PMID- 32795987 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200928 IS - 1929-0748 (Print) IS - 1929-0748 (Electronic) IS - 1929-0748 (Linking) VI - 9 IP - 8 DP - 2020 Aug 14 TI - The Effect of Improved Access to Family Planning on Postpartum Women: Protocol for a Randomized Controlled Trial. PG - e16697 LID - 10.2196/16697 [doi] LID - e16697 AB - BACKGROUND: The World Health Organization recommends that a woman waits at least 24 months after a live birth before getting pregnant again; however, an estimated 25% of birth intervals in low-income countries do not meet this recommendation for adequate birth spacing, and the unmet need for postpartum family planning (PPFP) services is high. Few randomized controlled trials have assessed the causal impact of access to PPFP services, and even fewer evaluations have investigated how such interventions may affect postpartum contraceptive use, birth spacing, and measures of health and well-being. OBJECTIVE: This protocol paper aims to describe a randomized controlled trial that is being conducted to identify the causal impact of an intervention to improve access to PPFP services on contraceptive use, pregnancy, and birth spacing in urban Malawi. The causal effect of the intervention will be determined by comparing outcomes for respondents who are randomly assigned to an intervention arm against outcomes for respondents who are randomly assigned to a control arm. METHODS: Married women aged 18-35 years who were either pregnant or had recently given birth were randomly assigned to either the intervention arm or control arm. Women assigned to the intervention arm received a package of services over a 2-year intervention period. Services included a brochure and up to 6 home visits from trained family planning counselors; free transportation to a high-quality family planning clinic; and financial reimbursement for family planning services, consultations, and referrals for services. Two follow-up surveys were conducted 1 and 2 years after the baseline survey. RESULTS: A total of 2143 women were randomly assigned to either the intervention arm (n=1026) or the control arm (n=1117). Data collection for the first follow-up survey began in August 2017 and was completed in February 2018. A total of 1773 women, or 82.73% of women who were eligible for follow-up, were successfully contacted and reinterviewed at the first follow-up. Data collection for the second follow-up survey began in August 2018 and was completed in February 2019. A total of 1669 women, or 77.88% of women who were eligible for follow-up, were successfully contacted and reinterviewed at the second follow-up. The analysis of the primary outcomes is ongoing and is expected to be completed in 2021. CONCLUSIONS: The results of this trial seek to fill the current knowledge gaps in the effectiveness of family planning interventions on improving fertility and health outcomes. The findings also show that the benefits of improving access to family planning are likely to extend beyond the fertility and health domain by improving other measures of women's well-being. TRIAL REGISTRATION: American Economics Association Registry Trial Number AEARCTR-0000697; https://www.socialscienceregistry.org/trials/697 Registry for International Development Impact Evaluations (RIDIE) Trial Number RIDIE-STUDY-ID-556784ed86956; https://ridie.3ieimpact.org/index.php?r=search/detailView&id=320. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/16697. CI - (c)Mahesh Karra, David Canning. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 14.08.2020. FAU - Karra, Mahesh AU - Karra M AUID- ORCID: 0000-0003-0962-092X AD - Frederick S Pardee School of Global Studies, Boston University, Boston, MA, United States. FAU - Canning, David AU - Canning D AUID- ORCID: 0000-0003-4041-1229 AD - Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, United States. LA - eng PT - Journal Article DEP - 20200814 PL - Canada TA - JMIR Res Protoc JT - JMIR research protocols JID - 101599504 PMC - PMC7455875 OTO - NOTNLM OT - Malawi OT - Sub-Saharan Africa OT - birth spacing OT - contraceptive use OT - postpartum family planning OT - randomized controlled trial OT - women's well-being COIS- Conflicts of Interest: External funding for the study was provided through two grants by the William and Flora Hewlett Foundation, Menlo Park, California, United States. The funder had no role in the design and implementation of this study and will have no role in the data analyses, interpretation of results, or in the dissemination of findings. In addition, the study protocol did not undergo peer review by the funding body. Finally, the investigators declare that no competing interests exist. EDAT- 2020/08/17 06:00 MHDA- 2020/08/17 06:01 PMCR- 2020/08/14 CRDT- 2020/08/16 06:00 PHST- 2019/10/15 00:00 [received] PHST- 2020/07/14 00:00 [accepted] PHST- 2020/06/20 00:00 [revised] PHST- 2020/08/16 06:00 [entrez] PHST- 2020/08/17 06:00 [pubmed] PHST- 2020/08/17 06:01 [medline] PHST- 2020/08/14 00:00 [pmc-release] AID - v9i8e16697 [pii] AID - 10.2196/16697 [doi] PST - epublish SO - JMIR Res Protoc. 2020 Aug 14;9(8):e16697. doi: 10.2196/16697.