Abstract
Objective
To understand the specific ways in which champions lead efforts to obtain and sustain
buy-in for immediate postpartum long-acting reversible contraception (LARC) programs.
Methods
We conducted a qualitative study with 60 semistructured interviews at 3 teaching hospitals
in Texas with physicians, nurses, administrators and other staff who participated
in the implementation of immediate postpartum LARC. Physicians self-identified as
champions and identified other champion physicians and administrators. Two researchers
analyzed and coded interview transcripts for content and themes.
Results
We found that champions draw on institutional knowledge and relationships to build
awareness and support for immediate postpartum LARC implementation. To obtain buy-in,
champions needed to demonstrate financial sustainability, engage key stakeholders
from multiple departments, and obtain nurse buy-in. Champions also created buy-in
by communicating goals for the service that focused on expanding reproductive autonomy,
improving maternal health, and improving access to postpartum contraception. Some
staff, especially nurses, identified reasons for the program that run counter to reproductive
justice principles: reducing birth rates, poverty, and/or unplanned pregnancy among
young women and high-parity women. Respondents at 2 hospitals noted that not all women
had equitable access to immediate postpartum LARC.
Conclusion
Physician and non-physician champions must secure long-term support across multiple
hospital departments to successfully implement an immediate postpartum LARC program.
For programs to equitably serve all women in need of postpartum contraceptive care,
champions and other program leaders need to implement strategies to address access
issues. They should also explicitly focus on reproductive justice principles during
program introduction and training.
Implications
Successfully implementing immediate postpartum long-acting reversible contraception
programs requires champions with institutional networking connections, administrative
and nursing support, and clearly communicated goals. Champions need to address access
issues and focus on reproductive justice principles during program introduction and
training to equitably serve all women in need of postpartum contraceptive care.
Keywords
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Article info
Publication history
Published online: November 04, 2021
Accepted:
October 11,
2021
Received in revised form:
October 8,
2021
Received:
March 9,
2021
Footnotes
Declaration of Competing Interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Funding: This project was supported by a grant from the Susan Thompson Buffett Foundation (5123), and a center grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (P2C HD042849) awarded to the Population Research Center at The University of Texas at Austin. The funders played no role in the design and conduct of the study; interpretation of the data; or preparation, review, or approval of this manuscript for publication.
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