Gage Anastasia J, Wood Francine Eva, Gay Rianne
Department of International Health and Sustainable Development, Tulane University, New Orleans, LA, United States.
Center on Gender Equity and Health, Department of Medicine, University of California, San Diego, La Jolla, CA, United States.
Front Glob Womens Health. 2023 Feb 13;4:1087009. doi: 10.3389/fgwh.2023.1087009. eCollection 2023.
Evidence shows that an expanded range of contraceptive methods, client-centered comprehensive counseling, and voluntary informed choice are key components of successful family planning programs. This study assessed the effect of the Momentum project on contraceptive choice among first-time mothers (FTMs) age 15-24 who were six-months pregnant at baseline in Kinshasa, Democratic Republic of the Congo, and socioeconomic determinants of the use of long-acting reversible contraception (LARC).
The study employed a quasi-experimental design, with three intervention health zones and three comparison health zones. Trained nursing students followed FTMs for 16 months and conducted monthly group education sessions and home visits consisting of counseling and provision of a range of contraceptive methods and referrals. Data were collected in 2018 and 2020 through interviewer-administered questionnaires. The effect of the project on contraceptive choice was estimated using intention-to-treat and dose-response analyses, with inverse probability weighting among 761 modern contraceptive users. Logistic regression analysis was used to examine predictors of LARC use.
Project effect was detected on receipt of family planning counseling, obtaining the current contraceptive method from a community-based health worker, informed choice, and current use of implants vs. other modern methods. There were significant dose-response associations of the level of exposure to Momentum interventions and the number of home visits with four of five outcomes. Positive predictors of LARC use included exposure to Momentum interventions, receipt of prenatal counseling on both birth spacing and family planning (age 15-19), and knowledge of LARCs (age 20-24). The FTM's perceived ability to ask her husband/male partner to use a condom was a negative predictor of LARC use.
Given limited resources, expanding community-based contraceptive counseling and distribution through trained nursing students may expand family planning access and informed choice among first-time mothers.
有证据表明，扩大避孕方法的范围、以客户为中心的全面咨询以及自愿知情选择是成功的计划生育项目的关键组成部分。本研究评估了“动力”项目对刚果民主共和国金沙萨基线时怀孕六个月的15至24岁初产妇避孕选择的影响，以及长效可逆避孕方法（LARC）使用的社会经济决定因素。
该研究采用了准实验设计，有三个干预健康区和三个对照健康区。经过培训的护理专业学生对初产妇进行了16个月的跟踪，并每月举办小组教育课程和进行家访，包括咨询、提供一系列避孕方法和转诊。2018年和2020年通过访员管理的问卷收集数据。使用意向性分析和剂量反应分析估计该项目对避孕选择的影响，并在761名现代避孕使用者中进行逆概率加权。采用逻辑回归分析来检验LARC使用的预测因素。
在接受计划生育咨询、从社区卫生工作者处获得当前避孕方法、知情选择以及当前使用植入剂与其他现代方法方面检测到了项目效果。在五个结果中的四个方面，“动力”干预的暴露水平和家访次数存在显著的剂量反应关联。LARC使用的积极预测因素包括接触“动力”干预、接受关于生育间隔和计划生育的产前咨询（15至19岁）以及对LARC的了解（20至24岁）。初产妇认为自己能够要求丈夫/男性伴侣使用避孕套是LARC使用的负面预测因素。
鉴于资源有限，通过经过培训的护理专业学生扩大基于社区的避孕咨询和分发可能会扩大初产妇的计划生育服务可及性和知情选择。
