FHI 360, Durham, NC, USA.
Institute for Reproductive Health, Kigali, Rwanda.
Glob Health Sci Pract. 2016 Mar 25;4(1):73-86. doi: 10.9745/GHSP-D-15-00291. Print 2016 Mar.
The primary objective of this study was to test the effectiveness of integrating family planning service components into infant immunization services to increase modern contraceptive method use among postpartum women.
The study was a separate sample, parallel, cluster-randomized controlled trial. Fourteen randomly selected primary health facilities were equally allocated to intervention (integrated family planning and immunization services at the same time and location) and control groups (standard immunization services only). At baseline (May-June 2010), we interviewed postpartum women attending immunization services for their infant aged 6 to 12 months using a structured questionnaire. A separate sample of postpartum women was interviewed 16 months later after implementation of the experimental health service intervention. We used linear mixed regression models to test the study hypothesis that postpartum women attending immunization services for their infants aged 6-12 months in the intervention facilities will be more likely to use a modern contraceptive method than postpartum women attending immunization services for their infants aged 6-12 months in control group facilities.
We interviewed and analyzed data for 825 women from the intervention group and 829 women from the control group. Results showed the intervention had a statistically significant, positive effect on modern contraceptive method use among intervention group participants compared with control group participants (regression coefficient, 0.15; 90% confidence interval [CI], 0.04 to 0.26). Although we conducted a 1-sided significance test, this effect was also significant at the 2-sided test with alpha = .05. Among those women who did not initiate a contraceptive method, awaiting the return of menses was the most common reason cited for non-use of a method. Women in both study groups overwhelmingly supported the concept of integrating family planning service components into infant immunization services (97.9% in each group), and service data collected during the intervention period did not indicate that the intervention had any negative effect on infant immunization service uptake.
Integrating family planning service components into infant immunization services can be an acceptable and effective strategy to increase contraceptive use among postpartum women. Additional research is needed to examine the extent to which this integration strategy can be replicated in other health care settings. Future research should also explore persistent misconceptions regarding the relationship between return of menses and return to fertility during the postpartum period.
本研究的主要目的是检验将计划生育服务内容纳入婴儿免疫服务以提高产后妇女现代避孕方法使用率的效果。
本研究为一项独立样本、平行、群组随机对照试验。随机选择 14 个初级保健机构，平均分配到干预组（在同一时间和地点提供计划生育和免疫服务）和对照组（仅提供标准免疫服务）。在基线（2010 年 5 月至 6 月），我们使用结构化问卷对接受婴儿 6-12 个月龄免疫服务的产后妇女进行访谈。在实施实验性卫生服务干预 16 个月后，对另一批产后妇女进行访谈。我们使用线性混合回归模型检验研究假设，即在干预设施中接受婴儿 6-12 个月龄免疫服务的产后妇女使用现代避孕方法的可能性将高于在对照设施中接受婴儿 6-12 个月龄免疫服务的产后妇女。
我们对干预组的 825 名妇女和对照组的 829 名妇女进行了访谈和数据分析。结果表明，与对照组相比，干预组的现代避孕方法使用率具有统计学意义的正向影响（回归系数，0.15；90%置信区间[CI]，0.04 至 0.26）。尽管我们进行了单侧显著性检验，但在双侧检验中，α=0.05，该效应也具有显著性。在那些未开始使用避孕方法的妇女中，等待月经恢复是未使用方法的最常见原因。两组妇女都强烈支持将计划生育服务内容纳入婴儿免疫服务的理念（每组 97.9%），并且在干预期间收集的服务数据表明，干预措施对婴儿免疫服务的接受度没有任何负面影响。
将计划生育服务内容纳入婴儿免疫服务可以是一种提高产后妇女避孕使用率的可接受且有效的策略。需要进一步研究以检验这种整合策略在其他医疗保健环境中的可复制性。未来的研究还应探讨产后期间关于月经恢复与生育能力恢复之间关系的持久误解。
