Twelve month follow-up of a contraceptive implant outreach service in rural Papua New Guinea

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Study Justification:
– Poor access to contraception contributes to high maternal mortality rates in Papua New Guinea (PNG).
– Contraceptive implants have been provided to women in rural areas of PNG since 2012 through outreach services.
– However, there is a lack of follow-up data on continuation and acceptability of contraceptive implants in these communities.
Highlights:
– The study assessed the acceptability, satisfaction, 12-month continuation rates, and efficacy of contraceptive implants among women in rural PNG.
– Of the 860 women surveyed, 97% still had the device in place after 12 months.
– 92% of women were very happy with the contraceptive implant.
– 76% of women reported no side effects, and irregular bleeding was the most commonly reported side effect.
– Documented failure rates were 0.8%, but pregnancy at the time of insertion could not be excluded in these cases.
Recommendations:
– Contraceptive implants have shown high continuation rates and high levels of satisfaction among rural populations in PNG.
– Implants have the potential to lower maternal morbidity and mortality and address the unmet need for contraception in these communities.
– Further research and monitoring should be conducted to assess long-term continuation rates and address any potential barriers to access and acceptability.
Key Role Players:
– Ministry of Health in PNG
– Local healthcare providers and clinics
– Community health workers
– Non-governmental organizations (NGOs) working in reproductive health
Cost Items for Planning Recommendations:
– Training and capacity building for healthcare providers
– Outreach services and transportation costs
– Contraceptive implant supplies
– Monitoring and evaluation activities
– Community awareness and education campaigns

Background: Poor access to contraception contributes to persistently high maternal mortality rates in Papua New Guinea (PNG). Since 2012 contraceptive implants have been provided to women in rural areas of PNG through outreach services but follow-up data in these communities on continuation and acceptability is lacking. Objective: To gain insight into women’s experience with contraceptive implants by assessing the acceptability, satisfaction, 12 month continuation rates and efficacy of contraceptive implants among women in rural PNG. Material and methods: We undertook a cross-sectional survey of women in two rural provinces who had received a contraceptive implant at least 12 months prior using a structured questionnaire. We sought information on device continuation rates, satisfaction scores, side effects and failure rates. Results: Of the 860 women surveyed, 97% (n = 836) still had the device in situ after 12 months and 92% (n = 793) were very happy with it. Seventy-six percent of women (n = 654) reported no side effects. Irregular bleeding was the most commonly reported side effect (n = 178, 20.6%) but only 7% (n = 13) said the bleeding was bothersome. Documented failure rates were 0.8% although pregnancy at the time of insertion could not be excluded in any of these cases. Conclusion: Twelve month implant follow-up data in this study showed high continuation rates and high levels of satisfaction among a rural population in PNG. Implants have the potential to lower maternal morbidity and mortality and simultaneously address the unmet need for contraception in these communities.

One potential innovation to improve access to maternal health based on the study is the implementation of a mobile contraceptive implant outreach service. This service could involve trained healthcare providers traveling to rural areas in Papua New Guinea to provide contraceptive implants to women who lack access to healthcare facilities. By bringing the service directly to the communities, it can help overcome barriers such as distance and transportation that may prevent women from accessing maternal health services. Additionally, the mobile outreach service could include comprehensive counseling and education on contraceptive methods, addressing any concerns or misconceptions that women may have. This innovation has the potential to increase the uptake of contraceptive implants, reduce maternal mortality rates, and meet the unmet need for contraception in rural communities.
AI Innovations Description
Based on the description provided, the recommendation to improve access to maternal health in rural Papua New Guinea (PNG) is to expand and strengthen the contraceptive implant outreach service. This recommendation is based on the findings of the study, which showed high continuation rates and high levels of satisfaction among women who received contraceptive implants in rural PNG.

Here are the key points to consider for developing this recommendation into an innovation:

1. Scaling up the outreach service: Expand the outreach service to reach more rural areas in PNG. This can be done by increasing the number of trained healthcare providers and establishing mobile clinics or outreach centers in remote communities.

2. Community engagement and awareness: Conduct community-based awareness campaigns to educate women and their families about the benefits of contraceptive implants. This can help dispel myths and misconceptions, increase acceptance, and encourage more women to access the service.

3. Training and capacity building: Provide comprehensive training to healthcare providers on contraceptive implant insertion, removal, and counseling. This will ensure that the service is delivered safely and effectively, and that providers can address any concerns or side effects experienced by women.

4. Integration with maternal health services: Integrate the contraceptive implant outreach service with existing maternal health programs and services. This can include linking women who receive implants to antenatal care, postnatal care, and other essential maternal health services.

5. Monitoring and evaluation: Establish a robust monitoring and evaluation system to track the continuation rates, satisfaction levels, side effects, and overall impact of the contraceptive implant outreach service. This data can help identify areas for improvement and guide future interventions.

By implementing these recommendations, the innovation of expanding and strengthening the contraceptive implant outreach service can significantly improve access to maternal health in rural PNG. It has the potential to reduce maternal mortality and morbidity by providing women with a reliable and long-acting contraceptive option that is well accepted and satisfactory.
AI Innovations Methodology
Based on the provided description, here are two potential recommendations to improve access to maternal health in rural Papua New Guinea:

1. Strengthening Outreach Services: Expand and enhance the existing outreach services that provide contraceptive implants to women in rural areas. This can be done by increasing the number of outreach teams, extending their reach to more remote communities, and ensuring regular visits to provide follow-up care and support.

2. Community Education and Awareness: Implement comprehensive community education programs to raise awareness about the benefits of contraceptive implants and address any misconceptions or concerns. This can include conducting workshops, distributing informational materials, and engaging local leaders and influencers to promote the use of contraceptive implants.

To simulate the impact of these recommendations on improving access to maternal health, the following methodology can be used:

1. Baseline Data Collection: Gather data on the current access to maternal health services, including the availability and utilization of contraceptive implants in rural areas of Papua New Guinea. This can involve surveys, interviews, and analysis of existing health records.

2. Define Metrics: Identify key metrics to measure the impact of the recommendations, such as the number of women reached, the increase in contraceptive implant usage, and changes in maternal health indicators (e.g., maternal mortality rates, unintended pregnancies).

3. Intervention Implementation: Implement the recommended interventions, including strengthening outreach services and community education programs. Monitor and document the implementation process, including any challenges or adaptations made.

4. Data Collection and Analysis: Conduct follow-up data collection after a specified period (e.g., 12 months) to assess the impact of the interventions. This can involve surveys, interviews, and analysis of health records to measure changes in the defined metrics.

5. Comparison and Evaluation: Compare the baseline data with the post-intervention data to evaluate the impact of the recommendations. Analyze the findings to determine the effectiveness of the interventions in improving access to maternal health, contraceptive usage, and maternal health outcomes.

6. Recommendations and Scaling Up: Based on the evaluation results, provide recommendations for further improvements and scaling up of the interventions. This can include refining strategies, allocating resources, and replicating successful approaches in other rural areas of Papua New Guinea.

By following this methodology, stakeholders can gain insights into the effectiveness of the recommendations and make informed decisions to improve access to maternal health in rural Papua New Guinea.

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