Factors associated with the uptake of immediate postpartum intrauterine contraceptive devices (PPIUCD) in Rwanda: a mixed methods study

BMC Pregnancy and Childbirth, Volume 20, No. 1, Year 2020

Interprétation

Background: Rwanda has a high unmet need for family planning which could be reduced by improving access to postpartum intrauterine contraceptives device (PPIUCD) insertion. The objective of the study was to assess the prevalence and factors associated with the uptake of PPIUCD among postpartum women in Muhima Hospital. Methods: A concurrent mixed-method study was used. Three hundred eight three (383) immediate postpartum mothers, and 10 health services providers were interviewed using a structured questionnaire and in-depth interviews respectively. Logistics regression was done to assess for factors associated with PPIUCD uptake and thematic analysis was used for qualitative data. Results: The prevalence for PPIUCD use was 28.1%, women who had spontaneous vaginal delivery were more likely to take up PPIUCD (Adjusted Odds Ratio (AOR) 2.623, 95% CI = 2.017–6.507 compared to those who had cesarean section; women who received PPIUCD counselling during the antenatal period were more likely to use PPIUCD ((AOR 2.072, 95% CI = 1.018–4.218) as compared to those who didn’t receive any form of counselling; mothers who received spouse approval were more likely to use PPIUCD (AOR 2.591,95% CI = 1.485–4.492); as compared to those who didn’t receive any spousal approval; women who had more than one child were more likely to use PPIUCD (AOR =2.265, 95% CI = 1.472–3.163) as compared to prime gravida; Mothers with birth to pregnancy interval less than two years were more likely to use PPIUCD (AOR =2.123, CI =1.477–2.706) as compared to those who had birth to pregnancy interval more than 2 years. From the qualitative findings, health education of mothers and partners on PPIUCD, training of health care providers, and availability of supplies to provide PPIUCD influenced the use of PPIUCD. Conclusion: The acceptability to use for PPIUCD was high in this population. PPIUCD uptake was associated with normal birth, PPIUCD counselling, spousal approval, parity, birth interval, level of education. Health education of mothers and partners on PPIUCD, training of health providers, and availability of supplies to provide PPIUCD influenced uptake of PPIUCD. The study was conducted at Muhima hospital, Department of Obstetrics and gynecology which is located in Nyarugenge District sector, Kigali city. Muhima is a 128-bed hospital specializing in gynecology and neonatology. This hospital oversees eight functional health centers. Muhima is the training site for all medical schools and schools of nursing and midwifery in Rwanda. Muhima District Hospital was chosen because it has a high number of deliveries and it is also one of the hospitals where the implementation of PPIUD was initiated. It has an average of more than 500 deliveries monthly. Mixed-method concurrent design was employed to determine the use of PPIUCD and its associated factors. The cross-sectional design involved the use of an interviewer-administered questionnaire which was conducted among women who were in the immediate postpartum period. Immediate postpartum was defined as women who have given have given birth10 minutes after birth up to 48 h of delivery [6] Also, in depth-interviews was conducted among health care providers at Muhima hospital to share their experiences about PPIUD service delivery. The study population consisted of women who were in the immediate postpartum care within 48 h after delivery before discharge at Muhima district hospital and Midwives who were working in the labor suite, immediate postpartum ward, and family planning department who were actively involved in the provision of PPIUCD. The study used a consecutive sampling method to select the eligible participants who were within 48 h after delivery. The participants were approached in the labor ward or postpartum ward where they were invited to take part in the study. The files of women who had delivered were checked to ensure that they had fulfilled the inclusion criteria of the study. The inclusion criteria for PPIUCD were Women aged 15–49 years, delivering either vaginally or by cesarean section, at Muhima hospital from January – February 2019 had received counselling for postpartum contraception and consented for postpartum use who were in the immediate postpartum period after delivery within 48 h of birth and midwives who were working in FP services, labor suite, immediate postpartum ward who were providing FP services and other maternal health services on the days of the study were included in the study. The exclusion criteria include: The study excluded women who were within10 minutes after childbirth to 48 h after delivery but clinically unstable such as the women who had PPH, Women who have been diagnosed with chorioamnionitis, Women who have a fever ≥37.5 degree Celsius during labor, and delivery, Women who had active genital tract infections or were are at high risk for STD, Women are known to have ruptured membranes for greater than 24 h before delivery. Women who have had 3rd and 4th-degree tears, Women who had been diagnosed to have uterine abnormalities, Health care workers who were not providing the methods. The participants were informed about the study including providing adequate information regarding the purpose, procedure, benefits, and risks of the study. The potential participants consented before they were interviewed for the study. Women who accepted to be inserted an IUD were considered to have used PPIUCD, while women who declined to use IUD were considered to have not used the PPIUCD. The sample size was powered to determine the prevalence of PPIUD. The sample size was calculated using a prevalence of 48% for contraceptive prevalence, 95% confidence interval, and an error margin of 5%. A total of 383 mothers were recruited for this study [16]. The sample size for factors associated was calculated using α = Type 1 error 5%., Z = the standard normal statistic corresponding to 1.96; β = Type II error as 20%; Odds = 3.1. The odds were derived from literature; Percent of exposed with outcome = 14; Risk/Prevalence ratio = 2.8; Risk/Prevalence difference = 9; Assuming a power of 80%, type 1 error of 5%, type II error of 20%, and odds of 3.10, the sample size of the study was estimated at 374 women. The study adopted a sample size of 383 to increase the statistical power of the study. Therefore, a sample size of 383 women was used in this study. The Fleiss formula in OpenEpi was used for determining the factors associated with the use of PPIUCD. (Ref: Fleiss, Statistical Methods for Rates and Proportions, formulas pages 3.18 & 3.19). The OpenEpi Calculator was used to calculate the sample size and it was accessed from https://www.openepi.com/SampleSize/SSCohort.htm. Data were collected through face-to-face interviewer-administered questionnaires; mixed-method were applied to collect data. The data collected include Social demographic factors; (age, level of education, marital status religious beliefs) knowledge about PPIUCD; Social-cultural factors:, (myths cultural norms, partner, support, peer influence) social-economic factors; (poverty, source of income, occupation), Reproductive factors: (parity, number of living children desired, mode of delivery, fertility desire, side effects of methods), Service delivery related factors; (availability for suppliers and IUCD, health care worker knowledge and skills, access to the health facility, knowledge for health care providers, quality of care delivered to the women, Family planning information and counselling during antenatal care). The prevalence of participants who used PPIUCD was measured. The tools were piloted and pretested before starting data collection to assess appropriateness, content clarity, and comprehensiveness of the questions and time taken to fill the questionnaires. The interviewer-administered structured questionnaires were used to collect quantitative data. The questionnaires included questions regarding the social demographics, knowledge about PPIUD use, social-cultural, social-economic, and reproductive factors. The study used a consecutive sampling method to select the eligible participants who were within 10 min to 48 h after childbirth. The participants were approached in the labor ward or postpartum ward where they were invited to take part in the study at Muhima hospital. The files of women who had delivered were checked to ensure that they had fulfilled the inclusion criteria of the study. The participants were informed about the study including providing adequate information regarding the purpose, procedure, benefits, and risks of the study. The potential participants consented before they were interviewed for the study. Women who accepted to use an IUD were considered to have used PPIUCD, while women who declined to use IUD were considered to have not used the PPIUCD. In-depth interviews (IDI) were used on one to one to explore the health care provider’s experience regarding PIUCD service provision. An IDI was used because it was able to capture detailed information and offers participants opportunities to share their personal experiences regarding provision for PPIUCD including the mode of supply, the training opportunity, and the institution support through PPIUCD provision. The approach has helped to distinguish an individual’s opinions about provision for PPIUD. Participants were purposively selected among the team of midwives working in antepartum, labor suite, postpartum, and family planning for the time of data collection. The study purposively selected midwives for an interview until saturation was met, which was reached after interviewing 10 midwives. The IDI was conducted at the workplace in the Muhima hospital. The IDI was conducted among selected health care providers in a convenient place where she or he was working at the time for data collection. An interview guide containing questions related to experience and practice and their perception regarding provision for PPIUCD was used in this facility-based. The interview was audiotaped and notes were taken by the research assistant. The outcome variables in this analysis are a binary variable for postpartum intrauterine contraceptive use and proportions were used to summarize participants who used PPIUCD. PPIUCD use is defined as any participant who chose IUD as postpartum family planning. Those women who did not choose to use IUD as postpartum contraceptive were classified as non-user. The prevalence of PPIUCD use was determined by dividing the number of women who had accepted to use PPIUCD by the total number of all postpartum women who participated in the study. To determine the factors associated with the use of PPIUCD, chi-square tests, and binary logistics regression were used. The bivariate analyses were conducted to determine the independent variables that were significantly associated with PPIUCD use. The significant variables were of value less than p < .05 at the 95% confidence interval. The variables that were p < 0.2 were subjected to multivariate analyses in the binary logistic model to obtain the adjusted odds ratios of the statistically significant variables. The interviews were recorded and transcribed verbatim in Kinyarwanda, after validating the transcription, the typed narratives were then translated into English and verified the accuracy. Analysis of the data was conducted by the primary author and included several iterative steps. Using thematic analysis, the transcripts were reviewed several times, and a set of codes were developed to describe groups of words or categories with similar meanings. The transcripts were then coded and managed using Atlas’s version 7. The grouped categories were refined and used to generate themes emerging from the data. Direct quotations from midwives are presented in italics to highlight key findings. Ethical review and approval were obtained from the Higher Degrees and Research Ethics Committee of the College of Health Sciences at Makerere University #SHSREC REF NO: 2018–045 and Research Ethics Committee of the College of Medicine and Health Sciences University of Rwanda No 404/CMHS IRB/2018. The administrative clearance and permissions were obtained from Muhima hospital ethical committee. Written informed consent was obtained from the mothers and the midwives. Participation was voluntary and all the interviews were conducted in private settings to ensure participant’s confidentiality.

Résumé de l’IA

Study Justification:

– Rwanda has a high unmet need for family planning, which can be addressed by improving access to postpartum intrauterine contraceptive devices (PPIUCD) insertion.
– The study aimed to assess the prevalence and factors associated with the uptake of PPIUCD among postpartum women in Muhima Hospital.

Study Highlights:

– The prevalence of PPIUCD use was found to be 28.1%.
– Factors associated with PPIUCD uptake included spontaneous vaginal delivery, receiving PPIUCD counseling during the antenatal period, spousal approval, having more than one child, and a birth-to-pregnancy interval of less than two years.
– Health education of mothers and partners on PPIUCD, training of healthcare providers, and availability of supplies were identified as influential factors for PPIUCD uptake.

Study Recommendations:

– Increase health education efforts to inform mothers and partners about PPIUCD and its benefits.
– Provide training for healthcare providers on PPIUCD insertion and counseling.
– Ensure the availability of necessary supplies for PPIUCD insertion.
– Strengthen antenatal counseling services to include information about PPIUCD.
– Promote spousal involvement and approval in decision-making regarding PPIUCD use.
– Consider the reproductive history of women, such as parity and birth-to-pregnancy interval, when providing PPIUCD counseling.

Key Role Players:

– Ministry of Health: Responsible for policy development and implementation of family planning programs.
– Muhima Hospital: Provides healthcare services and plays a crucial role in implementing PPIUCD services.
– Healthcare providers: Midwives and other healthcare professionals involved in the provision of PPIUCD services.
– Community health workers: Involved in health education and promotion of family planning methods.
– Non-governmental organizations (NGOs): Support implementation efforts and provide resources for PPIUCD services.

Cost Items for Planning Recommendations:

– Training programs for healthcare providers on PPIUCD insertion and counseling.
– Supplies and equipment for PPIUCD insertion.
– Health education materials for mothers and partners.
– Monitoring and evaluation of PPIUCD services.
– Support for community health workers’ involvement in promoting PPIUCD.
– Administrative and logistical support for implementing PPIUCD services.
Please note that the cost items provided are general categories and not actual cost estimates. The actual cost will depend on various factors such as the scale of implementation and local context.

Force de la preuve

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study utilized a mixed-method design, which provides a comprehensive understanding of the factors associated with the uptake of immediate postpartum intrauterine contraceptive devices (PPIUCD) in Rwanda. The quantitative data collected from 383 postpartum mothers and the logistic regression analysis provide statistical evidence for the factors associated with PPIUCD uptake. The qualitative data collected from in-depth interviews with healthcare providers offer additional insights into the influencing factors. However, the abstract lacks information on the representativeness of the study population and the generalizability of the findings. To improve the strength of the evidence, future studies could consider using a larger and more diverse sample to enhance the external validity of the findings.

Abstrait

The study was conducted at Muhima hospital, Department of Obstetrics and gynecology which is located in Nyarugenge District sector, Kigali city. Muhima is a 128-bed hospital specializing in gynecology and neonatology. This hospital oversees eight functional health centers. Muhima is the training site for all medical schools and schools of nursing and midwifery in Rwanda. Muhima District Hospital was chosen because it has a high number of deliveries and it is also one of the hospitals where the implementation of PPIUD was initiated. It has an average of more than 500 deliveries monthly. Mixed-method concurrent design was employed to determine the use of PPIUCD and its associated factors. The cross-sectional design involved the use of an interviewer-administered questionnaire which was conducted among women who were in the immediate postpartum period. Immediate postpartum was defined as women who have given have given birth10 minutes after birth up to 48 h of delivery [6] Also, in depth-interviews was conducted among health care providers at Muhima hospital to share their experiences about PPIUD service delivery. The study population consisted of women who were in the immediate postpartum care within 48 h after delivery before discharge at Muhima district hospital and Midwives who were working in the labor suite, immediate postpartum ward, and family planning department who were actively involved in the provision of PPIUCD. The study used a consecutive sampling method to select the eligible participants who were within 48 h after delivery. The participants were approached in the labor ward or postpartum ward where they were invited to take part in the study. The files of women who had delivered were checked to ensure that they had fulfilled the inclusion criteria of the study. The inclusion criteria for PPIUCD were Women aged 15–49 years, delivering either vaginally or by cesarean section, at Muhima hospital from January – February 2019 had received counselling for postpartum contraception and consented for postpartum use who were in the immediate postpartum period after delivery within 48 h of birth and midwives who were working in FP services, labor suite, immediate postpartum ward who were providing FP services and other maternal health services on the days of the study were included in the study. The exclusion criteria include: The study excluded women who were within10 minutes after childbirth to 48 h after delivery but clinically unstable such as the women who had PPH, Women who have been diagnosed with chorioamnionitis, Women who have a fever ≥37.5 degree Celsius during labor, and delivery, Women who had active genital tract infections or were are at high risk for STD, Women are known to have ruptured membranes for greater than 24 h before delivery. Women who have had 3rd and 4th-degree tears, Women who had been diagnosed to have uterine abnormalities, Health care workers who were not providing the methods. The participants were informed about the study including providing adequate information regarding the purpose, procedure, benefits, and risks of the study. The potential participants consented before they were interviewed for the study. Women who accepted to be inserted an IUD were considered to have used PPIUCD, while women who declined to use IUD were considered to have not used the PPIUCD. The sample size was powered to determine the prevalence of PPIUD. The sample size was calculated using a prevalence of 48% for contraceptive prevalence, 95% confidence interval, and an error margin of 5%. A total of 383 mothers were recruited for this study [16]. The sample size for factors associated was calculated using α = Type 1 error 5%., Z = the standard normal statistic corresponding to 1.96; β = Type II error as 20%; Odds = 3.1. The odds were derived from literature; Percent of exposed with outcome = 14; Risk/Prevalence ratio = 2.8; Risk/Prevalence difference = 9; Assuming a power of 80%, type 1 error of 5%, type II error of 20%, and odds of 3.10, the sample size of the study was estimated at 374 women. The study adopted a sample size of 383 to increase the statistical power of the study. Therefore, a sample size of 383 women was used in this study. The Fleiss formula in OpenEpi was used for determining the factors associated with the use of PPIUCD. (Ref: Fleiss, Statistical Methods for Rates and Proportions, formulas pages 3.18 & 3.19). The OpenEpi Calculator was used to calculate the sample size and it was accessed from https://www.openepi.com/SampleSize/SSCohort.htm. Data were collected through face-to-face interviewer-administered questionnaires; mixed-method were applied to collect data. The data collected include Social demographic factors; (age, level of education, marital status religious beliefs) knowledge about PPIUCD; Social-cultural factors:, (myths cultural norms, partner, support, peer influence) social-economic factors; (poverty, source of income, occupation), Reproductive factors: (parity, number of living children desired, mode of delivery, fertility desire, side effects of methods), Service delivery related factors; (availability for suppliers and IUCD, health care worker knowledge and skills, access to the health facility, knowledge for health care providers, quality of care delivered to the women, Family planning information and counselling during antenatal care). The prevalence of participants who used PPIUCD was measured. The tools were piloted and pretested before starting data collection to assess appropriateness, content clarity, and comprehensiveness of the questions and time taken to fill the questionnaires. The interviewer-administered structured questionnaires were used to collect quantitative data. The questionnaires included questions regarding the social demographics, knowledge about PPIUD use, social-cultural, social-economic, and reproductive factors. The study used a consecutive sampling method to select the eligible participants who were within 10 min to 48 h after childbirth. The participants were approached in the labor ward or postpartum ward where they were invited to take part in the study at Muhima hospital. The files of women who had delivered were checked to ensure that they had fulfilled the inclusion criteria of the study. The participants were informed about the study including providing adequate information regarding the purpose, procedure, benefits, and risks of the study. The potential participants consented before they were interviewed for the study. Women who accepted to use an IUD were considered to have used PPIUCD, while women who declined to use IUD were considered to have not used the PPIUCD. In-depth interviews (IDI) were used on one to one to explore the health care provider’s experience regarding PIUCD service provision. An IDI was used because it was able to capture detailed information and offers participants opportunities to share their personal experiences regarding provision for PPIUCD including the mode of supply, the training opportunity, and the institution support through PPIUCD provision. The approach has helped to distinguish an individual’s opinions about provision for PPIUD. Participants were purposively selected among the team of midwives working in antepartum, labor suite, postpartum, and family planning for the time of data collection. The study purposively selected midwives for an interview until saturation was met, which was reached after interviewing 10 midwives. The IDI was conducted at the workplace in the Muhima hospital. The IDI was conducted among selected health care providers in a convenient place where she or he was working at the time for data collection. An interview guide containing questions related to experience and practice and their perception regarding provision for PPIUCD was used in this facility-based. The interview was audiotaped and notes were taken by the research assistant. The outcome variables in this analysis are a binary variable for postpartum intrauterine contraceptive use and proportions were used to summarize participants who used PPIUCD. PPIUCD use is defined as any participant who chose IUD as postpartum family planning. Those women who did not choose to use IUD as postpartum contraceptive were classified as non-user. The prevalence of PPIUCD use was determined by dividing the number of women who had accepted to use PPIUCD by the total number of all postpartum women who participated in the study. To determine the factors associated with the use of PPIUCD, chi-square tests, and binary logistics regression were used. The bivariate analyses were conducted to determine the independent variables that were significantly associated with PPIUCD use. The significant variables were of value less than p < .05 at the 95% confidence interval. The variables that were p < 0.2 were subjected to multivariate analyses in the binary logistic model to obtain the adjusted odds ratios of the statistically significant variables. The interviews were recorded and transcribed verbatim in Kinyarwanda, after validating the transcription, the typed narratives were then translated into English and verified the accuracy. Analysis of the data was conducted by the primary author and included several iterative steps. Using thematic analysis, the transcripts were reviewed several times, and a set of codes were developed to describe groups of words or categories with similar meanings. The transcripts were then coded and managed using Atlas’s version 7. The grouped categories were refined and used to generate themes emerging from the data. Direct quotations from midwives are presented in italics to highlight key findings. Ethical review and approval were obtained from the Higher Degrees and Research Ethics Committee of the College of Health Sciences at Makerere University #SHSREC REF NO: 2018–045 and Research Ethics Committee of the College of Medicine and Health Sciences University of Rwanda No 404/CMHS IRB/2018. The administrative clearance and permissions were obtained from Muhima hospital ethical committee. Written informed consent was obtained from the mothers and the midwives. Participation was voluntary and all the interviews were conducted in private settings to ensure participant’s confidentiality.

Matériaux

N/A

Innovations

Based on the provided description, here are some potential innovations that could improve access to maternal health:

1. Mobile Health (mHealth) Applications: Develop mobile applications that provide information and education on postpartum intrauterine contraceptive devices (PPIUCD), including their benefits, risks, and availability. These apps can also provide reminders for follow-up appointments and offer a platform for women to ask questions and receive support.

2. Telemedicine Services: Implement telemedicine services to allow women in remote areas to access consultations with healthcare providers regarding PPIUCD. This can help overcome geographical barriers and provide timely guidance and support.

3. Training Programs for Healthcare Providers: Develop comprehensive training programs for healthcare providers on PPIUCD counseling and insertion techniques. This can ensure that providers have the necessary knowledge and skills to offer high-quality services.

4. Community Health Worker Programs: Establish community health worker programs to educate women and their families about PPIUCD and provide counseling and support. Community health workers can play a crucial role in increasing awareness and addressing misconceptions.

5. Supply Chain Management: Improve the supply chain management system to ensure a consistent availability of PPIUCD devices and related supplies in healthcare facilities. This can help prevent stockouts and ensure that women have access to the method when they need it.

6. Integration of PPIUCD Services: Integrate PPIUCD services into routine antenatal and postnatal care to increase accessibility. This can involve training healthcare providers to offer counseling and insertion services during these visits.

7. Public Awareness Campaigns: Launch public awareness campaigns to promote the benefits of PPIUCD and address any cultural or social barriers that may exist. These campaigns can be conducted through various media channels to reach a wide audience.

8. Financial Support: Explore options for financial support, such as subsidies or insurance coverage, to make PPIUCD more affordable for women. This can help remove financial barriers and increase uptake.

9. Research and Evaluation: Conduct further research and evaluation to assess the effectiveness of different interventions and identify areas for improvement. This can help inform future strategies and ensure evidence-based practices.

It is important to note that these recommendations are general and may need to be tailored to the specific context and needs of the healthcare system in Rwanda.

AI Innovations Description

The study titled “Factors associated with the uptake of immediate postpartum intrauterine contraceptive devices (PPIUCD) in Rwanda: a mixed methods study” aimed to assess the prevalence and factors associated with the uptake of PPIUCD among postpartum women in Muhima Hospital in Rwanda. The study used a mixed-method concurrent design, including structured questionnaires and in-depth interviews with postpartum women and healthcare providers, respectively.

The study found that the prevalence of PPIUCD use was 28.1%. Several factors were associated with the uptake of PPIUCD, including the mode of delivery (women who had spontaneous vaginal delivery were more likely to use PPIUCD), PPIUCD counseling during the antenatal period, spousal approval, parity (women with more than one child were more likely to use PPIUCD), and birth-to-pregnancy interval (mothers with a shorter interval were more likely to use PPIUCD). Qualitative findings highlighted the importance of health education for mothers and partners, training of healthcare providers, and the availability of supplies for providing PPIUCD in influencing its uptake.

The study was conducted at Muhima Hospital, which is located in Nyarugenge District sector, Kigali city, Rwanda. Muhima Hospital is a 128-bed hospital specializing in gynecology and neonatology and serves as a training site for medical schools and schools of nursing and midwifery in Rwanda. The study population consisted of postpartum women within 48 hours after delivery and midwives involved in the provision of PPIUCD at Muhima Hospital.

A consecutive sampling method was used to select the participants, and a total of 383 postpartum women were included in the study. Data were collected through face-to-face interviewer-administered questionnaires and in-depth interviews. The questionnaires covered various factors, including social demographics, knowledge about PPIUCD, social-cultural factors, social-economic factors, reproductive factors, and service delivery-related factors. The interviews with healthcare providers aimed to explore their experiences and perceptions regarding PPIUCD service provision.

The study used chi-square tests and binary logistic regression to determine the factors associated with PPIUCD use. Thematic analysis was applied to analyze the qualitative data from the in-depth interviews.

Ethical review and approval were obtained from the relevant ethics committees, and written informed consent was obtained from the participants. Confidentiality and privacy were ensured throughout the study.

Based on the findings of this study, a recommendation to improve access to maternal health, specifically PPIUCD, could include:

1. Strengthening PPIUCD counseling during the antenatal period: Providing comprehensive and accurate information about PPIUCD to pregnant women and their partners during antenatal care visits can increase awareness and promote informed decision-making regarding postpartum contraception.

2. Enhancing health education for mothers and partners: Conducting targeted health education sessions to raise awareness about the benefits and importance of PPIUCD can help dispel myths and misconceptions and increase acceptability and uptake.

3. Training healthcare providers: Providing training and capacity-building opportunities for healthcare providers on PPIUCD insertion and counseling can improve their knowledge and skills, ensuring quality service delivery and increasing confidence in offering PPIUCD as a postpartum contraceptive option.

4. Ensuring the availability of supplies: Ensuring a consistent and adequate supply of PPIUCD devices and related materials in healthcare facilities is crucial for providing timely and accessible services to women who choose this contraceptive method.

By implementing these recommendations, it is expected that access to PPIUCD and maternal health services in general can be improved, leading to a reduction in unmet need for family planning and better reproductive health outcomes for women in Rwanda.

AI Innovations Methodology

Based on the provided study, here are some potential recommendations for improving access to maternal health:

1. Increase PPIUCD counseling during the antenatal period: The study found that women who received PPIUCD counseling during the antenatal period were more likely to use PPIUCD. Therefore, increasing the availability and quality of counseling sessions during pregnancy can help improve awareness and acceptance of PPIUCD as a postpartum contraceptive option.

2. Improve health education for mothers and partners on PPIUCD: The qualitative findings of the study indicated that health education of mothers and partners on PPIUCD influenced its use. Enhancing health education programs that provide accurate information about the benefits, safety, and effectiveness of PPIUCD can help address misconceptions and increase acceptance.

3. Enhance training of healthcare providers: The study highlighted the importance of healthcare providers’ knowledge and skills in providing PPIUCD services. Investing in comprehensive training programs for healthcare providers, including midwives and nurses, can ensure that they are equipped with the necessary skills and knowledge to offer PPIUCD services effectively.

4. Ensure availability of supplies for PPIUCD: The study found that the availability of supplies to provide PPIUCD influenced its use. Ensuring a consistent supply of PPIUCD devices and related materials in healthcare facilities can help remove barriers to access and increase utilization.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could involve the following steps:

1. Define the target population: Identify the specific population group that the recommendations aim to benefit, such as postpartum women in a particular region or healthcare facility.

2. Collect baseline data: Gather data on the current access to maternal health services, including PPIUCD uptake, counseling practices, healthcare provider knowledge, and availability of supplies.

3. Implement the recommendations: Introduce the recommended interventions, such as increasing PPIUCD counseling, improving health education programs, enhancing healthcare provider training, and ensuring the availability of supplies.

4. Monitor and evaluate: Track the implementation of the recommendations and collect data on key indicators, such as the number of PPIUCD counseling sessions conducted, changes in healthcare provider knowledge and skills, and the availability of PPIUCD supplies.

5. Analyze the data: Use statistical analysis techniques to assess the impact of the recommendations on access to maternal health. Compare the baseline data with the post-intervention data to identify any significant changes or improvements.

6. Draw conclusions and make recommendations: Based on the analysis, draw conclusions about the effectiveness of the recommendations in improving access to maternal health. Identify any gaps or areas for further improvement and make recommendations for future interventions or policies.

7. Disseminate findings: Share the findings of the impact assessment with relevant stakeholders, such as healthcare providers, policymakers, and organizations involved in maternal health. This can help inform decision-making and guide future efforts to improve access to maternal health services.

Auteur

Dima Health

Statistics:

Citations: 6

Identifiers:

DOI: 10.1186/s12884-020-03337-5

Research Areas:

Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants, Workforce

Study Countries:

Rwanda

Study Design:

Case-Control Study, Cross Sectional Study, Grounded Theory

Study Approach:

Mixed-methods, Qualitative, Quantitative

Participants Gender:

Female

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