Evaluating Antepartum Perspectives on Postpartum Family Planning Related to the Jhpiego ACCESS-FP Program in Albania Pubblico

Abstract

Evaluating Antepartum Perspectives on Postpartum Family Planning Related to the Jhpiego ACCESS-FP Program in Albania

By Anne C Blauvelt

Background: Albania, a small Mediterranean nation, has undergone significant demographic change. Since 1955, Albanian TFR fell from 6.8 to 1.6. This occurred without use of modern methods of family planning (couples instead relying on withdrawal and abortion) and contributed to high rates of unwanted pregnancies. Recently, Jhpiego introduced nationwide provider training, with focused attention on postpartum and postabortion counseling in four cities. Providers in these cities received more detailed training on postpartum family planning, including IUD insertion instruction. Objectives: This study evaluates how antenatal counseling for postpartum family planning may increase uptake by looking at past use, current knowledge, and anticipated postpartum use of different methods. I hypothesized: Women whose Antenatal Care providers have received specialized family planning counseling training have heard of and plan to use more methods of postpartum family planning than women whose ANC providers did not receive this training. Methods: 242 women were surveyed from antenatal care clinics at maternity hospitals and polyclinics. Multivariate logistic models, controlling for age, education, rural/urban status and parity, were used to determine relationships between survey city and knowledge about, past use of, and anticipated use or family planning methods. Results: Evidence shows women in Tirana reported a higher rate of postpartum family planning counseling during ANC visits, 39.4%, than those in Durres, 18.5% (OR = 2.736; p = 0.0058). Additionally, 65.7% of women in Tirana planned to use a modern method of family planning postpartum, compared to only 38.2% of women in Durres (OR = 2.252; p = 0.0080). Furthermore, the methods specifically promoted by Jhpiego showed greater gains from ever use to anticipated use in Tirana than in Durres. Discussion: Although other factors could contribute to a higher anticipated rate of postpartum family planning use in Tirana over Durres, these results may be partly attributed to training providers for antenatal counseling for postpartum family planning, as supported by Jhpiego's work in Albania.

Table of Contents

1. Chapter 1. Introduction - 1

2. Chapter 2. Review of Literature - 3

a. Historical and Cultural Context - 3

i. Setting - 3

ii. Religious and Cultural Context of Family Planning - 5

b. Population and Health in Albania - 9

i. The Albanian Fertility Decline - 9

ii. Family Planning in Albania - 11

iii. Medical Family Planning Training - 16

c. Jhpiego and ACCESS-FP Albania - 20

i. Identifying a Problem - 21

ii. Jhpiego Programming - 22

iii. Previous Program Results - 23

3. Chapter 3. Project Content - 24

a. Study Methods -24

i. Study Design and Setting - 24

ii. Ethics - 26

iii. Subject Identification - 26

iv. Data Management - 27

v. Model Selection - 27

b. Results - 30

i. Respondent Demographics - 30

ii. Family Planning - 32

iii. Program Results - 34

4. Chapter 4. Discussion - 40

5. References - 47

6. Appendices - 49

a. Appendix A - 49

b. Appendix B - 56

c. Appendix C - 57

d. Appendix D - 58

e. Appendix E - 59

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Women's Studies
Parola chiave	Family Planning
Committee Chair / Thesis Advisor	Rochat, Roger, Emory University
Committee Members	Argeseanu, Solveig, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs International Non-governmental organization (e.g., CARE, Inc.)

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