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Espey J, Ingabire R, Nyombayire J, Hoagland A, Da Costa V, Mazzei A, Haddad LB, Parker R, Mukamuyango J, Umutoni V, Allen S, Karita E, Tichacek A, Wall KM. Postpartum long-acting contraception uptake and service delivery outcomes after a multilevel intervention in Kigali, Rwanda. BMJ SEXUAL & REPRODUCTIVE HEALTH 2021; 47:173-178. [PMID: 32938708 PMCID: PMC8861892 DOI: 10.1136/bmjsrh-2020-200741] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Postpartum family planning (PPFP) is critical to reduce maternal-child mortality, abortion and unintended pregnancy. As in most countries, the majority of PP women in Rwanda have an unmet need for PPFP. In particular, increasing use of the highly effective PP long-acting reversible contraceptive (LARC) methods (the intrauterine device (IUD) and implant) is a national priority. We developed a multilevel intervention to increase supply and demand for PPFP services in Kigali, Rwanda. METHODS We implemented our intervention (which included PPFP promotional counselling for clients, training for providers, and Ministry of Health stakeholder involvement) in six government health facilities from August 2017 to October 2018. While increasing knowledge and uptake of the IUD was a primary objective, all contraceptive method options were discussed and made available. Here, we report a secondary analysis of PP implant uptake and present already published data on PPIUD uptake for reference. RESULTS Over a 15-month implementation period, 12 068 women received PPFP educational counselling and delivered at a study facility. Of these women, 1252 chose a PP implant (10.4% uptake) and 3372 chose a PPIUD (27.9% uptake). On average providers at our intervention facilities inserted 83.5 PP implants/month and 224.8 PPIUDs/month. Prior to our intervention, 30 PP implants/month and 8 PPIUDs/month were inserted at our selected facilities. Providers reported high ease of LARC insertion, and clients reported minimal insertion anxiety and pain. CONCLUSIONS PP implant and PPIUD uptake significantly increased after implementation of our multilevel intervention. PPFP methods were well received by clients and providers.
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Affiliation(s)
- Julie Espey
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Rosine Ingabire
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Projet San Francisco, Kigali, Rwanda
| | - Julien Nyombayire
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Projet San Francisco, Kigali, Rwanda
| | - Alexandra Hoagland
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Projet San Francisco, Kigali, Rwanda
| | - Vanessa Da Costa
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Amelia Mazzei
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Projet San Francisco, Kigali, Rwanda
| | - Lisa B Haddad
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Rachel Parker
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jeannine Mukamuyango
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Projet San Francisco, Kigali, Rwanda
| | - Victoria Umutoni
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Susan Allen
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Etienne Karita
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Projet San Francisco, Kigali, Rwanda
| | - Amanda Tichacek
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Kristin M Wall
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, Georgia, USA
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Makins A, Arulkumaran S. The negative impact of COVID-19 on contraception and sexual and reproductive health: Could immediate postpartum LARCs be the solution? Int J Gynaecol Obstet 2020; 150:141-143. [PMID: 32449192 PMCID: PMC9087606 DOI: 10.1002/ijgo.13237] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 05/20/2020] [Accepted: 05/20/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Anita Makins
- FIGO-International Federation of Gynecology and Obstetrics, London, UK.,Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Sabaratnam Arulkumaran
- FIGO-International Federation of Gynecology and Obstetrics, London, UK.,St George's, University of London, London, UK
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