The effect of antenatal counseling and intrauterine device insertion services on postpartum contraceptive use in Nepal: Results from a stepped-wedge randomized controlled trial

التفاصيل البيبلوغرافية
العنوان: The effect of antenatal counseling and intrauterine device insertion services on postpartum contraceptive use in Nepal: Results from a stepped-wedge randomized controlled trial
المؤلفون: Saugat Joshi, David Canning, Iqbal Shah, Mahesh Puri, Julia Rohr, Sarah Huber-Krum, Aayush Khadka, Dev Maharjan, Elina Pradhan
المصدر: Contraception. 101:384-392
بيانات النشر: Elsevier BV, 2020.
سنة النشر: 2020
مصطلحات موضوعية: Adult, Counseling, Postnatal Care, medicine.medical_specialty, Health Personnel, Prenatal care, Intrauterine device, Contraceptive counseling, law.invention, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Nepal, Randomized controlled trial, Pregnancy, law, Humans, Medicine, Maternal Health Services, 030212 general & internal medicine, 030219 obstetrics & reproductive medicine, business.industry, Obstetrics, Postpartum Period, Obstetrics and Gynecology, Contraception, Contraceptive use, Reproductive Medicine, Sterilization (medicine), Family planning, Family Planning Services, Female, business, Postpartum period, Intrauterine Devices
الوصف: Objective There is high unmet need for family planning in the postpartum period in Nepal. The current study assessed the effects of a contraceptive counseling and postpartum intrauterine device (PPIUD) insertion intervention on use of contraception in the postpartum period. Study design We utilized a cluster, stepped-wedge design to randomly assign two hospital clusters (compromised of six hospitals) to begin the intervention at time one or time two. From 2015 to 2017, women completed surveys after delivery but before discharge (n = 75,893), and then at one year and two years postpartum. We estimated the intent-to-treat effect of the intervention using weighted, linear probability models and the adherence-adjusted effect (antenatal counseling) using an instrumental variable approach. Outcomes included modern contraceptive use and method mix measured at one and two years postpartum in a sample of 19,298 women (year I follow-up sample) and a sample of 19,248 women (year II follow-up sample). We used inverse probability weights to adjust for incomplete follow-up and bootstrap methods to give correct causal inference with the small number of six clusters. Results The intervention increased use of modern contraceptives by 3.8 percentage points [95% CI: −0.1, 9.5] at one-year postpartum, but only 0.3 percentage points [95% CI: −3.7, 4.1] at two years. The intervention significantly increased the use of PPIUDs at one year and two years postpartum, but there was less use of sterilization. Only 42% of women were counseled during the intervention period. The adherence-adjusted effects (antenatal counseling) were four times larger than the intent-to-treat effects. Conclusions Providing counseling during the antenatal period and PPIUD services in hospitals increased use of PPIUDs in the one- and two-year postpartum period and shifted the contraceptive method mix. Implications In order for antenatal counseling to increase postpartum contraceptive use, counseling may need to be provided in a wider range of prenatal care settings and at multiple time points. Healthcare providers should be trained on contraceptive counseling and PPIUD insertion, with the goal of expanding the available method mix and meeting postpartum women’s contraceptive needs.
تدمد: 0010-7824
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::9e499688ba808e30238a6193b95557cbTest
https://doi.org/10.1016/j.contraception.2019.12.014Test
حقوق: CLOSED
رقم الانضمام: edsair.doi.dedup.....9e499688ba808e30238a6193b95557cb
قاعدة البيانات: OpenAIRE