Improving the Acceptance Rate of Centchroman As a Postpartum Contraceptive Through a Quality Improvement Initiative

Abstract

BackgroundThe unmet need for contraception is two-pronged: a spacing method and a permanent method. Centchroman, a non-hormonal, non-steroidal oral contraceptive, is suitable for both of these purposes. The Government of India provides it free of cost under the name "Chhaya", but its current acceptance rates are lower than expected. We aimed to increase the acceptance rates of centchroman as a postpartum contraceptive through a quality improvement (QI) approach conducted over eight months at a tertiary care hospital in North India. Materials and MethodsThis QI study was done in three phases: a pre-intervention phase of over eight weeks to assess the baseline acceptance and prevalence rates of centchroman use; an intervention phase of over 12 weeks involving three Plan-Do-Study-Act (PDSA) cycles to increase the awareness and acceptance of centchroman among the target population using visual aids and counselling by the nursing staff and resident doctors, respectively; and a post-intervention phase of over 12 weeks to assess the acceptance and continuation rates of Chhaya. ResultsThe acceptance rates for centchroman increased from a baseline of 2.9% to 15.3%, 56.3%, and 78.2% after the first, second, and third PDSA cycles, respectively. On follow-up, continuation rates were 96.7%, 89.5%, and 78.6% at one, three, and six months, respectively. The majority of women reported only minor side effects, with the primary reason for discontinuation being a preference for intrauterine devices or medroxyprogesterone acetate injections over Chhaya. ConclusionThe postpartum period provides an important window of opportunity to counsel women for contraception. Despite an enviable safety profile and dosing schedule, centchroman remains largely under-utilized. Increasing awareness among women as well as health care workers may improve the acceptance of centchroman and help reduce the burden of untimely and unwanted conceptions.