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. 2022 Apr 26;22(1):556.
doi: 10.1186/s12913-022-07965-9.

Developing contraceptive services for immigrant women postpartum - a case study of a quality improvement collaborative in Sweden

Helena Kilander  1   2   3 , Maja Weinryb  2   4 , Malin Vikström  5 , Kerstin Petersson  5   6 , Elin C Larsson  7   8   9
Affiliations

Developing contraceptive services for immigrant women postpartum - a case study of a quality improvement collaborative in Sweden

Helena Kilander et al. BMC Health Serv Res. .

Abstract

Background: Immigrant women use less effective contraceptive methods and have a higher risk of unintended pregnancies. Maternal health care services offer a central opportunity to strengthen contraceptive services, especially among immigrants. This study aimed to evaluate a Quality Improvement Collaborative QIC. Its objective was to improve contraceptive services for immigrant women postpartum, through health care professionals' (HCPs) counselling and a more effective choice of contraceptive methods.

Methods: The pilot study was designed as an organisational case study including both qualitative and quantitative data collection and analysis. Midwives at three maternal health clinics (MHCs) in Stockholm, Sweden participated in a QIC during 2018-2019. In addition, two recently pregnant women and a couple contributed user feedback. Data on women's choice of contraceptive method at the postpartum visit were registered in the Swedish Pregnancy Register over 1 year.

Results: The participating midwives decided that increasing the proportion of immigrant women choosing a more effective contraceptive method postpartum would be the goal of the QIC. Evidence-based changes in contraceptive services, supported by user feedback, were tested in clinical practice during three action periods. During the QIC, the proportion of women choosing a more effective contraceptive method postpartum increased at an early stage of the QIC. Among immigrant women, the choice of a more effective contraception increased from 30 to 47% during the study period. Midwives reported that their counselling skills had developed due to participation in the QIC, and they found using a register beneficial for evaluating women's choice of contraceptive methods.

Conclusions: The QIC, supported by a register and user feedback, helped midwives to improve their contraceptive services during the pregnancy and postpartum periods. Immigrant women's choice of a more effective contraceptive method postpartum increased during the QIC. This implies that a QIC could increase the choice of a more effective contraception of postpartum contraception among immigrants.

Keywords: Contraception; Coproduction; Counselling; Family planning; Maternal health care; Postpartum; Quality improvement; System performance.

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Conflict of interest statement

One of the co-authors (H Kilander) has been reimbursed by Merck Sharpe & Dohme Bayer AB, Sweden and Campus Pharma AB, Sweden for running educational programmes and giving lectures. The other co-authors (M Weinryb, M Vikström, K Petersson, EC Larsson) have stated that they have no conflicts of interest in connection with this manuscript.

Figures

Fig. 1
Fig. 1
Timeline for the quality improvement collaborative, user involvement and the case study data collection 2018-2019
Fig. 2
Fig. 2
The quality improvement collaborative based on the Driver diagram [34], outlining the four main areas for evidence-based changes
See this image and copyright information in PMC

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