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Completed

NCT Number: NCT03585361

Utilizing All Health System Contacts to Offer Postpartum Family Planning (PPFP) in Ethiopia

This study is investigating whether use of postpartum family planning (PPFP) increases if messages on PPFP and, if desired, PPFP services are integrated into as many contacts as possible between women/couples and the health system during pregnancy and the first year after birth. Health system contacts may be at health facilities (including antenatal, labor and delivery, postnatal, and child immunization visits) or, with Ethiopia's Health Extension Program, at households or health posts in the community.

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Key information

Conditions

Contraceptive Usage Behavior Contraception Contraception Behavior Postpartum Family Planning Pregnancy Prenatal Care Reproductive Behavior

Sex eligibility

Female

Study type

Interventional

Phase

Not applicable

Primary location

Boru PHCU, Hitosa, Oromiya, Ethiopia

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About this study

This implementation research study used a quasi-experimental, mixed method design with two arms. Two districts in Arsi Zone in Ethiopia's Oromia Region (Hitosa and Lode Hitosa) were selected for the study. In each district, one primary health care unit (PHCU) - a public health center and its satellite health posts - was randomly assigned to the intervention arm and one to the comparison arm.

PPFP counseling, services, and documentation were strengthened through training and supervision at health centers in both intervention and comparison PHCUs, consistent with Government of Ethiopia policies and guidelines. Only the intervention arm received the community-based intervention. The community-based intervention involved training Health Extension Workers (HEWs) who staff health posts, make outreach home visits, and support volunteers under the government's Development Army. HEWs were trained on PPFP with a refresher on implant insertion. The community invention also involved giving tools to HEWs and volunteers to help them track women's PPFP preferences and pregnancy risk.

The study objectives are to:

  • Assess the effect of systematically integrating PPFP messages into contacts with the health system on uptake of PPFP through 12 months postpartum using a 'dose-response' analysis based on the number of contacts
  • Estimate the added effect of the community-based intervention by comparing uptake of PPFP through 12 months postpartum in intervention and comparison sites
  • Explore the acceptability and feasibility of tracking PPFP and reviewing data at health centers and HEWs and volunteers using record keeping and review processes to track women's decision-making and contraceptive use from pregnancy through 12 months postpartum
  • Explore factors influencing women's/couples' adoption of PPFP during the first 12 months postpartum.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Women
  • Pregnant at time of enrollment
  • Willing to give informed consent
  • Provider interviews
  • Providers providing PPFP messages or services in study area
  • Willing to give informed consent

Exclusion criteria

  • Women
  • Not pregnant at time of enrollment
  • Living outside study area
  • Provider interviews
  • Not working in antenatal, labor & delivery, postnatal, or immunization care

Treatment and study plan

Health centers provide PPFP counseling and services

Behavioral

Providers trained on PPFP counseling skills and insertion technique for placing intrauterine devices (IUDs) immediately after birth with a refresher on insertion techniques for IUDs and implants. Training also included how to use tools to document PPFP services and referrals. Follow up supervision ensured skill mastery and retention.

HEWs provide PPFP counseling and services

Behavioral

HEWs trained in PPFP counseling with a refresher on implant insertion skills. Training also included how to use tools to document PPFP services, method choice, and pregnancy risk at every contact during pregnancy and up to 12 months after birth. Follow up supervision ensured skill improvement and retention.

Volunteers (Development Army) promote PPFP

Behavioral

HEWs orient volunteers on promoting PPFP and how to use a pictoral tool to remind women to access ANC, immunization, and PPFP services and to document women's method preferences and pregnancy risk at every contact during pregnancy and up to 12 months after birth.

Health centers conduct data reviews

Behavioral

Health center staff document PPFP counseling, provision, and referrals in registers and use a facility dashboard to display and track aggregate PPFP data.

HEWs and volunteers track PPFP

Behavioral

HEWs and volunteers track PPFP counseling, choice of method, receipt of methods, and pregnancy risk starting in pregnancy through 12 months postpartum. HEWs and volunteers meet and review data.

Primary outcomes

  1. PPFP uptake

    Time frame: 12 months after birth

    Proportion of interviewed postpartum women who used a modern family planning method within 12 months after giving birth

Secondary outcomes

  1. Method choice

    Time frame: 12 months after birth

    Proportion of interviewed postpartum women who chose a method prior to delivery

Sponsors and collaborators

Lead sponsor

Jhpiego

Other

Collaborators

  • Bill and Melinda Gates Foundation
  • United States Agency for International Development (USAID)

Registry information

Official study title

Utilizing All Health System Contacts to Offer Postpartum Family Planning (PPFP) to Pregnant Women and Women Within Twelve Months Postpartum in Ethiopia

Important dates

Study start
2017
Primary completion
2018
Study completion
2018
First posted
Jul 13, 2018
Registry last updated
Jul 18, 2018

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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