PMID- 32938708
OWN - NLM
STAT- MEDLINE
DCOM- 20211025
LR  - 20220223
IS  - 2515-2009 (Electronic)
IS  - 2515-1991 (Print)
IS  - 2515-1991 (Linking)
VI  - 47
IP  - 3
DP  - 2021 Jul
TI  - Postpartum long-acting contraception uptake and service delivery outcomes after a 
      multilevel intervention in Kigali, Rwanda.
PG  - 173-178
LID - 10.1136/bmjsrh-2020-200741 [doi]
AB  - 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.
CI  - (c) Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and 
      permissions. Published by BMJ.
FAU - Espey, Julie
AU  - Espey J
AD  - Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, 
      School of Medicine, Rollins School of Public Health, Emory University, Atlanta, 
      Georgia, USA.
FAU - Ingabire, Rosine
AU  - Ingabire R
AD  - Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, 
      School of Medicine, Rollins School of Public Health, Emory University, Atlanta, 
      Georgia, USA.
AD  - Projet San Francisco, Kigali, Rwanda.
FAU - Nyombayire, Julien
AU  - Nyombayire J
AD  - Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, 
      School of Medicine, Rollins School of Public Health, Emory University, Atlanta, 
      Georgia, USA.
AD  - Projet San Francisco, Kigali, Rwanda.
FAU - Hoagland, Alexandra
AU  - Hoagland A
AD  - Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, 
      School of Medicine, Rollins School of Public Health, Emory University, Atlanta, 
      Georgia, USA.
AD  - Projet San Francisco, Kigali, Rwanda.
FAU - Da Costa, Vanessa
AU  - Da Costa V
AD  - Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, 
      School of Medicine, Rollins School of Public Health, Emory University, Atlanta, 
      Georgia, USA.
FAU - Mazzei, Amelia
AU  - Mazzei A
AD  - Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, 
      School of Medicine, Rollins School of Public Health, Emory University, Atlanta, 
      Georgia, USA.
AD  - Projet San Francisco, Kigali, Rwanda.
FAU - Haddad, Lisa B
AU  - Haddad LB
AD  - Department of Gynecology and Obstetrics, School of Medicine, Emory University, 
      Atlanta, Georgia, USA.
FAU - Parker, Rachel
AU  - Parker R
AD  - Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, 
      School of Medicine, Rollins School of Public Health, Emory University, Atlanta, 
      Georgia, USA.
FAU - Mukamuyango, Jeannine
AU  - Mukamuyango J
AD  - Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, 
      School of Medicine, Rollins School of Public Health, Emory University, Atlanta, 
      Georgia, USA.
AD  - Projet San Francisco, Kigali, Rwanda.
FAU - Umutoni, Victoria
AU  - Umutoni V
AD  - Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, 
      School of Medicine, Rollins School of Public Health, Emory University, Atlanta, 
      Georgia, USA.
FAU - Allen, Susan
AU  - Allen S
AD  - Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, 
      School of Medicine, Rollins School of Public Health, Emory University, Atlanta, 
      Georgia, USA.
FAU - Karita, Etienne
AU  - Karita E
AD  - Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, 
      School of Medicine, Rollins School of Public Health, Emory University, Atlanta, 
      Georgia, USA.
AD  - Projet San Francisco, Kigali, Rwanda.
FAU - Tichacek, Amanda
AU  - Tichacek A
AD  - Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, 
      School of Medicine, Rollins School of Public Health, Emory University, Atlanta, 
      Georgia, USA.
FAU - Wall, Kristin M
AU  - Wall KM
AUID- ORCID: 0000-0001-8547-2004
AD  - Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, 
      School of Medicine, Rollins School of Public Health, Emory University, Atlanta, 
      Georgia, USA kmwall@emory.edu.
AD  - Department of Epidemiology, Rollins School of Public Health, Laney Graduate 
      School, Emory University, Atlanta, Georgia, USA.
LA  - eng
GR  - P30 AI050409/AI/NIAID NIH HHS/United States
GR  - R01 AI051231/AI/NIAID NIH HHS/United States
GR  - R37 AI051231/AI/NIAID NIH HHS/United States
GR  - R01 AI064060/AI/NIAID NIH HHS/United States
GR  - D43 TW001042/TW/FIC NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20200916
PL  - England
TA  - BMJ Sex Reprod Health
JT  - BMJ sexual & reproductive health
JID - 101715577
SB  - IM
MH  - *Contraception
MH  - Family Planning Services
MH  - Female
MH  - Humans
MH  - *Intrauterine Devices
MH  - Postpartum Period
MH  - Pregnancy
MH  - Rwanda
PMC - PMC8861892
MID - NIHMS1773971
OTO - NOTNLM
OT  - contraceptive devices
OT  - counseling
OT  - family planning services
OT  - female
OT  - reproductive health services
COIS- Competing interests: None declared.
EDAT- 2020/09/18 06:00
MHDA- 2021/10/26 06:00
PMCR- 2022/02/22
CRDT- 2020/09/17 05:38
PHST- 2020/06/10 00:00 [received]
PHST- 2020/08/24 00:00 [revised]
PHST- 2020/08/25 00:00 [accepted]
PHST- 2020/09/18 06:00 [pubmed]
PHST- 2021/10/26 06:00 [medline]
PHST- 2020/09/17 05:38 [entrez]
PHST- 2022/02/22 00:00 [pmc-release]
AID - bmjsrh-2020-200741 [pii]
AID - 10.1136/bmjsrh-2020-200741 [doi]
PST - ppublish
SO  - BMJ Sex Reprod Health. 2021 Jul;47(3):173-178. doi: 10.1136/bmjsrh-2020-200741. 
      Epub 2020 Sep 16.