Knowledge, attitudes, and practices surrounding postpartum IUD and implant services among providers in Kigali, Rwanda Open Access
Ngarukiye, Amedee (Spring 2018)
Abstract
Background: Rwanda, which has the highest population density in continental Africa, has achieved remarkable success in reducing its total fertility rate (TFR) within the past decade from 6.1 children per woman in 2005 to 4.2 children per woman in 2014-2015. Contraceptive prevalence rates (CPR) in Rwanda are some of the highest in sub-Saharan Africa and are beneficial in improving maternal health, ultimately reducing infant mortality. While evidence shows that the IUD is one of the most effective contraceptive methods, more than half of women currently using modern contraceptives are using injectables and use of postpartum contraceptive methods use is low. Patient interaction with providers has been shown to be a major factor in increasing family planning method utilization.
Objective: This study seeks to examine the knowledge, attitudes, and practices among healthcare providers in Kigali, Rwanda surrounding the provision of these services during postpartum periods and to elucidate potential barriers and avenues of demand creation for postpartum long-acting reversible contraception (LARC) promotion.
Methods: Fourteen hospital-providers (nurses (n=2) and midwives (n=12)) across two healthcare facilities in Kigali, Rwanda were surveyed individually to assess their knowledge, attitudes, and practices with promoting and providing two postpartum LARC methods, the copper intrauterine device (IUD) and implant. The final questionnaire contained total of 149 questions concerning attitudes, experiences, and practices providing long-term contraceptive options and took an average of 90 minutes to complete. Questionnaires were administered in-person using Android tablets between May and August of 2017 at the two health centers, Kabusunzu and Nyarugunga. All quantitative variables were analyzed using SAS 9.4 while open-ended questions were analyzed in MaxQDA 12 using deductively developed codes.
Results: There was large variation in response to knowledge questions relating to postpartum IUDs. This variation indicated widespread disagreement among providers about procedures and best practices for postpartum IUD insertion. The most common advantages of postpartum IUDs according to providers were that the method is long-term (64.29%), does not contain hormones (57.14%), and has fewer side effects (35.71%), while advantages of postpartum implants included their ability to delay pregnancy/birth spacing (35.71%), reduce appointment frequency (35.71%), and that the method prevents pregnancy and is long-term (28.57%).
Discussion: The large variation in provider responses to knowledge-based questions suggests a need for additional training, a statement that was echoed by providers themselves. Although provider training and enthusiasm alone will not be sufficient to increase uptake of postpartum IUDs, these findings indicate that the lack of trained providers may be a barrier to patient uptake of these methods. Providing early client counseling and up-to-date, evidence-based resources for provider and client education may be ways to increase postpartum LARC provision across facilities.
Table of Contents
Table of Contents
Chapter 1: Introduction ...................................................................................... 1
Background........................................................................................................... 1
Chapter 2: Review of Existing Literature ............................................................ 3
Chapter 3: Materials and Methods ..................................................................... 11
Setting ............................................................................................................... 11
Population and recruitment ................................................................................... 11
Ethics ................................................................................................................ 12
Data collection .................................................................................................... 12
Measures ........................................................................................................... 12
Data analysis ...................................................................................................... 13
Chapter 4: Results ............................................................................................ 13
Characteristics of survey participants....................................................................... 13
Knowledge of IUDs and implants ............................................................................ 15
Knowledge, attitudes and perceptions of postpartum implants and IUDs ...................... 16
Attitudes and practices surrounding postpartum family planning counseling ................. 22
Knowledge and attitudes of PBF by clinic ................................................................. 25
Chapter 5: Discussion ....................................................................................... 27
Limitations .......................................................................................................... 30
Chapter 6: Implications and Future Recommendations ...................................... 30
References ...................................................................................................... 32
Appendix ........................................................................................................ 35
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