Rai Pramila, O'Connor Denise A, Ackerman Ilana N, Dangal Ganesh, Rimal Surya Prasad, Rai Pabitra, Buchbinder Rachelle
School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Kathmandu Model Hospital, Kathmandu, Nepal.
Lancet Reg Health Southeast Asia. 2025 May 14;37:100599. doi: 10.1016/j.lansea.2025.100599. eCollection 2025 Jun.
Integrating postpartum family planning services within maternity care, specifically counselling about family planning and postpartum intrauterine contraceptive device (PPIUCD) insertion, may help reduce unintended pregnancies and related complications. This study explored factors affecting the implementation and scale-up of integration of these services within maternity care in Nepal from the perspectives of healthcare providers and policymakers.
For this qualitative study, we conducted in-depth, semi-structured interviews remotely with healthcare providers and policymakers across all seven provinces of the Nepali maternal healthcare sector until theme saturation was achieved. Potentially eligible participants were invited through publicly available e-mail addresses, personal contacts, snowball sampling, and social media advertisements. Respondents were assessed for eligibility and subsequently recruited. The Consolidated Framework for Implementation Research and Theoretical Domains Framework guided our inquiry and analysis. We transcribed the interviews verbatim, translated the transcripts into English and analysed them using thematic analysis.
Based on 26 interviews, we identified five major barrier themes relating to care recipients, healthcare providers, health facilities and the health system. The themes included: (i) the perceived inadequate awareness and low desire for PPIUCDs among care recipients, (ii) PPIUCD-specific issues, (iii) inadequate capacity and capability to deliver the services, (iv) inadequate investment and priority, and (v) contextual factors such as pelvic inflammatory diseases and hygiene considerations. Some contrasting views were reported between healthcare providers and policy participants. Policy participants emphasised insufficient efforts by healthcare providers to provide counselling and PPIUCD, while healthcare providers identified PPIUCD-related issues (e.g., complexity of the insertion procedure) as a significant barrier hindering their efforts. Both healthcare providers and policy participants identified inadequate investment in and priority on integrating postpartum contraceptive services, including PPIUCD, as another important factor. Participants indicated that there is an urgent need to implement effective integrated counselling and contraception services.
Greater investment is needed to address multilevel barriers to implementing and scaling up integrated postpartum family planning services, particularly PPIUCD insertion within maternity services in Nepal. Priority should be given to health education for care recipients and the community, capacity building (ensuring care providers are capable), and upgrading of health facilities.
Monash International Postgraduate Research Scholarship and Monash Graduate Scholarship.
将产后计划生育服务纳入孕产妇保健服务，特别是提供计划生育咨询和插入产后宫内节育器（PPIUCD），可能有助于减少意外怀孕及相关并发症。本研究从医疗服务提供者和政策制定者的角度，探讨了影响尼泊尔孕产妇保健服务中这些服务整合实施和扩大规模的因素。
在这项定性研究中，我们通过电子邮件公开地址、个人联系、滚雪球抽样和社交媒体广告，远程对尼泊尔孕产妇保健部门所有七个省的医疗服务提供者和政策制定者进行了深入的半结构化访谈，直至达到主题饱和。邀请潜在符合条件的参与者，评估其资格并随后招募。实施研究综合框架和理论领域框架指导了我们的调查和分析。我们逐字转录访谈内容，将转录本翻译成英文，并使用主题分析进行分析。
基于26次访谈，我们确定了与受护理者、医疗服务提供者、卫生设施和卫生系统相关的五个主要障碍主题。这些主题包括：（i）受护理者对PPIUCD的认识不足和需求较低，（ii）PPIUCD特有的问题，（iii）提供服务的能力和资质不足，（iv）投资和优先级不足，以及（v）诸如盆腔炎和卫生考虑等背景因素。医疗服务提供者和政策参与者之间报告了一些不同观点。政策参与者强调医疗服务提供者在提供咨询和PPIUCD方面的努力不足，而医疗服务提供者则将PPIUCD相关问题（如插入程序的复杂性）视为阻碍其工作的重大障碍。医疗服务提供者和政策参与者都认为，对包括PPIUCD在内的产后避孕服务整合的投资和优先级不足是另一个重要因素。参与者表示迫切需要实施有效的综合咨询和避孕服务。
需要加大投资以消除实施和扩大综合产后计划生育服务，特别是在尼泊尔孕产妇服务中插入PPIUCD的多层次障碍。应优先考虑对受护理者和社区进行健康教育、能力建设（确保护理提供者有能力）以及升级卫生设施。
莫纳什国际研究生研究奖学金和莫纳什研究生奖学金。
