Effects of a Community-Based Program on Voluntary Modern Contraceptive Uptake Among Young First-Time Parents in Cross River State, Nigeria

Gwendolyn Morgan; Anjala Kanesathasan; Akinsewa Akiode

doi:10.9745/GHSP-D-20-00111

Key Findings

We implemented and evaluated a program to improve child spacing, modern contraceptive use, and related gender outcomes among first-time parents in Cross River State, Nigeria.

Contraceptive awareness, attitudes, and couples’ communication increased significantly from baseline to endline.
After controlling for significant factors related to family planning use, first-time mothers were 3.3 times more likely and male partners 3.7 times more likely to be using a modern contraceptive method at endline. Most first-time mothers and their partners preferred the contraceptive implant, and a smaller percentage chose the injectable.

Key Implications

This experience suggests that local and state governments can adapt and scale up 3 essential program elements:

Ensure the availability of modern contraceptive methods through local health facilities
Use community-based health workers to conduct home visits with first-time parents to provide tailored health information and referrals, as well as build linkages with the formal health sector
Include activities that address gender norms and couple dynamics to foster better alignment, communication, and joint action on reproductive issues

ABSTRACT

Background:

Reproductive health programs for youth have largely overlooked first-time parents (FTPs)—defined as young women younger than 25 years old who are pregnant or already have 1 child, and their partners. To address this gap, we implemented and evaluated a program to improve child spacing, modern contraceptive use, and related gender outcomes among FTPs in Cross River State (CRS), Nigeria. This paper examines the effectiveness of FTP interventions in improving voluntary uptake of contraception.

Methods:

We conducted small group sessions and home visits with FTPs from May to August 2018 in 2 local government areas of CRS. A pretest–posttest study examined the effectiveness of these interventions regarding healthy timing and spacing of pregnancy/family planning knowledge, attitudes, intentions, communication, decision making, and contraceptive use. We performed a bivariate analysis and logistic binomial regression to confirm change over time in the primary study outcome, current use of a modern method of contraception. We also performed analysis of demographic characteristics and secondary outcomes (e.g., birth spacing intentions and couple communication).

Results:

We interviewed 338 participating first-time mothers (FTMs) and 224 participating partners at baseline and endline. Important indicators of contraceptive awareness, attitudes, and couples’ communication increased significantly from baseline to endline. Voluntary current modern contraceptive use increased from 26% to 79% among nonpregnant FTMs (P<.000), and from 44% to 81% among partners (P<.000). After controlling for significant factors related to family planning use, FTMs were 3.3 times more likely (P<.001) and partners 3.7 times more likely (P<.000) to be using a modern contraceptive method at endline.

Conclusion:

Program participation was associated with significant improvements in voluntary uptake of modern contraceptive methods and multiple secondary outcomes. Even within a short timeframe, this intensive, multi-intervention effort achieved significant advancements across healthy timing and spacing of pregnancy and family planning outcomes for this vulnerable youth population.

Received: March 13, 2020.
Accepted: October 6, 2020.
Published: December 23, 2020.

This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit http://creativecommons.org/licenses/by/4.0/. When linking to this article, please use the following permanent link: https://doi.org/10.9745/GHSP-D-20-00111

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