Couples-based interventions and postpartum contraceptive uptake: A systematic review

Abstract

Objective: Systematically review the existing evidence about couples-based interventions and postpartum contraceptive uptake and generate recommendations for future research.

Data sources: PubMed, Web of Science, PsycINFO, Embase, and CINAHL through June 7, 2021.

Study selection and data extraction: Studies with a couples-based intervention assessing postpartum contraceptive uptake. Two independent reviewers screened studies, extracted data, and assessed risk of bias with RoB-2 (Cochrane Risk of Bias 2) for randomized and ROBINS-I (Risk of Bias in Non-Randomized Studies - Interventions) for observational studies. Data were synthesized in tables, figures, and a narrative review.

Results: A total of 925 papers were identified, 66 underwent full text review, and 17 articles, which included 18 studies - 16 randomized, 2 observational - were included. The lack of intervention and outcome homogeneity precluded meta-analysis and isolating the effect of partner involvement. Four studies were partner-required, where partner involvement was a required component of the intervention, and 14 were partner-optional. Unadjusted risk differences ranged from 0.01 to 0.51 in favor of couples-based interventions increasing postpartum contraceptive uptake versus standard of care. Bias assessment of the 16 randomized studies classified 8, 3, and 5 studies as at a high, some concern, and low risk of bias. Common sources of bias included intervention non-adherence and missing outcome data. One observational study was at a high and the other at a low risk of bias.

Conclusions: Future studies that assess couples-based interventions must clearly define and measure how partners are involved in the intervention and assess how intervention adherence impacts postpartum contraceptive uptake.

Keywords: Contraception; Postpartum period; Sexual partners; Spouses; Systematic review.

Figure 1.. Flow diagram

Papers identified in databases on June 7,2021. We screened out titles and abstracts that did not make reference to couples-based interventions or postpartum contraceptive use. In the full text reviews, incorrect interventions and outcomes included interventions and outcomes outside of our study inclusion criteria. For example, studies with interventions that only included the pregnant partner would be categorized as an incorrect intervention and excluded and studies with outcomes that only included knowledge about contraceptives, not contraceptive use, would be categorized as an incorrect outcome and excluded. *Other sources include references from reviewed papers, clinical trials registries, and papers from relevant reviews identified through the literature search.

Figure 2.. Unadjusted Risk Differences in Randomized Studies

Forest plot of unadjusted risk differences across included randomized studies. Abbreviations: CAM – Community Awareness Model; (–) – insufficient information available to calculate a confidence interval or not reported

Figure 3.. Risk of Bias Assessment in Randomized Trials

Heatmaps of the signaling questions (a) and final risk of bias assessment (b) for the included randomized controlled trials. “Rand” refers to randomization, “IntDeriv” refers to intervention derivations, “MissOut” refers to missing outcomes, “OutMeas” refers to outcome measurement, and “SelRes” refers to the selection of the reported results. In (a), “RoB” refers to Risk of Bias, whereas in (b), each number refers to the specific signaling question. Signalling questions for the risk of bias assessment are presented in Supplemental File 3. Additionally, specific details about how bias was assessed within each study are presented in Supplementary Table 3.