Evaluation of a multi-level intervention to improve postpartum intrauterine device services in Rwanda.

• Type of Material: Article
• Authors: Rosine Ingabire, Emory University; Julien Nyombayire, Emory University; Alexandra Hoagland, Emory University; Vanessa Da Costa, Emory University; Amelia Mazzei, Emory University; Lisa Haddad, Emory University; Rachel Parker, Emory University; Robertine Sinabamenye, Emory University; Jeannine Mukamuyango, Emory University; Julie Smith, Emory University; Victoria Umutoni, Emory University; Ellen Mork, University of Michigan; Susan Allen, Emory University; Etienne Karita, Emory University; Kristin Wall, Emory University
• Language: English
• Date: 2018-10-10
• Publisher: F1000Research
• Publication Version: Final Published Version
• Copyright Statement: © 2018 Ingabire R et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.12688/gatesopenres.12854.2
• Title of Journal or Parent Work: Gates Open Research
• ISSN: 2572-4754
• Volume: 2
• Start Page: 38
• End Page: 38
• Grant/Funding Information: This work was supported by the Bill & Melinda Gates Foundation [OPP1160661].; The contents of this manuscript are the responsibility of the authors and do not necessarily reflect the views of USAID or the US Government.; Additional support came from the Emory University Research Council Grant [URCGA16872456], Emory Global Field Experience Award, the Emory Center for AIDS Research [P30 AI050409], the National Institutes of Health [NIAID R01 AI51231; NIAID R01 AI64060; NIAID R37 AI51231], Centers for Disease Control and Prevention [CDC GH15-1616; 5NU2GGH001443], Emory AITRP Fogarty [5D43TW001042], and the International AIDS Vaccine Initiative (IAVI) [SOW2166] with the support of the United States Agency for International Development (USAID).
• Keywords: intrauterine device; Rwanda; birth spacing; Post-partum; family planning; contraception
• Research Categories: Health Sciences, Health Care Management; Health Sciences, Obstetrics and Gynecology; Health Sciences, Pathology

Abstract

Background. The copper intrauterine device is one of the most safe, effective, and cost-effective methods for preventing unintended pregnancy. It can be used postpartum irrespective of breastfeeding to improve birth spacing and reduce unintended pregnancy and maternal-child mortality. However, this method remains highly underutilized. Methods. We developed a multi-level intervention to increase uptake of the postpartum intrauterine device (PPIUD, defined as insertion up to six weeks post-delivery) in Kigali, Rwanda. High-volume hospitals and health centers were selected for implementation of PPIUD counseling and service delivery. Formative work informed development of a PPIUD counseling flipchart to be delivered during antenatal care, labor and delivery, infant vaccination visits, or in the community. Two-day didactic counseling, insertion/removal, and follow-up trainings were provided to labor and delivery and family planning nurses followed by a mentored practicum certification process. Counseling data were collected in government clinic logbooks. Insertions and follow-up data were collected in logbooks created for the implementation. Data were collected by trained government clinic staff and abstracted/managed by study staff. Stakeholders were involved from intervention development through dissemination of results. Results. Two hospitals (and their two associated health centers) and two additional health centers were selected. In 6-months prior to our intervention, 7.7 PPIUDs/month were inserted on average at the selected facilities. From August 2017-July 2018, we trained 83 counselors and 39 providers to provide PPIUD services. N=9,020 women received one-on-one PPIUD counseling after expressing interest in family planning who later delivered at a selected health facility. Of those, n=2,575 had PPIUDs inserted (average of 214.6 insertions/month), a 29% uptake. Most PPIUDs (62%) were inserted within 10 minutes of delivery of the placenta. Conclusions. This successful, comprehensive intervention has the potential to make a significant impact on PPIUD uptake in Rwanda. The intervention is scalable and adaptable to other sub-Saharan African countries.