Promoting long-acting reversible contraception among post-abortion clients with a provider-comparison intervention: a cluster randomized controlled trial in Nepal
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Published:2024-07-16
Issue:1
Volume:24
Page:
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ISSN:1471-2458
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Container-title:BMC Public Health
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language:en
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Short-container-title:BMC Public Health
Author:
Barofsky Jeremy,Spring Hannah,Gartoulla Pragya,Shrestha Raman,Sapkota Sabitri,McElwee Elizabeth,Church Kathryn,Datta Saugato,Livingston Karina
Abstract
Abstract
Background
Although long-acting reversible contraception (LARC) is more effective and longer lasting than short-acting methods, uptake remains low among post-abortion clients. Using a stepped-wedge, cluster-randomized trial, we evaluate the impact of a provider-level peer-comparison intervention to encourage choice of LARC in Nepal among post-abortion clients.
Methods
The intervention used prominently displayed monthly posters comparing the health clinic’s previous month performance on LARC uptake against peer clinics. To understand how the intervention affected behavior, while ensuring voluntarism and informed choice, we used mystery client visits, in-depth provider interviews, and client exit survey data. The trial examined 17,680 post-abortion clients in 36 clinics in Nepal from July 2016 to January 2017. The primary outcome was the proportion of clients receiving LARCs. Statistical analysis used ordinary least squares (OLS) regression with ANCOVA estimation to assess the intervention’s impact on LARC uptake while controlling for client- and clinic-level characteristics.
Results
The intervention increased LARC use among post-abortion clients by 6.6% points [95% CI: 0.85 to 12.3, p-value < 0.05], a 29.5% increase in LARC use compared to control clinics. This effect persisted after the formal experiment ended. Analysis of provider and client experiences showed that the behavioral intervention generated significant change in providers’ counseling practices, motivated the sharing of best practices. Quality of care indicators either remained stable or improved.
Conclusion
We find that a provider-level behavioral intervention increases LARC uptake among post-abortion clients. This type of intervention represents a low-cost option to contribute to reducing unmet need for contraception through provider behavior change.
Funder
William and Flora Hewlett Foundation
Publisher
Springer Science and Business Media LLC
Reference38 articles.
1. Tsui AO, Wasserheit JN, Haaga JG. Reproductive Health in Developing Countries: Expanding Dimensions, Building Solutions [Internet]. National Research Council (US) Panel on Reproductive Health, editor. Washington (DC): National Academies Press (US); 1997 [cited 2020 Mar 18]. http://www.ncbi.nlm.nih.gov/books/NBK233282/.
2. Duflo E. Women empowerment and Economic Development. J Econ Lit. 2012;50(4):1051–79.
3. Sedgh G, Ashford LS, Hussain R. Unmet Need for Contraception in Developing Countries: Examining Women’s Reasons for Not Using a Method. p. 93.
4. WHO/RHR. Preventing Unsafe Abortion [Internet]. Geneva, Switzerland: World Health Organization; 2019 [cited 2020 Jan 5]. (Human Reproduction Program: Research for Impact). Report No.: 19.21. https://apps.who.int/iris/bitstream/handle/10665/329887/WHO-RHR-19.21-eng.pdf?ua=1.
5. Singh A, Singh A, Mahapatra B. The consequences of Unintended Pregnancy for Maternal and Child Health in Rural India: evidence from prospective data. Matern Child Health J. 2013;17(3):493–500.