Department of Monitoring and Evaluation, Mekele University, Northern, Ethiopia.
Department of Clinical Nursing, Gambella Teachers Education and Health Science College, Gambella, Ethiopia.
BMC Health Serv Res. 2023 Jul 25;23(1):794. doi: 10.1186/s12913-023-09467-8.
Postpartum contraceptives during the first year after delivery is a key service for women to prevent unintended pregnancy and reduce the risk of maternal and child mortality by ensuring safe birth intervals. This process evaluation aimed to assess the availability, compliance, and accommodation of Post-Partum Contraceptives (PPC) and the experience of women's contraception in the first 12 months postpartum in Ayder Comprehensive Specialized Hospital (ACSH).
A case study evaluation design with a mixed method was employed from February 16/2020 to Mar 30, 2020. Direct observations, 12-month document reviews, and key informant interviews were conducted. The quantitative data were entered into Epi-Data version 3.1 and exported to SPSS version 21 for analysis. In the multivariate logistic regression analysis, variables with < 0.05 p-values and Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were used to declare the association. The qualitative data were transcribed, translated, coded, and analyzed using thematic analysis. The overall process of program implementation was measured based on pre-determined judgmental criteria.
From the total of charts reviewed 302 only 188 (62.3%) postpartum mothers used any method within 12 months of the postpartum period out of which only 27.1% mothers used of long-acting reversible contraceptive (LARC). The overall evaluation of postpartum contraceptives was 84.1% (V/good). Notable gaps observed in this study were poor provision of information in relation to methods given, poor technical performance in following the aseptic procedure, poor utilization of postpartum family planning guidelines and clinical checklists for counseling, and poor use of information education materials compared to the national standards. Residence, number of stillbirths or neonatal loss, counseling status of family planning during ANC visits, and maternal counseling status of family planning during postnatal care visits were factors associated with PPC.
The overall postpartum contraceptive service delivery in ACSH was V/good compared to the national family planning guideline standards. With the notable gaps identified, specific recommendations were suggested to different responsible bodies.
产后一年内的避孕药具是妇女预防意外怀孕和降低母婴死亡率的关键服务，通过确保安全的生育间隔来实现。本过程评估旨在评估 Ayder 综合专科医院（ACSH）产后 12 个月内避孕药具的可及性、依从性和适应性，以及妇女避孕的经验。
采用案例研究评估设计，结合混合方法，于 2020 年 2 月 16 日至 3 月 30 日进行。进行了直接观察、12 个月文件审查和关键知情人访谈。将定量数据输入 Epi-Data 版本 3.1 并导出到 SPSS 版本 21 进行分析。在多变量逻辑回归分析中，使用 <0.05 的 p 值和 95%置信区间（CI）的调整优势比（AOR）来声明关联。定性数据经过转录、翻译、编码和主题分析进行分析。根据预先确定的判断标准衡量方案实施的整体过程。
在所审查的总共 302 份图表中，只有 188 名（62.3%）产后母亲在产后 12 个月内使用了任何方法，其中只有 27.1%的母亲使用了长效可逆避孕方法（LARC）。产后避孕药具的总体评估为 84.1%（V/良好）。在这项研究中观察到了明显的差距，例如在提供方法方面信息不足、在遵循无菌程序方面技术表现不佳、在咨询方面未充分利用产后计划生育准则和临床清单、以及与国家标准相比信息教育材料的使用不佳。居住地、死产或新生儿死亡人数、ANC 访视期间计划生育咨询状况以及产后护理访视期间产妇计划生育咨询状况是与 PPC 相关的因素。
与国家计划生育准则标准相比，ACSH 的产后避孕药具服务总体上是 V/良好。根据确定的明显差距，向不同的责任机构提出了具体建议。
