Barriers to Uptake of Postpartum Long‐Acting Reversible Contraception: Qualitative Study of the Perspectives of Ugandan Health Workers and Potential Clients

Willcox, Merlin; King, Emma V.; Fall, Emma; Mubangizi, Vincent; Nkalubo, Julius; Natukunda, Silvia; Nahabwe, Haeven; Goodhart, Clare; Graffy, Jonathan

doi:10.1111/sifp.12088

Cited by 18 publications

(44 citation statements)

References 26 publications

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“…A comprehensive analysis of fears, side-effects experienced and perceived barriers to the use of PPFP and LARC has been reported previously (10). There was a high level of concordance within couples regarding these fears, especially that women needed time to recover from the delivery before using contraception, particularly if they were bleeding.…”

Section: Plos Onementioning

confidence: 88%

“…An additional three couples were interviewed in the antenatal period. We also interviewed 17 health workers and 18 village health team members (VHTs), but these results are reported elsewhere (10). Eighteen focus groups were carried out in June-July 2018, (total of 173 participants), and a further 16 focus groups in February-March 2019 (150 respondents, Table 2).…”

Section: Characteristics Of Participantsmentioning

confidence: 99%

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Couples’ decision-making on post-partum family planning and antenatal counselling in Uganda: A qualitative study

et al. 2021

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Background Although health workers have been trained to provide post-partum family planning (PPFP), uptake remains low in Uganda. An important reason is that women want the agreement of their partner, who is often absent at the time of delivery. In order to address this, we aimed to understand the views of couples and explore barriers and facilitators to implementation of antenatal couples’ counselling on PPFP in Uganda. Methods We conducted individual interviews with a purposive sample of 12 postpartum and 3 antenatal couples; and 34 focus groups with a total of 323 participants (68 adolescent women, 83 women aged 20–49, 79 men, 93 health workers) in four contrasting communities (urban and rural) in South-West and Central Uganda. These were recorded, transcribed, translated, and analysed thematically. Results Although most participants felt that it is important for partners to discuss family planning, half of the couples were unaware of each other’s views on contraception. Most had similar views on motivation to use family planning but not on preferred contraceptive methods. Most liked the idea of antenatal couples’ counselling on PPFP. The main barrier was the reluctance of men to attend antenatal clinics (ANC) in health facilities. Respondents felt that Village Health Teams (VHTs) could provide initial counselling on PPFP in couples’ homes (with telephone support from health workers, if needed) and encourage men to attend ANC. Suggested facilitators for men to attend ANC included health workers being more welcoming, holding ANC clinics at weekends and “outreach” clinics (in rural villages far from health facilities). Conclusion Antenatal couples’ counselling has the potential to facilitate agreement PPFP, but some men are reluctant to attend antenatal clinics. Counselling at home by VHTs as well as simple changes to the organisation of antenatal clinics, could make it possible to deliver antenatal couples’ counselling on PPFP.

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Section: Plos Onementioning

confidence: 88%

Section: Characteristics Of Participantsmentioning

confidence: 99%

Couples’ decision-making on post-partum family planning and antenatal counselling in Uganda: A qualitative study

et al. 2021

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“…Also, Shahabuddin et al [34] found decision-making towards contraceptive methods use and childbearing among adolescent girls were mainly made by either their husbands or mothers-in-law especially with unemployed husbands who were financially dependent on their parents. Recently, Willcox et al [35] suggested that the traditional believes as postponing the use of contraception until complete recovery, the fear that contraceptive methods may affect the newborn and that the baby may die for any reason and so there will urgent need for getting new pregnancy are barriers to uptake of immediate postpartum contraception.…”

Section: Discussionmentioning

confidence: 99%

Direct Interventional Discussion Effectively Improves Awareness and Knowledge about Modern Contraceptive Methods

Saad¹,

Sharafeldeen²

2020

ARSci

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Objectives: Determination of influence of direct interview of postpartum women about their awareness and knowledge regarding contraception and modern contraceptive methods. Patients & Methods: 1437 women joined the intervention and underwent evaluation of their knowledge about the concept and methods of contraception. Then, an interview was conducted with each woman to clarify advantages and appropriateness of various contraceptives and the proper time for initiation of contraception. All women were asked to discuss these data with their families and return to give their decision. Study outcomes included evaluation of women's knowledge about contraception and its modalities, frequency of non-users who accepted to use contraception and is considered as success of the intervention and frequency of requesting each modality of contraception. Results: TV programs and discussion with local health provider, relatives or friends are the main sources of knowledge of primiparas. 182 primiparas had good knowledge and chose the appropriate method of contraception during the 1st session of discussion, and 81 primiparas required >2 sessions to choose the method appropriate for them, while 21 primiparas insisted not to use contraception for an acceptance rate of 92.6% among primipara. Among multiparas, 222 multiparas were non-users, but after discussion 133 couples accepted to use contraception. Thus, 396 non-users had accepted to use contraception for an intervention success rate of 78.3%. Collectively 692 women (52.1%) received IUD and 635 women (47.9%) received hormonal contraception; 432 orally (32.6%) and 203 parenterally (15.3%). Conclusion: Ignorance, low financial status and cultural beliefs deleteriously affect knowledge about contraception options and its methods, so direct interview is mandatory. The applied intervention succeeded to replenish women's knowledge about benefits of using contraception. Primiparas had knowledge about contraception but their knowledge How to cite this paper: Saad, A.S. and Sharafeldeen, A. (2020) Direct Interventional Discussion Effectively Improves Awareness and Knowledge about Modern Contraceptive Methods. Advances in Reproductive Sciences,

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“…One additional article was included from the personal reference libraries of the authors. Four of the included articles were from North America [60][61][62] and Hawaii, 63 two from Nepal, 64,65 two from New Zealand, 66,67 one from Uganda 68 and one from Sri Lanka 69 (Table 1). Only four of the articles were solely adolescent-focused; IPP LARC was examined in eight studies and IPA LARC was investigated in two studies.…”

Section: Re Sultsmentioning

confidence: 99%

“…Included articles were assessed for methodologic quality using critical appraisal tools for prevalence surveys (n = 3), randomized controlled trials (n = 2), nonrandomized experimental studies (n = 1), qualitative studies (n = 3) and cross-sectional studies (n = 1). Eight studies were determined to be high-quality 60,61,[64][65][66][67][68][69] and two moderate-quality due to issues with participant recruitment, 60,63 based on methodology alone (Appendix S2). However, these assessments should not be interpreted as evidence of quality or of potential bias in the extracted data.…”

Section: Critical Appraisalmentioning

confidence: 99%

Acceptability of immediate postpartum and post‐abortion long‐acting reversible contraception provision to adolescents: A systematic review

Buckingham

Moulton

Subasinghe

et al. 2021

Acta Obstet Gynecol Scand

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Introduction Long‐acting reversible contraception (LARC) methods are safe for adolescents and provide the greatest assurance against rapid repeated pregnancy when inserted during the immediate postpartum (IPP) and immediate post‐abortion (IPA) period. Despite increasing enthusiasm for IPP/IPA LARC insertion, adolescents’ preferences and experiences have seldom been examined. The objective of this review was to examine the attitudes of adolescents (aged 10–19 years) towards IPP/IPA LARC, their experiences and perceptions around having an LARC device fitted IPP/IPA and the factors involved in decision‐making to use, not use or discontinue IPP/IPA LARC. Material and methods In January 2021, we searched seven bibliographic databases for original research articles published in English, from the year 2000. Studies of any design focused on IPP/IPA LARC were eligible for inclusion. Three of the authors assessed articles for eligibility and extracted data relevant to the outcomes of the review. Joanna Briggs Institute Critical Appraisal Tools were used to assess methodological quality. Key themes emerging from the data were synthesized and reported narratively. Results We identified 10 relevant articles, four of which were entirely adolescent‐focused. Only three addressed IPA LARC. IPP availability was important for ensuring access to LARC postpartum. Attitudes towards LARC IPP were associated with adolescents’ sociodemographic characteristics and positive perceptions related to the long duration of action. Determinants of discontinuation and nonuse included poor‐quality contraceptive counseling, intolerable side effects and subsequent distress, misconceptions about LARC safety IPP and the influence of partners and community on autonomy. No factors involved in IPA LARC decision‐making were available. Limited evidence demonstrated that adolescents may favor contraceptive implants over intrauterine devices, and in certain contexts may face greater barriers to IPA LARC access than adult women do. Conclusions Immediate insertion of LARC postpartum appears acceptable to adolescents who do not experience side effects and those with the opportunity to make autonomous contraception decisions. This important topic has been addressed in few studies involving an entirely adolescent population. Very limited evidence is available on IPA LARC. Further research on adolescents’ lived experiences of IPP/IPA LARC access and use is necessary to inform the provision of person‐centered care when assisting adolescents’ contraceptive choice following pregnancy.

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Barriers to Uptake of Postpartum Long‐Acting Reversible Contraception: Qualitative Study of the Perspectives of Ugandan Health Workers and Potential Clients

Cited by 18 publications

References 26 publications

Couples’ decision-making on post-partum family planning and antenatal counselling in Uganda: A qualitative study

Couples’ decision-making on post-partum family planning and antenatal counselling in Uganda: A qualitative study

Direct Interventional Discussion Effectively Improves Awareness and Knowledge about Modern Contraceptive Methods

Acceptability of immediate postpartum and post‐abortion long‐acting reversible contraception provision to adolescents: A systematic review

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