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Harris DM, Dam A, Morrison K, Mann C, Jackson A, Bledsoe SM, Rowan A, Longfield K. Barriers and Enablers Influencing Women's Adoption and Continuation of Vaginally Inserted Contraceptive Methods: A Literature Review. Stud Fam Plann 2022; 53:455-490. [PMID: 35922382 PMCID: PMC9545114 DOI: 10.1111/sifp.12209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Most vaginally inserted methods have limited availability and use despite offering characteristics that align with many women's stated preferences (e.g., nonhormonal and/or on demand). The objective of this review was to identify enablers and barriers to women's adoption and continuation of vaginally inserted contraceptive methods in low- and middle-income countries (LMICs). We searched three databases (PubMed, Embase, and Web of Science) and 18 websites using keywords related to five vaginally inserted contraceptive methods (diaphragm, vaginal ring, female condom, copper intrauterine device [IUD], hormonal IUD) and terms associated with their adoption and continuation. Searches were limited to resources published between January 2010 and September 2020. Studies eligible for inclusion in our review presented results on women's use and perspectives on the enablers and barriers to adoption and continuation of the vaginally inserted contraceptive methods of interest in LMICs. Relevant studies among women's partners were also included, but not those of providers or other stakeholders. Data were coded, analyzed, and disaggregated according to a framework grounded in family planning (FP) literature and behavioral theories common to FP research and program implementation. Our initial search yielded 13,848 results, with 182 studies ultimately included in the analysis. Across methods, we found common enablers for method adoption, including quality contraceptive counseling as well as alignment between a woman's preferences and a method's duration of use and side effect profile. Common barriers included a lack of familiarity with the methods and product cost. Notably, vaginal insertion was not a major barrier to adoption in the literature reviewed. Vaginally inserted methods of contraception have the potential to fill a gap in method offerings and expand choice. Programmatic actions should address key barriers and enable voluntary use.
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Affiliation(s)
- Danielle M Harris
- Danielle M. Harris is Senior Program Manager, Kate Morrison is Program Manager, and Shannon Bledsoe is Executive Director, Catalyst Global, Carlsbad, CA, United States
| | - Anita Dam
- Anita Dam is Technical Advisor for the Introduction & Access of HIV Prevention Technologies, United States Agency for International Development (USAID), Global Health Technical Professionals Program, Washington, DC, USA
| | - Kate Morrison
- Danielle M. Harris is Senior Program Manager, Kate Morrison is Program Manager, and Shannon Bledsoe is Executive Director, Catalyst Global, Carlsbad, CA, United States
| | - Chastain Mann
- Chastain Mann is Chief Executive Officer, Mann Global Health, Columbus, North Carolina, USA
| | - Ashley Jackson
- Ashley Jackson is Team Lead for Sexual & Reproductive Health, Primary Health Care Program, PATH, Seattle, Washington, USA
| | - Shannon M Bledsoe
- Danielle M. Harris is Senior Program Manager, Kate Morrison is Program Manager, and Shannon Bledsoe is Executive Director, Catalyst Global, Carlsbad, CA, United States
| | - Andrea Rowan
- Andrea Rowan is Independent Consultant and Kim Longfield is Founder and Principal, Databoom, Washington, DC, USA
| | - Kim Longfield
- Andrea Rowan is Independent Consultant and Kim Longfield is Founder and Principal, Databoom, Washington, DC, USA
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Wall KM, Ingabire R, Mazzei A, Umuhoza C, Parker R, Tichacek A, Nizam A, Sales JM, Haddad LB, Corso P, Allen S, Nyombayire J, Karita E. Implementation and evaluation of a large-scale postpartum family planning program in Rwanda: study protocol for a clinic-randomized controlled trial. Trials 2022; 23:337. [PMID: 35459259 PMCID: PMC9027832 DOI: 10.1186/s13063-022-06261-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 03/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Though the Rwandan Ministry of Health (MOH) prioritizes the scale-up of postpartum family planning (PPFP) programs, uptake and sustainability of PPFP services in Rwanda are low. Furthermore, highly effective long-acting reversible contraceptive method use (LARC), key in effective PPFP programs, is specifically low in Rwanda. We previously pilot tested a supply-demand intervention which significantly increased the use of postpartum LARC (PPLARC) in Rwandan government clinics. In this protocol, we use an implementation science framework to test whether our intervention is adaptable to large-scale implementation, cost-effective, and sustainable. METHODS In a type 2 effectiveness-implementation hybrid study, we will evaluate the impact of our PPFP intervention on postpartum LARC (PPLARC) uptake in a clinic-randomized trial in 12 high-volume health facilities in Kigali, Rwanda. We will evaluate this hybrid study using the RE-AIM framework. The independent effectiveness of each PPFP demand creation strategy on PPLARC uptake among antenatal clinic attendees who later deliver in a study facility will be estimated. To assess sustainability, we will assess the intervention adoption, implementation, and maintenance. Finally, we will evaluate intervention cost-effectiveness and develop a national costed implementation plan. DISCUSSION Adaptability and sustainability within government facilities are critical aspects of our proposal, and the MOH and other local stakeholders will be engaged from the outset. We expect to deliver PPFP counseling to over 21,000 women/couples during the project period. We hypothesize that the intervention will significantly increase the number of stakeholders engaged, PPFP providers and promoters trained, couples/clients receiving information about PPFP, and PPLARC uptake comparing intervention versus standard of care. We expect PPFP client satisfaction will be high. Finally, we also hypothesize that the intervention will be cost-saving relative to the standard of care. This intervention could dramatically reduce unintended pregnancy and abortion, as well as improve maternal and newborn health. Our PPFP implementation model is designed to be replicable and expandable to other countries in the region which similarly have a high unmet need for PPFP. TRIAL REGISTRATION ClinicalTrials.gov NCT05056545 . Registered on 31 March 2022.
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Affiliation(s)
- Kristin M Wall
- Department of Epidemiology, School of Public Health, Emory University, Atlanta, USA.
| | - Rosine Ingabire
- Projet San Francisco (PSF)/Center for Family Health Research (CFHR), Kigali, Rwanda
| | - Amelia Mazzei
- Projet San Francisco (PSF)/Center for Family Health Research (CFHR), Kigali, Rwanda
- Department of Pathology, School of Medicine, Emory University, Atlanta, USA
| | - Claudine Umuhoza
- Projet San Francisco (PSF)/Center for Family Health Research (CFHR), Kigali, Rwanda
| | - Rachel Parker
- Department of Pathology, School of Medicine, Emory University, Atlanta, USA
| | - Amanda Tichacek
- Department of Pathology, School of Medicine, Emory University, Atlanta, USA
| | - Azhar Nizam
- Department of Biostatistics and Bioinformatics, School of Public Health, Emory University, Atlanta, USA
| | - Jessica M Sales
- Department of Behavioral, Social and Health Education Sciences, School of Public Health, Emory University, Atlanta, USA
| | | | - Phaedra Corso
- Office of Research, Department of Health Policy, Kennesaw State University, Kennesaw, USA
| | - Susan Allen
- Department of Pathology, School of Medicine, Emory University, Atlanta, USA
| | - Julien Nyombayire
- Projet San Francisco (PSF)/Center for Family Health Research (CFHR), Kigali, Rwanda
| | - Etienne Karita
- Projet San Francisco (PSF)/Center for Family Health Research (CFHR), Kigali, Rwanda
- Department of Pathology, School of Medicine, Emory University, Atlanta, USA
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Espey J, Ingabire R, Nyombayire J, Hoagland A, Da Costa V, Mazzei A, Haddad LB, Parker R, Mukamuyango J, Umutoni V, Allen S, Karita E, Tichacek A, Wall KM. Postpartum long-acting contraception uptake and service delivery outcomes after a multilevel intervention in Kigali, Rwanda. BMJ SEXUAL & REPRODUCTIVE HEALTH 2021; 47:173-178. [PMID: 32938708 PMCID: PMC8861892 DOI: 10.1136/bmjsrh-2020-200741] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 05/27/2023]
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.
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Affiliation(s)
- Julie Espey
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Rosine Ingabire
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Projet San Francisco, Kigali, Rwanda
| | - Julien Nyombayire
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Projet San Francisco, Kigali, Rwanda
| | - Alexandra Hoagland
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Projet San Francisco, Kigali, Rwanda
| | - Vanessa Da Costa
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Amelia Mazzei
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Projet San Francisco, Kigali, Rwanda
| | - Lisa B Haddad
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Rachel Parker
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jeannine Mukamuyango
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Projet San Francisco, Kigali, Rwanda
| | - Victoria Umutoni
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Susan Allen
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Etienne Karita
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Projet San Francisco, Kigali, Rwanda
| | - Amanda Tichacek
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Kristin M Wall
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, Georgia, USA
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Kraft MBDPL, Miadaira M, Marangoni M, Juliato CRT, Surita FG. Postplacental Placement of Intrauterine Devices: Acceptability, Reasons for Refusal and Proposals to Increase its Use. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:172-177. [PMID: 33860500 PMCID: PMC10208734 DOI: 10.1055/s-0041-1725053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To evaluate the acceptability of postplacental placement of intrauterine devices (PPIUD), reasons for refusal and suggested policies to increase its use. METHODS Cross-sectional study conducted at the Women Hospital of the Universidade de Campinas, Campinas, SP, Brazil. Postplacental placement of intrauterine devices was offered to women admitted in labor who did not present infections, uterine malformation, twin pregnancy, preterm birth, and were at least 18 years old. In case of refusal, the parturient was asked to give their reasons and the answers were classified as misinformation about contraception or other reasons. The following were considered misinformation: fear of pain, bleeding, contraception failure and future infertility. Bivariate analysis was performed. RESULTS Amongst 241 invited women, the refusal rate was of 41.9%. Misinformation corresponded to 50.5% of all refusals, and the reasons were: fear of pain (39.9%); fear of contraception failure (4.9%); fear of bleeding (3.9%); fear of future infertility (1.9%); other reasons for refusal were 49.5%. Parturients aged between 18 and 27 years old refused the PPIUD more frequently due to misinformation (67.4%), and older parturients (between 28 and 43 years old) refused frequently due to other reasons (63.6%) (p = 0.002). The mean age of those who declined the PPIUD due to misinformation was 27.3 ± 6.4 years old, while those who declined for other reasons had a mean age of 29.9 ± 5.9 years old (p = 0.017). CONCLUSION The refusal of the PPIUD was high, especially amongst young women and due to misinformation. It is necessary to develop educative measures during antenatal care to counsel women about contraception, reproductive health and consequences of unintended pregnancy.
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Affiliation(s)
| | - Mariana Miadaira
- Department of Obstetrics and Gynecology, School of Medical Science, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Marcos Marangoni
- Department of Obstetrics and Gynecology, School of Medical Science, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Cássia Raquel Teatin Juliato
- Department of Obstetrics and Gynecology, School of Medical Science, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Fernanda Garanhani Surita
- Department of Obstetrics and Gynecology, School of Medical Science, Universidade Estadual de Campinas, Campinas, SP, Brazil
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