Increasing IUD and Implant Use Among Those at Risk of a Subsequent Preterm Birth: A Randomized Controlled Trial of Postpartum Contraceptive Counseling

Torres, Leah; Turok, David K.; Clark, Erin A.S.; Sanders, Jessica N.; Godfrey, Emily M.

doi:10.1016/j.whi.2018.05.003

Cited by 9 publications

(6 citation statements)

References 14 publications

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“…Among women of all ages, additional antenatal or postpartum counselling was associated with increased postpartum use in two RCTs and one non-randomised study in Nepal, 63 Nigeria 64 and Turkey, 65 but tailored antenatal counselling did not increase use in the UK, China or South Africa. 66 Structured counselling increased LARC uptake after a preterm birth in the USA, 67 and counselling on lactational amenorrhea increased modern method use by 10% 1 year postpartum in Brazil. 68 Physician counselling was associated with higher satisfaction in a RCT in the USA, 69 but did not increase postpartum use in Turkey, 70 compared with leaflet/video counselling.…”

Section: Resultsmentioning

confidence: 99%

A systematic review of the effectiveness of counselling strategies for modern contraceptive methods: what works and what doesn’t?

Cavallaro

Beňová

Owolabi

et al. 2019

BMJ Sex Reprod Health

101

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AimThe aim of this systematic review was to synthesise the evidence on the comparative effectiveness of different counselling strategies for modern contraception on contraceptive behaviour and satisfaction, and to examine their advantages and disadvantages.MethodsSix electronic databases (Medline, Embase, Global Health, Popline, CINAHL Plus, and Cochrane Library) were searched to identify publications comparing two or more contraceptive counselling strategies and reporting quantitative results on contraceptive use, uptake, continuation or switching, or client satisfaction. Studies of women or couples from any country, published in English since 1990 were considered.ResultsA total of 63 publications corresponding to 61 studies met the inclusion criteria. There was substantial heterogeneity in study settings, interventions and outcome measures. Interventions targeting women initiating a method (including structured counselling on side effects) tended to show positive effects on contraceptive continuation. In contrast, the majority of studies of provider training and decision-making tools for method choice did not find evidence of an effect. Additional antenatal or postpartum counselling sessions were associated with increased postpartum contraceptive use, regardless of their timing in pregnancy or postpartum. Dedicated pre-abortion contraceptive counselling was associated with increased use only when accompanied by broader contraceptive method provision. Male partner or couples counselling was effective at increasing contraceptive use in two of five studies targeting non-users, women initiating implants or seeking abortion. High-quality evidence is lacking for the majority of intervention types.ConclusionsThe evidence base and quality of studies are limited, and further research is needed to determine the effectiveness of many counselling interventions in different settings.

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Section: Resultsmentioning

confidence: 99%

A systematic review of the effectiveness of counselling strategies for modern contraceptive methods: what works and what doesn’t?

Cavallaro

Beňová

Owolabi

et al. 2019

BMJ Sex Reprod Health

101

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show abstract

“…The data in these studies suggest uptake increases with increased preventive screening, contraceptive awareness, availability, and/or coverage, especially when integrated into routine healthcare. Structured counseling before discharge in an inpatient setting also increases modern contraceptive method uptake among postpartum women [13]. Other studies in lower-resourced settings demonstrated that providing vouchers to women individually and/or to their spouses to facilitate free access to family planning services improves contraceptive uptake and use [14,15].…”

Section: Introductionmentioning

confidence: 99%

Provision of family planning vouchers and early initiation of postpartum contraceptive use among women living with HIV in southwestern Uganda: A randomized controlled trial

et al. 2019

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Background Unwanted pregnancies remain a burden for women living with HIV (WLWH). Family planning prevents unplanned pregnancies while promoting longer birth intervals, key strategies to eliminate perinatal transmission of HIV and promote maternal and child health. We evaluated the effect of a family planning voucher, inclusive of immediate postpartum counseling, on uptake, early initiation, and continuation of modern contraceptive methods among recently postpartum WLWH delivering at a publicly funded regional referral hospital in rural, southwestern Uganda. Methods and findings We performed a randomized controlled trial between October, 2016 and June, 2018 at a referral hospital in southwestern Uganda. This interim analysis includes adult WLWH randomized and enrolled equally to receive a family planning voucher or standard of care (control). Enrolled postpartum WLWH completed an interviewer-administered questionnaire at enrollment and 6 months postpartum. Our primary outcome of interest for this analysis is initiation of a modern family planning method within 8 weeks postpartum. Secondary outcomes included family planning initiation at 12, 14, 16, and 20 weeks postpartum, family planning discontinuation and/or change, pregnancy incidence, and mean time without contraception. The trial was registered with clinicaltrials.gov (NCT02964169). At enrollment, half of the women in both the voucher (N = 87, 55%) and control (N = 86, 54%) groups wanted to have a child in 2 years postpartum. Over 80% of referent pregnancies in the voucher (N = 136, 86%) and control (N = 128, 81%) groups were planned. All women were accessing ART. The mean CD4 count was 396 cells/mm 3 (SD = 61) for those enrolled in the control group versus 393 cells/mm 3 (SD = 64) in the family planning voucher group. By 8 weeks postpartum, family planning was initiated in 144 (91%) participants in the voucher group and 83 (52%) participants in the control group (odds ratio [OR] 9.42; CI 4.67–13.97, P < 0.001). We also found high family planning uptake rates for both groups, with higher rates among the intervention group at 12 weeks (OR 5.66; CI 2.65–12.12, P < 0.001), 14 weeks (OR 2.51; CI 1.31–4.79, P < 0.001), 16 weeks (OR 4.02; CI 1.66–9.77, P = 0.001), and 20 weeks (OR 3.65; CI 1.40–9.47, P = 0.004) postpartum. The average time to family planning initiation was reduced to 5.9 weeks (SD = 2.4) for those in the voucher group compared to 9.3 weeks (SD = 5) in the control ( P < 0.001). One pregnancy was recorded in the group receiving standard of care; none were reported in the voucher group. Method mix did not differ by group: injectables were selected by most women (N = 150, 50%), and 52% of this proportion were in the experimental arm, with <10% in each arm selecting condoms, oral contracepti...

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“…[25][26][27] Prenatal and postpartum contraception counseling appears to be a consistent predictor in postpartum contraception use. 8,28,29 Prenatal care is also a positive predictor for postpartum follow-up. Women with less prenatal care or who begin prenatal visits later than 14 weeks gestation have a lower rate of postpartum follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…5,7 Less effective methods, including male condoms and withdrawal, have a higher probability of pregnancy annually, from 18 -28%. 5,8 In some settings, women can obtain immediate LARCs before hospital discharge, yet this option for contraception delivery has not been implemented fully across the country, including parts of Kansas. In one study of over 8,000 postpartum women at a single institution, less than one in four women who expressed interest in LARCs at the time of hospital discharge successfully obtained one by 90 days postpartum.…”

Section: Introductionmentioning

confidence: 99%

Initiation of Postpartum Contraception by 90 Days at a Midwest Academic Center

Eisenach

Uvodich

Wolff³

et al. 2020

kjm

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Introduction. Contraception is a critical component of addressing the health needs of women in the postpartum period. We assessed contraception initiation by 90 days postpartum at a large, academic medical center in the Midwest. Methods. In this retrospective cohort study, 299 charts were randomly sampled and 231 were analyzed from deliveries between May 1 to July 5, 2018. Contraceptive method, maternal demographics, and obstetric characteristics at hospital discharge were collected, as well as contraceptive method at the postpartum follow-up appointment. Methods and strata of contraception were categorized as follows: 1) highly effective methods (HEM) defined as sterilization, intrauterine device, or implant, 2) moderately effective methods (MEM) defined as injectable contraception, progestin-only pills, and combined estrogen/progestin pills, patches, and rings, and 3) less effective methods (LEM) defined as condoms, natural family planning, and lactational amenorrhea. Women lost to follow-up who had initiated a HEM or injectable contraception were coded as still using the method at 90 days. We used logistic regression to identity factors associated with HEM use. Results. Of the 231 included patients, 118 (51%) received contraception before hospital discharge and 166 (83%) by 90 days postpartum. Postpartum visits were attended by 74% (171/231) of patients. Before hospital discharge, 28% (65/231) obtained a HEM and 41% (82/200) were using a HEM by 90 days postpartum. Patients obtaining HEM or injectable contraception before hospital discharge attended a follow-up visit less often than those who did not receive HEM before discharge (RR = 0.68, 95% CI: 0.54 - 0.86, p ≤ 0.01). Conclusion. When readily available, many women will initiate contraception in the postpartum period. Health systems should work to ensure comprehensive access to contraception for women in the postpartum period.

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Increasing IUD and Implant Use Among Those at Risk of a Subsequent Preterm Birth: A Randomized Controlled Trial of Postpartum Contraceptive Counseling

Cited by 9 publications

References 14 publications

A systematic review of the effectiveness of counselling strategies for modern contraceptive methods: what works and what doesn’t?

A systematic review of the effectiveness of counselling strategies for modern contraceptive methods: what works and what doesn’t?

Provision of family planning vouchers and early initiation of postpartum contraceptive use among women living with HIV in southwestern Uganda: A randomized controlled trial

Initiation of Postpartum Contraception by 90 Days at a Midwest Academic Center

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