RT Journal Article
SR Electronic
T1 Evaluating the Implementation of an Intervention to Improve Postpartum Contraception in Tanzania: A Qualitative Study of Provider and Client Perspectives
JF Global Health: Science and Practice
JO GLOB HEALTH SCI PRACT
FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs
SP 270
OP 289
DO 10.9745/GHSP-D-19-00365
VO 8
IS 2
A1 Kristy Hackett
A1 Sarah Huber-Krum
A1 Joel M. Francis
A1 Leigh Senderowicz
A1 Erin Pearson
A1 Hellen Siril
A1 Nzovu Ulenga
A1 Iqbal Shah
YR 2020
UL http://www.ghspjournal.org/content/8/2/270.abstract
AB Key FindingsConstraints on staff, time, and supplies and challenges with referrals influenced implementation outcomes and threatened sustainability.Women reported that interpersonal aspects of care varied.Providers reported that additional training opportunities, improved staffing, and increased availability of PPIUD supplies would strengthen future initiatives.Key ImplicationsWe recommend that PPFP program imple-menters consider: Assessing the feasibility of integrating PPFP counseling into existing antenatal care services before program implementationEnsuring that future initiatives emphasize patient-centered PPFP counseling, informed choice, and respectful and nondiscriminatory service deliveryImplementing a stronger interfacility performance and quality improvement system to strengthen coordinationUsing different models of PPFP counseling to help alleviate provider workloadBackground:This qualitative study assessed implementation of the Postpartum Intrauterine Device (PPIUD) Initiative in Tanzania, a country with high rates of unintended pregnancy and low contraceptive prevalence. The PPIUD Initiative was implemented to reduce unmet need for contraception among new mothers through postpartum family planning counseling delivered during antenatal care and offering PPIUD insertion immediately following birth.Methods:We used the implementation outcomes framework and an ecological framework to analyze in-depth interviews with providers (N=15) and women (N=47) participating in the initiative. We applied a multistage coding protocol and used thematic content analysis to identify the factors influencing implementation.Results:Both women and providers were enthusiastic and receptive to the PPIUD Initiative. Health system and resource constraints made adoption and fidelity to the intended intervention challenging. Many providers questioned the sustainability of the initiative, and most agreed that changes to the initiative’s design (e.g., additional training opportunities, improved staffing, and availability of PPIUD supplies) would strengthen future iterations of the initiative. According to women, interpersonal aspects of care varied, with some women reporting rushed or incomplete counseling or an emphasis on the PPIUD over other methods. The perception that some providers treat older married women more favorably suggests that fidelity to the intended PPIUD Initiative was not uniformly achieved.Conclusions:Study findings inform initiatives seeking to develop and adopt postpartum family planning programs and enhance program implementation. A comprehensive needs assessment to evaluate feasibility and identify potential adaptations for the local context is recommended. Training and supervision to improve interpersonal aspects of care, including an emphasis on patient-centered counseling, informed choice, and respectful and nondiscriminatory service delivery should be integrated into future postpartum family planning initiatives.