Ipas, Chapel Hill, NC, USA.
University of Wisconsin - Madison School of Medicine and Public Health, Madison, WI, USA.
BMC Womens Health. 2020 May 12;20(1):102. doi: 10.1186/s12905-020-00956-0.
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.
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.
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.
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.
Registered with clinicaltrials.gov (NCT02718222) on March 24, 2016, retrospectively registered.
世界卫生组织建议在产后时期进行计划生育（PPFP），以保持健康的生育间隔。本研究评估了一项旨在提高坦桑尼亚妇女获得产后计划生育服务的干预措施。该干预措施包括在产前和分娩期间提供关于产后计划生育的咨询，并将产后宫内节育器（PPIUD）的放置作为产妇选择在产后即刻放置 PPIUD 的分娩服务的综合部分。
这项整群随机对照试验招募了 15264 名年龄在 18 岁及以上的产后坦桑尼亚妇女，她们于 2016 年 1 月至 9 月期间在五家研究医院中的一家分娩。我们使用差异分析方法比较了干预前和干预后治疗组和对照组的产后宫内节育器咨询和产后宫内节育器选择的结果。我们还使用工具变量估计法进行了干预依从性调整分析。
我们使用线性概率模型来获得百分比点（pp）的效应大小。该干预措施使 PPIUD 咨询增加了 19.8pp（95%CI：9.1-22.6pp），并增加了 6.3pp（95%CI：2.3-8.0pp）的 PPIUD 选择。在干预依从性调整的估计中，如果所有妇女都接受了咨询，那么我们观察到 PPIUD 选择的比例将增加 31.6pp（95%CI：24.3-35.8pp）。在接受咨询的妇女中，选择 PPIUD 的决定因素包括在咨询期间收到信息传单和在入院分娩服务后接受咨询。
该干预措施适度增加了 PPIUD 咨询和 PPIUD 选择的比率，主要是由于在接受研究设施分娩的妇女中 PPIUD 咨询的覆盖率较低。如果对所有妇女进行普遍的 PPIUD 咨询，那么 PPIUD 的选择比例将会大幅增加。给予妇女关于 PPIUD 的信息材料，并在入院分娩后进行咨询，可能会增加选择 PPIUD 的妇女比例。
于 2016 年 3 月 24 日在 clinicaltrials.gov（NCT02718222）注册，为回顾性注册。
