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

Huber‐Krum, Sarah; Khadka, Aayush; Pradhan, Elina; Rohr, Julia; Puri, Mahesh; Maharjan, Dev; Joshi, Saugat; Shah, Iqbal; Canning, David

doi:10.1016/j.contraception.2019.12.014

Cited by 9 publications

(12 citation statements)

References 31 publications

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“…For example, a study conducted in Northern West Ethiopia indicated that family planning counselling during ANC was associated with increasing modern contraceptive uptake by six weeks postpartum [18]. Similarly, a study in Nepal indicated that family planning counselling during ANC has improved postpartum contraceptive uptake [34]. The lack of consistency between studies investigating an association between family planning counselling during ANC and postpartum modern contraceptive uptake may be related to differences in the quality of the family planning counselling provided.…”

Section: Plos Global Public Healthmentioning

confidence: 99%

The role of family planning counselling during maternal and child health services in postpartum modern contraceptive uptake in Ethiopia: A national longitudinal study

Mruts

Tessema

Jordan

et al. 2022

PLOS Glob Public Health

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Family planning counselling can help improve the postpartum modern contraceptive uptake. However, studies in Ethiopia indicate inconsistent effects of integrated family planning counselling on postpartum modern contraceptive uptake. This study aimed to determine the extent of family planning counselling and its role in improving postpartum contraceptive uptake among women in Ethiopia. We used the Performance Monitoring for Action (PMA) Ethiopia panel survey data, a community-based prospective cohort study. Randomly selected pregnant women were recruited at the baseline interview and followed by six weeks and six months postpartum. A weighted generalised linear model fitted with a Poisson distribution and a log link function was used to estimate the adjusted relative risk (aRR) and 95% Confidence Interval (CI) of modern contraceptive uptake. The coverages of family planning counselling provision during ANC, prior to discharge and child immunisation were 20%, 27% and 23%, respectively. The modern contraceptive uptakes by six weeks and six months postpartum were 18% and 36%, respectively. Family planning counselling prior to discharge from the facility was associated with increased modern contraceptive uptake by six weeks (aRR 1.25; 95% CI 0.94, 1.65) and six months postpartum periods (aRR 1.07; 95% CI 0.90, 1.27). Moreover, women who received family planning counselling during child immunisation were 35% more likely to use modern contraceptives by six months postpartum (aRR 1.35;95% CI 1.12, 1.62). However, counselling during ANC visits was not associated with modern contraceptive uptake by either six weeks or six months postpartum. A significant proportion of women had missed the opportunity, and the postpartum modern contraceptive uptake was low. Despite these, family planning counselling prior to discharge from the facility and during child immunisation improved the postpartum modern contraceptive uptake. However, our finding revealed insufficient evidence that family planning counselling during ANC is associated with postpartum modern contraceptive uptake.

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Section: Plos Global Public Healthmentioning

confidence: 99%

The role of family planning counselling during maternal and child health services in postpartum modern contraceptive uptake in Ethiopia: A national longitudinal study

Mruts

Tessema

Jordan

et al. 2022

PLOS Glob Public Health

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“…A cluster randomized controlled trial in Nepal, which improved women’s access to FP counseling during pregnancy and provided women with the option to receive IUD insertions in the immediate postpartum period, found positive effects on modern contraceptive use 1 y after exposure to the intervention. However, these findings were not sustained after 2 y of intervention exposure, with effects only being observed on the contraceptive method mix, mainly through an increase in IUDs and a reduction in other methods ( 29 ). Notably, these three randomized trials reported effects only on contraceptive use, but not on pregnancy or birth spacing.…”

mentioning

confidence: 98%

The causal effect of a family planning intervention on women’s contraceptive use and birth spacing

Karra

Maggio

Guo

et al. 2022

Proc. Natl. Acad. Sci. U.S.A.

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Significance Improving access to family planning may promote contraceptive use after childbirth and reduce the likelihood of closely spaced high-risk births; however, empirical evidence for these claims is limited. We present findings from a field experiment that examines the causal impact of a broad-based family-planning intervention on postpartum contraceptive use and fertility over a 2-y period, which allows us to assess impact on high-risk short pregnancy intervals. Our findings demonstrate that the benefits of family planning extend beyond contraceptive use to improve fertility and healthy birth spacing. Evidence from this study will contribute to the design of effective family-planning programs and to informing the ongoing policy debate about how such programs impact longer-term health and development more broadly.

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“…Among the 21 included studies, 18 [ 40 – 57 ] were compatible for meta-analysis. However, the remaining three studies [ 22 , 58 , 59 ] were excluded from the meta-analysis due to disparities in outcome measurements and study designs that prevented meaningful comparison. Nonetheless, the narrative synthesis incorporated findings from all eligible studies (Fig.…”

Section: Resultsmentioning

confidence: 99%

Effective strategies for increasing the uptake of modern methods of family planning in South Asia: a systematic review and meta-analysis

Memon,

Tahmeena,

Fazal

et al. 2024

BMC Women's Health

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Background Family planning (FP) interventions have improved the use of modern contraceptives, yet a high unmet need for contraception still exists in South Asia. This systematic review of existing research was conducted to identify effective FP interventions that led to an increase in the uptake of modern methods of contraception in South Asia. Methods Five electronic databases were searched for relevant studies published between January 1st, 2000 and May 4, 2023. Experimental studies that reported data on the impact of FP interventions on modern contraceptive use among women of reproductive age (15–49 years) in the South Asian region were included. A random-effects Inverse Variance weighted model was employed to pool the adjusted odds ratio (OR) on modern contraceptive use and unmet need for contraception. In addition, we computed subgroup meta-estimates based on intervention type and the urban-rural divide. Results Among 643 studies identified, 21 met the inclusion criteria. The overall pooled odds ratio for modern contraceptive use was significantly higher (OR 1.51; 95% CI 1.35–1.70; heterogeneity; I2 = 81%) for FP interventions with a significant reduction in unmet need for contraception (OR 0.86; 95% CI 0.78–0.94, I2 = 50%). The subgroup analysis revealed demand-generation (OR 1.61; 95% CI 1.32–1.96), health system integrated (OR 1.53; 95% CI 1.07–2.20), and franchised FP clinic interventions (OR 1.32; 95% CI 1.21–1.44) had promoted the modern contraceptive uptake. Further, FP interventions implemented in urban settings showed a higher increase in modern contraceptive use (OR 1.73; 95% CI 1.44–2.07) compared to rural settings (OR 1.46; 95% CI 1.28–1.66). Given the considerable heterogeneity observed across studies and the low degree of certainty indicated by the GRADE summary for the primary outcome, caution is advised when interpreting the results. Conclusion The review collated experimentally evaluated FP interventions that increased modern contraception use and reduced the unmet need in South Asia. The demand generation interventions were the most effective in increasing the uptake of modern contraceptive methods. Furthermore, the urban environment provides a conducive environment for interventions to improve contraceptive usage. However, further studies should assess which aspects were most effective on attitudes towards contraception, selection of more effective methods, and contraceptive behaviors.

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

Cited by 9 publications

References 31 publications

The role of family planning counselling during maternal and child health services in postpartum modern contraceptive uptake in Ethiopia: A national longitudinal study

The role of family planning counselling during maternal and child health services in postpartum modern contraceptive uptake in Ethiopia: A national longitudinal study

The causal effect of a family planning intervention on women’s contraceptive use and birth spacing

Effective strategies for increasing the uptake of modern methods of family planning in South Asia: a systematic review and meta-analysis

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