Reducing Barriers to Postabortion Contraception: The Role of Expanding Coverage of Postabortion Care in Dar es Salaam, Tanzania

Abstract

Expanding postabortion care (PAC) coverage to 64 public facilities over 30 months in Dar es Salaam, Tanzania, contributed to >6,000 women voluntarily adopting a contraceptive method, for an overall acceptance rate of about 81% and 78% adopting a long-acting method. Key interventions included clinical training and follow-up mentorship; PAC service reorganization, equipment provision, and an expanded method mix offering; standardized PAC documentation tools; and community linkages and referrals.

Training of healthcare providers and use of long‐acting reversible contraception in low‐ and middle‐income countries: A systematic review

“…20,[38][39][40][41][42][43][44] In 17 studies, the women's sociodemographic characteristics were described, including factors such as age, education, parity, number of living children and marital status. 17,18,[20][21][22][23][24]27,29,32,35,37,[39][40][41][42]44 Our primary outcome of interest, end-use of LARC, was reported in all 28 included studies, and was measured as (1) change in uptake of LARC -including number of women choosing LARC to be their first method of contraception as well as women switching to LARC from a different method [18][19][20]24,25,[27][28][29][30][31][32][35][36][37][38][39][40][41][42][43][44] ; and (2) change in IUD uptake specifically -including postpartum intrauterine devices. …”

“…17,[21][22][23]26,33,34 No studies reported the number of unintended pregnancies at 12 months after initiating LARC use, and 15 studies reported the preferred LARC method among healthcare workers and women. 19,20,25,[27][28][29][30][31][32]36,38,[40][41][42][43] Uptake of other contraceptives was measured in 19 studies, including use of SARC methods, 19,24,27,28,31,32,37,[39][40][41] overall users of family planning methods 18,25,30,[32][33][34][36][37][38]40,41,43,44 and users of oral contraceptives specifically. 27,28,30,31,…”

“…27,28,30,31,41 Of the included studies, 89% found an increased uptake of LARC methods (n = 24 cohort + 1 randomized control trial/ 28), 17,19,21,[23][24][25][27][28][29][30][31][32][33][34][37][38][39][40][41][42]44 whereas 11% of the studies found a decreased or unchanged LARC uptake (n = 3/28) 20,26,35 after training of healthcare providers (Table 1). The LARC method that most healthcare workers and women preferred was implants (86.6%; n = 13/15), 25,[28][29][30][31][32][33]36,38,[40][41][42][43] whereas two studies found that IUDs were the preferred method (13.4%, n = 2/15). 20,27 Due to the presence of pronounced heterogeneity in terms of reporting of outcomes and interventions in the included studies we did not find it meaningful to perform a meta-analysis.…”

“…In 18 studies [17][18][19]22,24,25,[28][29][30][31]33,34,36,40,[42][43][44] a steady supply of contraceptives was ensured simultaneously with the training intervention, which may have influenced the positive changes in uptake. Likewise, 12 studies 17,24,[32][33][34][35][36]38,40,[42][43][44] arranged activities to improve community awareness of the availability of LARCs, as well as to dispel myths and end-user misconceptions surrounding LARCs. Four studies 27,28,32,35 attempted to nullify religious barriers through recruitment of religious leaders in the local community to promote the use of contraceptives.…”

“…Four studies 27,28,32,35 attempted to nullify religious barriers through recruitment of religious leaders in the local community to promote the use of contraceptives. Other interventions that may confound the association included making all contraceptives free of charge, 31,36,42 physical expansion of preexisting facilities 20,25,30 and direct counseling for partners. 41,43 This ultimately makes it difficult to separate the impact of provider training from other factors.…”