Process evaluation of postpartum contraceptive service delivery in Ayder Comprehensive Specialized Hospital Mekelle, Tigray, Ethiopia in 2020

Abstract

BackgroundPostpartum contraceptives during the first year after delivery is a key service for women to prevent unintended pregnancy and reduce the risk of maternal and child mortality by ensuring safe birth intervals. This process evaluation aimed to assess the availability, compliance, and accommodation of Post-Partum Contraceptives (PPC) and the experience of women’s contraception in the first 12 months postpartum in Ayder Comprehensive Specialized Hospital (ACSH).MethodsA case study evaluation design with a mixed method was employed from February 16/2020 to Mar 30, 2020. Direct observations, 12-month document reviews, and key informant interviews were conducted. The quantitative data were entered into Epi-Data version 3.1 and exported to SPSS version 21 for analysis. In the multivariate logistic regression analysis, variables with < 0.05 p-values and Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were used to declare the association. The qualitative data were transcribed, translated, coded, and analyzed using thematic analysis. The overall process of program implementation was measured based on pre-determined judgmental criteria.ResultFrom the total of charts reviewed 302 only 188 (62.3%) postpartum mothers used any method within 12 months of the postpartum period out of which only 27.1% mothers used of long-acting reversible contraceptive (LARC). The overall evaluation of postpartum contraceptives was 84.1% (V/good). Notable gaps observed in this study were poor provision of information in relation to methods given, poor technical performance in following the aseptic procedure, poor utilization of postpartum family planning guidelines and clinical checklists for counseling, and poor use of information education materials compared to the national standards. Residence, number of stillbirths or neonatal loss, counseling status of family planning during ANC visits, and maternal counseling status of family planning during postnatal care visits were factors associated with PPC.ConclusionThe overall postpartum contraceptive service delivery in ACSH was V/good compared to the national family planning guideline standards. With the notable gaps identified, specific recommendations were suggested to different responsible bodies.