Abstract
To evaluate the impact of structured training given to dedicated family planning counsellors on postpartum intrauterine device (PPIUD) services across six tertiary hospitals in Bangladesh. Family planning counsellors underwent structured training on postpartum family planning, PPIUD in particular, over a four-day period. Impact of training was evaluated by comparing PPIUD counselling rates, consent rates, insertion rates, and removal rates five months before and five months after the training, using data from women delivering in the participating facilities. A total of 27622 women were included in this analysis: 11263 (40.8%) before the training intervention and 16359 (59.2%) after it. There was an increase in the proportion of women who were counselled (from 75.3% to 83.8%, P<0.001), and a small decrease in the proportion of women agreeing to have a PPIUD inserted following counselling (13.7% vs 12.9%, P=0.03). Overall insertion rate was similar before and after training (9.5% vs 9.8%, P=0.42), while removal rate reduced from 2.8% to 1.8% (P=0.41). Structured training had no impact on overall PPIUD insertion rate. However, it did impact numbers of women receiving counselling, perceived quality of the counselling received, and overall removal rates.
Highlights
Birth spacing is an effective way to reduce maternal, perinatal, and child morbidity and mortality, and WHO recommends a period of at least 24 months between delivery and conception to reduce the adverse risks of pregnancy[1] Encouraging use of effective contraception can ensure sufficient spacing between pregnancies, as well as avoid instances of unsafe abortion—another contributor to maternal morbidity and mortality
In Bangladesh, the government has committed to ending preventable child and maternal deaths by 2030; despite various family planning initiatives, unmet need for contraception remains high with unintended pregnancies accounting for approximately one-third of all pregnancies.[2]
The proportion of counselled women who consented to have a postpartum intrauterine device (PPIUD) inserted fell slightly from 13.7% to 12.9%, while the proportion of women having a PPIUD inserted fell from 91.6% to 88.9%
Summary
Birth spacing is an effective way to reduce maternal, perinatal, and child morbidity and mortality, and WHO recommends a period of at least 24 months between delivery and conception to reduce the adverse risks of pregnancy[1] Encouraging use of effective contraception can ensure sufficient spacing between pregnancies, as well as avoid instances of unsafe abortion—another contributor to maternal morbidity and mortality. In Bangladesh, the government has committed to ending preventable child and maternal deaths by 2030; despite various family planning initiatives, unmet need for contraception remains high with unintended pregnancies accounting for approximately one-third of all pregnancies.[2]. Healthcare providers should be well equipped to offer accurate and balanced counselling to women and their families This will ensure that they receive sufficient information about contraceptive methods regarding effectiveness, correct use, common adverse effects, health risks and benefits, and signs and symptoms that would necessitate return to the clinic.[6,7,8]. To address unmet need for contraception as well as reduce maternal mortality in Bangladesh, the Obstetrical and Gynaecological Society of Bangladesh (OGSB), in partnership with the International Federation of Gynecology and Obstetrics (FIGO), developed an initiative seeking to provide women with postpartum family planning (PPFP) counselling and PPIUD services. The measures are indirect and asses PPFP counselling rates, PPIUD consent rates, insertion rates, and removal rates at six weeks postpartum across the six facilities
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