1
|
Gelaw SG, Deyessa N, Kidane A, Evensen A, Teka A, Bokan B, Yesuf SA. Effect of postpartum family planning intervention and associated factors during child immunization in Addis Ababa, Ethiopia. Pan Afr Med J 2024; 47:110. [PMID: 38766567 PMCID: PMC11101312 DOI: 10.11604/pamj.2024.47.110.34883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 03/05/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction World Health Organization (WHO) recommends postpartum family planning (PPFP) as a critical component of health care that has the potential to save millions of maternal and infant lives in low- and middle-income countries. Methods participants in our randomized, controlled trial were mothers coming for vaccination of their child in three selected health centers in Addis Ababa during the first 10 weeks postpartum. Eligible mothers were randomly assigned to intervention (pamphlet-supported counseling about the benefits of family planning) and non-intervention (routine care) arms. Data were collected when mothers came with their infants for a routine measles vaccination at nine months of life. Family planning (FP) use was compared between the groups using logistic regression, and bivariate and multivariate analyses. The study also used Kaplan Meier and Cox regressions to compare the median time of PPFP use and its correlation using SPSS version 26. The research was undertaken from December 2019 to June 2021. Results a total of 347 women (177 control, 170 intervention) enrolled in the study. Fifty-eight percent were 24-30 years old. Young age, knowledge about FP, previous use of an FP method, and being married were found to be independent predictors for PPFP use. When comparing intervention and non-intervention groups, there was no significant effect on contraceptive use (adjusted OR 0.633 [95% CI 0.385-1.040]). Conclusion pamphlet-supported counseling of mothers in the first 10 weeks postpartum did not increase PPFP at nine months postpartum. Successful interventions will likely require holistic strategies, especially in resource-limited settings. The trial had been registered with clinicaltrials.gov (NCT04521517) on September 24, 2019.
Collapse
Affiliation(s)
- Sawra Getnet Gelaw
- Department of Family Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Negussie Deyessa
- Department of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Achenef Kidane
- Bill and Melinda Gates Foundation, Outbreak Response Consultant, Addis Ababa, Ethiopia
| | - Ann Evensen
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Wisconsin, USA
| | - Aschalew Teka
- World Health Organization, Technical Officer Immunization Program, Addis Ababa, Ethiopia
| | - Bethelhem Bokan
- Department of Family Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Subah Abderehim Yesuf
- Department of Family Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| |
Collapse
|
2
|
Gage AJ, Akilimali PZ, Wood FE, Gay R, Olivia Padis C, Bertrand JT. Evaluation of the effect of the Momentum project on family planning outcomes among first-time mothers aged 15-24 years in Kinshasa, DRC. Contraception 2023; 125:110088. [PMID: 37331463 DOI: 10.1016/j.contraception.2023.110088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVES This article presents the effect of Momentum, a nursing student-led community-based service delivery project, on postpartum family planning (FP) outcomes among first-time mothers in Kinshasa, Democratic Republic of the Congo. STUDY DESIGN We employed a quasi-experimental design, with three intervention and three comparison health zones (HZ). Data were collected through interviewer-administered questionnaires in 2018 and 2020. The sample consisted of 1927 nulliparous women aged 15-24 years who were 6 months pregnant at baseline. Random effects and treatment effects models were used to assess the effect of Momentum on 14 postpartum FP outcomes. RESULTS The intervention group was associated with a unit increase of 0.6 (95% confidence interval [CI]: 0.4, 0.8)) in contraceptive knowledge and personal agency (95% CI: 0.3, 0.9), a unit decrease of 0.9 (95% CI: -1.2, -0.5) in the number of FP myths/misconceptions endorsed, and percentage point increases of 23.4 (95% CI: 0.2, 0.3) in FP discussion with a health worker, 13.0 (95% CI: 0.1, 0.2) in obtaining a contraceptive method within 6 weeks of delivery, and 13.3 (95% CI: 0.1, 0.2) in modern contraceptive use within 12 months of delivery. Intervention effects included percentage point increases of 5.4 (95% CI: 0.0, 0.1) in partner discussion and 15.4 (95% CI: 0.1, 0.2) in perceived community support for postpartum FP use. The level of exposure to Momentum was significantly associated with all behavioral outcomes. CONCLUSIONS The study demonstrated the effect of Momentum on increased postpartum FP-related knowledge, perceived norms, personal agency, partner discussion, and modern contraceptive use. IMPLICATIONS Community-based service delivery by nursing students can potentially lead to improved postpartum FP outcomes among urban adolescent and young first-time mothers in other provinces of the Democratic Republic of the Congo and other African countries.
Collapse
Affiliation(s)
- Anastasia J Gage
- Department of Health Policy and Management, Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, United States.
| | - Pierre Z Akilimali
- University of Kinshasa, School of Public Health, Kinshasa, Democratic Republic of the Congo.
| | - Francine E Wood
- Department of Health Policy and Management, Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, United States.
| | - Rianne Gay
- Tulane International, LLC, Kinshasa, Democratic Republic of the Congo.
| | - C Olivia Padis
- Department of Health Policy and Management, Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, United States.
| | - Jane T Bertrand
- Department of Health Policy and Management, Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, United States.
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Montt-Maray E, Adamjee L, Horanieh N, Witt A, González-Capella T, Zinke-Allmang A, Cislaghi B. Understanding ethical challenges of family planning interventions in sub-Saharan Africa: a scoping review. Front Glob Womens Health 2023; 4:1149632. [PMID: 37674903 PMCID: PMC10478786 DOI: 10.3389/fgwh.2023.1149632] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 08/10/2023] [Indexed: 09/08/2023] Open
Abstract
Background Improving the design of family planning (FP) interventions is essential to advancing gender equality, maternal health outcomes, and reproductive autonomy for both men and women. While progress has been made towards applying a rights-based approach to FP interventions in sub-Saharan Africa, the ethical implications of FP interventions has been underreported and underexplored. Several ethical challenges persist related to measuring success, choice, and target population. Methods We conducted a scoping review to understand if and how FP interventions published between 2000 and 2020 within sub-Saharan Africa address the ethical challenges raised within the literature. We identified a total of 1,652 papers, of which 40 were included in the review. Results Our review demonstrated that the majority of family planning interventions in sub-Saharan Africa place a strong emphasis, on measuring success through quantitative indicators such as uptake of modern contraception methods among women, specifically those that are married and visiting healthcare centres. They also tend to bias the provision of family planning by promoting long-acting reversible contraception over other forms of contraception methods potentially undermining individuals' autonomy and choice. The interventions in our review also found most interventions exclusively target women, not recognising the importance of gender norms and social networks on women's choice in using contraception and the need for more equitable FP services. Conclusion The results of this review highlight how FP interventions measured success through quantitative indicators that focus on uptake of modern contraception methods among women. Utilising these measures makes it difficult to break away from the legacy of FP as a tool for population control as they limit the ability to incorporate autonomy, choice, and rights. Our results are meant to encourage members of the global family planning community to think critically about the ethical implications of their existing interventions and how they may be improved. More public health and policy research is required to assess the effect of applying the new indicators with the FP community as well as explicitly outlining monitoring and evaluation strategies for new interventions to allow for programme improvement and the dissemination of lessons learned.
Collapse
Affiliation(s)
- Eloisa Montt-Maray
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lamiah Adamjee
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Nour Horanieh
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Alice Witt
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Thaïs González-Capella
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Anja Zinke-Allmang
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
5
|
Dwivedi LK, Ranjan M, Mishra R, Ahmed W, Bhatia M. Clustering of child deaths among families in low and middle-income countries: A meta-analysis. Health Sci Rep 2023; 6:e1197. [PMID: 37415675 PMCID: PMC10319960 DOI: 10.1002/hsr2.1197] [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: 02/17/2023] [Accepted: 03/22/2023] [Indexed: 07/08/2023] Open
Abstract
Background and Aims Several studies have examined the phenomenon of "death clustering," in which two or more children born to the same mother or from the same family die at an early age. Therefore, a scientific examination of the results is essential to understand how the survival status of the older siblings affects the survival of the younger siblings. By using meta-analysis, this study aims to provide a quantitative synthesis of the results of studies on "child death clustering" in low- and middle-income countries (LMICs). Methods This study followed the PRISMA-P 2015 guidelines. We used four electronic databases-PubMed, Medline, Scopus, and Google Scholar with search and citation analysis capabilities. Initially, 140 studies were identified, but only 27 met the eligibility criteria eventually. These were studies that had used the death of a previous child as a covariate to determine the survival status of the index child. The heterogeneity and the publication bias of the studies were examined using the Cochran test, I 2 statistic, and Egger's meta-regression test. Results The pooled estimate of 114 study estimates for LMICs contains some bias. India's 37 study estimates were distributed more or less equally along the middle line, indicating no publication bias, while there was a slight bias in the estimates for Africa, Latin America, and Bangladesh. The odds of experiencing the death of the index child in the selected LMICs were 2.3 times higher for mothers who had lost any prior child as compared to those mothers who had not had any prior child loss. For African mothers, the odds were five times higher, whereas for Indian mothers, the odds were 1.66 times higher. Mothers' characteristics, such as education, occupation, health-seeking behavior, and maternal competence, significantly affect the child's survival status. Conclusion Achieving the sustainable development goals would not be possible if mothers in countries experiencing high levels of under-five mortality are not provided with better health and nutrition facilities. Mothers who have lost multiple children should be targeted for assistance.
Collapse
Affiliation(s)
- Laxmi Kant Dwivedi
- Department of Survey Research & Data AnalyticsInternational Institute for Population SciencesMumbaiIndia
| | - Mukesh Ranjan
- Pachhunga University CollegeMizoram UniversityAizawlIndia
| | - Rahul Mishra
- Department of Survey Research & Data AnalyticsInternational Institute for Population SciencesMumbaiIndia
| | - Waquar Ahmed
- School of Health Systems StudiesTata Institute of Social SciencesMumbaiIndia
| | - Mrigesh Bhatia
- Department of Health PolicyLondon School of Economics and Political ScienceLondonUK
| |
Collapse
|
6
|
Sack DE, Emílio A, Graves E, Matino A, Paulo P, Aboobacar AU, De Schacht C, Audet CM. Attitudes and perceptions towards postpartum contraceptive use among seroconcordant partners with HIV in rural Mozambique: a qualitative study. Glob Health Res Policy 2023; 8:7. [PMID: 36918959 PMCID: PMC10014407 DOI: 10.1186/s41256-023-00292-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 03/05/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Postpartum contraceptive uptake reduces short interpregnancy intervals, unintended pregnancies, and their negative sequalae: poor maternal and fetal outcomes. Healthy timing and spacing of pregnancy in people living with HIV (PLHIV) also allows time to achieve viral suppression to reduce parent-to-child HIV transmission. There is scant understanding about how couples-based interventions impact postpartum contraceptive uptake among PLHIV in sub-Saharan Africa. METHODS We interviewed 38 recently pregnant people and 26 of their partners enrolled in the intervention arm of the Homens para Saúde Mais (HoPS+) [Men for Health Plus] trial to assess their perceptions of, attitudes towards, and experiences with contraceptive use. Individuals in the HoPS+ intervention arm received joint-as opposed to individual-HIV-related services during pregnancy and postpartum periods, six counseling and skills sessions, and nine sessions with a peer support couple. Our thematic analysis of the 64 in-depth interviews generated 14 deductive codes and 3 inductive codes across themes within the Information, Motivation, and Behavior Model of health behavior change. RESULTS Participants reported accurate and inaccurate information about birth spacing and contraceptive methods. They described personal (health, economic, and religious) and social (gender norms, desired number of children) motivations for deciding whether to use contraceptives-with slightly different motivations among pregnant and non-pregnant partners. Finally, they explained the skills needed to overcome barriers to contraceptive use including how engagement in HoPS+ improved their shared decision-making skills and respect amongst partners-which facilitated postpartum contraceptive uptake. There were also several cases where non-pregnant partners unilaterally made family planning decisions despite disagreement from their partner. CONCLUSIONS These findings suggest that couples-based interventions during pregnancy and post-partum periods aimed at increasing postpartum contraceptive uptake must center pregnant partners' desires. Specifically, pregnant partners should be allowed to titrate the level of non-pregnant partner involvement in intervention activities to avoid potentially emboldening harmful gender-based intercouple decision-making dynamics.
Collapse
Affiliation(s)
- Daniel E Sack
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Ave, Suite 750, Nashville, TN, 37203, USA.
| | | | - Erin Graves
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Ave, Suite 750, Nashville, TN, 37203, USA
| | | | - Paula Paulo
- Friends in Global Health, Quelimane, Mozambique
| | | | | | - Carolyn M Audet
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Ave, Suite 750, Nashville, TN, 37203, USA
| |
Collapse
|
7
|
Fotso JC, Cleland JG, Kouo Ngamby M, Lukong Baye M, Adje EO. Pregnancy risks and contraceptive use among postpartum mothers in Cameroon: implications for improving the coverage of postpartum family planning services. Reprod Health 2023; 20:2. [PMID: 36593506 PMCID: PMC9806904 DOI: 10.1186/s12978-022-01552-1] [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: 02/03/2022] [Accepted: 12/09/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The health hazards of short inter-birth intervals are severe in Cameroon. One-quarter of inter-birth intervals are less than 24 months and the probability of death before age 5 for children born after a short interval is double that associated with intervals of 36-47 months. We examine the risk of an unintended pregnancy in the 18 months following childbirth in Cameroon, taking into account the protective effects of lactational amenorrhea, delayed resumption of sex as well as contraceptive use. METHODS Data from 3007 postpartum women in the nationally representative 2018 Cameroon Demographic and Health Survey were used. Risk of an unintended pregnancy was defined from current status information on resumption of sex and menses, contraceptive use, desire for another child within 12 months, and, for the minority of pregnant women, whether the conception was intended. Predictors of risk, and of modern method use, were assessed by bivariate and multivariate analysis. RESULTS In the first 6 postpartum months, only 8% of women were fully at risk (i.e., sex and menses resumed but no contraceptive use), rising to 24% at 6-11 postpartum months, and further to 30% at months 12-17. Though 89% wanted to delay the next birth by at least 1 year, only 17% were currently using a modern method. Menstruating women were much more likely to be users than amenorrheic women: 27% versus 15% at months 12-17 postpartum. Urban and better educated women recorded higher contraceptive use but lower protection from other factors than rural, less educated women, with the net result that risk differed little across these population strata. Uptake of maternal and child health (MCH) services was high but only one-third of women had discussed family planning at a facility visit during the preceding 12 months. CONCLUSIONS These results underscore the need for improved postpartum family planning services by means of closer integration with mainstream health services. In view of evidence from other sources of heavy workload and weak motivation of health staff, this will require strong leadership. A related priority is to increase the number of staff trained in provision of long-acting methods, such as implants.
Collapse
Affiliation(s)
| | - John G. Cleland
- EVIHDAF, Nouvelle Route Bastos, BP 35328 Yaoundé, Cameroon ,grid.8991.90000 0004 0425 469XDepartment of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Martina Lukong Baye
- National Multisector Program to Combat Maternal, Newborn & Child Mortality, Ministry of Health, Yaoundé, Cameroon
| | | |
Collapse
|
8
|
Sey-Sawo J, Adeyemo FO, Okojie OH. Effects of Postpartum Family Planning Counselling on Contraceptives Knowledge, Attitude and Intention Among Women Attending a General Hospital in The Gambia: A Randomized Controlled Trial. Open Access J Contracept 2023; 14:61-72. [PMID: 36987511 PMCID: PMC10040163 DOI: 10.2147/oajc.s388882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/18/2023] [Indexed: 03/30/2023] Open
Abstract
Purpose This study aimed to evaluate the effectiveness of PPFP counselling on contraceptives knowledge, attitudes and intention among women attending a general hospital in The Gambia. Materials and Methods A quasi-experimental design with an intervention and comparison group was used. The intervention was PPFP counselling using the GATHER approach. A sample size of 674 participants was determined by a formula for comparison between the two groups. The questionnaire was developed based on a literature review and was pre-tested on 10% of the total study sample size (68). A reliability of 0.731 was obtained. A systematic random sampling method was employed to select study participants who met the inclusion criteria. Data were collected during face-to-face interviews in local languages with a 100% response rate at baseline and 96% at post-test. Data were analysed using the SPSS version 21.00 and the statistical analysis included both descriptive and inferential methods. An ethical approval was obtained from the Research and Ethics Committee, School of Basic Medical Sciences, College of Medicine, University of Benin (CMS/REC/2017/017) and the Gambia Government/Medical Research Council Laboratories Joint Ethics Committee (R017016Av1.1). Results Baseline respondents' socio-demographic characteristics revealed that the two groups had similar characteristics. A statistically significant difference existed on knowledge, attitude, and intention to use contraceptive methods between the intervention and comparison groups at post-intervention (p<0.05) while no significant difference was observed at baseline. Significant gains were achieved in the intervention group in terms of knowledge, attitude, and intention post-intervention. Conclusion PPFP counselling during the postpartum period and before the discharge of women from the hospital may improve knowledge, attitude and intention to use contraceptives and, therefore, increase the likelihood of contraceptive uptake and thus prevent unwanted and closely spaced pregnancies.
Collapse
Affiliation(s)
- Jainaba Sey-Sawo
- Department of Nursing and Reproductive Health, University of The Gambia, Serekunda, The Gambia
- Correspondence: Jainaba Sey-Sawo, School of Medicine and Allied Health Sciences, University of The Gambia, P. O. Box 1646, Serekunda, The Gambia, Tel +220 3650105, Email
| | | | - Obehi H Okojie
- Department of Community Health, University of Benin, Benin, Edo State, Nigeria
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
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]
|
11
|
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.
Collapse
|
12
|
Couples-based interventions and postpartum contraceptive uptake: A systematic review. Contraception 2022; 112:23-36. [PMID: 35577147 PMCID: PMC9968552 DOI: 10.1016/j.contraception.2022.05.001] [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: 09/23/2021] [Revised: 04/29/2022] [Accepted: 05/02/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Systematically review the existing evidence about couples-based interventions and postpartum contraceptive uptake and generate recommendations for future research. DATA SOURCES PubMed, Web of Science, PsycINFO, Embase, and CINAHL through June 7, 2021. STUDY SELECTION AND DATA EXTRACTION Studies with a couples-based intervention assessing postpartum contraceptive uptake. Two independent reviewers screened studies, extracted data, and assessed risk of bias with RoB-2 (Cochrane Risk of Bias 2) for randomized and ROBINS-I (Risk of Bias in Non-Randomized Studies - Interventions) for observational studies. Data were synthesized in tables, figures, and a narrative review. RESULTS A total of 925 papers were identified, 66 underwent full text review, and 17 articles, which included 18 studies - 16 randomized, 2 observational - were included. The lack of intervention and outcome homogeneity precluded meta-analysis and isolating the effect of partner involvement. Four studies were partner-required, where partner involvement was a required component of the intervention, and 14 were partner-optional. Unadjusted risk differences ranged from 0.01 to 0.51 in favor of couples-based interventions increasing postpartum contraceptive uptake versus standard of care. Bias assessment of the 16 randomized studies classified 8, 3, and 5 studies as at a high, some concern, and low risk of bias. Common sources of bias included intervention non-adherence and missing outcome data. One observational study was at a high and the other at a low risk of bias. CONCLUSIONS Future studies that assess couples-based interventions must clearly define and measure how partners are involved in the intervention and assess how intervention adherence impacts postpartum contraceptive uptake.
Collapse
|
13
|
Bansal A, Shirisha P, Mahapatra B, Dwivedi LK. Role of maternal and child health services on the uptake of contraceptive use in India: A reproductive calendar approach. PLoS One 2022; 17:e0269170. [PMID: 35704629 PMCID: PMC9200305 DOI: 10.1371/journal.pone.0269170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 05/16/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND According to the latest round of National Family Health Survey-4 (NFHS (2015-16)) maternal and child health care (MCH) services improved drastically compared to NFHS-3. Previous studies have established that the uptake of MCH services increases the likelihood of early adoption of contraceptives among women. So, our study aims to examine if the early initiation of contraceptive has proportionately improved with the recent increase in MCH services. METHODS This study used the reproductive calendar of NFHS-4, 2015-16, to evaluate contraceptive initiation within 12 months after the last birth among 1,36,962 currently married women in India. A complementary log-log regression model was created to examine the link between the time of initiation of contraception and MCH care at the national level. RESULTS It was found that only a quarter of women within 12 months from last birth have adopted the modern contraceptive method. Among those majority of the females adopted sterilization mostly at the time of birth. The multivariable model identified, that the period of initiation of contraceptive depends on the gender composition of children and access to MCH services. It was found that the odds of early initiation of contraceptive use was higher when a women have only son (AOR = 1.15,95% CI- 1.22, 1.18) compared to women with only daughter. Also, it was found that women who have availed MCH services were more likely to adopt contraceptives earlier. CONCLUSION The number of women availing MCH services has increased in India, but it did not result in a proportional increase in initiation of contraception after childbirth. Facilitating family planning services alongside MCH services will be beneficial in low-resource settings. It is a golden opportunity to educate and encourage women for early adoption of contraceptive.
Collapse
Affiliation(s)
- Anjali Bansal
- International Institute for Population Sciences, Govandi East, Mumbai, India
| | - P. Shirisha
- Department of Humanities and Social Sciences, Humanities and Science Block, IIT Madras, Chennai, Tamil Nadu, India
| | | | - Laxmi Kant Dwivedi
- International Institute for Population Sciences, Govandi East, Mumbai, India
| |
Collapse
|
14
|
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.
Collapse
|
15
|
Tilahun T, Bekuma TT, Getachew M, Oljira R, Seme A. Barriers and determinants of postpartum family planning uptake among postpartum women in Western Ethiopia: a facility-based cross-sectional study. Arch Public Health 2022; 80:27. [PMID: 35022070 PMCID: PMC8753320 DOI: 10.1186/s13690-022-00786-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 01/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background Despite Ethiopia’s efforts to avail postpartum family planning (PPFP) services, the unmet need for family planning among postpartum women remains high. Therefore, this study is aimed to assess barriers and determinants of postpartum family-planning uptake among women visiting Maternal, Neonatal, and Child Health (MNCH) services in public health facilities of western Ethiopia. Methods A facility-based cross-sectional study design with a quantitative method was conducted on 989 postpartum women in Western Ethiopia from September 1 to October 30, 2020. Data were collected through face-to-face interviews using pretested structured questionnaires, entered using EPI-INFO version 7.0, and analyzed by SPSS version 25. Descriptive analysis and logistic regressions were performed. The adjusted odds ratio with a 95% confidence interval was used and statistical significance was declared at P-value < 0.05. Result In this study, 56.1% of participants had used PPFP in the last year. The most commonly used method was injectable (51.7%). Family planning use before the index pregnancy (AOR = 2.09;95%CI:1.29,3,41),counselling on PPFP during antenatal care and delivery (AOR = 4.89;95%CI:2.31,10.37),health facility delivery (AOR = 7.61;95%CI:4.36,13.28), skilled birth attendance (AOR = 4.99;95%CI:2.88,8.64),COVID-19 restrictions (AOR = 0.59;95%CI:0.39,0.90) were factors associated with PPFP utilization. Being breastfeeding and amenorrhea were major reasons for not using postpartum family planning. Conclusion Post-partum family planning utilization among study participants was low. Given the associated factors, it is recommended that health facilities should make postpartum family planning one of their top priorities and focus on these factors to improve its utilization.
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
Sarfraz M, Hamid S, Rawstorne P, Ali M, Jayasuriya R. Role of social network in decision making for increasing uptake and continuing use of long acting reversible (LARC) methods in Pakistan. Reprod Health 2021; 18:96. [PMID: 34001169 PMCID: PMC8130116 DOI: 10.1186/s12978-021-01149-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/05/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Despite evidence from recent Demographic Health Surveys that show 98% of the adult Pakistani population have an awareness of at least one modern contraceptive method, only 25% of married couples in Pakistan used a modern method of contraception. Of the modern contraceptive methods, LARC usage has increased only from 2.1 to 3%. This low uptake is puzzling in the context of high awareness of LARC methods and its availability through public sector facilities at subsidized costs. This study aimed to understand the social influences in initiating and continuing use of an LARC methods for contraception in a rural setting in Pakistan. METHODS In-depth interviews were conducted with 27 women who were using a LARC method for contraception. Data was managed using NVivo 12 and themes were identified using a content analysis approach to analyze the transcripts. RESULTS Four key themes, supported by sub-themes relating to a temporal model, were identified to explain women's experiences with initiating and continuing use of a LARC. The themes were (i) Use of trusted networks for information on LARCs; (ii) Personal motivation and family support in decision to use LARC; (iii) Choice of LARC methods and access to providers; and (iv) Social and professional support instrumental in long term use of LARC. Results highlight the significant role of immediate social network of female family members in supporting the women in initiating LARCs and maintaining the method's use. CONCLUSION This study contributes to an in depth understanding of the decision-making process of women who adopted LARC and maintained its use. Women who proceeded to use an LARC and who persisted with its use despite the experience of side effects and social pressures, were able to do so with support from other female family members and spouse.
Collapse
Affiliation(s)
| | - Saima Hamid
- Health Services Academy, Islamabad, Pakistan
- Fatima Jinnah Women University, Rawalpindi, Pakistan
| | - Patrick Rawstorne
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Moazzam Ali
- Department of Sexual and Reproductive Health, World Health Organization, Geneva, Switzerland
| | - Rohan Jayasuriya
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| |
Collapse
|
19
|
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.
Collapse
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
| | | | | |
Collapse
|
20
|
El Weshahi HMT, Galal AF, Sultan EA. Providers' perspectives of socio-cultural and health service challenges related to postpartum family planning in Alexandria, Egypt. J Egypt Public Health Assoc 2021; 96:5. [PMID: 33595785 PMCID: PMC7889777 DOI: 10.1186/s42506-020-00066-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 12/17/2020] [Indexed: 11/25/2022]
Abstract
Background Postpartum family planning (PPFP) focuses on prevention of unintended pregnancy and closely spaced pregnancies through the first 12 months following childbirth. Adoption of family planning during the postpartum period in Egypt faces unique challenges. This study aimed to explore the socio-cultural and health service challenges related to PPFP in Alexandria, Egypt, from perspectives of family planning providers working in public settings. Methods Three focus group discussions were conducted in the period from May to July 2017. It included 32 family planning physicians working in the family health centers and maternal and child health centers in Alexandria for 3 years or more. A discussion guide was prepared. Analysis of data was done using thematic data analysis using a deductive approach. Results The working experience of participants ranged from 3 to 30 years. The most frequently reported reasons for unmet need for PPFP were cultural norms about the contraceptive effects of lactation and inaccurate knowledge of women about the conditions for appropriate use of the lactation amenorrhea as a contraceptive method. The most commonly cited challenge related to the quality of service was the inadequate health education services about PPFP. Lack of training and supervision of community health workers was one of the underlying causes of the perceived inadequacy of the service. Conclusions Mass media campaigns advocating for family planning are urgently needed with full support from the government. Improvement of health education services is a must. Redistribution of family planning providers with an increase in the staff members is highly recommended.
Collapse
Affiliation(s)
| | - Ahmed Fawzy Galal
- Obstetrics and Gynecology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Eman Anwar Sultan
- Community Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| |
Collapse
|
21
|
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.
Collapse
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
| |
Collapse
|
22
|
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.
Collapse
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
| |
Collapse
|
23
|
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.
Collapse
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
| | | |
Collapse
|
24
|
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.
Collapse
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
| |
Collapse
|
25
|
Dev R, Kohler P, Feder M, Unger JA, Woods NF, Drake AL. A systematic review and meta-analysis of postpartum contraceptive use among women in low- and middle-income countries. Reprod Health 2019; 16:154. [PMID: 31665032 PMCID: PMC6819406 DOI: 10.1186/s12978-019-0824-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 10/09/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Short birth intervals increase risk for adverse maternal and infant outcomes including preterm birth, low birth weight (LBW), and infant mortality. Although postpartum family planning (PPFP) is an increasingly high priority for many countries, uptake and need for PPFP varies in low- and middle-income countries (LMIC). We performed a systematic review and meta-analysis to characterize postpartum contraceptive use, and predictors and barriers to use, among postpartum women in LMIC. METHODS PubMed, EMBASE, CINAHL, PsycINFO, Scopus, Web of Science, and Global Health databases were searched for articles and abstracts published between January 1997 and May 2018. Studies with data on contraceptive uptake through 12 months postpartum in low- and middle-income countries were included. We used random-effects models to compute pooled estimates and confidence intervals of modern contraceptive prevalence rates (mCPR), fertility intentions (birth spacing and birth limiting), and unmet need for contraception in the postpartum period. RESULTS Among 669 studies identified, 90 were selected for full-text review, and 35 met inclusion criteria. The majority of studies were from East Africa, West Africa, and South Asia/South East Asia. The overall pooled mCPR during the postpartum period across all regions was 41.2% (95% CI: 15.7-69.1%), with lower pooled mCPR in West Africa (36.3%; 95% CI: 27.0-45.5%). The pooled prevalence of unmet need was 48.5% (95% CI: 19.1-78.0%) across all regions, and highest in South Asia/South East Asia (59.4, 95% CI: 53.4-65.4%). Perceptions of low pregnancy risk due to breastfeeding and postpartum amenorrhea were commonly associated with lack of contraceptive use and use of male condoms, withdrawal, and abstinence. Women who were not using contraception were also less likely to utilize maternal and child health (MCH) services and reside in urban settings, and be more likely to have a fear of method side effects and receive inadequate FP counseling. In contrast, women who received FP counseling in antenatal and/or postnatal care were more likely to use PPFP. CONCLUSIONS PPFP use is low and unmet need for contraception following pregnancy in LMIC is high. Tailored counseling approaches may help overcome misconceptions and meet heterogeneous needs for PPFP.
Collapse
Affiliation(s)
- Rubee Dev
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, Guangdong China
| | - Pamela Kohler
- Department of Psychosocial and Community Health & Department of Global Health, University of Washington, Seattle, WA USA
| | | | - Jennifer A. Unger
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA USA
| | - Nancy F. Woods
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA USA
| | - Alison L. Drake
- Department of Global Health, University of Washington, Seattle, WA USA
| |
Collapse
|
26
|
Dulli L. Mobile Technology for Sexual and Reproductive Health Interventions in Low- and Middle-Income Countries. Am J Public Health 2019; 109:836-837. [PMID: 31067087 DOI: 10.2105/ajph.2019.305094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Lisa Dulli
- Lisa Dulli is with the Division of Health Services Research, Program Sciences and Technical Support Department, Family Health International (FHI 360), Durham, NC
| |
Collapse
|
27
|
Ingabire R, Nyombayire J, Hoagland A, Da Costa V, Mazzei A, Haddad L, Parker R, Sinabamenye R, Mukamuyango J, Smith J, Umutoni V, Mork E, Allen S, Karita E, Wall KM. Evaluation of a multi-level intervention to improve postpartum intrauterine device services in Rwanda. Gates Open Res 2019; 2:38. [PMID: 30569036 DOI: 10.12688/gatesopenres.12854.2] [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] [Accepted: 10/05/2018] [Indexed: 11/20/2022] Open
Abstract
Background. The copper intrauterine device is one of the most safe, effective, and cost-effective methods for preventing unintended pregnancy. It can be used postpartum irrespective of breastfeeding to improve birth spacing and reduce unintended pregnancy and maternal-child mortality. However, this method remains highly underutilized. Methods. We developed a multi-level intervention to increase uptake of the postpartum intrauterine device (PPIUD, defined as insertion up to six weeks post-delivery) in Kigali, Rwanda. High-volume hospitals and health centers were selected for implementation of PPIUD counseling and service delivery. Formative work informed development of a PPIUD counseling flipchart to be delivered during antenatal care, labor and delivery, infant vaccination visits, or in the community. Two-day didactic counseling, insertion/removal, and follow-up trainings were provided to labor and delivery and family planning nurses followed by a mentored practicum certification process. Counseling data were collected in government clinic logbooks. Insertions and follow-up data were collected in logbooks created for the implementation. Data were collected by trained government clinic staff and abstracted/managed by study staff. Stakeholders were involved from intervention development through dissemination of results. Results. Two hospitals (and their two associated health centers) and two additional health centers were selected. In 6-months prior to our intervention, 7.7 PPIUDs/month were inserted on average at the selected facilities. From August 2017-July 2018, we trained 83 counselors and 39 providers to provide PPIUD services. N=9,020 women received one-on-one PPIUD counseling after expressing interest in family planning who later delivered at a selected health facility. Of those, n=2,575 had PPIUDs inserted (average of 214.6 insertions/month), a 29% uptake. Most PPIUDs (62%) were inserted within 10 minutes of delivery of the placenta. Conclusions. This successful, comprehensive intervention has the potential to make a significant impact on PPIUD uptake in Rwanda. The intervention is scalable and adaptable to other sub-Saharan African countries.
Collapse
Affiliation(s)
- Rosine Ingabire
- Projet San Francisco, Pathology & Laboratory Medicine, Emory University, Kigali, Rwanda
| | - Julien Nyombayire
- Projet San Francisco, Pathology & Laboratory Medicine, Emory University, Kigali, Rwanda
| | - Alexandra Hoagland
- Projet San Francisco, Pathology & Laboratory Medicine, Emory University, Kigali, Rwanda
| | - Vanessa Da Costa
- Pathology & Laboratory Medicine, Emory University, Atlanta, GA, 30322, USA
| | - Amelia Mazzei
- Projet San Francisco, Pathology & Laboratory Medicine, Emory University, Kigali, Rwanda
| | - Lisa Haddad
- Gynecology and Obstetrics, Emory University, Atlanta, GA, 30322, USA
| | - Rachel Parker
- Pathology & Laboratory Medicine, Emory University, Atlanta, GA, 30322, USA
| | - Robertine Sinabamenye
- Projet San Francisco, Pathology & Laboratory Medicine, Emory University, Kigali, Rwanda
| | - Jeannine Mukamuyango
- Projet San Francisco, Pathology & Laboratory Medicine, Emory University, Kigali, Rwanda
| | - Julie Smith
- Pathology & Laboratory Medicine, Emory University, Atlanta, GA, 30322, USA
| | - Victoria Umutoni
- Pathology & Laboratory Medicine, Emory University, Atlanta, GA, 30322, USA
| | - Ellen Mork
- Health Policy and Management, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Susan Allen
- Pathology & Laboratory Medicine, Emory University, Atlanta, GA, 30322, USA
| | - Etienne Karita
- Projet San Francisco, Pathology & Laboratory Medicine, Emory University, Kigali, Rwanda
| | - Kristin M Wall
- Pathology & Laboratory Medicine, Emory University, Atlanta, GA, 30322, USA.,Epidemiology, Emory University, Atlanta, GA, 30322, USA
| |
Collapse
|
28
|
Ingabire R, Nyombayire J, Hoagland A, Da Costa V, Mazzei A, Haddad L, Parker R, Sinabamenye R, Mukamuyango J, Smith J, Umutoni V, Mork E, Allen S, Karita E, Wall KM. Evaluation of a multi-level intervention to improve postpartum intrauterine device services in Rwanda. Gates Open Res 2019; 2:38. [PMID: 30569036 PMCID: PMC6266741 DOI: 10.12688/gatesopenres.12854.3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2019] [Indexed: 11/20/2022] Open
Abstract
Background. The copper intrauterine device is one of the most safe, effective, and cost-effective methods for preventing unintended pregnancy. It can be used postpartum irrespective of breastfeeding to improve birth spacing and reduce unintended pregnancy and maternal-child mortality. However, this method remains highly underutilized. Methods. We developed a multi-level intervention to increase uptake of the postpartum intrauterine device (PPIUD, defined as insertion up to six weeks post-delivery) in Kigali, Rwanda. High-volume hospitals and health centers were selected for implementation of PPIUD counseling and service delivery. Formative work informed development of a PPIUD counseling flipchart to be delivered during antenatal care, labor and delivery, infant vaccination visits, or in the community. Two-day didactic counseling, insertion/removal, and follow-up trainings were provided to labor and delivery and family planning nurses followed by a mentored practicum certification process. Counseling data were collected in government clinic logbooks. Insertions and follow-up data were collected in logbooks created for the implementation. Data were collected by trained government clinic staff and abstracted/managed by study staff. Stakeholders were involved from intervention development through dissemination of results. Results. Two hospitals (and their two associated health centers) and two additional health centers were selected. In 6-months prior to our intervention, 7.7 PPIUDs/month were inserted on average at the selected facilities. From August 2017-July 2018, we trained 83 counselors and 39 providers to provide PPIUD services. N=9,020 women received one-on-one PPIUD counseling after expressing interest in family planning who later delivered at a selected health facility. Of those, n=2,575 had PPIUDs inserted (average of 214.6 insertions/month), a 29% uptake. Most PPIUDs (62%) were inserted within 10 minutes of delivery of the placenta. Conclusions. This successful, comprehensive intervention has the potential to make a significant impact on PPIUD uptake in Rwanda. The intervention is scalable and adaptable to other sub-Saharan African countries.
Collapse
Affiliation(s)
- Rosine Ingabire
- Projet San Francisco, Pathology & Laboratory Medicine, Emory University, Kigali, Rwanda
| | - Julien Nyombayire
- Projet San Francisco, Pathology & Laboratory Medicine, Emory University, Kigali, Rwanda
| | - Alexandra Hoagland
- Projet San Francisco, Pathology & Laboratory Medicine, Emory University, Kigali, Rwanda
| | - Vanessa Da Costa
- Pathology & Laboratory Medicine, Emory University, Atlanta, GA, 30322, USA
| | - Amelia Mazzei
- Projet San Francisco, Pathology & Laboratory Medicine, Emory University, Kigali, Rwanda
| | - Lisa Haddad
- Gynecology and Obstetrics, Emory University, Atlanta, GA, 30322, USA
| | - Rachel Parker
- Pathology & Laboratory Medicine, Emory University, Atlanta, GA, 30322, USA
| | - Robertine Sinabamenye
- Projet San Francisco, Pathology & Laboratory Medicine, Emory University, Kigali, Rwanda
| | - Jeannine Mukamuyango
- Projet San Francisco, Pathology & Laboratory Medicine, Emory University, Kigali, Rwanda
| | - Julie Smith
- Pathology & Laboratory Medicine, Emory University, Atlanta, GA, 30322, USA
| | - Victoria Umutoni
- Pathology & Laboratory Medicine, Emory University, Atlanta, GA, 30322, USA
| | - Ellen Mork
- Health Policy and Management, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Susan Allen
- Pathology & Laboratory Medicine, Emory University, Atlanta, GA, 30322, USA
| | - Etienne Karita
- Projet San Francisco, Pathology & Laboratory Medicine, Emory University, Kigali, Rwanda
| | - Kristin M Wall
- Pathology & Laboratory Medicine, Emory University, Atlanta, GA, 30322, USA.,Epidemiology, Emory University, Atlanta, GA, 30322, USA
| |
Collapse
|
29
|
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.
Collapse
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
| |
Collapse
|
30
|
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.
Collapse
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.
| |
Collapse
|
31
|
Ingabire R, Nyombayire J, Hoagland A, Da Costa V, Mazzei A, Haddad L, Parker R, Sinabamenye R, Mukamuyango J, Smith J, Umutoni V, Mork E, Allen S, Karita E, Wall KM. Evaluation of a multi-level intervention to improve post-partum intrauterine device services in Rwanda. Gates Open Res 2018. [DOI: 10.12688/gatesopenres.12854.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background. The copper intrauterine device is one of the most safe, effective, and cost-effective methods for preventing unintended pregnancy. It can be used post-partum irrespective of breastfeeding to improve birth spacing and reduce unintended pregnancy and maternal-child mortality. However, this method remains highly underutilized. Methods. We developed a multi-level intervention targeting supply, demand, and sustainability to increase uptake of the post-partum intrauterine device (PPIUD, defined as insertion up to six weeks post-delivery) in Kigali, Rwanda. High-volume hospitals and health centers were selected for implementation of promotions and service delivery. Formative work informed development of a PPIUD promotional flipchart delivered in-clinic (during antenatal care, labor and delivery, or infant vaccination visits) or in the community. Two-day PPIUD didactic counseling, insertion/removal, and follow-up trainings were provided to labor and delivery and family planning nurses followed by a mentored practicum certification process. Stakeholders were involved from intervention development through dissemination of results. Results. Two hospitals (and their two associated health centers) and two health centers were selected. In the 6-months prior to our intervention, only one nurse and one midwife from each hospital were providing PPIUD services, and just 46 PPIUDs had been placed at the selected health facilities. From August 2017-July 2018, we trained 83 promotional agents and 39 providers to provide PPIUD services. N=9,073 women received PPIUD promotions who later delivered at a selected health facility, and of those n=2,633 had PPIUDs inserted (29% uptake). Most PPIUDs (60%) were inserted within 10 minutes of delivery of the placenta, with an additional 13% intra-cesarean, 17% between 10 minutes and 48 hours after delivery, and 8% between 4 and 6 weeks after delivery. Conclusions. This successful, comprehensive intervention has the potential to make a significant impact on PPIUD uptake in Rwanda. The intervention is scalable and adaptable to other sub-Saharan African countries.
Collapse
|
32
|
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).
Collapse
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
| |
Collapse
|
33
|
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.
Collapse
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
| |
Collapse
|
34
|
Tokhi M, Comrie-Thomson L, Davis J, Portela A, Chersich M, Luchters S. Involving men to improve maternal and newborn health: A systematic review of the effectiveness of interventions. PLoS One 2018; 13:e0191620. [PMID: 29370258 PMCID: PMC5784936 DOI: 10.1371/journal.pone.0191620] [Citation(s) in RCA: 199] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 01/08/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Emerging evidence and program experience indicate that engaging men in maternal and newborn health can have considerable health benefits for women and children in low- and middle-income countries. Previous reviews have identified male involvement as a promising intervention, but with a complex evidence base and limited direct evidence of effectiveness for mortality and morbidity outcomes. OBJECTIVE To determine the effect of interventions to engage men during pregnancy, childbirth and infancy on mortality and morbidity, as well as effects on mechanisms by which male involvement is hypothesised to influence mortality and morbidity outcomes: home care practices, care-seeking, and couple relationships. METHODS Using a comprehensive, highly sensitive mapping of maternal health intervention studies conducted in low- and middle-income countries between 2000 and 2012, we identified interventions that have engaged men to improve maternal and newborn health. Primary outcomes were care-seeking for essential services, mortality and morbidity, and home care practices. Secondary outcomes relating to couple relationships were extracted from included studies. RESULTS Thirteen studies from nine countries were included. Interventions to engage men were associated with improved antenatal care attendance, skilled birth attendance, facility birth, postpartum care, birth and complications preparedness and maternal nutrition. The impact of interventions on mortality, morbidity and breastfeeding was less clear. Included interventions improved male partner support for women and increased couple communication and joint decision-making, with ambiguous effects on women's autonomy. CONCLUSION Interventions to engage men in maternal and newborn health can increase care-seeking, improve home care practices, and support more equitable couple communication and decision-making for maternal and newborn health. These findings support engaging men as a health promotion strategy, although evidence gaps remain around effects on mortality and morbidity. Findings also indicate that interventions to increase male involvement should be carefully designed and implemented to mitigate potential harmful effects on couple relationship dynamics.
Collapse
Affiliation(s)
- Mariam Tokhi
- Burnet Institute, Melbourne, Victoria, Australia
| | - Liz Comrie-Thomson
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Uro-gynaecology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- * E-mail:
| | | | - Anayda Portela
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Matthew Chersich
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Stanley Luchters
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, International Centre for Reproductive Health (ICRH), Ghent University, Ghent, Belgium
| |
Collapse
|