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Postpartum long-acting contraception uptake and service delivery outcomes after a multilevel intervention in Kigali, Rwanda
  1. Julie Espey1,
  2. Rosine Ingabire1,2,
  3. Julien Nyombayire1,2,
  4. Alexandra Hoagland1,2,
  5. Vanessa Da Costa1,
  6. Amelia Mazzei1,2,
  7. Lisa B Haddad3,
  8. Rachel Parker1,
  9. Jeannine Mukamuyango1,2,
  10. Victoria Umutoni1,
  11. Susan Allen1,
  12. Etienne Karita1,2,
  13. Amanda Tichacek1,
  14. Kristin M Wall1,4
  1. 1Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
  2. 2Projet San Francisco, Kigali, Rwanda
  3. 3Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia, USA
  4. 4Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, Georgia, USA
  1. Correspondence to Dr Kristin M Wall, Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA 30322, USA; kmwall{at}emory.edu

Abstract

Introduction Postpartum family planning (PPFP) is critical to reduce maternal–child mortality, abortion and unintended pregnancy. As in most countries, the majority of PP women in Rwanda have an unmet need for PPFP. In particular, increasing use of the highly effective PP long-acting reversible contraceptive (LARC) methods (the intrauterine device (IUD) and implant) is a national priority. We developed a multilevel intervention to increase supply and demand for PPFP services in Kigali, Rwanda.

Methods We implemented our intervention (which included PPFP promotional counselling for clients, training for providers, and Ministry of Health stakeholder involvement) in six government health facilities from August 2017 to October 2018. While increasing knowledge and uptake of the IUD was a primary objective, all contraceptive method options were discussed and made available. Here, we report a secondary analysis of PP implant uptake and present already published data on PPIUD uptake for reference.

Results Over a 15-month implementation period, 12 068 women received PPFP educational counselling and delivered at a study facility. Of these women, 1252 chose a PP implant (10.4% uptake) and 3372 chose a PPIUD (27.9% uptake). On average providers at our intervention facilities inserted 83.5 PP implants/month and 224.8 PPIUDs/month. Prior to our intervention, 30 PP implants/month and 8 PPIUDs/month were inserted at our selected facilities. Providers reported high ease of LARC insertion, and clients reported minimal insertion anxiety and pain.

Conclusions PP implant and PPIUD uptake significantly increased after implementation of our multilevel intervention. PPFP methods were well received by clients and providers.

  • counseling
  • contraceptive devices
  • female
  • family planning services
  • reproductive health services
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Footnotes

  • Contributors AM, LBH, VU, AT: made substantial contributions to the interpretation of data; drafted the work or revised it critically for important intellectual content; gave final approval of the version to be published; and agree to be accountable for all aspects of the work. JN, JE, AH, JM, EK, RP: made substantial contributions to the design of the work; made substantial contributions to the analysis and/or interpretation of data; drafted the work or revised it critically for important intellectual content; gave final approval of the version to be published; and agree to be accountable for all aspects of the work. KMW, RI, VDC, SA: made substantial contributions to the conception and design of the work; made substantial contributions to the acquisition, analysis, and interpretation of data; drafted the work or revised it critically for important intellectual content; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

  • Funding This work was supported by the Bill & Melinda Gates Foundation (OPP1160661). Additional support came from the Emory University Research Council Grant (URCGA16872456), Emory Global Field Experience Award, the Emory Center for AIDS Research (P30AI050409), the National Institutes of Health (NIAID R01 AI51231; NIAID R01 AI64060; NIAID R37 AI51231) and Emory AITRP Fogarty (5D43TW001042).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open-access repository. Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Wall, Kristin, 2018, "Replication Data for: an interim evaluation of a multi-level intervention to improve post-partum intrauterine device (PPIUD) services in Rwanda", https://doi.org/10.7910/DVN/WLZ7PC, Harvard Dataverse, V1.

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