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. 2021 Jul;47(3):173-178.
doi: 10.1136/bmjsrh-2020-200741. Epub 2020 Sep 16.

Postpartum long-acting contraception uptake and service delivery outcomes after a multilevel intervention in Kigali, Rwanda

Julie Espey  1 , Rosine Ingabire  1   2 , Julien Nyombayire  1   2 , Alexandra Hoagland  1   2 , Vanessa Da Costa  1 , Amelia Mazzei  1   2 , Lisa B Haddad  3 , Rachel Parker  1 , Jeannine Mukamuyango  1   2 , Victoria Umutoni  1 , Susan Allen  1 , Etienne Karita  1   2 , Amanda Tichacek  1 , Kristin M Wall  4   5
Affiliations

Postpartum long-acting contraception uptake and service delivery outcomes after a multilevel intervention in Kigali, Rwanda

Julie Espey et al. BMJ Sex Reprod Health. 2021 Jul.

Abstract

Introduction: Postpartum family planning (PPFP) is critical to reduce maternal-child mortality, abortion and unintended pregnancy. As in most countries, the majority of PP women in Rwanda have an unmet need for PPFP. In particular, increasing use of the highly effective PP long-acting reversible contraceptive (LARC) methods (the intrauterine device (IUD) and implant) is a national priority. We developed a multilevel intervention to increase supply and demand for PPFP services in Kigali, Rwanda.

Methods: We implemented our intervention (which included PPFP promotional counselling for clients, training for providers, and Ministry of Health stakeholder involvement) in six government health facilities from August 2017 to October 2018. While increasing knowledge and uptake of the IUD was a primary objective, all contraceptive method options were discussed and made available. Here, we report a secondary analysis of PP implant uptake and present already published data on PPIUD uptake for reference.

Results: Over a 15-month implementation period, 12 068 women received PPFP educational counselling and delivered at a study facility. Of these women, 1252 chose a PP implant (10.4% uptake) and 3372 chose a PPIUD (27.9% uptake). On average providers at our intervention facilities inserted 83.5 PP implants/month and 224.8 PPIUDs/month. Prior to our intervention, 30 PP implants/month and 8 PPIUDs/month were inserted at our selected facilities. Providers reported high ease of LARC insertion, and clients reported minimal insertion anxiety and pain.

Conclusions: PP implant and PPIUD uptake significantly increased after implementation of our multilevel intervention. PPFP methods were well received by clients and providers.

Keywords: contraceptive devices; counseling; family planning services; female; reproductive health services.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1.
Figure 1.
Postpartum Implant (PP Implant) and Postpartum Intrauterine Device (PPIUD) Insertions among by Month. Kigali, Rwanda; August 2017 – October 2018 (among N=12,068 women who received our intervention and delivered at a study health facility)
See this image and copyright information in PMC

References

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