PMID- 32398077
OWN - NLM
STAT- MEDLINE
DCOM- 20201117
LR  - 20220826
IS  - 1472-6874 (Electronic)
IS  - 1472-6874 (Linking)
VI  - 20
IP  - 1
DP  - 2020 May 12
TI  - Effect of a postpartum family planning intervention on postpartum intrauterine 
      device counseling and choice: evidence from a cluster-randomized trial in 
      Tanzania.
PG  - 102
LID - 10.1186/s12905-020-00956-0 [doi]
LID - 102
AB  - BACKGROUND: The World Health Organization recommends postpartum family planning 
      (PPFP) for healthy birth spacing. This study is an evaluation of an intervention 
      that sought to improve women's access to PPFP in Tanzania. The intervention 
      included counseling on PPFP during antenatal and delivery care and introducing 
      postpartum intrauterine device (PPIUD) insertion as an integrated part of 
      delivery services for women electing PPIUD in the immediate postpartum period. 
      METHODS: This cluster-randomized controlled trial recruited 15,264 postpartum 
      Tanzanian women aged 18 or older who delivered in one of five study hospitals 
      between January and September 2016. We present the effectiveness of the 
      intervention using a difference-in-differences approach to compare outcomes, 
      receipt of PPIUD counseling and choice of PPIUD after delivery, between the pre- 
      and post-intervention period in the treatment and control group. We also present 
      an intervention adherence-adjusted analysis using an instrumental variables 
      estimation. RESULTS: We estimate linear probability models to obtain effect sizes 
      in percentage points (pp). The intervention increased PPIUD counseling by 19.8 pp 
      (95% CI: 9.1 - 22.6 pp) and choice of PPIUD by 6.3 pp (95% CI: 2.3 - 8.0 pp). The 
      adherence-adjusted estimates demonstrate that if all women had been counseled, we 
      would have observed a 31.6 pp increase in choice of PPIUD (95% CI: 24.3 - 35.8 
      pp). Among women counseled, determinants of choosing PPIUD included receiving an 
      informational leaflet during counseling and being counseled after admission for 
      delivery services. CONCLUSIONS: The intervention modestly increased the rate of 
      PPIUD counseling and choice of PPIUD, primarily due to low coverage of PPIUD 
      counseling among women delivering in study facilities. With universal PPIUD 
      counseling, large increases in choice of PPIUD would have been observed. Giving 
      women informational materials on PPIUD and counseling after admission for 
      delivery are likely to increase the proportion of women choosing PPIUD. TRIAL 
      REGISTRATION: Registered with clinicaltrials.gov (NCT02718222) on March 24, 2016, 
      retrospectively registered.
FAU - Pearson, Erin
AU  - Pearson E
AD  - Ipas, Chapel Hill, NC, USA. pearsone@ipas.org.
FAU - Senderowicz, Leigh
AU  - Senderowicz L
AD  - University of Wisconsin - Madison School of Medicine and Public Health, Madison, 
      WI, USA.
FAU - Pradhan, Elina
AU  - Pradhan E
AD  - World Bank, Washington, DC, USA.
FAU - Francis, Joel
AU  - Francis J
AD  - Department of Family Medicine and Primary Care, School of Clinical Medicine, 
      University of the Witwatersrand, Johannesburg, South Africa.
FAU - Muganyizi, Projestine
AU  - Muganyizi P
AD  - Association of Gynaecologists and Obstetricians of Tanzania (AGOTA), Dar es 
      Salaam, Tanzania.
AD  - Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
FAU - Shah, Iqbal
AU  - Shah I
AD  - Harvard T.H. Chan School of Public Health, Boston, MA, USA.
FAU - Canning, David
AU  - Canning D
AD  - Harvard T.H. Chan School of Public Health, Boston, MA, USA.
FAU - Karra, Mahesh
AU  - Karra M
AD  - Boston University, Boston, MA, USA.
FAU - Ulenga, Nzovu
AU  - Ulenga N
AD  - Management and Development for Health, Dar es Salaam, Tanzania.
FAU - Barnighausen, Till
AU  - Barnighausen T
AD  - Harvard T.H. Chan School of Public Health, Boston, MA, USA.
AD  - Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, 
      Germany.
LA  - eng
SI  - ClinicalTrials.gov/NCT02718222
GR  - 4041/Susan Thompson Buffett Foundation/International
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20200512
PL  - England
TA  - BMC Womens Health
JT  - BMC women's health
JID - 101088690
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Choice Behavior
MH  - Contraception/methods
MH  - *Contraception Behavior
MH  - *Counseling
MH  - Family Planning Services/*organization & administration
MH  - Female
MH  - Humans
MH  - *Intrauterine Devices
MH  - Postnatal Care/*organization & administration
MH  - Postpartum Period
MH  - Pregnancy
MH  - Tanzania
PMC - PMC7218519
OTO - NOTNLM
OT  - Counseling
OT  - PPIUD
OT  - Tanzania
COIS- The authors declare that they have no competing interests.
EDAT- 2020/05/14 06:00
MHDA- 2020/11/18 06:00
PMCR- 2020/05/12
CRDT- 2020/05/14 06:00
PHST- 2019/10/11 00:00 [received]
PHST- 2020/04/16 00:00 [accepted]
PHST- 2020/05/14 06:00 [entrez]
PHST- 2020/05/14 06:00 [pubmed]
PHST- 2020/11/18 06:00 [medline]
PHST- 2020/05/12 00:00 [pmc-release]
AID - 10.1186/s12905-020-00956-0 [pii]
AID - 956 [pii]
AID - 10.1186/s12905-020-00956-0 [doi]
PST - epublish
SO  - BMC Womens Health. 2020 May 12;20(1):102. doi: 10.1186/s12905-020-00956-0.