Pregnancy Clinical Trial
Official title:
Utilizing All Health System Contacts to Offer Postpartum Family Planning (PPFP) to Pregnant Women and Women Within Twelve Months Postpartum 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.
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:
1. 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
2. Estimate the added effect of the community-based intervention by comparing uptake of
PPFP through 12 months postpartum in intervention and comparison sites
3. 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
4. Explore factors influencing women's/couples' adoption of PPFP during the first 12 months
postpartum.
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