw
- Department of Health Service Management, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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25
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Tran NT, Seuc A, Tshikaya B, Mutuale M, Landoulsi S, Kini B, Mbu Nkolomonyi B, Nyandwe Kyloka J, Langwana F, Cuzin-Kihl A, Kiarie J, Gaffield ME, Yodi R, Mashinda Kulimba D. Effectiveness of post-partum family planning interventions on contraceptive use and method mix at 1 year after childbirth in Kinshasa, DR Congo (Yam Daabo): a single-blind, cluster-randomised controlled trial. Lancet Glob Health 2020; 8:e399-e410. [PMID: 31958404 PMCID: PMC7708388 DOI: 10.1016/s2214-109x(19)30546-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 12/01/2019] [Accepted: 12/04/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND In rural Burkina Faso, a package of six low-technology, post-partum contraceptive interventions (ie, refresher training for providers, a counselling tool, supportive supervision, daily availability of contraceptive services, client appointment cards, and invitation letters to attend appointments for partners), aimed at strengthening existing primary health-care services and enhancing demand for them, doubled the use of modern contraceptives at 12 months post partum (ie, 55% uptake in intervention recipients vs 29% in routine-care users). This study assessed the effect of a similar package but in urban settings of Kinshasa province, Democratic Republic of the Congo, in an effort to reduce the unmet need for post-partum family planning. METHODS Yam Daabo was a multi-intervention, single-blinded, cluster-randomised controlled trial done in six primary health-care centres (clusters) in Kinshasa. Centres were randomly allocated to receive the six-component intervention or standard antenatal and postnatal care in matched pairs (1:1) on the basis of number of monthly births, the ratio of health workers per population in the health zone, and the urban and suburban settings. Only data analysts could be masked to cluster allocation. Health-care facilities were eligible if they provided a continuum of antenatal, delivery, and postnatal care, were well stocked with contraceptives, and were situated close to the main study centre. All pregnant women presenting to the six centres were eligible if they were in their third pregnancy trimester and had no counterindications to deliver in the facility. The main outcome was prevalence of use of modern contraceptives at 12 months after delivery. Analysis was by modified intention-to-treat using generalised linear mixed models or Fisher's exact test for small groups. Prevalence ratios were adjusted for cluster effects and baseline characteristics. This study was registered with the Pan-African Clinical Trials Registry (PACTR201609001784334). FINDINGS From July 1, 2016, to Feb 2, 2017, eight of 52 clinics assessed for eligibility met the criteria and were randomised. Of 690 women approached, 576 (83%) women were enrolled: 286 in the four intervention clusters and 290 in the four control clusters. Of them, 519 (90%) completed the 12-month study exit interview (252 in the intervention group and 267 in the control group) and were included in the intention-to-treat analysis. At 12 months, 115 (46%) of 252 women in the intervention group and 94 (35%) of 267 in the control group were using modern contraceptives (adjusted prevalence ratio [PR] 1·58, 95% CI 0·74-3·38), with significant differences in the use of contraceptive implants (22% vs 6%; adjusted PR 4·36, 95% CI 1·96-9·70), but without difference in the use of short-acting contraceptives (23% vs 28%; 0·92, 0·29-2·98) and non-modern or inappropriate methods (7% vs 18%; 0·45, 0·13-1·54). There were no serious adverse events or maternal deaths related to the study. INTERPRETATION The Yam Daabo intervention package did not have a significant effect on the overall use of effective modern contraceptives but significantly increased implant use in women post partum who live in urban settings in Kinshasa up to a year after childbirth. However, interferences from external family planning initiatives in the control group might have diminished differences between the services received. Such an intervention could be potentially relevant in similar contexts in DR Congo and other countries. FUNDING Government of France; UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction.
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Affiliation(s)
- Nguyen Toan Tran
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland; Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology, Sydney, NSW, Australia.
| | - Armando Seuc
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Béatrice Tshikaya
- Programme National de Santé de la Reproduction, Kinshasa, Democratic Republic of the Congo
| | - Maurice Mutuale
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Sihem Landoulsi
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Brigitte Kini
- World Health Organization Country Office in the Democratic Republic of the Congo, Kinshasa, Democratic Republic of the Congo
| | - Bernadette Mbu Nkolomonyi
- World Health Organization Country Office in the Democratic Republic of the Congo, Kinshasa, Democratic Republic of the Congo
| | - Jean Nyandwe Kyloka
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Félicité Langwana
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Asa Cuzin-Kihl
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - James Kiarie
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Mary Eluned Gaffield
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Rachel Yodi
- Programme National de Santé de la Reproduction, Kinshasa, Democratic Republic of the Congo
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Huber-Krum S, Khadka A, Pradhan E, Rohr J, Puri M, Maharjan D, Joshi S, Shah I, Canning D. The effect of antenatal counseling and intrauterine device insertion services on postpartum contraceptive use in Nepal: Results from a stepped-wedge randomized controlled trial. Contraception 2020; 101:384-392. [PMID: 31935388 DOI: 10.1016/j.contraception.2019.12.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 12/13/2019] [Accepted: 12/26/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE There is high unmet need for family planning in the postpartum period in Nepal. The current study assessed the effects of a contraceptive counseling and postpartum intrauterine device (PPIUD) insertion intervention on use of contraception in the postpartum period. STUDY DESIGN We utilized a cluster, stepped-wedge design to randomly assign two hospital clusters (compromised of six hospitals) to begin the intervention at time one or time two. From 2015 to 2017, women completed surveys after delivery but before discharge (n = 75,893), and then at one year and two years postpartum. We estimated the intent-to-treat effect of the intervention using weighted, linear probability models and the adherence-adjusted effect (antenatal counseling) using an instrumental variable approach. Outcomes included modern contraceptive use and method mix measured at one and two years postpartum in a sample of 19,298 women (year I follow-up sample) and a sample of 19,248 women (year II follow-up sample). We used inverse probability weights to adjust for incomplete follow-up and bootstrap methods to give correct causal inference with the small number of six clusters. RESULTS The intervention increased use of modern contraceptives by 3.8 percentage points [95% CI: -0.1, 9.5] at one-year postpartum, but only 0.3 percentage points [95% CI: -3.7, 4.1] at two years. The intervention significantly increased the use of PPIUDs at one year and two years postpartum, but there was less use of sterilization. Only 42% of women were counseled during the intervention period. The adherence-adjusted effects (antenatal counseling) were four times larger than the intent-to-treat effects. CONCLUSIONS Providing counseling during the antenatal period and PPIUD services in hospitals increased use of PPIUDs in the one- and two-year postpartum period and shifted the contraceptive method mix. IMPLICATIONS In order for antenatal counseling to increase postpartum contraceptive use, counseling may need to be provided in a wider range of prenatal care settings and at multiple time points. Healthcare providers should be trained on contraceptive counseling and PPIUD insertion, with the goal of expanding the available method mix and meeting postpartum women's contraceptive needs.
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Affiliation(s)
- Sarah Huber-Krum
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Aayush Khadka
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Julia Rohr
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mahesh Puri
- Center for Research on Environment, Health and Population Activities (CREHPA), Kathmandu, Nepal
| | - Dev Maharjan
- Center for Research on Environment, Health and Population Activities (CREHPA), Kathmandu, Nepal
| | - Saugat Joshi
- Center for Research on Environment, Health and Population Activities (CREHPA), Kathmandu, Nepal
| | - Iqbal Shah
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - David Canning
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Harrington EK, Drake AL, Matemo D, Ronen K, Osoti AO, John-Stewart G, Kinuthia J, Unger JA. An mHealth SMS intervention on Postpartum Contraceptive Use Among Women and Couples in Kenya: A Randomized Controlled Trial. Am J Public Health 2019; 109:934-941. [PMID: 31067089 DOI: 10.2105/ajph.2019.305051] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objectives. To assess the effect of 2-way short message service (SMS) with a nurse on postpartum contraceptive use among individual women and couples. Methods. From 2016 to 2017, we conducted a randomized controlled trial at 2 public hospitals in western Kenya. We assigned eligible pregnant women to receive 2-way SMS with a nurse or no SMS, with the option to include male partners. We delivered automated family planning-focused SMS messages weekly until 6 months postpartum. Women and men receiving SMS could interact with nurses via SMS. In intention-to-treat analysis, we compared highly effective contraceptive (HEC) use at 6 months postpartum between groups using the χ2 test. We used Poisson regression in adjusted analysis. Results. We randomized 260 women to 2-way SMS or control, and we enrolled 103 male partners. At 6 months postpartum, 69.9% women receiving SMS reported HEC use, compared with 57.4% in control (relative risk = 1.22; 95% confidence interval [CI] = 1.01, 1.47; P = .04). In analysis adjusted for baseline demographic differences, the adjusted relative risk for HEC use in the SMS group was 1.26 (95% CI = 1.04, 1.52; P = .02). Conclusions. Two-way SMS with a nurse, including optional male participation, increased postpartum contraceptive use. Trial Registration. ClinicalTrials.gov; identifier: NCT02781714.
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Affiliation(s)
- Elizabeth K Harrington
- Elizabeth K. Harrington and Jennifer A. Unger are with the Department of Obstetrics & Gynecology, University of Washington, Seattle. Alison L. Drake, Keshet Ronen, Grace John-Stewart, and Jennifer A. Unger are with the Department of Global Health, University of Washington, Seattle. Grace John-Stewart is also with the Departments of Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle. Alfred O. Osoti is with the University of Nairobi, Nairobi, Kenya. Daniel Matemo and John Kinuthia are with the Kenyatta National Hospital, Nairobi, Kenya
| | - Alison L Drake
- Elizabeth K. Harrington and Jennifer A. Unger are with the Department of Obstetrics & Gynecology, University of Washington, Seattle. Alison L. Drake, Keshet Ronen, Grace John-Stewart, and Jennifer A. Unger are with the Department of Global Health, University of Washington, Seattle. Grace John-Stewart is also with the Departments of Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle. Alfred O. Osoti is with the University of Nairobi, Nairobi, Kenya. Daniel Matemo and John Kinuthia are with the Kenyatta National Hospital, Nairobi, Kenya
| | - Daniel Matemo
- Elizabeth K. Harrington and Jennifer A. Unger are with the Department of Obstetrics & Gynecology, University of Washington, Seattle. Alison L. Drake, Keshet Ronen, Grace John-Stewart, and Jennifer A. Unger are with the Department of Global Health, University of Washington, Seattle. Grace John-Stewart is also with the Departments of Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle. Alfred O. Osoti is with the University of Nairobi, Nairobi, Kenya. Daniel Matemo and John Kinuthia are with the Kenyatta National Hospital, Nairobi, Kenya
| | - Keshet Ronen
- Elizabeth K. Harrington and Jennifer A. Unger are with the Department of Obstetrics & Gynecology, University of Washington, Seattle. Alison L. Drake, Keshet Ronen, Grace John-Stewart, and Jennifer A. Unger are with the Department of Global Health, University of Washington, Seattle. Grace John-Stewart is also with the Departments of Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle. Alfred O. Osoti is with the University of Nairobi, Nairobi, Kenya. Daniel Matemo and John Kinuthia are with the Kenyatta National Hospital, Nairobi, Kenya
| | - Alfred O Osoti
- Elizabeth K. Harrington and Jennifer A. Unger are with the Department of Obstetrics & Gynecology, University of Washington, Seattle. Alison L. Drake, Keshet Ronen, Grace John-Stewart, and Jennifer A. Unger are with the Department of Global Health, University of Washington, Seattle. Grace John-Stewart is also with the Departments of Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle. Alfred O. Osoti is with the University of Nairobi, Nairobi, Kenya. Daniel Matemo and John Kinuthia are with the Kenyatta National Hospital, Nairobi, Kenya
| | - Grace John-Stewart
- Elizabeth K. Harrington and Jennifer A. Unger are with the Department of Obstetrics & Gynecology, University of Washington, Seattle. Alison L. Drake, Keshet Ronen, Grace John-Stewart, and Jennifer A. Unger are with the Department of Global Health, University of Washington, Seattle. Grace John-Stewart is also with the Departments of Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle. Alfred O. Osoti is with the University of Nairobi, Nairobi, Kenya. Daniel Matemo and John Kinuthia are with the Kenyatta National Hospital, Nairobi, Kenya
| | - John Kinuthia
- Elizabeth K. Harrington and Jennifer A. Unger are with the Department of Obstetrics & Gynecology, University of Washington, Seattle. Alison L. Drake, Keshet Ronen, Grace John-Stewart, and Jennifer A. Unger are with the Department of Global Health, University of Washington, Seattle. Grace John-Stewart is also with the Departments of Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle. Alfred O. Osoti is with the University of Nairobi, Nairobi, Kenya. Daniel Matemo and John Kinuthia are with the Kenyatta National Hospital, Nairobi, Kenya
| | - Jennifer A Unger
- Elizabeth K. Harrington and Jennifer A. Unger are with the Department of Obstetrics & Gynecology, University of Washington, Seattle. Alison L. Drake, Keshet Ronen, Grace John-Stewart, and Jennifer A. Unger are with the Department of Global Health, University of Washington, Seattle. Grace John-Stewart is also with the Departments of Medicine, Pediatrics, and Epidemiology, University of Washington, Seattle. Alfred O. Osoti is with the University of Nairobi, Nairobi, Kenya. Daniel Matemo and John Kinuthia are with the Kenyatta National Hospital, Nairobi, Kenya
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Zimmerman LA, Yi Y, Yihdego M, Abrha S, Shiferaw S, Seme A, Ahmed S. Effect of integrating maternal health services and family planning services on postpartum family planning behavior in Ethiopia: results from a longitudinal survey. BMC Public Health 2019; 19:1448. [PMID: 31684905 PMCID: PMC6829796 DOI: 10.1186/s12889-019-7703-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 09/27/2019] [Indexed: 11/22/2022] Open
Abstract
Background Very few postpartum women want to become pregnant within the next 2 years, but approximately 60% of postpartum women in low- and middle-income countries are not using contraceptive methods. The World Health Organization recommends that women receive postpartum family planning (PPFP) counseling during antenatal, immediate postpartum, and postnatal services. Our objective was to establish whether PPFP counseling is being provided in antenatal and postnatal care services in SNNPR, Ethiopia and whether receipt of PPFP counseling improved uptake of postpartum family planning use by 6 months postpartum. Methods Longitudinal data from the Performance Monitoring for Accountability 2020 – Maternal and Newborn Health study were used. At screening, 329 women were identified as six or more months pregnant; 307 completed the survey at 6 months postpartum. We used weighted parametric survival analysis with Weibull distribution to assess the effect of receipt of postpartum counseling in antenatal and/or postnatal care by 6 weeks postpartum on contraceptive uptake, after adjusting for intention to use family planning, wantedness of the index pregnancy, delivery location, amenorrhea, exclusive breastfeeding, residence, parity, and education. Results Coverage of PPFP counseling is low; by six-weeks postpartum only 20% of women had received counseling. Women who received counseling in postnatal care only and postnatal care and antenatal care took up contraception at significantly higher rates than women who did not receive any counseling (HR: 3.4, p < .01 and HR: 2.5, p = .01, respectively). There was no difference between women who received PPFP counseling only in ANC and women who did not receive counseling at all. Women who did not want the child at all took up contraception at significantly lower rates than women who wanted the child at that time (HR: 0.3, p = .04). Women who had four or more children took up contraception at significantly lower rates than woman with 1–3 children (HR: 0.3, p = .01). There were no significant differences by delivery location, exclusive breastfeeding, residence, or education. Conclusion Integration of postpartum family planning counseling into postnatal care services is an effective means to increase postpartum contraceptive uptake, but significant gaps in coverage, particularly in the delivery and postnatal period, remain.
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Affiliation(s)
- Linnea A Zimmerman
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, USA.
| | - Yuanyuan Yi
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, USA
| | - Mahari Yihdego
- PMA2020-Ethiopia, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Abrha
- School of Public Health, Wolaita Sodo University, Wolaita, Ethiopia
| | - Solomon Shiferaw
- Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Assefa Seme
- Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Saifuddin Ahmed
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, USA
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Ross J, Bietsch K. The Open Birth Interval: A Resource for Reproductive Health Programs and Women's Empowerment. GLOBAL HEALTH: SCIENCE AND PRACTICE 2019; 7:355-370. [PMID: 31558595 PMCID: PMC6816813 DOI: 10.9745/ghsp-d-19-00056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 06/03/2019] [Indexed: 12/24/2022]
Abstract
The open birth interval is the time since a woman's last birth. It reflects not only desire for contraception and child health services but also freedom for outside activities, employment, and personal autonomy. It merits attention from policy makers, program managers, and service providers.
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Affiliation(s)
- John Ross
- Independent Consultant, New Paltz, NY, USA.
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Gul X, Hameed W, Hussain S, Sheikh I, Siddiqui JUR. A study protocol for an mHealth, multi-centre randomized control trial to promote use of postpartum contraception amongst rural women in Punjab, Pakistan. BMC Pregnancy Childbirth 2019; 19:283. [PMID: 31395034 PMCID: PMC6686472 DOI: 10.1186/s12884-019-2427-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 07/25/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Provision of family planning services during the immediate post-partum phase is considered effective and cost-efficient for promoting healthy timing and spacing of pregnancies. This research aims to test the effectiveness of mobile phone-based interventions in promoting use of postpartum contraception. Moreover, it will also test the non-inferiority of text and voice messages compared to interactive phone-based counselling. METHODS A three-arm, 10-month, multicentre, randomized controlled trial will be conducted at 15 social franchise (SF) health facilities in Punjab province of Pakistan. Pregnant women aged 15-44 years who are in their first or second trimester and have a mobile phone for their own use will be eligible to participate in this study. The participants will be randomly allocated to one of three study arms: a) voice and text messages; b) interactive telephone-based counselling; or c) control arm (no additional phone-based support). The intervention counselling module will be developed based on the Integrated Behaviour Model which was recently adapted, and tested for the family planning context in Pakistan. It will broadly cover birth-preparedness, importance of birth spacing, and postnatal care. The phone-based intervention aims to improve women's ability to use contraception by providing them with information about a range of methods, access to family planning methods through outlets such as Suraj SF providers, connecting them with MSS field health educators to help them reach the centres, motivation by re-enforcing the benefits of contraceptive use on women's quality of life, and dispelling myths and misconceptions about modern contraceptive methods. Risk differences will be used as the measure of effect of the intervention on the outcomes. DISCUSSION The study findings will highlight effectiveness of mobile phone in raising awareness of maternal health and contraception, which in turn, is expected to be translated into increased proportion of: at least four antenatal visits, skilled birth or institutional delivery, postpartum contraceptive use, postnatal check-up, child immunization, and breastfeeding. Moreover, if the text and voice messages approach is proven to be non-inferior to interactive calls, it will provide evidence to making promotion of healthcare less resource intensive, and thereby contribute in improving the efficiency of the healthcare system. TRIAL REGISTRATION This trial was prospectively registered with the Clinical Trials registry ( NCT03612518 ) on August 2nd, 2018.
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Affiliation(s)
- Xaher Gul
- Marie Stopes Society, Plot 21-C, Commercial Area, Old Sunset Boulevard, DHA Phase II, Karachi, Pakistan
| | - Waqas Hameed
- Marie Stopes Society, Plot 21-C, Commercial Area, Old Sunset Boulevard, DHA Phase II, Karachi, Pakistan
| | - Sharmeen Hussain
- Marie Stopes Society, Plot 21-C, Commercial Area, Old Sunset Boulevard, DHA Phase II, Karachi, Pakistan
| | - Ishaque Sheikh
- Marie Stopes Society, Plot 21-C, Commercial Area, Old Sunset Boulevard, DHA Phase II, Karachi, Pakistan
| | - Junaid-ur-Rehman Siddiqui
- Marie Stopes Society, Plot 21-C, Commercial Area, Old Sunset Boulevard, DHA Phase II, Karachi, Pakistan
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Phillips TK, Myer L. Shifting to the long view: engagement of pregnant and postpartum women living with HIV in lifelong antiretroviral therapy services. Expert Rev Anti Infect Ther 2019; 17:349-361. [PMID: 30978126 DOI: 10.1080/14787210.2019.1607296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction: The advent of policies promoting lifelong antiretroviral therapy (ART) for all pregnant and postpartum women living with HIV has shifted focus from short-term prevention of mother-to-child transmission (PMTCT) to lifelong engagement in ART services. However, disengagement from care threatens the long-term treatment and prevention benefits of lifelong ART. Areas covered: A framework for considering the unique aspects of ART for pregnant and postpartum women is presented along with a review of the literature on maternal engagement in care in sub-Saharan Africa and a discussion of potential interventions to sustain engagement in lifelong ART. Expert opinion: Engaging women and mothers in ART services for life is critical for maternal health, PMTCT, and prevention of sexual transmission. Evidence-based interventions exist to support engagement in care but most focus on periods of mother-to-child transmission risk. In the long term, life transitions and health-care transfers are inevitable. Thus, interventions that can reach beyond a single facility or provide a bridge between health services should be prioritized. Multicomponent interventions will also be essential to address the numerous intersecting barriers to sustained engagement in ART services.
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Affiliation(s)
- Tamsin K Phillips
- a Division of Epidemiology & Biostatistics and Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine , University of Cape Town , Cape Town , South Africa
| | - Landon Myer
- a Division of Epidemiology & Biostatistics and Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine , University of Cape Town , Cape Town , South Africa
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Abebaw Y, Berhe S, Abebe SM, Adefris M, Gebeyehu A, Gure T, Asmare B, Dagnu M, Alebachew W, Admasu S, Abdisa S, G/Egziabher MA. Providers' knowledge on postpartum intrauterine contraceptive device (PPIUCD) service provision in Amhara region public health facility, Ethiopia. PLoS One 2019; 14:e0214334. [PMID: 30946759 PMCID: PMC6449033 DOI: 10.1371/journal.pone.0214334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 03/11/2019] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Postpartum intrauterine contraceptive devices (PP-IUCD) are one type of post-partum family planning method, which can be provided to a post-partum woman starting from the placental delivery time (within 10 minutes), or within the first 48 hours of postpartum period. In most developing countries, delivery time is the primary opportunity for women to access post-partum family planning methods, especially for those living in remote areas. Hence, this study assesses providers' knowledge on postpartum intrauterine contraceptive device service provision. METHODS A facility-based cross-sectional study was conducted in Amhara region health center and hospitals. Health providers surveyed included obstetricians, gynecologists, general practitioners, emergency surgical officers, health officers, midwives and nurses from September 18, 2015 to December18, 2016. Simple random sampling was used to select 864 subjects. Data were collected by using a structured self-administered questionnaire and observing the facility. Multilevel analysis was done to see factors associated with outcome. RESULTS A total of 197 health facilities and 864 providers are included in the final analysis. Of the total providers 524 (60.6%) were from a health center. The mean age (±SD) of participants was 27.8 years (±5.4). The number of providers with good knowledge accounted for 253 of those surveyed (29.3%). The proportion of good knowledge among trained PP-IUCD providers was 35.7% (those who scored above average), and 27.9% was untrained about PP-IUCD. A considerable heterogeneity was observed between health facilities for each indicator of provider's knowledge. Gender differences were observed as the mean knowledge score deference on PP-IUCD by 0.4 points (β = -0.41; -0.72, -0.10) when the participant was female. Having experience of regular counseling of pregnant women increases PP-IUCD knowledge score by 0.97. (β = 0.97; 95% CI: 0.48, 1.47). Where the health facility requested clients to purchase the IUCD themselves, the mean knowledge score decreased by 0.47 points compared with free of charge at the facility level (β = -0.47; 95%CI: -0.87, -0.07). CONCLUSION Our findings showed that providers' knowledge about postpartum IUCD was low in the Amhara region public health facility. The lowest knowledge score was noted among nurses, health Officers, midwives, and general practice professionals. Factors associated with providers' knowledge on PP-IUCD are the status of health facility, female sex, training on PP-IUCD, regular counseling of pregnant women, and unavailability of IUCD service.
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Affiliation(s)
- Yeshiwas Abebaw
- Department of Obstetrics and Gynecology, College of Medicine and Health Science University of Gondar, Gondar, Ethiopia
| | - Solomon Berhe
- Department of Obstetrics and Gynecology, College of Medicine and Health Science University of Gondar, Gondar, Ethiopia
| | - Solomon Mekonnen Abebe
- Department of Human Nutrition, Institute of Public Health, College of medicine and Health science, University of Gondar, Gondar, Ethiopia
| | - Mulat Adefris
- Department of Obstetrics and Gynecology, College of Medicine and Health Science University of Gondar, Gondar, Ethiopia
| | | | - Tadesse Gure
- Department of Obstetrics and Gynecology, College of Medicine and Health Science University of Gondar, Gondar, Ethiopia
| | - Birtukan Asmare
- Department of Obstetrics and Gynecology, College of Medicine and Health Science University of Gondar, Gondar, Ethiopia
| | - Masresha Dagnu
- Department of Obstetrics and Gynecology, College of Medicine and Health Science University of Gondar, Gondar, Ethiopia
| | - Wubetu Alebachew
- Department of Obstetrics and Gynecology, College of Medicine and Health Science University of Gondar, Gondar, Ethiopia
| | - Shumye Admasu
- Department of Obstetrics and Gynecologyn, College of Medicine and Health Science Debretabor University, Debretabor, Ethiopia
| | - Solomon Abdisa
- Department of Obstetrics and Gynecology, College of Medicine and Health Science University of Gondar, Gondar, Ethiopia
| | - Melkamu Axumawit G/Egziabher
- Department of Obstetrics and Gynecology, College of Medicine and Health Science University of Gondar, Gondar, Ethiopia
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Pfitzer A, Maly C, Tappis H, Kabue M, Mackenzie D, Healy S, Srivastava V, Ndirangu G. Characteristics of successful integrated family planning and maternal and child health services: Findings from a mixed-method, descriptive evaluation. F1000Res 2019; 8:229. [PMID: 32047599 PMCID: PMC6993833 DOI: 10.12688/f1000research.17208.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Most postpartum women in low- and middle-income countries want to delay or avoid future pregnancies but are not using modern contraception. One promising strategy for increasing the use of postpartum family planning (PPFP) is integration with maternal, newborn and child health (MNCH) services. However, there is limited evidence on effective service integration strategies. We examine facilitators of and barriers to effective PPFP integration in MNCH services in Kenya and India. Methods: We conducted a cross-sectional, mixed-method study in two counties in Kenya and two states in India. Data collection included surveying 215 MNCH clients and surveying or interviewing 82 health care providers and managers in 15 health facilities across the four sites. We analyzed data from each country separately. First, we analyzed quantitative data to assess the extent to which PPFP was integrated within MNCH services at each facility. Then we analyzed qualitative data and synthesized findings from both data sources to identify characteristics of well and poorly integrated facilities. Results: PPFP integration success varied by service delivery area, health facility, and country. Issues influencing the extent of integration included availability of physical space for PPFP services, health workforce composition and capacity, family planning commodities availability, duration and nature of support provided. Conclusions: Although integration level varied between health facilities, factors enabling and hindering PPFP integration were similar in India and Kenya. Better measures are needed to verify whether services are integrated as prescribed by national policies.
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Affiliation(s)
- Anne Pfitzer
- Maternal and Child Survival Program, Jhpiego, Washington, DC, 20036, USA
| | | | | | | | - Devon Mackenzie
- Maternal and Child Survival Program, Jhpiego, Washington, DC, 20036, USA
| | - Sadie Healy
- Molloy Consultants, Cincinnati, OH, 45208, USA
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Unger J, Ronen K, Perrier T, DeRenzi B, Slyker J, Drake A, Mogaka D, Kinuthia J, John-Stewart G. Short message service communication improves exclusive breastfeeding and early postpartum contraception in a low- to middle-income country setting: a randomised trial. BJOG 2018; 125:1620-1629. [PMID: 29924912 PMCID: PMC6179930 DOI: 10.1111/1471-0528.15337] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the effect of short message service (SMS) communication on facility delivery, exclusive breastfeeding (EBF), and contraceptive use. DESIGN Mobile WACh was a three-arm unblinded individually randomised controlled trial. SETTING A public sector maternal child health (MCH) clinic in Nairobi, Kenya. POPULATION Three hundred women attending antenatal care were randomised, 100 to each arm, and followed for 24 weeks postpartum. Pregnant women, at least 14 years old with access to a mobile phone and able to read SMS were eligible for participation. METHODS Women were randomised (1:1:1) to receive one-way SMS versus two-way SMS with a nurse versus control. Weekly SMS content was tailored for maternal characteristics and pregnancy or postpartum timing. MAIN OUTCOME MEASURES Facility delivery, EBF, and contraceptive use were compared separately between each intervention arm and the control arm by Kaplan-Meier analysis and chi-square tests using intent-to-treat analyses. RESULTS The overall facility delivery rate was high (98%) and did not differ by arm. Compared with controls, probability of EBF was higher in the one-way SMS arm at 10 and 16 weeks, and in the two-way SMS arm at 10, 16, and 24 weeks (P < 0.005 for all). Contraceptive use was significantly higher in both intervention arms by 16 weeks (one-way SMS: 72% and two-way SMS: 73%; P = 0.03 and P = 0.02 versus 57% control, respectively); however, this difference was not significant when correcting for multiple comparisons. CONCLUSION One-way and two-way SMS improved EBF practices and early contraceptive use. Two-way SMS had an added benefit on sustained EBF, providing evidence that SMS messaging influences uptake of interventions that improve maternal and neonatal health. SOURCE OF FUNDING Funding was provided by the National Institutes of Health (K12HD001264 to JAU, R01HD080460, K24HD054314 to GJS, and K01AI116298 to ALD), the National Science Foundation (Graduate Research Fellowship to TP and BD), as well as the University of Washington Global Center for Integrated Health of Women Adolescents and Children (Global WACh). TWEETABLE ABSTRACT The Mobile WACh RCT demonstrates that SMS improved practice of exclusive breastfeeding and early postpartum contraception.
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Affiliation(s)
- Jennifer Unger
- Department of Global Health, University of Washington, Seattle, WA
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Keshet Ronen
- Department of Global Health, University of Washington, Seattle, WA
| | - Trevor Perrier
- Department of Computer Science and Engineering, University of Washington, Seattle, WA
| | - Brian DeRenzi
- Department of Computer Science, University of Cape Town, Cape Town, South Africa
| | - Jennifer Slyker
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Alison Drake
- Department of Global Health, University of Washington, Seattle, WA
| | - Dyphna Mogaka
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - John Kinuthia
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
- University of Nairobi, Obstetrics and Gynaecology, Nairobi, Kenya
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, WA
- Department of Epidemiology, University of Washington, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
- Department of Pediatrics, University of Washington, Seattle, WA
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McConnell M, Rothschild CW, Ettenger A, Muigai F, Cohen J. Free contraception and behavioural nudges in the postpartum period: evidence from a randomised control trial in Nairobi, Kenya. BMJ Glob Health 2018; 3:e000888. [PMID: 30364345 PMCID: PMC6195134 DOI: 10.1136/bmjgh-2018-000888] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/20/2018] [Accepted: 08/24/2018] [Indexed: 11/04/2022] Open
Abstract
Background Short birth intervals are a major risk factor for poor maternal and newborn outcomes. Utilisation of modern contraceptive methods during the postpartum period can reduce risky birth intervals but contraceptive coverage during this critical period remains low. Methods We conducted a randomised controlled experiment to test whether vouchers for free contraception, provided with and without behavioural ‘nudges’, could increase modern contraceptive use in the postpartum period. 686 pregnant women attending antenatal care in two private maternity hospitals in Nairobi, Kenya, were enrolled in the study. The primary outcomes were the use of modern contraceptive methods at nearly 3 months and 6 months after expected delivery date (EDD). We tested the impact of a standard voucher that could be redeemed for free modern contraception, a deadline voucher that expired 2 months after delivery and both types of vouchers with and without a short message service (SMS) reminder, relative to a control group that received no voucher and no SMS reminder. Results By nearly 6 months after EDD, we find that the combination of the standard voucher with an SMS reminder increased the probability of reporting utilisation of a modern contraceptive method by 25 percentage points (pp) (95% CI 6 pp to 44 pp) compared with the control group. Estimated impacts in other treatment arms were not statistically significantly different from the control group. Conclusions Reducing financial barriers to postpartum contraception alone may not be enough to encourage take-up. Programmes targeting the postpartum period should consider addressing behavioural barriers to take-up.
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Affiliation(s)
- Margaret McConnell
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | | | - Allison Ettenger
- Results for Development (R4D) Institute, Seattle, Washington, USA
| | | | - Jessica Cohen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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Yugbaré Belemsaga D, Goujon A, Bado A, Kouanda S, Duysburgh E, Temmerman M, Degomme O. Integration of postpartum care into child health and immunization services in Burkina Faso: findings from a cross-sectional study. Reprod Health 2018; 15:171. [PMID: 30305123 PMCID: PMC6180606 DOI: 10.1186/s12978-018-0602-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 09/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Missed Opportunities for Maternal and Infant Health (MOMI) project, which aimed at upgrading maternal and infant postpartum care (PPC), implemented a package of interventions including the integration of maternal PPC in infant immunization services in 12 health facilities in Kaya Health district in Burkina Faso from 2013 to 2015. This paper assesses the coverage and the quality of combined mother-infant PPC in reproductive, maternal, newborn and child health services (RMNCH). METHODS We conducted a mixed methods study with cross-sectional surveys before and after the intervention in the Kaya health and demographic surveillance system. On the quantitative side, two household surveys were performed in 2012 (N = 757) and in 2014 (N = 754) among mothers within one year postpartum. The analysis examines the result of the intervention by the date of delivery at three key time points in the PPC schedule: the first 48 h, days 6-10 and during weeks 6-8 and beyond. On the qualitative side, in depth interviews, focus group discussions and observations were conducted in four health facilities in 2012 and 2015. They involved mothers in the postpartum period, facility and community health workers, and other stakeholders. We performed a descriptive analysis and a two-sample test of proportions of the quantitative data. The qualitative data were recorded, transcribed and analysed along the themes relevant for the intervention. RESULTS The findings show that the WHO guidelines, in terms of content and improvement of maternal PPC, were followed for physical examinations and consultations. They also show a significant increase in the coverage of maternal PPC services from 50% (372/752) before the intervention to 81% (544/672) one year after the start of the intervention. However, more women were assessed at days 6-10 than at later visits. Integration of maternal PPC was low, with little improvements in history taking and physical examination of mothers in immunization services. While health workers are polyvalent, difficulties in restructuring and organizing services hindered the integration. CONCLUSION Unless a comprehensive strategy of integration within RMNCH services is implemented to address the primary health care challenges within the health system, integration will not yield the desired results.
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Affiliation(s)
- Danielle Yugbaré Belemsaga
- Département Biomédical et santé publique, Institut de Recherche en Sciences de la Santé (IRSS), 03 B.P 7192, Ouagadougou 03, Burkina Faso
- Wittgenstein Centre for Demography and Global Human Capital (IIASA, VID/OAW, WU), Vienna, Austria
| | - Anne Goujon
- Wittgenstein Centre for Demography and Global Human Capital (IIASA, VID/OAW, WU), Vienna, Austria
| | - Aristide Bado
- Département Biomédical et santé publique, Institut de Recherche en Sciences de la Santé (IRSS), 03 B.P 7192, Ouagadougou 03, Burkina Faso
| | - Seni Kouanda
- Département Biomédical et santé publique, Institut de Recherche en Sciences de la Santé (IRSS), 03 B.P 7192, Ouagadougou 03, Burkina Faso
- African Institute of Public Health, Ouagadougou, Burkina Faso
| | - Els Duysburgh
- International Centre for Reproductive Health, Faculty of Medicine and Health Sciences Department of Uro-Gynaecology, Ghent University, Ghent, Belgium
| | - Marleen Temmerman
- International Centre for Reproductive Health, Faculty of Medicine and Health Sciences Department of Uro-Gynaecology, Ghent University, Ghent, Belgium
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Olivier Degomme
- International Centre for Reproductive Health, Faculty of Medicine and Health Sciences Department of Uro-Gynaecology, Ghent University, Ghent, Belgium
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Jarvis L, Wickstrom J, Vance G, Gausman J. Quality and Cost Interventions During the Extended Perinatal Period to Increase Family Planning Use in Kinshasa, DRC: Results From an Initial Study. GLOBAL HEALTH: SCIENCE AND PRACTICE 2018; 6:456-472. [PMID: 30287528 PMCID: PMC6172126 DOI: 10.9745/ghsp-d-18-00075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 07/10/2018] [Indexed: 12/03/2022]
Abstract
The combined intervention of free contraceptives plus a set of quality inputs for family planning during the extended perinatal period, including provision of long-acting methods immediately postpartum, had the strongest effect on use of modern contraceptives, especially long-acting methods. Background: Most women worldwide do not desire another pregnancy within a year after giving birth, but uptake of modern contraception during this time period is low. We independently tested 2 approaches to increasing contraceptive uptake and the 2 approaches combined using a quasi-experimental study design in Kinshasa, the Democratic Republic of the Congo. Methods: The primary analytic data came from client exit interviews conducted post-intervention (N=563) from 4 study groups. The first arm (n=150) received free family planning, and the second arm (n=113) a quality inputs intervention involving systematic screening, referral, and immediate provision of long-acting reversible contraceptives (LARCs) after labor and delivery. The third arm (n=150) received a combination of the 2 interventions, and the fourth (n=150) no intervention. Family planning service statistics were also collected throughout the intervention period. Results: Women in the quality arm (odds ratio [OR]=4.5; 95% confidence interval [CI], 1.8 to 10.9) and free/quality arm (OR=6.7; 95% CI, 2.8 to 16.1) were more likely to be properly screened for family planning than women in the control group, but paper referral was seldom implemented in any group. Women in the free arm (OR=3.8; 95% CI, 1.6 to 9.0) and in the free/quality arm (OR=11.0; 95% CI, 4.3 to 27.9) were more likely than the control group to report being properly counseled on family planning. Clients were more likely to be modern contraceptive users (excluding condoms) in the free arm (OR=3.2; 95% CI, 1.4 to 7.2) and in the free/quality arm (OR=8.6; 95% CI, 3.9 to 19.0) than in the control group. Clients in all study arms were more likely to use a LARC compared with the control group (Quality arm: OR=2.9; 95% CI, 1.1 to 7.9. Free arm: OR=5.6; 95% CI, 2.3 to 13.7. Free/quality arm: OR=8.4; 95% CI, 3.4 to 20.6). Service statistics from the combined intervention arm showed that a significantly greater proportion of family planning adoption occurred within the immediate postpartum period (0 to 2 days) in the quality arm (P<.001) and free/quality arm (P<.001) than in the control arm. Quality inputs, free contraceptives, and the combined intervention had positive impacts on aspects of screening and contraceptive uptake. The combined intervention performed best by all measures. Conclusion: Providing family planning, including LARCs, in the immediate postpartum period, implementing a systematic screening and referral system, and providing free methods may improve family planning access and uptake in the extended perinatal period in this environment.
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Affiliation(s)
- Leah Jarvis
- EngenderHealth, New York, NY, USA. Now with Population Council, New York, NY, USA.
| | - Jane Wickstrom
- EngenderHealth, New York, NY, USA. Now with Bill & Melinda Gates Foundation, Seattle, WA, USA
| | | | - Jewel Gausman
- Harvard T. H. Chan School of Public Health, Amman, Jordan
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Tran NT, Yameogo WMM, Langwana F, Kouanda S, Thieba B, Mashinda D, Yodi R, Nyandwe Kyloka J, Millogo T, Coulibaly A, Zan S, Kini B, Ouedraogo B, Puludisi F, Cuzin-Kihl A, Reier S, Kiarie J, Gaffield ME. Birth spacing and informed family planning choices after childbirth in Burkina Faso and the Democratic Republic of Congo: Participatory action research to design and evaluate a decision-making tool for providers and their clients. PATIENT EDUCATION AND COUNSELING 2018; 101:1871-1875. [PMID: 30001823 DOI: 10.1016/j.pec.2018.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 04/03/2018] [Accepted: 05/01/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Postpartum family planning (PPFP) is essential for maternal and newborn health but is often not systematically addressed before or after childbirth. This article describes the development and field-testing of a PPFP counseling tool to support providers and women. METHODS Participatory action research involving women, men, providers, policymakers, researchers, and contraceptive experts from Burkina Faso and the Democratic Republic of Congo. RESULTS The tool consists of an A4-size flipchart with illustrations on the client side and clinical information and counseling tips on the provider side, and can be used during visits of the antenatal-delivery-postnatal care continuum. Qualitative results suggest that the tool is easily understandable, user-friendly, relevant, and useful with regard to providing PPFP information to clients, and respectful of clients' rights and choices. It may have a positive influence on clients' attitudes towards PPFP and their decision to use contraception. CONCLUSIONS The tool holds promise in guiding a systematic discussion on birth spacing options among providers and clients. Its impact on contraceptive uptake requires further research. PRACTICE IMPLICATIONS If proven effective, the tool could be disseminated to Ministries of Health and local, regional, and global partners to strengthen national family planning and maternal and child health strategies in low-resource countries.
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Affiliation(s)
- Nguyen Toan Tran
- Institute of Demography and Socioeconomics (IDESO), University of Geneva, Geneva, Switzerland; Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia; Department of Reproductive Health Research, World Health Organization, Geneva, Switzerland.
| | - Wambi Maurice M Yameogo
- Research Institute in Health Sciences (Institut de Recherche en Sciences de la Santé) & African Institute of Public Health (Institut Africain de la Santé Publique), Ouagadougou, Burkina Faso.
| | - Félicité Langwana
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
| | - Seni Kouanda
- Research Institute in Health Sciences (Institut de Recherche en Sciences de la Santé) & African Institute of Public Health (Institut Africain de la Santé Publique), Ouagadougou, Burkina Faso.
| | - Blandine Thieba
- Research Institute in Health Sciences (Institut de Recherche en Sciences de la Santé) & African Institute of Public Health (Institut Africain de la Santé Publique), Ouagadougou, Burkina Faso.
| | - Désiré Mashinda
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
| | - Rachel Yodi
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
| | - Jean Nyandwe Kyloka
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
| | - Tieba Millogo
- Research Institute in Health Sciences (Institut de Recherche en Sciences de la Santé) & African Institute of Public Health (Institut Africain de la Santé Publique), Ouagadougou, Burkina Faso.
| | - Abou Coulibaly
- Research Institute in Health Sciences (Institut de Recherche en Sciences de la Santé) & African Institute of Public Health (Institut Africain de la Santé Publique), Ouagadougou, Burkina Faso.
| | - Souleymane Zan
- World Health Organization Country Office in Burkina Faso, Ouagadougou, Burkina Faso.
| | - Brigitte Kini
- World Health Organization Country Office in the Democratic Republic of Congo, Kinshasa, Democratic Republic of Congo.
| | - Bibata Ouedraogo
- Bokin Medical Center (Centre Médical de Bokin), District sanitaire de Yako, Région du Nord, Burkina Faso.
| | - Fifi Puludisi
- Bumbu Mother and Child Center (Centre Mère et Enfant de Bumbu), Commune de Bumbu, Province de Kinshasa, Democratic Republic of Congo.
| | - Asa Cuzin-Kihl
- Department of Reproductive Health Research, World Health Organization, Geneva, Switzerland.
| | - Suzanne Reier
- Department of Reproductive Health Research, World Health Organization, Geneva, Switzerland.
| | - James Kiarie
- Department of Reproductive Health Research, World Health Organization, Geneva, Switzerland.
| | - Mary Eluned Gaffield
- Department of Reproductive Health Research, World Health Organization, Geneva, Switzerland.
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Finlay JE, Mejía-Guevara I, Akachi Y. Inequality in total fertility rates and the proximate determinants of fertility in 21 sub-Saharan African countries. PLoS One 2018; 13:e0203344. [PMID: 30226852 PMCID: PMC6143190 DOI: 10.1371/journal.pone.0203344] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 08/20/2018] [Indexed: 11/18/2022] Open
Abstract
In this paper, we examine the inequality in the dynamics of the total fertility rate within 21 sub-Saharan African countries by wealth quintiles. We also examine the associated inequality within each country in the proximate determinants of fertility–marriage, contraception, and breastfeeding. Applying Bongaarts’ proximate determinants of fertility framework, for 14/21 countries we analyze, we find that those in the richest wealth quintiles have had a more rapid decline in fertility rates than those in the poorest wealth quintiles. The rapid decline for those in the richest wealth quintiles is attributable to delayed marriage and modest increases in contraceptive use. Although the poorest lag in fertility decline, postpartum abstinence and breastfeeding are the most important factors for them for fertility regulation. Further encouraging maternal health programs that focus on natural methods of fertility regulation will work in favor of the poorest in sub-Saharan Africa in moving through the demographic transition.
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Affiliation(s)
- Jocelyn E. Finlay
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Iván Mejía-Guevara
- Department of Biology, Stanford University, Stanford, California, United States of America
- Stanford Medicine Center for Population Health Sciences, Palo Alto, California, United States of America
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Dynes MM, Bernstein E, Morof D, Kelly L, Ruiz A, Mongo W, Chaote P, Bujari RN, Serbanescu F. Client and provider factors associated with integration of family planning services among maternal and reproductive health clients in Kigoma Region, Tanzania: a cross-sectional study, April-July 2016. Reprod Health 2018; 15:152. [PMID: 30208913 PMCID: PMC6134585 DOI: 10.1186/s12978-018-0593-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 08/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Integration of family planning (FP) services into non-FP care visits is an essential strategy for reducing maternal and neonatal mortality through reduction of short birth intervals and unplanned pregnancies. METHODS Cross-sectional surveys were conducted across 61 facilities in Kigoma Region, Tanzania, April-July 2016. Multilevel, mixed effects logistic regression analyses were conducted on matched data from providers (n = 330) and clients seeking delivery (n = 935), well-baby (n = 272), pregnancy loss (PL; n = 229), and other routine (postnatal, HIV/STI, other; n = 69) services. Outcomes of interest included receipt of FP information and a modern FP method (significance level p < 0.05). RESULTS Clients had significantly greater odds of receiving FP information if the primary reason for seeking care was for PL versus (vs) any other types of care (aOR 1.97), had four or more pregnancies vs fewer (aOR 1.78), and had had a FP discussion with their partner vs no FP discussion (aOR 1.73). Clients had lower odds of receiving FP information if they were aged 40-49 vs 15-19 (aOR 0.50) and reported attending religious services at least weekly vs less frequently (aOR 0.61). Clients of providers who perceived that in-service training had helped vs had not helped job performance (aOR 2.27), and clients of providers having high vs low recent FP training index scores (aOR 1.58) had greater odds of receiving FP information. Clients had greater odds of receiving a modern method when they received information on two or more vs fewer methods (aOR 7.13), had had a FP discussion with their partner vs no discussion (aOR 5.87), if the primary reason for seeking care was for PL vs any other types of care (aOR 4.08), had zero vs one or more live births (aOR 3.92), made their own FP decisions vs not made own FP decisions (aOR 3.17), received FP information from two or more vs fewer sources (aOR 3.12), and were in the middle or high vs the low wealth tercile (aOR 1.99 and 2.30, respectively). Well-baby care clients, Other routine services clients, and married clients had significantly lower odds of receiving a method (aOR 0.14; aOR 0.08; and aOR 0.41, respectively) compared to their counterparts. CONCLUSIONS Strategies that better integrate FP into routine care visits, encourage women to have FP discussions with their partners and providers, increase FP training among providers, and expand FP options and sources of information may help reduce the unmet need for FP, and ultimately lower maternal and neonatal mortality.
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Affiliation(s)
- M M Dynes
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, USA.
| | - E Bernstein
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, USA
| | - D Morof
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, USA
| | - L Kelly
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, USA
| | - A Ruiz
- Centers for Disease Control and Prevention, Division of Reproductive Health (CDCF Contractor), Atlanta, USA
| | - W Mongo
- EngenderHealth, Washington, DC, USA
| | - P Chaote
- Regional Medical Officer, Kigoma, Kigoma Region, Tanzania
| | - R N Bujari
- AMCA Inter Consult, Dar es Salaam, Tanzania
| | - F Serbanescu
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, USA
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Ajayi AI, Adeniyi OV, Akpan W. Maternal health care visits as predictors of contraceptive use among childbearing women in a medically underserved state in Nigeria. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2018; 37:19. [PMID: 30041704 PMCID: PMC6057093 DOI: 10.1186/s41043-018-0150-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 07/17/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Health care visits during pregnancy, childbirth and after childbirth may be crucial in expanding the uptake of contraceptive care in resource-poor settings. However, little is known about how health care visits influence the uptake of modern contraception in Nigeria. The focus of this paper was to examine how health care visits influence the use of contraceptives among parous women in a medically underserved setting. METHODS The study adopted a descriptive survey design. Data was collected from 411 women who gave birth between 2010 and 2015 selected through a two-stage cluster random sampling technique. Health care visits for antenatal care services, childbirth, postnatal care and modern contraceptive were dichotomised (yes, no). Descriptive analyses were performed, and percentages, frequencies and means were reported. Multiple logistic regressions were computed, and odds ratios and 95% confidence intervals were calculated. RESULTS Knowledge of all contraceptive methods was lowest among women who reside in rural areas. Health care visits for antenatal care (UOR 4.5; 95% CI 2.0-10.5), childbirth (UOR2.1; 95% CI 1.4-3.2) and postnatal care services (UOR 2.3; 95% CI 1.5-3.5) independently predict ever use of any contraceptive methods. Likewise, health care visits for antenatal care (UOR 5.6; 95% CI 2.1-14.8), childbirth (UOR 2.3; 95% CI 1.5-3.6) and postnatal care services (UOR 2.8; 95% CI 1.8-4.5) were independent predictors of current use of modern contraceptive methods. In the adjusted model, health care visits for antenatal care services (AOR 3.2; 95% CI 1.1-8.8) were significantly associated with the use of modern contraceptive methods. CONCLUSION Health care visits significantly predict the use of modern contraceptive methods. Expanding access to health care services would potentially increase contraceptive use among childbearing women in the medically underserved settings.
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Affiliation(s)
- Anthony Idowu Ajayi
- Department of Sociology, Faculty of Social Sciences & Humanities, University of Fort Hare, 50 Church street, East London, 5200 South Africa
| | - Oladele Vincent Adeniyi
- Department of Family Medicine, Walter Sisulu University, Cecilia Makiwane Hospital, East London Hospital Complex, East London, South Africa
| | - Wilson Akpan
- Department of Sociology, Faculty of Social Sciences & Humanities, University of Fort Hare, 50 Church street, East London, 5200 South Africa
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Baqui AH, Ahmed S, Begum N, Khanam R, Mohan D, Harrison M, Al Kabir A, McKaig C, Brandes N, Norton M, Ahmed S. Impact of integrating a postpartum family planning program into a community-based maternal and newborn health program on birth spacing and preterm birth in rural Bangladesh. J Glob Health 2018; 8:020406. [PMID: 30023053 PMCID: PMC6036944 DOI: 10.7189/jogh.08.020406] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Short birth intervals are associated with an increased risk of adverse perinatal outcomes. However, reduction of rates of short birth intervals is challenging in low-resource settings where majority of the women deliver at home with limited access to family planning services immediately after delivery. This study examines the feasibility of integrating a post-partum family planning intervention package within a community-based maternal and newborn health intervention package, and evaluates the impact of integration on reduction of rates of short birth intervals and preterm births. Methods In a quasi-experimental trial design, unions with an average population of about 25 000 and a first level health facility were allocated to an intervention arm (n = 4) to receive integrated post-partum family planning and maternal and newborn health (PPFP-MNH) interventions, or to a control arm (n = 4) to receive the MNH interventions only. Trained community health workers were the primary outreach service providers in both study arms. The primary outcomes of interest were birth spacing and preterm births. We also examined if there were any unintended consequences of integration. Results At baseline, short birth intervals of less than 24 months and preterm birth rates were similar among women in the intervention and control arms. Integrating PPFP into the MNH intervention package did not negatively influence maternal and neonatal outcomes; during the intervention period, there was no difference in community health workers’ home visit coverage or neonatal care practices between the two study arms. Compared to the control arm, women in the intervention arm had a 19% lower risk of short birth interval (adjusted relative risk (RR) = 0.81, 95% confidence interval (CI) = 0.69-0.95) and 21% lower risk of preterm birth (adjusted RR = 0.79; 95% CI = 0.63-0.99). Conclusions Study findings demonstrate the feasibility and effectiveness of integrating PPFP interventions into a community based MNH intervention package. Thus, MNH programs should consider systematically integrating PPFP as a service component to improve pregnancy spacing and reduce the risk of preterm birth.
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Affiliation(s)
- Abdullah H Baqui
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Nazma Begum
- Johns Hopkins University-Bangladesh, Dhaka, Bangladesh
| | - Rasheda Khanam
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Diwakar Mohan
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Meagan Harrison
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ahmed Al Kabir
- Research, Training and Management (RTM) International, Dhaka, Bangladesh
| | | | - Neal Brandes
- US Agency for International Development, Washington, D.C., USA
| | - Maureen Norton
- US Agency for International Development, Washington, D.C., USA
| | - Saifuddin Ahmed
- Department of Population, Family and reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Starrs AM, Ezeh AC, Barker G, Basu A, Bertrand JT, Blum R, Coll-Seck AM, Grover A, Laski L, Roa M, Sathar ZA, Say L, Serour GI, Singh S, Stenberg K, Temmerman M, Biddlecom A, Popinchalk A, Summers C, Ashford LS. Accelerate progress-sexual and reproductive health and rights for all: report of the Guttmacher-Lancet Commission. Lancet 2018; 391:2642-2692. [PMID: 29753597 DOI: 10.1016/s0140-6736(18)30293-9] [Citation(s) in RCA: 459] [Impact Index Per Article: 76.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 02/02/2018] [Accepted: 02/08/2018] [Indexed: 01/10/2023]
Affiliation(s)
| | - Alex C Ezeh
- African Population and Health Research Center, Nairobi, Kenya; School of Public Health, University of Witwatersrand, Johannesburg, South Africa; Center for Global Development, Washington, DC, USA
| | | | - Alaka Basu
- Department of Development Sociology, Cornell University, Ithaca, NY, USA
| | - Jane T Bertrand
- Tulane School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Robert Blum
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | - Monica Roa
- Independent Consultant, Islamabad, Pakistan
| | | | - Lale Say
- World Health Organization, Geneva, Switzerland
| | - Gamal I Serour
- International Islamic Center For Population Studies And Research, Al Azhar University, Cairo, Egypt
| | | | | | - Marleen Temmerman
- Department of Obstetrics and Gynaecology, Aga Khan University, Nairobi, Kenya
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Tran NT, Gaffield ME, Seuc A, Landoulsi S, Yamaego WME, Cuzin-Kihl A, Kouanda S, Thieba B, Mashinda D, Yodi R, Kiarie J, Reier S. Effectiveness of a package of postpartum family planning interventions on the uptake of contraceptive methods until twelve months postpartum in Burkina Faso and the Democratic Republic of Congo: the YAM DAABO study protocol. BMC Health Serv Res 2018; 18:439. [PMID: 29890982 PMCID: PMC5996535 DOI: 10.1186/s12913-018-3199-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 05/10/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Postpartum family planning (PPFP) information and services can prevent maternal and child morbidity and mortality in low-resource countries, where high unmet need for PPFP remains despite opportunities offered by routine postnatal care visits. This study aims to identify a package of PPFP interventions and determine its effectiveness on the uptake of contraceptive methods during the first year postpartum. We hypothesize that implementing a PPFP intervention package that is designed to strengthen existing antenatal and postnatal care services will result in an increase in contraceptive use. METHODS This is an operational research project using a complex intervention design with three interacting phases. The pre-formative phase aims to map study sites to establish a sampling frame. The formative phase employs a participatory approach using qualitative methodology to identify barriers and catalysts to PPFP uptake to inform the design of a PPFP intervention package. The intervention phase applies a cluster randomized-controlled trial design based at the primary healthcare level, with the experimental group implementing the PPFP package, and the control group implementing usual care. The primary outcome is modern contraceptive method uptake at twelve months postpartum. Qualitative research is embedded in the intervention phase to understand the operational reasons for success or failure of PPFP services. DISCUSSION Designing, testing, and scaling-up effective, affordable, and sustainable health interventions in low-resource countries is critical to address the high unmet need for PPFP. Due to socio-cultural complexities surrounding contraceptive use, this research assumes that this is more effectively accomplished by engaging key stakeholders, including adolescents, women, men, key community members, service providers, and policy-makers. At the individual level, knowledge, attitudes, and behaviors of women and couples toward PPFP will likely be influenced by a set of low-cost interventions. At the health service delivery level, the implementation of this trial will probably require a shift in behavior and accountability of providers regarding the systematic integration of PPFP into their clinical practice, as well as the optimization of health service organization to ensure the availability of competent staff and contraceptive supplies. TRIAL REGISTRATION Retrospectively registered in the Pan African Clinical Trials Registry ( PACTR201609001784334 , 27 September 2016).
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Affiliation(s)
- Nguyen Toan Tran
- Department of Reproductive Health Research, World Health Organization, Avenue Appia 20, 1211 Genève 27, Switzerland
- Institute of Demography and Socioeconomics (IDESO), Geneva University, Boulevard du Pont d’Arve 40, 1211 Geneva, Switzerland
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology, PO Box 123, Sydney, NSW 2007 Australia
| | - Mary Eluned Gaffield
- Department of Reproductive Health Research, World Health Organization, Avenue Appia 20, 1211 Genève 27, Switzerland
| | - Armando Seuc
- Department of Reproductive Health Research, World Health Organization, Avenue Appia 20, 1211 Genève 27, Switzerland
| | - Sihem Landoulsi
- Department of Reproductive Health Research, World Health Organization, Avenue Appia 20, 1211 Genève 27, Switzerland
| | - Wambi Maurice E. Yamaego
- Institut de Recherche en Sciences de la Santé, 03 B.P. 7192, Ouagadougou 03, Burkina Faso
- Institut Africain de la Santé Publique, 12 B.P. 199, Ouagadougou, Burkina Faso
| | - Asa Cuzin-Kihl
- Department of Reproductive Health Research, World Health Organization, Avenue Appia 20, 1211 Genève 27, Switzerland
| | - Seni Kouanda
- Institut de Recherche en Sciences de la Santé, 03 B.P. 7192, Ouagadougou 03, Burkina Faso
- Institut Africain de la Santé Publique, 12 B.P. 199, Ouagadougou, Burkina Faso
| | - Blandine Thieba
- Institut de Recherche en Sciences de la Santé, 03 B.P. 7192, Ouagadougou 03, Burkina Faso
- Institut Africain de la Santé Publique, 12 B.P. 199, Ouagadougou, Burkina Faso
| | - Désiré Mashinda
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Rachel Yodi
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - James Kiarie
- Department of Reproductive Health Research, World Health Organization, Avenue Appia 20, 1211 Genève 27, Switzerland
| | - Suzanne Reier
- Department of Reproductive Health Research, World Health Organization, Avenue Appia 20, 1211 Genève 27, Switzerland
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Mackenzie D, Pfitzer A, Maly C, Waka C, Singh G, Sanyal A. Postpartum family planning integration with maternal, newborn and child health services: a cross-sectional analysis of client flow patterns in India and Kenya. BMJ Open 2018; 8:e018580. [PMID: 29615443 PMCID: PMC5892750 DOI: 10.1136/bmjopen-2017-018580] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 01/22/2018] [Accepted: 01/24/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Maternal, newborn and child health (MNCH) services represent opportunities to integrate postpartum family planning (PPFP). Objectives were to determine levels of MNCH-family planning (FP) integration and associations between integration, client characteristics and service delivery factors in facilities that received programmatic PPFP support. DESIGN AND SETTING Cross-sectional client flow assessment conducted during May-July 2014, over 5 days at 10 purposively selected public sector facilities in India (4 hospitals) and Kenya (2 hospitals and 4 health centres). PARTICIPANTS 2158 client visits tracked (1294 India; 864 Kenya). Women aged 18 or older accessing services while pregnant and/or with a child under 2 years. INTERVENTIONS PPFP/postpartum intrauterine device-Bihar, India (2012-2013); Jharkhand, India (2009-2014); Embu, Kenya (2006-2010). Maternal, infant and young child nutrition/FP integration-Bondo, Kenya (2011-2014). PRIMARY OUTCOME MEASURES Proportion of visits where clients received integrated MNCH-FP services, client characteristics as predictors of MNCH-FP integration and MNCH-FP integration as predictor of length of time spent at facility. RESULTS Levels of MNCH-FP integration varied widely across facilities (5.3% to 63.0%), as did proportion of clients receiving MNCH-FP integrated services by service area. Clients travelling 30-59 min were half as likely to receive integrated services versus those travelling under 30 min (OR 0.5, 95% CI 0.4 to 0.7, P<0.001). Clients receiving MNCH-FP services (vs MNCH services only) spent an average of 10.5 min longer at the facility (95% CI -0.1 to 21.9, not statistically significant). CONCLUSIONS Findings suggest importance of focused programmatic support for integration by MNCH service area. FP integration was highest in areas receiving specific support. Integration does not seem to impose an undue burden on clients in terms of time spent at the facility. Clients living furthest from facilities are least likely to receive integrated services.
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Affiliation(s)
- Devon Mackenzie
- Jhpiego/Maternal and Child Survival Program, Washington, DC, USA
| | - Anne Pfitzer
- Jhpiego/Maternal and Child Survival Program, Washington, DC, USA
| | | | | | | | - Abanti Sanyal
- Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Maru S, Nirola I, Thapa A, Thapa P, Kunwar L, Wu WJ, Halliday S, Citrin D, Schwarz R, Basnett I, Kc N, Karki K, Chaudhari P, Maru D. An integrated community health worker intervention in rural Nepal: a type 2 hybrid effectiveness-implementation study protocol. Implement Sci 2018; 13:53. [PMID: 29598824 PMCID: PMC5875011 DOI: 10.1186/s13012-018-0741-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/13/2018] [Indexed: 11/13/2022] Open
Abstract
Background Evidence-based medicines, technologies, and protocols exist to prevent many of the annual 300,000 maternal, 2.7 million neonatal, and 9 million child deaths, but they are not being effectively implemented and utilized in rural areas. Nepal, one of South Asia’s poorest countries with over 80% of its population living in rural areas, exemplifies this challenge. Community health workers are an important cadre in low-income countries where human resources for health and health care infrastructure are limited. As local women, they are uniquely positioned to understand and successfully navigate barriers to health care access. Recent case studies of large community health worker programs have highlighted the importance of training, both initial and ongoing, and accountability through structured management, salaries, and ongoing monitoring and evaluation. A gap in the evidence regarding whether such community health worker systems can change health outcomes, as well as be sustainably adopted at scale, remains. In this study, we plan to evaluate a community health worker system delivering an evidence-based integrated reproductive, maternal, newborn, and child health intervention as it is scaled up in rural Nepal. Methods We will conduct a type 2 hybrid effectiveness-implementation study to test both the effect of an integrated reproductive, maternal, newborn, and child health intervention and the implementation process via a professional community health worker system. The intervention integrates five evidence-based approaches: (1) home-based antenatal care and post-natal care counseling and care coordination; (2) continuous surveillance of all reproductive age women, pregnancies, and children under age 2 years via a mobile application; (3) Community-Based Integrated Management of Newborn and Childhood Illness; (4) group antenatal and postnatal care; and 5) the Balanced Counseling Strategy to post-partum contraception. We will evaluate effectiveness using a pre-post quasi-experimental design with stepped implementation and implementation using the RE-AIM framework. Discussion This is the first hybrid effectiveness-implementation study of an integrated reproductive, maternal, newborn, and child health intervention in rural Nepal that we are aware of. As Nepal takes steps towards achieving the Sustainable Development Goals, the data from this three-year study will be useful in the detailed planning of a professionalized community health worker cadre delivering evidence-based reproductive, maternal, newborn, and child health interventions to the country’s rural population. Trial registration ClinicalTrials.gov Identifier: NCT03371186, registered 04 December 2017, retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s13012-018-0741-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sheela Maru
- Possible, Kathmandu, Nepal.,Department of Obstetrics and Gynecology, Boston Medical Center, Boston, MA, USA.,Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, USA
| | - Isha Nirola
- Possible, Kathmandu, Nepal.,Department Medicine, Division of Women's Health, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | - Wan-Ju Wu
- Possible, Kathmandu, Nepal.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Scott Halliday
- Possible, Kathmandu, Nepal.,Henry M. Jackson School of International Studies, University of Washington, Seattle, WA, USA
| | - David Citrin
- Possible, Kathmandu, Nepal.,Henry M. Jackson School of International Studies, University of Washington, Seattle, WA, USA.,Department of Anthropology, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
| | - Ryan Schwarz
- Possible, Kathmandu, Nepal.,Department of Medicine, Division of Global Health Equity, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Indira Basnett
- Department of Health Services, Nepal Health Sector Programme, Ministry of Health, Kathmandu, Nepal
| | - Naresh Kc
- Department of Health Services, Family Health Division, Ministry of Health, Kathmandu, Nepal
| | - Khem Karki
- Department of Community Medicine, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | - Pushpa Chaudhari
- Department of Health Services, Ministry of Health, Kathmandu, Nepal
| | - Duncan Maru
- Possible, Kathmandu, Nepal. .,Department of Medicine, Division of Global Health Equity, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. .,Department of Medicine, Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA. .,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
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47
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Achwoka D, Pintye J, McGrath CJ, Kinuthia J, Unger JA, Obudho N, Langat A, John-Stewart G, Drake AL. Uptake and correlates of contraception among postpartum women in Kenya: results from a national cross-sectional survey. Contraception 2018; 97:227-235. [PMID: 29031815 PMCID: PMC5861297 DOI: 10.1016/j.contraception.2017.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 10/04/2017] [Accepted: 10/09/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective was to characterize uptake and correlates of effective contraceptive use postpartum. STUDY DESIGN We analyzed data from a national, cross-sectional evaluation of prevention of mother-to-child HIV transmission programs that enrolled women attending 6-week or 9-month infant immunization visits at 120 Kenyan maternal and child health clinics. We classified women who resumed sexual activity postpartum and did not desire a child within 2 years as having a need for family planning (FP). RESULTS We included 955 (94%) of 1012 women 8-10 months postpartum in the analysis. Mean age was 25.8 years and 36% were primigravidas. By 9 months postpartum, 62% of all women used contraception and 59% used effective contraception [injectables, implants, intrauterine devices [IUDs], oral contraceptives [OCs] and tubal ligations]. Most contraceptive users (61%) used injectables, followed by implants (10%), OCs (6%), IUDs (4%) and condoms alone (2%). The majority (n=733, 77%) had a need for FP, and 67% of 733 women with FP need used effective contraception. Among women with a need for FP, effective contraception use was higher among those who discussed FP in postnatal care (PNC) than who did not discuss FP in PNC [prevalence ratio (PR) for PNC alone: 1.35, 95% confidence interval (CI): 1.16-1.58; PR for PNC and antenatal care (ANC): 1.42, 95% CI: 1.21-1.67; p=.001 for both]. CONCLUSIONS Two thirds of postpartum women with a need for FP used effective contraception at 9 months postpartum, and use was associated with discussing FP during PNC. IMPLICATIONS Integrating FP counseling in ANC/PNC could be an effective strategy to increase effective contraception use.
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Affiliation(s)
- Dunstan Achwoka
- US Centers for Disease Control and Prevention (CDC), Division of Global HIV & TB (DGHT), Nairobi, Kenya.
| | - Jillian Pintye
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Nursing, University of Washington, Seattle, WA, USA
| | - Christine J McGrath
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, USA
| | - John Kinuthia
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Jennifer A Unger
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Obstetrics and Gynecology, University of WA, Seattle
| | - Norah Obudho
- Afya Bora Consortium Fellow in Global Health Leadership, University of Nairobi, Nairobi, Kenya
| | - Agnes Langat
- US Centers for Disease Control and Prevention (CDC), Division of Global HIV & TB (DGHT), Nairobi, Kenya
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA
| | - Alison L Drake
- Department of Global Health, University of Washington, Seattle, WA, USA
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Harrison MS, Goldenberg RL. Immediate postpartum use of long-acting reversible contraceptives in low- and middle-income countries. Matern Health Neonatol Perinatol 2017; 3:24. [PMID: 29299334 PMCID: PMC5740832 DOI: 10.1186/s40748-017-0063-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 10/05/2017] [Indexed: 02/03/2023] Open
Abstract
Globally, data show that many women of reproductive age desire to use modern family planning methods. Many of these women do not have access to modern contraceptives, which is termed their 'unmet need' for contraception. In low- and middle-income countries where total fertility rates can be high and many women have undesired fertility, or wish to increase their inter-pregnancy intervals, access to modern contraceptives is often inadequate. The puerperium is a unique time for interventions to offer modern contraceptive methods. Having just given birth, women may desire contraceptives to prevent short-interval pregnancy, or further pregnancy, altogether. In high-, middle-, and low-income countries there has been an increased interest in the placement of long-acting reversible contraceptives at or immediately after delivery, regardless of delivery mode. These methods can provide women with highly effective contraception for years, can be manufactured at low cost, are generally well tolerated with a good safety profile, and do not require the user to remember to take them. Oral contraceptives and injectable medications require the patient to present to the clinic during a specific timeframe for follow-up care or a refill, and the clinic may not be proximate, affordable, or have the desired contraceptive in stock. This document will review the currently published literature on the use of immediate postpartum long-acting reversible contraceptives (placed within two days of delivery) in low- and middle-income countries to report on the prevalence of use and satisfaction rates, and note the lack of data on cost and economic implications. We will also explore data on how future maternal, neonatal, and infant outcomes may be influenced by increased peripartum long-term contraceptive use.
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Affiliation(s)
- Margo S. Harrison
- Columbia University Medical Center, New York, NY USA
- 622 W 168th St, PH 16-29, New York, NY 10032 USA
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Karra M, Canning D, Foster S, Shah IH, Senanayake H, Ratnasiri UDP, Pathiraja RP. Location and content of counselling and acceptance of postpartum IUD in Sri Lanka. Reprod Health 2017; 14:42. [PMID: 28292333 PMCID: PMC5351270 DOI: 10.1186/s12978-017-0304-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 03/07/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The immediate postpartum IUD (PPIUD) is a long-acting, reversible method of contraception that can be used safely and effectively following a birth. To appropriately facilitate the immediate postpartum insertion of IUDs, women must be informed of the method's availability and must be counselled on its benefits and risks prior to entering the delivery room. We examine the relationship between the location and quality of antenatal counselling and women's acceptance of immediate postpartum IUD (PPIUD) in four hospitals in Sri Lanka. METHODS Data were collected between January 2015 and May 2015. Modified Poisson regressions with robust standard errors are used to assess the relationships between place of counselling, indicators of counselling quality, and PPIUD uptake following delivery. RESULTS We find that women who were counselled in hospital antenatal clinics and admission wards were much more likely to have a PPIUD inserted than women who were counselled in field clinics or during home visits. Hospital-based counselling had higher quality indicators for providing information on PPIUD, and women were more likely to receive PPIUD information leaflets in hospital locations than in lower-tiered clinics or during home visits. Women who were counselled at hospital locations also reported a higher level of satisfaction with the counselling that they received. Receipt of hospital-based counselling was also linked to higher PPIUD uptake, in spite of the fact that women were more likely to be given information about the risks and alternatives to PPIUD in hospitals. The information about the risks of and alternatives to PPIUD, whether provided in hospital or in non-hospital settings, tended to lower the likelihood of acceptance to have a PPIUD insertion. Counselling in hospital admission wards was focused on women who had not been counselled at field clinics. CONCLUSIONS The study findings call for efforts that improve the training of midwives who provide PPIUD counselling at field clinics and during the home visits. We also recommend that routine PPIUD counselling be conducted in hospitals, even if women have already been counselled elsewhere.
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Affiliation(s)
- Mahesh Karra
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Boston, MA, 02115, USA.
| | - David Canning
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Boston, MA, 02115, USA
| | - Sorcha Foster
- Queens University Belfast, University Road Belfast, BT7 1NN, Belfast, Northern Ireland, UK
| | - Iqbal H Shah
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Boston, MA, 02115, USA
| | - Hemantha Senanayake
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Agadjanian V, Hayford SR. HIV status, fertility intentions, and contraception in the era of expanded access to antiretroviral therapy: A case study of rural Mozambique. Glob Public Health 2016; 13:582-596. [PMID: 28032523 DOI: 10.1080/17441692.2016.1268188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Provision of effective contraception to HIV-positive women of reproductive age is critical to effective management of HIV infection and prevention of both vertical and horizontal HIV transmission in developing countries. This exploratory retrospective study examines contraceptive use during the prolonged post-partum period in a sample of 285 HIV-positive and HIV-negative women who gave birth at four rural maternity clinics in a high HIV-prevalence region in Mozambique. Multivariate analyses show no significant variations by HIV status in contraceptive timing (mean time to first contraceptive use of 7.1 months) or prevalence (31% at time of survey) but detect a moderating effect of fertility intentions: while HIV status makes no difference for women wishing to stop childbearing, among women who want to continue having children, or are unsure about their reproductive plans, HIV-positive status is associated with higher likelihood of contraceptive use. Regardless of HIV status, virtually no condom use is reported. These results are situated within the context of a rapidly widening access to post-partum antiretroviral therapy in the study site and similar sub-Saharan settings.
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Affiliation(s)
- Victor Agadjanian
- a Department of Sociology , University of Kansas , Lawrence , KS , USA
| | - Sarah R Hayford
- b Department of Sociology and Institute for Population Research , Ohio State University , Columbus , OH , USA
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