Cross-sectional assessment of government health center needs to implement long-acting reversible contraception services in rural Rwanda

• Type of Material: Article
• Authors: Amelia Mazzei, Emory University; Rosine Ingabire, Rwanda Zambia Health Research Group; Etienne Karita, Emory University; Jeannine Mukamuyango, Rwanda Zambia Health Research Group; Julien Nyombayire, Emory University; Rachel Parker, Emory University; Amanda Tichacek, Emory University; Susan Allen, Emory University; Kristin Wall, Emory University
• Language: English
• Date: 2021-12-15
• Publisher: BMC
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2021
• Final Published Version (URL): http://dx.doi.org/10.1186/s12905-021-01555-3
• Title of Journal or Parent Work: BMC WOMENS HEALTH
• Volume: 21
• Issue: 1
• Start Page: 411
• End Page: 411
• Grant/Funding Information: This study was supported by the Centers for Disease Control and Prevention (CDC) (U2GPS001839, U2GPS 1904), NIAID (R01 AI23980, R01 AI40951), NIMH (R01 MH66767, R01 MH95503), NICHD (R01 HD40125, R01 HD072659), CDC (U2GPS 1839), Emory AITRP Fogarty (5D43TW001042), Emory Center for AIDS Research (CFAR) (P30 AI050409), and the International AIDS Vaccine Initiative (IAVI) (SOW2166) with the support of the United States Agency for International Development (USAID). The funders had no role in the design of the study; the collection, analysis, and interpretation of data; or in writing the manuscript. Contents of this manuscript are the responsibility of the authors and do not necessarily reflect the views of USAID or the US Government.
• Keywords: INTRAUTERINE-DEVICE; Rwanda; FAMILY-PLANNING-SERVICES; Health center needs assessment; BARRIERS; Life Sciences & Biomedicine; WOMEN; Public, Environmental & Occupational Health; COUNTRIES; Family planning; COUPLES; Science & Technology; Obstetrics & Gynecology; KNOWLEDGE; Couples; Long-acting reversible contraception; HIV
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

Background: There is unmet need for family planning in Rwanda. We previously developed an evidence-based couples’ family planning counseling (C)FPC program in the capital city that combines: (1) fertility goal-based family planning counseling with a focus on long-acting reversible contraceptive (LARC) for couples wishing to delay pregnancy; (2) health center capacity building for provision of LARC methods, and (3) LARC promotion by community health workers (CHW) trained in community-based provision of oral and injectable contraception. From 2015 to 2016, this service was integrated into eight government health centers in Kigali, reaching 6072 clients and resulting in 5743 LARC insertions. Methods: From May to July 2016, we conducted cross-sectional health center needs assessments in 30 rural health centers using surveys, key informant interviews, logbook extraction, and structured observations. The assessment focused on the infrastructure, materials, and human resources needed for LARC demand creation and provision. Results: Few nurses had received training in LARC insertion [41% implant, 27% intrauterine device (IUD)]. All health centers reported working with CHW, but none trained in LARC promotion. Health centers had limited numbers of IUDs (median 10), implants (median 39), functional gynecological exam tables (median 2), and lamps for viewing the cervix (median 0). Many did not have backup power supplies (40%). Most health centers reported no funding partners for family planning assistance (60%). Per national guidelines, couples’ voluntary HIV counseling and testing (CVCT) was provided at the first antenatal visit at all clinics, reaching over 80% of pregnant women and their partners. However, only 10% of health centers had integrated family planning and HIV services. Conclusions: To successfully implement (C)FPC and LARC services in rural health centers across Rwanda, material and human resource capacity for LARC provision will need to be greatly strengthened through equipment (gynecological exam tables, sterilization capacity, lamps, and backup power supplies), provider trainings and follow-up supervision, and new funding partnerships. Simultaneously, awareness of LARC methods will need to be increased among couples through education and promotion to ensure that demand and supply scale up together. The potential for integrating (C)FPC with ongoing CVCT in antenatal clinics is unique in Africa and should be pursued.