Advertisement

A cross-sectional study of factors associated with immediate postpartum uptake of contraceptive implants in Papua New Guinea

      Abstract

      Objectives

      In 2016 the Port Moresby General Hospital in Papua New Guinea introduced a midwife led postpartum contraception service to educate patients and provide contraceptive implants. This study examines the factors that were associated with immediate postpartum uptake of the implants.

      Study Design

      We conducted a cross-sectional study of patients on the hospital postnatal ward who gave birth between March 2017 and January 2018. Patients aged 16–45 who had a vaginal birth with a singleton, live baby not requiring admission to the special care nursery were eligible for inclusion and invited to complete a survey prior to discharge.

      Results

      Of 2082 patients approached, all consented to participate in the survey. Of those completing the survey, 531 (25.5%) chose to have the contraceptive implant provided immediately postpartum. Excluding patients who chose tubal ligation (n = 330), in multivariable analysis, higher odds of implant uptake was associated with no prior contraception use compared to prior use (aOR 1.38; 95% CI 1.07 –1.77), unplanned pregnancy compared to planned (aOR 1.37, 95% CI 1.07–1.79), and having received antenatal education about the implant compared to no information (AOR 1.65, 95% CI 1.23–2.10).

      Conclusions

      Antenatal education about the contraceptive implant impacted on likelihood of immediate postpartum method uptake. Patients who had no prior use of contraception and those with unplanned pregnancies were also more likely to request the implants, suggesting that the midwife-led postpartum service is successfully reaching patients with a previous unmet need for contraception.

      Implications

      This study demonstrates successful delivery of a postpartum implant program in a setting where community access to contraception is limited. Antenatal information and education can support implant uptake and that the program provides the opportunity for birth spacing and limiting in patients with a previous unmet need.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Contraception
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Canning D
        • Schultz TP.
        The economic consequences of reproductive health and family planning.
        Lancet. 2012; 380: 165-167https://doi.org/10.1016/S0140-6736(12)60827-7
        • Chandra-Mouli V
        • McCarraher DR
        • Phillips SJ
        • Williamson NE
        • Hainsworth G.
        Contraception for adolescents in low and middle income countries: needs, barriers, and access.
        Reprod Health. 2014; 11 (1-1)https://doi.org/10.1186/1742-4755-11-1
        • Cleland J
        • Conde-Agudelo A
        • Peterson H
        • Ross J
        • Tsiu A.
        Contraception and health.
        Lancet. 2012; 380: 149-156https://doi.org/10.1016/S0140-6736(12)60609-6
      1. High Impact Practices in Family Planning (HIPs). Immediate Postpartum Family Planning: A Key Component of Childbirth Care. USAID; 2017. Accessible at: https://www.fphighimpactpractices.org/briefs/immediate-postpartum-family-planning/21/01/2022 (accessed June 30 2022).

        • Cleland J
        • Bernstein S
        • Ezeh A
        • Faundes A
        • Glasier A
        • Innis J.
        Family planning: the unfinished agenda.
        Lancet. 2006; 368: 1810-1827https://doi.org/10.1016/S0140-6736(06)69480-4
        • Pasha O
        • Goudar SS
        • Patel A
        • Garces A
        • Esamai F
        • Chomba E
        • et al.
        Postpartum contraceptive use and unmet need for family planning in five low-income countries.
        Reprod Health. 2015; (12 Suppl 2Suppl 2S11)https://doi.org/10.1186/1742-4755-12-s2-s11
      2. WHO. Program strategies for postpartum family planning. Geneva World Health Organization 2013. Available at Programming strategies for postpartum family planning (who.int) (accessed 30 June 2022).

        • Harrison MS
        • Goldenberg RL.
        Immediate postpartum use of long-acting reversible contraceptives in low- and middle-income countries.
        Matern Health Neonatol Perinatol. 2017; 3: 24https://doi.org/10.1186/s40748-017-0063-z
      3. World Population Review. Papua New Guinea Population 2022 (Live) Walnut, California: World Population Review; 2022. Available from: https://worldpopulationreview.com/countries/papua-new-guinea-population. (accessed 30 June 2022)

      4. National Statistics Office. Papua New Guinea demographic and health survey 2016–18: key indicators report. Port Moresby National Statistics Office, 2019.

      5. Mola G, Kirby B. Discrepancies between national maternal mortality data and international estimates: the experience of Papua New Guinea. Reprod Health Matters 2013;21(42):191-202. https://doi.org/10.1016/s0968-8080(13)42725-8

        • Pham BN
        • Whittaker M
        • Okely AD
        • Pomat W.
        Measuring unmet need for contraception among women in rural areas of Papua New Guinea.
        Sex Reprod Health Matters. 2020; 281848004https://doi.org/10.1080/26410397.2020.1848004
      6. National Statistical Office (NSO) Papua New Guinea and ICF. Papua New Guinea Demographic and Health Survey 2016-2018. Port Moresby, Papua New Guinea, and Rockville, Maryland, USA: NSO and ICF, 2019.

        • Gupta S
        • Bernays S
        • Black KI
        • Ramsay P
        • Bolnga J
        • Kelly-Hanku A.
        Community attitudes and gendered influences on decision making around contraceptive implant use in rural Papua New Guinea.
        Reprod Health. 2020; 17: 136https://doi.org/10.1186/s12978-020-00985-w
        • Shaamash AH
        • Sayed GH
        • Hussien MM
        • Shaaban M.
        A comparative study of the levonorgestrel-releasing intrauterine system Mirena vs the Copper T380A intrauterine device during lactation: breast-feeding performance, infant growth and infant development.
        Contraception. 2005; 72 (Epub 2005 Jul 6): 346-351https://doi.org/10.1016/j.contraception.2005.04.004
        • Gurtcheff SE
        • Turok DK
        • Stoddard G
        • Murphy PA
        • Gibsob M
        • Jones KP.
        Lactogenesis after early postpartum use of the contraceptive implant.
        Obstet Gynecol. 2011; 117: 1114-1121
        • Reinprayoon D
        • Taneepanichskul S
        • Bunyavejchevin S
        • Thaithumyanon P
        • Punnahitananda S
        • Tosukhowong P
        • et al.
        Implanon on parameters of breastfeeding compared to those of an intrauterine device.
        Contraception. 2000; 62: 239-246https://doi.org/10.1016/s0010-7824(00)00173-6
      7. Taneepanichskul S, Reinprayoon D, Thaithumyanon P, Praisuwanna P, Tosukhowong P, Diebenet T. Effects of the etonogestrel-releasing implant Implanon and a nonmedicated intrauterine device on the growth of breast-fed infants. Contraception 2006;73(4):368-71. https://doi:10.1016/j.contraception.2005.10.010. Epub 2005 Dec 27.

      8. Blumenthal PD, Goldthwaite LM. Intrauterine Device Insertion During Cesarean Delivery: The Rising Tide of the Postdelivery Intrauterine Device. Obstetrics & Gynecology 2015;126(1):1-2. https://doi.org/10.1097/AOG.0000000000000944.

      9. Mola G. Implant insertions 2016-2022 Port Moresby General Hospital. Personal Communication. June 2022.

      10. Trading Economic. Papua New Guinea- Literacy Rate, Adult Female (% Of Females Ages 15 And Above). Avaliable from https://tradingeconomics.com/papua-new-guinea/literacy-rate-adult-female-percent-of-females-ages-15-and-above-wb-data.html (accessed June 30 2022).

      11. Excellent Family Planning Progress in Nigeria Reported by PMA2020.
        Glob Health Sci Pract. 2017; 5: 28-32https://doi.org/10.9745/ghsp-d-17-00094
        • Langlois ÉV
        • Miszkurka M
        • Zunzunegui MV
        • Ghaffar A
        • Ziegler D
        • Karp I.
        Inequities in postnatal care in low- and middle-income countries: a systematic review and meta-analysis.
        Bull World Health Organ. 2015; 93 (259-70G)https://doi.org/10.2471/BLT.14.140996
        • Mbizvo MT
        • Phillips SJ.
        Family planning: choices and challenges for developing countries.
        Best Pract Res Clin Obstet Gynaecol. 2014; 28: 931-943https://doi.org/10.1016/j.bpobgyn.2014.04.014
      12. Austad KE, Shah P, Shryer H, Chary A, Rohloff P. Use of progesterone implants in low-resource settings: preliminary outcomes of a longitudinal cohort of progesterone implant users in rural Guatemala. Contraception 2017;96(4):294. https://doi:10.1016/j.contraception.2017.07.118

      13. Tran NT, Seuc A, Tshikaya B, Mutuale M, Landoulsi S, Kini B, et al. Effectiveness of post-partum family planning interventions on contraceptive use and method mix at 1 year after childbirth in Kinshasa, DR Congo (Yam Daabo): a single-blind, cluster-randomised controlled trial. Lancet Glob Health 2020;8(3):e399-e410. https://doi.org/10.1016/S2214-109X(19)30546-7

      14. Tran NT, Seuc A, Coulibaly A, Landoulsi S, Millogo T , Sissoko F et al. Post-partum family planning in Burkina Faso (Yam Daabo): a two group, multi-intervention, single-blinded, cluster-randomised controlled trial. The Lancet Global Health 2019;7(8):e1109-e17.https://doi

        • Cavallaro FL
        • Benova L
        • Owolabi OO
        • Ali M.
        A systematic review of the effectiveness of counselling strategies for modern contraceptive methods: what works and what doesn’t?.
        BMJ Sex Reprod Health. 2020; 46: 254-269https://doi.org/10.1136/bmjsrh-2019-200377
        • Moray KV
        • Chaurasia H
        • Sachin O
        • Joshi B.
        A systematic review on clinical effectiveness, side-effect profile and meta-analysis on continuation rate of etonogestrel contraceptive implant.
        Reprod Health. 2021; 18: 4https://doi.org/10.1186/s12978-020-01054-y
        • Gupta S
        • Mola G
        • Ramsay P
        • Jenkins G
        • Stein W
        • Bolnga J
        • et al.
        Twelve month follow-up of a contraceptive implant outreach service in rural Papua New Guinea.
        Aust N Z J Obstet Gynaecol. 2017; 57: 213-218https://doi.org/10.1111/ajo.12596
        • Gupta S
        • Ramsay P
        • Mola G
        • McGeechan K
        • Bolnga J
        • Kelly-Hanku A
        • et al.
        Impact of the contraceptive implant on maternal and neonatal morbidity and mortality in rural Papua New Guinea: a retrospective observational cohort study.
        Contraception. 2019; 100: 42-47https://doi.org/10.1016/j.contraception.2019.03.042