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Provider perspectives in implementing the Postpartum Intrauterine Device Initiative in Sri Lanka: a qualitative study
  1. Ranjith de Silva1,
  2. Sarah Huber-Krum2,
  3. Arnjali Samarasekera1,
  4. Mahesh Karra3,
  5. Erin Pearson4,
  6. Hemantha Senanayake1,
  7. David Canning2,
  8. Iqbal Shah2
  1. 1Sri Lanka College of Obstetricians and Gynaecologists, Colombo, Sri Lanka
  2. 2Harvard T H Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA
  3. 3Frederick S Pardee School of Global Studies, Boston University, Boston, Massachusetts, USA
  4. 4Ipas, Chapel Hill, North Carolina, USA
  1. Correspondence to Dr Sarah Huber-Krum, T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA; shuber{at}hsph.harvard.edu

Abstract

Background Integration of maternal care and family planning services has the potential to reduce unintended pregnancies and closely spaced births, leading to reductions in maternal mortality and morbidity. However, few models exist detailing how to implement/integrate such services. This study explored the implementation of the Postpartum Intrauterine Device (PPIUD) Initiative in Sri Lanka, which trained healthcare providers on how to counsel women about contraception during routine antenatal care and insert PPIUD immediately following delivery.

Methods We applied a qualitative design to ascertain the perspectives of maternal health service providers who participated in the PPIUD Initiative. We conducted 12 in-depth interviews with providers. We used thematic analysis to analyse the data and the results were interpreted within the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework.

Results Findings indicated that providers were willing to adopt the intervention and reiterated the importance of postpartum family planning. However, the intervention was not consistently implemented as intended, including provider bias in counselling and lack of attention to women’s preferences. Organisational barriers to implementation included time constraints and inadequate training. Providers suggested that a range of paramedical staff be trained in counselling and PPIUD insertion to mitigate barriers and to facilitate scaling up the intervention.

Conclusions To improve and scale up the PPIUD Initiative, training efforts should be expanded to primary and secondary care facilities and implementation strategies better utilised (eg, on-the-job training). The training can be strengthened by improving providers’ knowledge of all types of methods and interpersonal communication skills, and emphasising the importance of unbiased, evidence-based contraceptive counselling techniques.

  • contraception behavior
  • counseling
  • family planning services
  • intrauterine devices
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Footnotes

  • Contributors IS and DC conceived the study idea and designed the study. RDS, AS and HS oversaw data collection and implementation of the study and conducted data analysis. SHK and RDS drafted the manuscript, with input from MK and IS. All the authors discussed the results and commented on the manuscript.

  • Funding This study was funded by a grant from an anonymous foundation to Harvard University.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was granted by the Ethics Review Committee at the Faculty of Medicine, University of Colombo (protocol number EC-15-059). This study also obtained human subjects exemption from the Institutional Review Board (IRB) at Harvard University (protocol number IRB15-0375). All procedures performed in this study were in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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

  • Data availability statement Data are available upon reasonable request.

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