Abstract
Despite the provision of free and subsidized family planning services and clients’ demonstrated intentions to delay pregnancies, family planning uptake among women who receive abortion and postabortion services at Sunaulo Parivar Nepal (SPN), one of Nepal’s largest non-governmental sexual and reproductive health (SRH) providers, remains low. Through meetings, interviews, and observations with SPN’s stakeholders, service providers, and clients at its 36 SRH centers, we developed hypotheses about client- and provider-side barriers that may inhibit postabortion family planning (PAFP) uptake. On the provider side, we found that the lack of benchmarks (such as the performance of other facilities) against which providers could compare their own performance and the lack of feedback on the performance were important barriers to PAFP uptake. We designed several variants of three interventions to address these barriers. Through conversations with team members at SPN’s centralized support office and service providers at SPN centers, we prioritized a peer-comparison tool that allows providers at one center to compare their performance with that of other similar centers. We used feedback from the community of providers on the tools’ usability and features to select a variant of the tool that also leverages and reinforces providers’ strong intrinsic motivation to provide quality PAFP services. In this paper, we detail the process of identifying barriers and creating an intervention to overcome those barriers. The intervention’s effectiveness will be tested with a center-level, stepped-wedge randomized control trial in which SPN’s 36 centers will be randomly assigned to receive the intervention at 1-month intervals over a 6-month period. Existing medical record data will be used to monitor family planning uptake.
Highlights
On average, approximately 210 million women become pregnant each year
Interviews, and observations with Sunaulo Parivar Nepal (SPN)’s stakeholders, service providers, and clients at its 36 sexual and reproductive health (SRH) centers, we developed hypotheses about client- and provider-side barriers that may inhibit postabortion family planning (PAFP) uptake
We explain how we worked with providers to design interventions that increase PAFP uptake
Summary
Approximately 210 million women become pregnant each year. As of 2003, fifth of these women (42 million) induce abortion, of which approximately 21 million were unsafe [1]. A primary cause of these abortions is the unmet need for family planning, as evidenced by the reduced rate of abortion in countries following the introduction of national contraceptive programs [2]. A woman’s fertility can return 1 week after an abortion, highlighting the importance of postabortion family planning (PAFP) uptake [3]. Research suggests that timely access to PAFP services can prevent subsequent unintended pregnancies. Practitioners aim to increase patients’ timely access to contraception by integrating counseling on family planning into postabortion
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