Abstract
BackgroundPostpartum women have high rates of unmet need for modern contraception in the two years following birth in Nepal. We assessed whether providing contraceptive counseling during pregnancy and/or prior to discharge from the hospital for birth or after discharge from the hospital for birth was associated with reduced postpartum unmet need in Nepal.MethodsWe used data from a larger a stepped-wedge, cluster randomized trial, including contraceptive counselling in six tertiary hospitals. Group 1 hospitals (three hospitals) initiated the intervention after three months of baseline data collection, while Group 2 hospitals (three hospitals) initiated the same intervention after nine months. We have enrolled 21,280 women in the baseline interviews and conducted two follow-up interviews with them, one and two years after they had delivered in one of our study hospitals. We estimated the effect of counseling and its timing (pre-discharge, post- discharge, both, or neither) on unmet need for modern contraception in the postpartum period, using random-effects logistic regressions.ResultsUnmet need for modern contraception was high (54% at one year and 50% at two years). Women counseled in either the pre-discharge period (Odds ratio [OR] 0·86; 95% CI: 0·80, 0·93) or in the post-discharge period (OR 0·86; 95% CI: 0·79, 0·93) were less likely to have an unmet need in the postpartum period compared to women with no counseling. However, women who received counseling in both the pre- and post-discharge period were 27% less likely than women who had not received counseling to have unmet need (OR 0.73; 95% CI: 0·67, 0·80).ConclusionsCounseling women either before or after discharge reduces unmet need for postpartum contraception but counseling in both periods is most effective.
Highlights
In developing countries, 218 million women want to space or limit their pregnancies but are not using a modern method of contraception [1]
Unmet need for modern contraception was high (54% at one year and 50% at two years)
Women counseled in either the pre-discharge period (Odds ratio [OR] 0 86; 95% CI: 0 80, 0 93) or in the post-discharge period were less likely to have an unmet need in the postpartum period compared to women with no counseling
Summary
218 million women want to space or limit their pregnancies but are not using a modern method of contraception [1]. By helping women to prevent unintended pregnancies, programs can reduce unintended births and unsafe abortions, and improve maternal and child health [2, 3]. These gains can contribute to other development objectives, such as curbing poverty and slowing population growth [4, 5]. Postpartum women have high rates of unmet need for modern contraception in the two years following birth in Nepal. We assessed whether providing contraceptive counseling during pregnancy and/or prior to discharge from the hospital for birth or after discharge from the hospital for birth was associated with reduced postpartum unmet need in Nepal
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