Abstract
We executed a cluster-randomized parallel arm pragmatic trial to observe the association of home-based postpartum contraceptive provision, including the contraceptive implant, with three and 12-month contraceptive utilization, satisfaction, and pregnancy rates. Eight clusters were randomized to receive either the home-based contraceptive delivery (condoms, pills, injection, implant) during the routine 40-day postpartum visit in addition to routine care, or routine care alone, which included comprehensive contraceptive counseling throughout antepartum care. 208 women were enrolled in the study, 108 in the intervention clusters and 100 in control clusters. 94 (87.0%) women in the intervention group and 91 (91%) of women in control clusters were evaluated 12 months post-enrollment. Likelihood of using contraception at that time was borderline increased in intervention clusters (RR 1.1 [1.0,1.3], p = 0.05) with an increased likelihood of long-acting contraceptive use (the implant; RR 1.6 [1.3,1.9], p < 0.001). Pregnancy rates were also borderline reduced in the intervention clusters (RR 1.0 [1.0,1.1], p = 0.07). There was no difference in satisfaction of women with contraceptive use between arms with about 95% of women very satisfied or a little satisfied in each arm. Continuation rates at twelve months of contraceptives in the intervention group were 0.0% for condom users, 80.0% for contraceptive pill users, 57% for injectable users, and 83% for implant users. Most women who discontinued their initial method chose a more long-term or permanent method. There was a trend toward a significant association with reduced short interval pregnancy. Our study had a borderline increase in overall use of contraception by 12 months, did have an increased likelihood of long-acting contraceptive use of the implant by 12 months, and resulted in a trend toward reduced short interval pregnancy in the intervention clusters as compared to control clusters.
Highlights
We conducted a cluster-randomized, pragmatic, parallel arm trial whereby study nurses brought contraceptives to the homes of postpartum women in intervention clusters..[1]
Our primary outcome showed that our intervention increased contraceptive utilization at three months in the intervention group compared to the control, which has been published
When we surveyed the women at twelve months post-enrollment, we found that the rate of contraceptive uptake in the intervention communities was almost higher overall than in the control communities, and that the rate of implant use was significantly higher
Summary
We conducted a cluster-randomized, pragmatic, parallel arm trial whereby study nurses brought contraceptives (condoms, pills, injection, implant) to the homes of postpartum women in intervention clusters..[1] The objective of the study was to observe whether providing contraceptives at a 40 day postpartum home visit was associated with an increase in implant uptake by three months postpartum.[1] Our results found that our intervention was successful and increased overall contraceptive uptake (RR 1.3 [1.1,1.5], p < 0.001) as well as implant uptake by three months (RR 1.3 [1.2,1.4]) with high satisfaction and no adverse outcomes.[2] The objective of this additional analysis is to present the 12-month continuation, satisfaction, and pregnancy rates of the study, which represent secondary outcomes of the trial.[1] We hypothesized based on prior literature that our trial would have high rates of contraceptive continuation and satisfaction and likely reduce the likelihood of short interval pregnancy.[3,4]
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