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Increasing Family Planning Uptake Among Postpartum Women

This study has been completed.
Sponsor:
Collaborators:
Ghana Health Services
Ministry of Health, Zambia
Information provided by (Responsible Party):
FHI 360
ClinicalTrials.gov Identifier:
NCT00949481
First received: July 28, 2009
Last updated: August 15, 2012
Last verified: August 2012
  Purpose

The rationale for the study stems from the goal of reducing the very high unmet need for family planning among women in their first year postpartum. It is understood that the reason this need is so high in general is because postpartum women do not always "demand" family planning services, and family planning providers do not always "supply" services to postpartum (amenorrheic) women who do "demand" them. To address these supply and demand problems, corresponding supply and demand solutions will be tested.

  1. Demand Generating Strategy—Integrate into Immunization Services Following birth, return to fertility among postpartum women is dependent on many factors. These include time since last birth, breastfeeding intensity, and menstrual status. However, when and how fertility returns is often misunderstood by women. For instance, many women think that they can not get pregnant before their menses return, or that as long as they are breastfeeding they are protected from pregnancy. Educating women about their return to fertility following giving birth, and reminding women about the importance of birth spacing for their health and the health of their children is the focus of the demand-generating strategy.

    To reach postpartum women with these messages a demand generating activity at immunization clinics will be conducted, as immunization services are well attended. Based on the recommended immunization schedules for infants, women will make several visits to these clinics throughout the course of their first year postpartum, which provides an ideal opportunity to "hit" them with family planning messages more than once.

    To aid providers of immunization services in their delivery of family planning messages, a simple job aid was developed. The job aid takes providers through a series of 3 questions that will allow the provider to determine a mother's immediate risk for pregnancy (based on LAM criteria). If a woman is currently at risk for pregnancy, it prompts the provider to give a healthy timing and spacing message and to make a referral to the family planning clinic. If a woman is not currently at risk for pregnancy, the job aid helps the provider instruct the mother about when her risk for pregnancy will change, and therefore when she will need to seek family planning services to achieve proper birth spacing (should this be desirable to the mother).

    Also, in the family planning (FP) clinics that are located in the same facility as the immunization clinic, providers will be given the pregnancy checklist. This job-aid has already been researched (refer to citations). The purpose of providing it is to make sure that when women are referred to FP clinics by immunization providers, FP providers will supply them with a method. As a consequence, it hoped that by the time women are 9-12 months postpartum, there will be an increase in uptake of non-condom family planning methods.

  2. Supply Solution—Diversify Tools Available to Rule-Out Pregnancy The supply strategy focuses on giving providers the tools to give contraceptive methods to women who are amenorrheic. As recommended by the WHO, it is standard practice for FP providers to rule out the possibility of pregnancy before providing many types of methods to their clients. The presence of menses is often used to make this determination. However, return of menses can be delayed for many months in the postpartum period, limiting a provider's ability to supply postpartum women with contraceptive methods. To overcome this challenge, the Pregnancy Checklist was developed. It is a job-aid designed to rule out pregnancy based on client responses to questions concerning her recent sexual and reproductive history. Urine pregnancy testing is another viable option for ruling out pregnancy in non-menstruating FP clients, especially in situations where providers feel they cannot trust women to answer questions honestly. Thus, family planning clinics will be provided with free pregnancy test strips, and the change in same day uptake of FP methods will be measured.

Hypotheses

  1. Providing family planning messages to women attending immunization clinics with their child will cause them to seek family planning services in a greater proportion at 9-12 postpartum.
  2. The availability of free pregnancy testing will increase same day method provision for new and restarting family planning clients.

Condition Intervention
Postpartum Period
Other: Pregnancy Test
Other: Job aid

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Health Services Research
Official Title: Increasing Family Planning Uptake Among Postpartum Women: Testing Supply and Demand Solutions

Resource links provided by NLM:


Further study details as provided by FHI 360:

Primary Outcome Measures:
  • The difference in current use of a modern family method among women attending immunization clinics for a child 9 to 12 months old between arms 2 and 3 of the study. [ Time Frame: 13 months ] [ Designated as safety issue: No ]
  • The difference in immediate uptake of a modern family planning method (excluding condoms) among new and re-starting family planning clients between arms 1 and 3 of the study. [ Time Frame: 6 months ] [ Designated as safety issue: No ]

Enrollment: 14050
Study Start Date: February 2009
Study Completion Date: August 2009
Primary Completion Date: August 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Supply
In each country, this arm will be comprised of women attending family planning clinics within the 5 facilities randomized to this group.
Other: Pregnancy Test
Free pregnancy test strips will be supplied to family planning clinics
Experimental: Demand
In each country, this arm will be comprised of women attending immunization clinics within the 5 facilities randomized to this group.
Other: Job aid

A new job-aid will be given to immunization providers that will guide them in assessing a mother's risk for pregnancy (based on LAM criteria), and guide them in making family planning referrals, including when a woman should start to use a family planning method if she wants to prevent pregnancy. The providers in immunization clinics will be asked to make such an assessment each time a woman has her baby vaccinated.

Additionally, in family planning clinics located in the same facilities as the immunization clinics, family planning providers will be trained to use and provided with the pregnancy checklist (see "links" for more information on the checklist)

No Intervention: Control
In each country, this arm will be comprised of women attending family planning and immunization clinics in 5 facilities randomized to this group.

  Eligibility

Genders Eligible for Study:   Female
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • New and restarting family planning client (women seeking family planning service)
  • Women with children 9-12 months of age attending immunization services

Exclusion Criteria:

  • Attending immunization services with a child other than one's own
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00949481

Locations
Ghana
Central Region, GHANA
Cape Coast and surrounding, Central Region, Ghana
Zambia
Central Province, ZAMBIA
Kabwe; Chimbombo, Central Province, Zambia
Sponsors and Collaborators
FHI 360
Ghana Health Services
Ministry of Health, Zambia
  More Information

Publications:
Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: FHI 360
ClinicalTrials.gov Identifier: NCT00949481     History of Changes
Other Study ID Numbers: 10083
Study First Received: July 28, 2009
Last Updated: August 15, 2012
Health Authority: Ghana: Ghana Health Service Ethical Review Committee
Zambia: ERES Converge

Keywords provided by FHI 360:
postpartum
family planning
job aid
immunization
pregnancy test

ClinicalTrials.gov processed this record on November 27, 2014