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

Abstract

BackgroundPostpartum 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.MethodsThis 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.DiscussionDesigning, 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 registrationRetrospectively registered in the Pan African Clinical Trials Registry (PACTR201609001784334, 27 September 2016).

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

“…The primary outcome was prevalence of use of modern contraceptives at month 12 post partum. We amended our original protocol 14 to extend the follow-up period from month 9 to month 12 post partum to allow for better comparability with other published research, after the initial funder's research grant deadline was chosen. This extension was approved by the ethics committees at WHO headquarters and country level.…”

“…The objective of our twin study was to assess the effect of a similar package on modern contraceptive prevalence in urban settings of Kinshasa province, Democratic Republic of the Congo, where poverty, hunger, and under development are important challenges. 10 Demographic and Health Survey data from DR Congo (2013- 14) show a country-wide median breastfeeding duration of 22 months (2 months of exclusive breastfeeding), a median post-partum sexual abstinence of 8 months, and median amenorrhoea duration of 13 months. 11 The median duration of birth intervals is 31 months, but 27% of babies are born less than 24 months after their previous sibling.…”

Discontinuation and Switching of Postpartum Contraceptive Methods Over Twelve Months in Burkina Faso and the DRC: A Secondary Analysis of the Yam-Daabo trial

“…The study had the statistical power to detect a 15-point difference between the intervention and control groups in terms of the proportion of women adopting an effective PPFP method at 6-month. In each country, 8 health centres were selected (4 intervention and 4 controls) for the study, and, taking into account the loss to follow-up, each centre had to include 70 women (refer to the published protocol [2]).…”

“…More than 70% of African countries have a prevalence rate of less than 50%, which is part of the reasons why maternal mortality is high in Africa [1]. To improve the use of postpartum contraceptive methods, in 2015, we implemented a set of interventions in two African countries, Burkina Faso and the Democratic Republic of Congo (DRC), and tested them in a cluster-randomized trial called Yam-Daabo described previously [2,3]. The main results showed a signi cant increase in the use of contraceptive methods among women receiving interventions compared to women in the control group in both countries [4,5].…”

Dynamics of Long-Acting and Reversible Contraceptive Adoption During the First Year Postpartum: A Secondary Analysis of the Yam Daabo Cluster Randomized-Controlled Trial in Burkina Faso and DR Congo

“…We performed a secondary analysis of the Yam Daabo study, which was a two-group, multi-intervention, single-blinded, cluster-randomized controlled trial with health centres as the randomization units.The study involved two countries: Burkina Faso and DR Congo. Methodological details on the Yam Daabo are available elsewhere [11].…”