Postpartum quality improvement strategy for increasing long-acting contraception uptake at a University Hospital in Haiti

Jean-Baptiste, Meredith Casella; Louis, Stéphanie; Millien, Christophe; Jeune, Erwine Dina; Sainterant, Ornella; Joseph, Jean Paul

doi:10.1136/bmjoq-2017-000204

Cited by 3 publications

(6 citation statements)

References 7 publications

(8 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Conversely, its lack of accessibility (eg, unavailable contraceptive methods, obligation to consult a health professional) may have dissuaded couples from using it 44,51,57,58 . Finally, the place of birth was associated with contraceptive use because women giving birth in a hospital seemed to choose most effective contraceptives such as LARCs more often 29,35,41,47,49,59 …”

Section: Resultsmentioning

confidence: 99%

Factors Influencing Contraceptive Choice During the Postpartum Period: A Qualitative Systematic Review

Robinet

Jeffredo

Clesse

2023

J Midwife Womens Health

View full text Add to dashboard Cite

Introduction The objective of this article is to identify the factors that influence the choice of contraceptive methods in the postpartum period. Methods We conducted a qualitative systematic review including articles published between 2000 and 2021 on postpartum contraception and its related influential factors. Relying on Preferred Reporting Items for Systematic Reviews and Meta‐Analyses and synthesis without meta‐analysis checklists, the search strategy relied on a combination of 2 lists of keywords applied to 9 databases. A bias assessment was carried out with the help of the Cochrane's randomized controlled trial tool, the checklist from Downs and Black, and Consolidated criteria for reporting qualitative research (CoreQ). A thematic analysis was performed to identify categories of influential factors. Results A total of 34 studies met our inclusion criteria and enabled us to isolate 4 categories of factors: (1) demographic and economic factors (geographic and ethnic origin, age, living environment, education/wealth), (2) clinical elements (parity, evolution of pregnancy, childbirth and afterwards, contraception used previously and its mechanism, pregnancy planning), (3) health care delivery (pregnancy monitoring, sessions about contraception, health care system, place of delivery), and (4) sociocultural factors (knowledge and beliefs about contraception, religion, the influence of family and society). The decision process related to postpartum contraception is influenced by a combination of socioenvironmental factors and clinical elements. Discussion The main influential factors (parity, level of education, knowledge and beliefs about contraception, and influence of family) need to be addressed by clinicians during consultations. Further multivariate research should provide quantitative data on this topic.

show abstract

Section: Resultsmentioning

confidence: 99%

Factors Influencing Contraceptive Choice During the Postpartum Period: A Qualitative Systematic Review

Robinet

Jeffredo

Clesse

2023

J Midwife Womens Health

View full text Add to dashboard Cite

show abstract

“…This new strategy produced an average improvement of Immediate postpartum LARCs from 5% to 32% of women delivering at the hospital, accepting a long-acting method (including bilateral tubal ligations) by the end of the project and which has proved sustainable at an average of 20% to date. 30 The study done in Kenya Nairobi in 2018, over 16 weeks, showed that the percentage of women using LARCs increased from 17% noted in the baseline study to 83%. The improvement is likely to have been due to the implementation of the options that were derived from the decision matrix.…”

Section: Discussionmentioning

confidence: 99%

Continuous quality improvement strategy for increasing immediate postpartum long-acting reversible contraceptive use at Jimma University Medical Center, Jimma, Ethiopia

et al. 2023

View full text Add to dashboard Cite

BackgroundEven though the immediate postpartum period is a golden time and a great opportunity to provide long-acting reversible contraceptives to prevent unintended pregnancy, its utilisation is very low in Ethiopia. Quality of care in postpartum long-acting reversible contraceptive provision is thought to be an issue for this low utilisation. Thus, continuous quality improvement intervention is necessary to increase the use of postpartum long-acting reversible contraceptives at Jimma University Medical Center.MethodA quality improvement intervention to offer long-acting reversible contraceptive methods to immediate postpartum women at Jimma University Medical Center was initiated in June 2019. To study the baseline prevalence of long-acting reversible contraceptive use at Jimma Medical Centre over 8 weeks, we reviewed postpartum family planning registration logbooks and patients’ charts. Based on the baseline data, the quality gaps were identified, prioritised and change ideas were generated and tested over another 8 weeks towards achieving the immediate postpartum long-acting reversible contraceptive prevalence target set.ResultThis new intervention resulted in an average increase in immediate postpartum long-acting reversible contraceptive methods use from 6.9% to 25.4% by the end of the project intervention. The major barriers to low long-acting reversible contraceptive use were lack of attention from hospital administrative staff and quality improvement teams on the provision of long-acting reversible contraceptives, lack of training of healthcare providers on postpartum contraception and unavailability of contraception commodities at each postpartum service delivery points.Conclusion and recommendationsThe immediate postpartum long-acting reversible contraceptive use at Jimma Medical Centre was increased by training of healthcare providers, availing contraception commodities through administrative staff involvement, weekly audit and feedback on contraception use. Thus, training of the newly hired healthcare providers on postpartum contraception, involvement of hospital administrative staff, regular audits and feedback on contraception use is necessary to increase postpartum long-acting reversible contraception uptake.

show abstract

Section: Discussionmentioning

confidence: 99%

“…To date, there were no QI initiatives conducted to improve the unmet need of PPTL. A QI initiative conducted to improve long-term contraception in postpartum women in Haiti proved successful by increasing the uptake from 5% to 32% [ 9 ]. Considering the effectiveness of this QI initiative in long-term contraception in postpartum and with the background of barriers to PPTL addressed in the earlier studies, we conducted the QI to improve the unmet need for PPTL.…”

Section: Discussionmentioning

confidence: 99%

“…Separate counseling sessions were organized in the antenatal clinics and beside the labor wards. About 50% of the women who were reluctant initially changed their minds after counseling [ 9 , 11 ]. A key rectifying measure would be to have a clinician inquest over the contraception desire during the course of pregnancy as 50% of desired women did not have a detailed discussion with the service provider [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A Prospective Quality Improvement Initiative to Address the Barriers to Postpartum Tubal Ligation Among Multiparous Women

Sarkar¹,

Panneer²,

Vanya³

et al. 2022

Cureus

View full text Add to dashboard Cite

Background: Unmet need for postpartum tubal ligation (PPTL) is still high in low-middle income countries. The commonly observed barriers are issues with the consent forms, non-availability of operation theater, lack of knowledge, patient desire for more children, partner opposition and social non-acceptance. Considering the unmet need and the barriers, this quality improvement (QI) initiative was conducted to increase the frequency of PPTL among multiparous women by 50% from baseline.Materials and methods: This QI was conducted at a tertiary care teaching hospital over a period of 18 months. The study consisted of three phases. Baseline observations during the pre-intervention phase over six months, intervention phase consisting of three Plan-Do-Study-Act (PDSA) cycles over 12 months and post-intervention surveillance phase over a period of three months. In the first PDSA cycle, hospital and provider barriers were focused on. The patient barrier was addressed in the second cycle. The barrier at the level of partner and family members was addressed in the third cycle.Results: The baseline prevalence of PPTL in the studied population over a period of six months was 30.2%. After the first PDSA cycle, the prevalence of PPTL performed increased from 30.2% to 49.5%. The prevalence increased to 68.8% after the second cycle. A further increase to 74.4% was observed after the third intervention. There was a satisfactory continuation rate of 72% at the end of the post-intervention followup phase conducted over four months.Conclusion: This QI initiative proved effective and sustainable over time. There was continuous motivation among the service providers to educate and counsel women for PPTL. Ultimately, we were able to address the low prevalence of PPTL through minor modifications in our hospital strategies.

show abstract

Postpartum quality improvement strategy for increasing long-acting contraception uptake at a University Hospital in Haiti

Cited by 3 publications

References 7 publications

Factors Influencing Contraceptive Choice During the Postpartum Period: A Qualitative Systematic Review

Factors Influencing Contraceptive Choice During the Postpartum Period: A Qualitative Systematic Review

Continuous quality improvement strategy for increasing immediate postpartum long-acting reversible contraceptive use at Jimma University Medical Center, Jimma, Ethiopia

A Prospective Quality Improvement Initiative to Address the Barriers to Postpartum Tubal Ligation Among Multiparous Women

Contact Info

Product

Resources

About