Impact of a post-partum family planning intervention on contraception and fertility in Tanzania: two-year follow-up of a cluster-randomised controlled trial.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-02-01 DOI:10.1080/13625187.2023.2290985

Julia K Rohr, Sarah Huber-Krum, Angelica Rugarabamu, Erin Pearson, Joel M Francis, Muqi Guo, Hellen Siril, Iqbal Shah, David Canning, Nzovu Ulenga, Till W Bärnighausen

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Abstract

Purpose: We evaluate contraceptive use and pregnancy two years following an intervention in Tanzania, which provided antenatal post-partum family planning counselling and post-partum intrauterine device (PPIUD) services following delivery.

Methods: We analyse data from five hospitals in Tanzania using a difference-in-difference cluster randomised design, with randomisation at the hospital level. We use women-level data collected at the index birth and a follow-up survey two years later among 6,410 women. Outcomes (overall modern contraceptive use, contraceptive type, pregnancy) are modelled with an intent-to-treat (ITT) approach using linear regression. We compare with the complier average causal effect (CACE) of the intervention among those counselled.

Results: The intervention increased long-term PPIUD use by 5.8 percentage points (95% CI: 0.7-11.2%) through substitution away from other modern methods. There was no impact on overall modern contraceptive prevalence or pregnancy. Only 29% of women reported receiving PPIUD counselling. When accounting for this in the CACE analysis we saw a larger impact with 25.7% percentage point increase in PPIUD use (95% CI: 22.7-28.6%).

Conclusion: The intervention provided women an additional contraceptive choice, resulting in higher use of PPIUD over two years. Increase in PPIUD use was brought about by shifting methods, not creating new modern contraceptive users.

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坦桑尼亚产后计划生育干预对避孕和生育的影响：分组随机对照试验的两年随访。

目的：我们对坦桑尼亚一项干预措施实施两年后的避孕药具使用和怀孕情况进行了评估，该干预措施提供产前产后计划生育咨询和产后宫内节育器（PPIUD）服务：我们采用差异群组随机设计方法分析了坦桑尼亚五家医院的数据，并在医院层面进行了随机化。我们使用了在指标分娩时收集的妇女层面的数据，并在两年后对 6410 名妇女进行了随访调查。结果（现代避孕药具的总体使用情况、避孕药具类型、怀孕情况）采用线性回归的意向治疗（ITT）方法进行建模。我们将干预效果与接受咨询者的平均因果效应（CACE）进行了比较：结果：通过替代其他现代避孕方法，干预措施将 PPIUD 的长期使用率提高了 5.8 个百分点（95% CI：0.7-11.2%）。对现代避孕方法的总体使用率或怀孕率没有影响。只有 29% 的妇女表示接受过 PPIUD 咨询。当在 CACE 分析中考虑到这一点时，我们发现其影响更大，PPIUD 使用率增加了 25.7 个百分点（95% CI：22.7-28.6%）：干预为妇女提供了额外的避孕选择，从而在两年内提高了 PPIUD 的使用率。宫内节育器使用率的增加是由于避孕方法的改变，而不是新的现代避孕药具使用者的出现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.