Uptake of long acting reversible contraception following integrated couples HIV and fertility goal-based family planning counselling in Catholic and non-Catholic, urban and rural government health centers in Kigali, Rwanda

Abstract

Background: When integrated with couples' voluntary HIV counselling and testing (CVCT), family planning including long acting reversible contraceptives (LARC) addresses prongs one and two of prevention of mother-tochild transmission (PMTCT). Methods: In this observational study, we enrolled equal numbers of HIV concordant and discordant couples in four rural and four urban clinics, with two Catholic and two non-Catholic clinics in each area. Eligible couples were fertile, not already using a LARC method, and wished to limit or delay fertility for at least 2 years. We provided CVCT and fertility goal-based family planning counselling with the offer of LARC and conducted multivariate analysis of clinic, couple, and individual predictors of LARC uptake. Results: Of 1290 couples enrolled, 960 (74%) selected LARC: Jadelle 5-year implant (37%), Implanon 3-year implant (26%), or copper intrauterine device (IUD) (11%). Uptake was higher in non-Catholic clinics (85% vs. 63% in Catholic clinics, p < 0.0001), in urban clinics (82% vs. 67% in rural clinics, p < 0.0001), and in HIV concordant couples (79% vs. 70% of discordant couples, p = .0005). Religion of the couple was unrelated to clinic religious affiliation, and uptake was highest among Catholics (80%) and lowest among Protestants (70%) who were predominantly Pentecostal. In multivariable analysis, urban location and non-Catholic clinic affiliation, Catholic religion of woman or couple, younger age of men, lower educational level of both partners, non-use of condoms or injectable contraception at

The impact of faith-based organizations on maternal and child health care outcomes in Africa: taking stock of research evidence

“…These studies were conducted in Nigeria, Tanzania, Ghana, Malawi, Uganda, Mozambique, and the Democratic Republic of the Congo (DRC). The additional primary studies were conducted in Tanzania, Rwanda, Cameroon, Ethiopia, Nigeria, Uganda, Kenya, Malawi, and the DRC [ 25 - 31 ]; these included five cross-sectional studies [ 25 , 29 , 31 - 33 ]; an economic evaluation [ 30 ] and two qualitative studies [ 26 , 28 ]. The characteristics of included studies are described in Table 1 and Table 2 .…”

“…Four cross-sectional studies met six of the eight JBI criteria for quality [ 30 - 33 ] while the study by Mukamuyango et al . [ 25 ] met all the eight criteria of the JBI appraisal tool ( Annex 2 ). The key methodological aspects that were not described include the identification of potential confounders and how these confounders were controlled in the analyses.…”

Understanding the association between informed choice and long-term reversible contraception among women aged 15-49 in Uganda: findings from the 2016 Demographic Health Survey

“…These results are supported by current literature which notes that women are more likely to choose a LARC over other contraceptive methods when they experience informed choice through access to highquality family planning services and information. (15)(16)(17) Although the connection between informed choice and LARCs is well established in countries such as the United States (15), there is limited knowledge about informed choice and LARC use in sub-Saharan Africa. A 2020 observational study in Rwanda by Mukamuyango et al of 1290 couples found that couples that were provided information about LARC and HIV counselling were more likely to use a LARC method.…”

“…Prior research has shown that women who are more informed about family planning choices are more likely to choose a highly effective LARC method. (15)(16)(17) Furthermore, the Ugandan Ministry of Health has prioritized in the 2020-2025 National Family Planning Advocacy Strategy Costed Implementation Plan Ugandan increasing the availability of LARCs in healthcare facilities and ensuring that all citizens are informed about their contraceptive choices.…”

Afiliação religiosa e decisões de cuidado à saúde

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