Expanding Access to the Intrauterine Device in Public Health Facilities in Ethiopia: A Mixed-Methods Study

Tefera, Bekele; Mehta, Sarah; Zerihun, Habtamu; Lew, Candace; Brooks, Mohamad I.; Nigatu, Tariku; Hagos, Kidest Lulu; Asnake, Mengistu; Tasissa, Adeba; Ali, Seid; Desalegn, Ketsela; Adane, Girmay

doi:10.9745/ghsp-d-15-00365

Cited by 17 publications

(37 citation statements)

References 13 publications

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“…Despite the lack of removal services by HEWs, the monitoring data indicated that implants were the most commonly accepted MCM among post partum mothers that brought a child for immunisation at health posts in Assosa during the study period. Similar ndings have been documented in other studies within the context of Ethiopia (41). In this study, HEWs expressed concerns about women having to travel far distances and incur costs to access larger health facilies where implant removals are carried out.…”

Section: Perceptions Of Key Actorssupporting

confidence: 86%

What mechanisms drive uptake of family planning when integrated with childhood immunisation in Ethiopia? A realist evaluation

Krishnaratne

Hamon

Hoyt

et al. 2020

Preprint

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Background: Maternal and child health are key priorities among the Sustainable Development Goals , which include a particular focus on reducing morbidity and mortality among women of reproductive age, newborns, and children under the age of five. Two key components of maternal and child health are family planning (FP) and immunisation. Providing these services through an integrated delivery system could increase the uptake of vaccines and modern contraceptive methods (MCMs) particularly during the post-partum period. Methods: A realist evaluation was conducted in two woredas in Ethiopia to determine the key mechanisms and their triggers that drive successful implementation and service uptake of an intervention of integrated delivery of immunisations and FP. This evaluation included the: 1) development of an initial programme theory; 2) review of relevant published theories; 3) analysis of project monitoring data; 4) analysis of qualitative data from 23 semi-structured interviews to determine key mechanisms and drivers; and 5) development of a revised programme theory comprised of context-mechanism-actor-outcome and context-mechanism-intervention-actor-outcome configurations based on empirical findings. Results: The proportion of women who brought their children for immunisation and received MCMs was 63.0% (4,260/6,764) overall [74.3% (2,944/3,961) in Assosa woreda and 46.9% (1,316/2,803) in Bambasi woreda]. Key contextual factors identified were: a strong belief in values among religious leaders and community members that challenged FP; a lack of support for FP from male partners based on religious values; and the use of trained Health Extension Workers (HEWs) to deliver FP services. Within these contexts, intervention components that focused on the alignment of religious texts with FP, the promotion of FP by religious leaders, and the training of HEWs and health care workers on FP counselling and service delivery, influenced the implementation of the intervention and triggered several mechanisms of acceptability, access, and adoption of innovations. Conclusions: Linking context and intervention components to the mechanisms they triggered helped explain the intervention outcomes, and more broadly how and for who the intervention worked. This enabled the development of a programme theory that could be used to inform the integrated delivery of FP services in similar contexts.

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Section: Perceptions Of Key Actorssupporting

confidence: 86%

What mechanisms drive uptake of family planning when integrated with childhood immunisation in Ethiopia? A realist evaluation

Krishnaratne

Hamon

Hoyt

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…A total of 14 publications reported on projects for the general population [27][28][29][30][31][32][33][34][35][36][37][38][39][40]. The most common approach to promote IUD use in the general population is the simple one of training and supporting providers together with demand-creation activities.…”

Section: Programs For General Populationsmentioning

confidence: 99%

“…Given the number of trained providers, the 2400 IUD insertions in 2011 were small, though implant acceptors in the same year were much more numerous (17,000). As part of another large private-public collaboration in Ethiopia, this time involving Pathfinder, providers in 738 facilities were trained in IUD insertion [38]. Before-after analysis of records in 40 facilities showed that IUD's share of method-acceptance rose from less than 1% to 5.7%, implying three to four insertions per facility-day at endline.…”

Section: Programs For General Populationsmentioning

confidence: 99%

The promotion of intrauterine contraception in low- and middle-income countries: a narrative review

et al. 2017

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The evidence base is weak and offers few lessons on what strategies are most effective. The overall impression is that IUD use can be increased in a variety of ways but that progress is hampered by persistent adverse perceptions by both providers and potential clients. Provider enthusiasm is a key to success. The lack of a population impact stems in part from the fact that nearly all interventions are initiated by international organizations, with limited national reach except in small countries, rather than by government agencies.

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“…The data was collected using a structured questionnaire developed based on existing literature, previous experience on questionnaire preparation on Postpartum intrauterine contraceptive devices (PPIUCD) research [25,26], and through discussion with subject area experts. The questionnaire consists of three sub-sections designed to assess: 1) sociodemographic characteristics of women; 2) women's experience on health education and counseling on IPPFP during their stay in the MWHs; and 3) practice of health service utilization during pregnancy and birth (e.g., delivery complication, mode of delivery) and utilization of IPPFP.…”

Section: Data Collection Processmentioning

confidence: 99%

Utilization of Maternity Waiting Homes to Increase Uptake of Immediate Postpartum Family Planning in Primary Health Care Facilities in Ethiopia

Asnake

Tefera

Tilahun

et al. 2020

Preprint

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Background: Maternity waiting home (MWH) within primary health care facilities is an ideal platform to reach women with family planning education and counseling. MWH users interact with health care providers on a regular basis throughout their waiting period and can prepare to initiate family planning method of their choice immediately after childbirth. However, to date, there has been no clear evidence about the use of MWHs to increase uptakes of immediate postpartum family planning (IPPFP). Therefore, the aim of this study is to assess the contribution of MWHs to increase IPPFP uptake among women who deliver in health facilities in Ethiopia.Methods: A comparative cross-sectional study design was conducted to collect quantitative data from women who gave birth in the past 12 months. Multi-stage random sampling procedures were employed to select 884 women. Descriptive summary and logistic regression with 95% confidence intervals were conducted in Stata 14 to analyze the data.Result: The prevalence of IPPFP use among women who used MWHs was 44% and 36% among those who did not use MWHs. The use of MWHs significantly contributed to increase immediate postpartum family planning uptake (OR = 1.48, 95% CI = 1.08- 2.04, p=.016).Conclusions: This study showed that, MWHs significantly contributed for improving IPPFP uptake by an average of 8%-point difference for beneficiaries within 48 hours after delivery. Developing a comprehensive package of service for maternal care has the potential to improve family planning uptake of postpartum women. Women’s who have used maternity waiting home more likely utilized postpartum family planning than women who have not used maternity waiting home. Providing a comprehensive package of services, including family planning information and counseling, in maternity waiting homes can have a positive impact on improving postpartum family planning use.

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Expanding Access to the Intrauterine Device in Public Health Facilities in Ethiopia: A Mixed-Methods Study

Cited by 17 publications

References 13 publications

What mechanisms drive uptake of family planning when integrated with childhood immunisation in Ethiopia? A realist evaluation

What mechanisms drive uptake of family planning when integrated with childhood immunisation in Ethiopia? A realist evaluation

The promotion of intrauterine contraception in low- and middle-income countries: a narrative review

Utilization of Maternity Waiting Homes to Increase Uptake of Immediate Postpartum Family Planning in Primary Health Care Facilities in Ethiopia

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