Long-acting Reversible Contraception Use Research Articles

Long-acting reversible contraceptives utilization and its determinants among married Yemeni women of childbearing age who no longer want children.

Some contraceptive methods, such as long-acting and permanent methods, are more effective than others in preventing conception and are key predictors of fertility in a community. This study aimed to determine which factors were linked to married women of childbearing age who no longer desired children using long-acting reversible contraceptives (LARCs) in Yemen. We used a population-based secondary dataset from Yemen’s National Health and Demographic Survey (YNHDS), conducted in 2013. The study analyzed a weighted sample of 5149 currently married women aged 15 to 49 years who had no plans to have children. Logistic regression analyses were used to investigate the parameters linked to the present use of LARCs. The final model’s specifications were evaluated using a goodness-of-fit test. An alpha threshold of 5% was used to determine statistical significance. Of the total sample, 45.3% (95% CI: 43.3–47.4) were using contraception. LARCs were used by 21.8% (95% CI: 19.6–24.1) of current contraceptive users, with the majority (63.8%) opting for short-acting reversible contraceptives (SARCs). In the adjusted analysis, maternal education, husbands’ fertility intention, place of residence, governorate, and wealth groups were all linked to the usage of LARCs. According to the findings, women whose spouses sought more children, for example, were more likely to use LARCs than those who shared their partners’ fertility intentions (AOR = 1.44; 95% CI: 1.07–1.94; P = .015). In this study, married women of reproductive age who had no intention of having children infrequently used contraception and long-acting methods. Improving women’s education and socioeconomic status could contribute to increasing their use of LARCs.

Factors associated with use of long-acting reversible and permanent contraceptives among married women in rural Kenya: A community-based cross-sectional study in Kisii and Kilifi counties.

Long-acting and permanent contraceptive methods (LAPM) are effective and economical methods for delaying or limiting pregnancies, however they are not widely used. The Kenya government is promoting the use of modern methods of family planning through various mechanisms. This study aimed to determine the prevalence and factors associated with the use of LAPM among married women of reproductive age in targeted rural sub-counties of Kilifi and Kisii counties, Kenya. Baseline and end line Data from a program implemented on improving Access to Quality Care and Extending and Strengthening Health Systems (AQCESS) in Kilifi and Kisii counties of Kenya were used. Multi-stage sampling was used to sample 1117 and 1873 women for the end line and baseline surveys, respectively. Descriptive analysis was used to explore the respondents' characteristics and use of LAPM on a self-weighted samples. Univariable and multivariable binary logistic regression models using svy command were used to assess factors associated with the use of LAPM. A total of 762 and 531 women for the baseline and end line survey, respectively were included in this study. The prevalence of use of LAPM for baseline and end line survey were 21.5% (95% CI: 18.7-24.6%) and 23.2% (95% CI: 19.6%-27.0%), p-value = 0.485. The use of LAPM in Kisii and Kilifi counties was higher than the national average in both surveys. The multivariable analysis for the end line survey showed having 3-5 number of children ever born (aOR = 2.04; 95% CI: 1.24-3.36) and future fertility preference to have another child (aOR = 0.50; 95% CI: 0.26-0.96) were significantly associated with odds of LAPM use. The baseline showed that having at least secondary education (aOR = 1.93; 95%CI: 1.04-3.60), joint decision making about woman's own health (aOR = 2.08; 95%CI: 1.36-3.17), and intention to have another child in future (aOR = 0.59; 95%CI: 0.40-0.89) were significantly associated with the use of LAPM. Future fertility preference to have another child was significantly associated with the use of LAPM in the two surveys. Continued health promotion and targeted media campaigns on the use of LAPM in rural areas with low socioeconomic status is needed in order to improve utilization of these methods. Programs involving men in decision making on partner's health including family planning in the rural areas should be encouraged.

Relationships between Penile-Vaginal Intercourse Frequency and Condom/Contraceptive Use from 2009 to 2018: Findings from the National Survey of Sexual Health and Behavior

Objectives: To examine changes over time in event-level condom/contraceptive use and the association between past year penile-vaginal intercourse frequency and event-level condom/contraceptive use. Methods: Data were from the 2009 and 2018 National Survey of Sexual Health and Behavior, an online probability survey of U.S. adolescents and adults. Results: The use of condoms and highly effective hormonal contraceptives decreased while long-acting reversible contraceptive use increased from 2009 to 2018 among adults. Increased penile-vaginal intercourse frequency was associated with decreased use of most contraceptive methods but an increase in condom use for adolescents. Conclusions: Sexual frequency should be considered when assessing condom/contraceptive use.

Factors associated with long-acting and short-acting reversible contraceptives use among 10-24-years-old youths in Lilongwe, Malawi.

BackgroundEvidence suggests that Malawi continues to register substantial progress on key Family Planning (FP) indicators. However, FP adoption is still low among married youth (15–24 years old), only 38% of married girls use modern contraceptive methods coupled with high-unmet needs (22%) in the same age group.ObjectiveIdentifying factors associated with long-acting (LARC) and short-acting (SARC) reversible contraceptive use among 10–24-years-old youth in Lilongwe, Malawi.MethodologyA retrospective study using secondary data from 64 youth outreach clinic sites in the Lilongwe district. A quantitative approach using secondary data that was analyzed in STATA version 14 was used. A sample of 14,954 youth who accessed FP and Reproductive Health (RH) services during youth outreach clinics were included in the study.ResultsSARC uptake was higher than LARC (p < 0.01). Of the youths who accessed FP methods, LARC uptake was 25% (n = 3,735). Variations were noted in the uptake of LARC, especially on age, education level, client status occupation, and marital status. Factors associated with LARC uptake varied; new clients were almost twice likely to use LARC (AOR = 1.87, CI: 1.59–2.19, P < 0.01) while youth aged 20–24, the single, and student youth were less likely to use LARC. Compared to young women with formal occupations, students were less likely to use LARC (AOR = 0.30, CI: 0.158–0.58, P < 0.01). Related to the number of living children, youths with a living child were likely to use LARC (AOR = 6.40, CI: 3.91–10.48, P < 0.01).ConclusionThis study showed that LARC uptake in youth outreach clinics in Lilongwe is low, though increasing over time. In addition to this, this study shows that SARC uptake is high among youth compared to LARC. Furthermore, LARC uptake varied by age education, client status (new, existing, and unknown client), occupation, number of living children, and marital status, and there were variations in LARC uptake by the clinic. Current outreach services reach youth with LARC services, but gaps exist for underserved youths.

Understanding the association between informed choice and long-term reversible contraception among Ugandan women: Findings from the 2016 Demographic Health Survey.

To understand the relationship between informed choice and long-acting reversible contraceptive (LARC) use among women aged 15-49 years in Uganda after adjusting for potential confounding. This cross-sectional study uses data from the 2016 Uganda Standard Demographic and Health Survey. Thomas-Rao corrections to a χ2 test were used for the bivariable analysis. A design-adjusted multivariable logistic regression was used to estimate the association between informed choice and LARC use. Propensity score matching was conducted as a sensitivity analysis. In all, 3646 women were included in the analysis and 975 reported using a LARC. In the design-adjusted multivariable analysis, the odds of reporting LARC usage were 1.98 (95% confidence interval 1.61-2.43) times higher among women who reported informed choice compared with those who did not. The subsequent propensity score analysis reported similar findings. Providing informed choice can help to increase the number of women who use LARC in Uganda. As such, the Ugandan Ministry of Health should further expand access to family planning counseling as it could contribute to the reduction of unplanned pregnancies across Uganda with the use of LARC.

Patient characteristics of contraception and sterilization selection at vaginal delivery

To examine patient characteristics among those who selected the long-acting reversible contraception (LARC) and surgical sterilization methods at vaginal delivery. Retrospective cohort study. The National Inpatient Sample. A total of 8,013,785 vaginal deliveries from October 2016 to December2019. Exposure assignment per LARC (subdermal contraceptive implant [implants] or intrauterine device [IUD]) or surgical sterilization (bilateral salpingectomy [BS] or bilateral tubal ligation [BTL]) type. Utilization trends of LARC or surgical sterilization, assessed with linear segmented regression with log-transformation, and differences in patient characteristics per the exposure strata (implants vs. IUD in the LARC group and BS or BTL in the surgical sterilization group), assessed using the multivariate binary logistic regression model. In a comparison between LARC and surgical sterilization, surgical sterilization use decreased from 1.90% to 1.55% (18.4% relative decrease), whereas LARC use increased from 0.35% to 1.02% (191% relative increase). In the LARC group, implant use (from 0.12% to 0.50%) increased more compared with IUD use (from 0.22% to 0.52%): relative increase, 317% vs. 136%. In the surgical sterilization group, BTL use decreased from 0.66% to 0.18% (72.7% relative decrease), whereas BS use was statistically unchanged (from 1.24% to 1.37%). In a multivariate analysis, recent year remained an independent characteristic for implant use in the LARC group and BS use in the surgical sterilization group. Moreover, in both LARC and surgical sterilization strata, procedure choices significantly differed on the basis of patient, pregnancy, hospital, and delivery factors. Immediate postpartum contraception choice has evolved in recent years in the United States with an increasing demand for the LARC methods with implants at the time of vaginal delivery.

Expression of Concern

This article refers to:Effect of a mobile phone-assisted postpartum family planning service on the use of long-acting reversible contraception: a randomised controlled trial

Are LARC Users Less Likely to Use Condoms? An Analysis of U.S. Women Initiating LARC in 2008-2018.

Public health professionals have raised concern that increased use of long-acting reversible contraceptives (LARC) could raise women's risk for sexually transmitted infections (STIs), because LARC's superior pregnancy protection may decrease women's motivation to use a barrier method for supplemental pregnancy prevention. This study uses population-based data to examine whether condom use is lower, particularly among young women who are at increased STI risk, after initiating LARC versus moderately effective methods. With the 2011-2019 data files of the National Survey of Family Growth, we examine the percent of sexually active months with condom use in the year after LARC or moderately effective method initiation for a nationally representative sample of 2,018 women aged 15-44years. Multinomial logistic models regressed condom use on method type and age group, as well as their interaction, while adjusting for key confounders. The unadjusted likelihood of any condom use is substantially lower among women who initiated LARC versus moderately effective methods (12% vs. 37%), and this difference is greater among younger versus older women. After accounting for differences in women's reproductive and sociodemographic profiles, however, a statistically significant difference in condom use by method initiated remains only for those aged 20-34years. Crude estimates suggest that condom use is lower after initiating LARC versus moderately effective methods, especially among young women. After accounting for the confounding effects of LARC users' distinct profiles-particularly in terms of parity and teenage childbearing-the difference is decreased overall and no longer significant for adolescent women. Overall results indicate a need for new STI prevention strategies and policies that emphasize the importance of dual prevention for LARC users at risk of STIs.

Counseling increases immediate postpartum Long-Acting Reversible Contraception (LARC) acceptability in Hispanic women

ObjectiveDetermine if providing basic contraceptive counseling during prenatal visits increases pregnant Hispanic women's acceptance of immediate postpartum long-acting reversible contraception (LARC). Study DesignRespondents completed a short survey consisting of demographic information, an acculturation scale, and perceptions of immediate postpartum LARC use. After reading a brief educational excerpt on intrauterine devices (IUDs) and the subdermal contraceptive implant, LARC acceptability was reassessed. The study included 198 Hispanic women, ages 14 and older, in the 2nd or 3rd trimester of pregnancy receiving care at an academic practice along the United States-Mexico border in West Texas. Analysis was performed using a McNemar test, univariate and multivariable relative risk (RR) regression. ResultsPrior to an educational intervention, 34.5% of respondents indicated that they were planning to use immediate postpartum LARC. Following the educational intervention, 74.5% of respondents indicated they would consider a postpartum LARC. The pre/post comparison on the intent to use postpartum LARC showed that a significant number of respondents changed their intention to use LARC after reading the educational intervention (RR= 2.54, p<0.0001). LARC acceptability was high among single women, those less than 25-years-old, women with current unintended pregnancies, and women using a contraceptive method that failed when they became pregnant. ConclusionIn communities with a high proportion of Hispanic women, postpartum contraceptive counseling is crucial for patient education and family planning. When women are provided with brief, structured contraceptive counseling during prenatal visits, they are more willing to consider use of an immediate postpartum LARC for their future family planning.

Factors associated with discontinuation among long-acting reversible contraceptive users: a multisite prospective cohort study in urban public health facilities in Ethiopia

ObjectiveThe study aims to determine discontinuation among long-acting reversible contraceptive users at 3, 6, 9 and 12 months after initiation and its associated factors among new long-acting reversible contraceptive (LARC)...

Uptake of Immediate Postpartum LARCs and Associated Factors among Mothers Who Gave Birth at Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia.

Background Postpartum family planning is an effective strategy for reducing maternal and childhood morbidity and mortality by preventing unintended pregnancy and short interpregnancy intervals. Despite the paramount advantages of long-acting reversible contraceptives (LARC), their uptake remains low in Ethiopia. Therefore, the aim of this study was to assess the uptake of immediate postpartum LARC methods and its associated factors among women who gave birth in Hawassa University Comprehensive Specialized Hospital, Hawassa city, Southern Ethiopia. Methods An institution-based cross-sectional study was conducted among 418 eligible mothers who were in the immediate postpartum period. Data were collected using a pretested structured questionnaire before their discharge from the hospital and analyzed by using SPSS version 20. The statistical significance was declared at P value less than 0.05. Results The uptake LARCs among immediate postpartum mothers was 25.4%. The most commonly reported reasons for not using LARC were preference to start contraception after six weeks of delivery (43.3%) and the need to use other methods of contraception (26%). Having unplanned birth (AOR: 1.97; 95% CI: 1.04-3.71) and receiving family planning counselling on LARCs during the postpartum period (AOR: 21.1; 95% CI: 6.49-68.66) were factors significantly associated with immediate postpartum LARC use. Conclusion Low utilization of immediate postpartum LARC uptake was found in the current study setting. There was increased utilization of immediate postpartum LARC among mothers who received family planning counselling during the postpartum period. Therefore, strengthening family planning counselling during the immediate postpartum period is crucial to enhance postpartum LARC use.

The Effects of Text Messaging for Increasing the Rate of long-acting Reversible Contraception use in Teenage Pregnancy: A Randomized Controlled Trial

Background: A teenage pregnancy rate is a one of SDGs goal. Thailand had a teenage pregnancy rate higher inAsia-Pacific from less developed regions. A one of cause is a sex when they was young. This study is aimed tostudy an effective of a text messaging of teenage pregnant to the long-acting reversible contraception.Materials and Methods: This is a randomized controlled trial. The study was an effective of a text messaging ofteenage pregnant to the long-acting reversible contraception. A samples had 2 group from teenage pregnant in SiSaKet hospital. The control group was 212 samples. The trail group was 212 samples.Result: The control group had a standard care of postpartum. The trial group had a standard care of postpartumand a text message about long-acting reversible contraception. The researcher were following a both sample. Theyfound a trial group had a reversible contraception higher than a control group at a significant level. (P-value&lt;0.001)Conclusion: Present, a communication is important onthe digital time especially in teenager. A one of measurementpostpartum teenager in this time is a text message. It will be reducing a repeat pregnant among teenage.

Results of the National Contraception Survey Conducted by Sociedad Española de Contracepción (2020).

Background: The National Contraception Survey conducted by Sociedad Española de Contracepción intends to know the sexual and contraceptive habits of Spanish women of reproductive age. Methods: A descriptive and cross-sectional study with random sample selection was conducted with women aged from 14 to 49 years old in July and August 2020. Results: A total of 1801 women participated in the study, of which 78.7% used some contraception method during their sexual relationships. The most frequently used methods were condoms (31.3%) and combined oral contraceptives (18.5%) at their last sexual encounter. A total of 25.7% used both condoms and pills, especially younger women and those who had no steady partners (p < 0.001). Use of Long-acting Reversible Contraceptives continues to be low, although a slight increase in their use is observed, and they are recommended for 50% of the users who need contraception. Counselling on contraception was provided to 64.3% of the women, mainly by their gynaecologists. Regarding the decision to use a contraceptive method, the one suggested by health professionals was more influential, although this was not the case for women aged less than 20 years old (p < 0.001). A total of 38.4% of the women have used emergency oral contraception at least once and 66.8% of those who do not make continuous use of contraception methods do so out of personal choice. Conclusions: It is necessary to deepen work on counselling and awareness among the population towards the use of efficient contraceptive methods that prevent unplanned pregnancies.

O-293 The GnRH-agonist trigger alone can be used for egg maturation in altruistic egg donors using long-acting reversible contraceptives without compromising the outcome

Abstract Study question Does use of long-acting reversible contraceptives (LARC) compromise the efficacy of a GnRH agonist trigger in egg donors? Summary answer Using a GnRH-agonist trigger in altruistic egg donors using LARCs does not appear to compromise oocyte yield or maturity. What is known already GnRH-agonist triggers are recommended for altruistic egg donors to reduce the risk of ovarian hyperstimulation syndrome (OHSS) as any impact on the luteal phase would be clinically irrelevant. There is increasing usage of LARCs by young women due to their convenience and side-effect profile. A recent British Fertility Society survey (Mascarenhas et. al., 2021) indicated that many clinicians recommend removal before starting ovarian stimulation which incurs inconvenience to the donors and also risks unintended pregnancy. We had previously confirmed that women with LARC would respond to a GnRH-agonist trigger with an LH release deemed sufficient to induce oocyte maturation. Study design, size, duration Electronic records of 56 altruistic egg donation cycles with a GnRH-agonist trigger between January 2017 and December 2021 were retrospectively analysed. Of these, 38 were not on contraception or using non-hormonal contraceptive methods (Nil group), five were using oral contraception (Pill group), nine had a copper or levonorgesterol intrauterine device in situ (IUCD group) and four had a LARC in situ (LARC group). Participants/materials, setting, methods All stimulation involved GnRH-antagonist control. Donors with IUCDs or LARCs in situ were advised they could continue on their choice of contraception throughout the egg donation process. Oocyte retrieval was performed 36-37 hours post-GnRH-agonist trigger. The number of oocytes retrieved and the number of mature oocytes were recorded. As the numbers were small, the data is presented as median and interquartile range (IQR) and, given the small numbers, statistical analyses were expectedly, not significantly different. Main results and the role of chance The median age and AMH of the Nil group was 27.2 (IQR 25.4-29.3) years and 41.0 (IQR 33.0-65.3) pmol/L, for the IUCD group was 28.8 (IQR 24.8-29.3) years and 45.0 (IQR 38.0-54.0) pmol/L, and for the Pill group was 26.0 (IQR 24.0-27.2) years and 36.0 (31.0-40.0) pmol/L. Women in the LARC group were younger than in the nil group with a median age of 23.3 (IQR 22.6-23.6) (p = 0.016), but with no significant difference in the AMH levels 32.6 (IQR 22.8-40.5) pmol/L. There was no difference apparent in the number of oocytes retrieved between the groups: Nil group = 18.5 (IQR 12-24); Pill group = 21 (IQR 21-23); IUCD group = 19 (IQR 18-20); LARC group = 23 (IQR 11-33). The number of mature oocytes also appeared similar: Nil group = 14 (IQR 9-22); Pill group = 19 (IQR 17-20); IUCD group = 17 (IQR 15-18); LARC group = 19 (IQR 11-26). The oocyte maturity rates were also similar: Nil group = 86%; Pill group = 83%; IUCD group = 89%; LARC group = 78%. Limitations, reasons for caution A retrospective cohort study carries inherent disadvantages of confounding variables or variation in baseline characteristics as compared with a randomised controlled trial. The low sample size would have meant that results of any statistical analysis runs the risk of being insignificant or spurious which we have therefore deliberately refrained from. Wider implications of the findings Although derived from a small sample size, the finding that the GnRH-trigger alone can be deployed in women using LARCs without compromising egg numbers or maturity can give clinicians confidence to perform GnRH-agonist triggering for altruistic egg donors or others wishing to store eggs or embryos, thus maximising patient safety. Trial registration number Not applicable

Inequalities in short-acting reversible, long-acting reversible and permanent contraception use among currently married women in India

BackgroundIn India, the usage of modern contraception methods among women is relatively lower in comparison to other developed economies. Even within India, there is a state-wise variation in family planning use that leads to unintended pregnancies. Significantly less evidence is available regarding the determinants of modern contraception use and the level of inequalities associated with this. Therefore, the present study has examined the level of inequalities in modern contraception use among currently married women in India.MethodsThis study used the fourth round of National Family Health Survey (NFHS-4) conducted in 2015-16. Our analysis has divided the uses of contraception into three modern methods of family planning such as Short-Acting Reversible Contraception (SARC), Long-Acting Reversible Contraception (LARC) and permanent contraception methods. SARC includes pills, injectable, and condoms, while LARC includes intrauterine devices, implants, and permanent contraception methods (i.e., male and female sterilization). We have employed a concentration index to examine the level of socioeconomic inequalities in utilizing modern contraception methods.ResultsOur results show that utilization of permanent methods of contraception is more among the currently married women in the higher age group (40–49) as compared to the lower age group (25–29). Women aged 25–29 years are 3.41 times (OR: 3.41; 95% CI: 3.30–3.54) more likely to use SARC methods in India. Similarly, women with 15 + years of education and rich are more likely to use the LARC methods. At the regional level, we have found that southern region states are three times more likely to use permanent methods of contraception. Our decomposition results show that women age group (40–49), women having 2–3 children and richer wealth quintiles are more contributed for the inequality in modern contraceptive use among women.ConclusionsThe use of SARC and LARC methods by women who are marginalized and of lower socioeconomic status is remarkably low. Universal free access to family planning methods among marginalized women and awareness campaigns in the rural areas could be a potential policy prescription to reduce the inequalities of contraceptive use among currently married women in India.

Society of Family Planning clinical recommendation: Extended use of long-acting reversible contraception

In this clinical recommendation, we review the evidence supporting the use of the copper intrauterine device, levonorgestrel intrauterine devices and etonogestrel subdermal implant beyond the Food and Drug Administration approved duration of use for contraception (extended use). Clinicians should discuss effectiveness as well as other clinical considerations with patients to allow them to make contraceptive decisions that support their reproductive goals and clinical needs. Extended use of long acting reversible contraception may be a safe, effective and desirable option for many patients.

The Impact of the COVID-19 Pandemic on Postpartum LARC: A Retrospective Cohort Study [A20

INTRODUCTION: At the onset of the COVID-19 pandemic, providers were encouraged to counsel patients interested in long-acting reversible contraception (LARC) about immediate postpartum placement to decrease in-person postpartum visits. We assessed the impact of this COVID-related hospital policy on postpartum LARC uptake. METHODS: In this retrospective cohort study, we compared patients who delivered a live born infant(s) during two periods, one immediately prior to the COVID pandemic (“pre-COVID cohort” (December 16, 2019 to March 1, 2020)), and one at the onset of the pandemic (“COVID cohort” (March 16-May 31, 2020)). We collected electronic medical record data, including sociodemographic characteristics and contraception choices, in the antenatal and postpartum periods for 649 patients. Odds ratios were adjusted for age and race. RESULTS: We found an increase in immediate postpartum LARC use during COVID (13% vs. 9%, P=.12, aOR 1.44, CI 0.87-2.39). The etonogestrel implant was the most placed form of immediate postpartum LARC in both cohorts (67% and 71% in pre- and during COVID cohorts, respectively). In general, contraceptive choices at discharge differed between the cohorts (P=.01), with fewer patients desiring LARC placement at the postpartum visit during COVID (13% vs. 6% in pre- and during COVID cohorts). There was no difference between the average number of postpartum visits attended in each cohort (OR 0.93, CI 0.68-1.28). CONCLUSION: Changes in contraceptive counseling during COVID were accompanied by differences in postpartum contraceptive choices at discharge. Targeted contraceptive counseling can influence patient choices in the setting of expected barriers to routine postpartum care.

Association of the Delaware Contraceptive Access Now Initiative with Postpartum LARC Use

ObjectivesAlthough multi-component policy interventions can be important tools to increase access to contraception, we know little about how they may change contraceptive use among postpartum women. We estimate the association of the Delaware Contraceptive Access Now (DelCAN) initiative with use of postpartum Long-Acting Reversible Contraception (LARC). DelCAN included Medicaid payment reform for immediate postpartum LARC use, provider training and technical assistance in LARC provision, and a public awareness campaign.MethodsWe used a difference-in-differences design and data from the 2012 to 2017 pregnancy risk assessment monitoring system to compare changes in postpartum LARC use in Delaware versus 15 comparison states, and differences in such changes by women’s Medicaid enrollment.ResultsRelative to the comparison states, postpartum LARC use in Delaware increased by 5.26 percentage points (95% CI 2.90–7.61, P < 0.001) during the 2015–2017 DelCAN implementation period. This increase was the largest among Medicaid-covered women, and grew over the first three implementation years. By the third year of the DelCAN initiative (2017), the relative increase in postpartum LARC use for Medicaid women exceeded that for non-Medicaid women by 7.24 percentage points (95% CI 0.12–14.37, P = 0.046).Conclusions for PracticeThe DelCAN initiative was associated with increased LARC use among postpartum women in Delaware. During the first 3 years of the initiative, LARC use increased progressively and to a greater extent among Medicaid-enrolled women. Comprehensive initiatives that combine Medicaid payment reforms, provider training, free contraceptive services, and public awareness efforts may reduce unmet demand for highly effective contraceptives in the postpartum months.

Determinan Penggunaan Metode Kontrasepsi Jangka Panjang Di Indonesia (Analisis SDKI 2017)

Effective contraception such as the Long-acting reversible contraceptives can prevent one in every three maternal deaths by allowing women to arrange births, avoid unwanted pregnancies and abortions, and stop giving birth when they have reached the desired family size. This study aimed to determine the factors associated with long-acting reversible contraceptives methods in Indonesia. This study used secondary data by analyzing the results of the Indonesian Demographic and Health Survey (IDHS) in 2017. The sample was married women aged 15-19 years with a total of respondents being 19522. This study showed, that the most types of contraception used by respondents were short-acting contraceptive methods (pills and injections), namely 75.4%, and only 24.6% of respondents used long-acting reversible contraceptives. The results of the multivariate analysis described the determinants of long-acting reversible contraceptives were age, parity, occupation, cost of family planning, and decision-maker. It is necessary to improve counseling services and promote the long-acting reversible contraceptives as effective contraception in delaying birth, considering that most of the respondents used long-acting reversible contraceptives when they were &gt;35 years old with grand multipara. In addition, decision-making by respondents and their partners as well as health workers as service providers is also very influential in increasing the use of long-acting reversible contraceptives so effective counseling and involving partners is also important.

Implementation and evaluation of a large-scale postpartum family planning program in Rwanda: study protocol for a clinic-randomized controlled trial

BackgroundThough the Rwandan Ministry of Health (MOH) prioritizes the scale-up of postpartum family planning (PPFP) programs, uptake and sustainability of PPFP services in Rwanda are low. Furthermore, highly effective long-acting reversible contraceptive method use (LARC), key in effective PPFP programs, is specifically low in Rwanda. We previously pilot tested a supply-demand intervention which significantly increased the use of postpartum LARC (PPLARC) in Rwandan government clinics. In this protocol, we use an implementation science framework to test whether our intervention is adaptable to large-scale implementation, cost-effective, and sustainable.MethodsIn a type 2 effectiveness-implementation hybrid study, we will evaluate the impact of our PPFP intervention on postpartum LARC (PPLARC) uptake in a clinic-randomized trial in 12 high-volume health facilities in Kigali, Rwanda. We will evaluate this hybrid study using the RE-AIM framework. The independent effectiveness of each PPFP demand creation strategy on PPLARC uptake among antenatal clinic attendees who later deliver in a study facility will be estimated. To assess sustainability, we will assess the intervention adoption, implementation, and maintenance. Finally, we will evaluate intervention cost-effectiveness and develop a national costed implementation plan.DiscussionAdaptability and sustainability within government facilities are critical aspects of our proposal, and the MOH and other local stakeholders will be engaged from the outset. We expect to deliver PPFP counseling to over 21,000 women/couples during the project period. We hypothesize that the intervention will significantly increase the number of stakeholders engaged, PPFP providers and promoters trained, couples/clients receiving information about PPFP, and PPLARC uptake comparing intervention versus standard of care. We expect PPFP client satisfaction will be high. Finally, we also hypothesize that the intervention will be cost-saving relative to the standard of care. This intervention could dramatically reduce unintended pregnancy and abortion, as well as improve maternal and newborn health. Our PPFP implementation model is designed to be replicable and expandable to other countries in the region which similarly have a high unmet need for PPFP.Trial registrationClinicalTrials.gov NCT05056545. Registered on 31 March 2022.