Delivery of home-based postpartum contraception in rural Guatemalan women: a cluster-randomized trial protocol
Margo S Harrison, Saskia Bunge-Montes, Claudia Rivera, Andrea Jimenez-Zambrano, Gretchen Heinrichs, Sharon Scarbro, Elizabeth Juarez-Colunga, Antonio Bolanos, Edwin Asturias, Stephen Berman, Jeanelle Sheeder, Margo S Harrison, Saskia Bunge-Montes, Claudia Rivera, Andrea Jimenez-Zambrano, Gretchen Heinrichs, Sharon Scarbro, Elizabeth Juarez-Colunga, Antonio Bolanos, Edwin Asturias, Stephen Berman, Jeanelle Sheeder
Abstract
Background: Postpartum contraception is important to prevent unintended and closely spaced pregnancies following childbirth.
Methods: This study is a cluster-randomized trial of communities in rural Guatemala where women receive ante- and postnatal care through a community-based nursing program. When nurses visit women for their postpartum visit in the intervention clusters, instead of providing only routine care that includes postpartum contraceptive education and counseling, the nurses will also bring a range of barrier, short-acting, and long-acting contraceptives that will be offered and administered in the home setting, after routine clinical care is provided.
Discussion: A barrier to postpartum contraception is access to medications and devices. Our study removes some access barriers (distance, time, cost) by providing contraception in the home. We also trained community nurses to place implants, which are a type of long-acting reversible contraceptive method that was previously only available in the closest town which is about an hour away by vehicular travel. Therefore, our study examines how home-based delivery of routinely available contraceptives and the less routinely available implant may be associated with increased uptake of postpartum contraception within 3 months of childbirth. The potential implications of this study include that nurses may be able to be trained to safely provide contraceptives, including placing implants, in the home setting, and provision of home-based contraception may be an effective way of delivering an evidence-based intervention for preventing unintended and closely spaced pregnancies in the postpartum period.
Trial registration: Clinicaltrials.gov, NCT04005391. Retrospectively registered on 1 July 2019.
Keywords: Cluster-randomized trial; Community programming; Implant; Long-acting reversible contraceptives; Nursing; Postpartum contraception.
Conflict of interest statement
The authors declare that they have no competing interests.
Figures
References
- World Health Organization. Programming strategies for postpartum family planning. 2013. . Accessed 12 September 2019.
- Pasha O, Goudar SS, Patel A, et al. Postpartum contraceptive use and unmet need for family planning in five low-income countries. Reprod Health. 2015;12(Suppl 2):S11. doi: 10.1186/1742-4755-12-S2-S11.
- Schultz C, Larrea N, Celada M, Heinrichs G. A qualitative assessment of community attitudes and barriers to family planning use in the Trifinio region of southwest Guatemala. Matern Child Health J. 2018;22(4):461–466. doi: 10.1007/s10995-018-2479-0.
- Secura GM, Allsworth JE, Madden T, Mullersman JL, Peipert JF. The Contraceptive CHOICE Project: reducing barriers to long-acting reversible contraception. Am J Obstet Gynecol. 2010;203(2):115. doi: 10.1016/j.ajog.2010.04.017.
- Asturias EJ, Heinrichs G, Domek G, et al. The Center for Human Development in Guatemala. Adv Pedistrics. 2016;63(1):357–387. doi: 10.1016/j.yapd.2016.04.001.
- Curtis KM, Tepper NK, Jatlaoui TC, et al. U.S. medical eligibility criteria for contraceptive use, 2016. MMWR Recomm Rep. 2016;65(3):1–104. doi: 10.15585/mmwr.rr6503a1externalicon.
- REDCap. REDCap. 2019. . Accessed 5 July 2019.
Source: PubMed