Evaluation of a Community-Based Intervention on Postpartum Contraceptive Utilization in Rural Nepal [12OP

Abstract

INTRODUCTION: Unmet need for postpartum contraception in rural Nepal remains high. Strategies that integrate contraceptive counseling along the continuum of reproductive health care are more effective than isolated counseling sessions. One program is utilizing a system of Community Health Workers (CHWs) to provide integrated reproductive, maternal, newborn, and child health care. Structured contraceptive counseling is delivered at antenatal and postnatal home visits and data collected via a mobile phone application. METHODS: A mixed methods approach was used to evaluate the effect of the intervention on postpartum contraceptive uptake. We compared the odds of modern contraceptive uptake among recently postpartum women in the pre-intervention and intervention groups using multivariate logistic regression. Eleven individual interviews were conducted with staff and participants to understand the implementation process and mechanisms of behavior change. RESULTS: There were 445 postpartum women in the pre-intervention group and 510 in the intervention group. Modern contraceptive use increased from 29.4% pre-intervention to 46.1% in the intervention group. Women in the intervention group had twice the odds of using a modern contraceptive method as compared to the pre-intervention group (OR=2.05, P<.0001). Salient themes noted in the interviews include overall positive perceptions of the intervention and emphasis on the need to involve family members as they play a critical role in women's contraceptive decision-making. CONCLUSION: An integrated community-based structured contraceptive counseling intervention delivered by professionalized CHWs in the home in rural Nepal appears to be effective in increasing use of modern contraceptive methods. The intervention is being to scaled to other similar settings in Nepal.