Improving the Acceptance Rate of Long Acting Reversible Contraception as a Method of Post-abortion Contraception: A Prospective Quality Improvement Study.

Abstract

Background: Among the 121 million unintended pregnancies annually of which 61% (73.3 millions) ended up in abortion. This huge 61% figure reminds us of the unmet need for family planning which still remains a global health issue. So, comes the utmost need for post-abortion contraception (PAC) which significantly minimizes the risk of repeat unintended pregnancies. Long acting reversible contraception (LARC), requiring administration less than once a month, remains the most recommended contraceptive method by international bodies like the center for disease control and the American College of Obstetricians and Gynecologists. Still it remains underutilized despite its contraceptive and non-contraceptive benefits. This QI project aimed to address the barriers to acceptance of LARC as a PAC in the Indian scenario, thereby introducing appropriate interventions to improve the existing acceptance rate of LARC by at least 50% by baseline.

Materials and methods: This QI was conducted at a tertiary care teaching hospital over a period of 24 months (July 2021 to June 2023) using a point-of-care QI methodology systematically. This QI study was conducted in three phases: a pre-intervention baseline phase (6 months), an intervention phase with three PDSA cycles (12 months: each PDSA cycle of 4 months) and a post-intervention follow-up phase (6 months). The QI study has been done in strict compliance with the SQUIRE guidelines.

Results: Baseline observations showed poor acceptance of LARC as PAC with the average of 14.5% over a period of six months. After the end of first cycle, LARC acceptance rate improved to 40%. At the end of the second PDSA cycle, the rate of acceptance increased to 52.6%. Highest level of acceptance was observed after the third cycle which was about 75%. Although a minimal decrease in the acceptance of LARC was noted in subsequent months (ranging from 57.8 to 69.2%; average 62.9%), a satisfactory increase in the acceptance of LARC as PAC was observed when compared to the baseline data (acceptance of 14.5%).

Conclusion: Improvement in the acceptance of LARC as PAC was the result of proper communication and effective counselling. It was through the collaborative effort of the entire team and meticulous counselling by doctors, nursing staff and counselors that a good acceptance rate could be sustained over time.