Banerjee SK, Andersen K, Pearson E, Warvadekar J, Khan DU, Batra S.
Evaluating the relative effectiveness of high-intensity and low-intensity models of behaviour change communication interventions for abortion care-seeking in Bihar and Jharkhand, India: a cross-sectional study. British Medical Journal. 2017;7 (2).
Publisher's VersionAbstract
Background
This study aimed to compare the effectiveness of a high-intensity model (HIM) and a low-intensity model (LIM) of behaviour change communication interventions in Bihar and Jharkhand states of India designed to improve women's knowledge and usage of safe abortion services, as well as the dose effect of intervention exposure.
Methods
We conducted two cross-sectional household surveys among married women aged 15–49 years in intervention and comparison districts. Difference-in-difference models were used to assess the efficacy of the intervention, adjusting for sociodemographic characteristics.
Results
Although both intervention types improved abortion knowledge, the HIM intervention was more effective in improving comprehensive knowledge about abortion. In particular, there were improvements in knowledge on legality of abortion (AOR=2.2; 95% CI 1.6 to 2.9) and nearby sources of safe abortion care (AOR=1.7; 95% CI 1.2 to 1.3).
Conclusions
Higher level of exposure to abortion-related messages was related to more accurate knowledge about abortion within both intervention groups. Evidence was mixed on changes in abortion care-seeking behaviour. More work is needed to ensure that women seek safe abortion services in lieu of informal services that may be more likely to lead to postabortion complications.
Keywords: abortion, behaviour change, India, knowledge, post abortion
Biswas KK, Pearson E, Shahidullah SH, Sultana S, Chowdhury R, Andersen KL.
Integrating postabortion care, menstrual regulation and family planning services in Bangladesh: a pre-post evaluation. Reproductive Health. 2017;14 (37).
Publisher's VersionAbstract
Background
In Bangladesh, abortion is restricted except to save the life of a woman, but menstrual regulation is allowed to induce menstruation and return to non-pregnancy after a missed period. MR services are typically provided through the Directorate General of Family Planning, while postabortion care services for incomplete abortion are provided by facilities under the Directorate General of Health Services. The bifurcated health system results in reduced quality of care, particularly for postabortion care patients whose procedures are often performed using sub-optimal uterine evacuation technology and typically do not receive postabortion contraceptive services. This study evaluated the success of a pilot project that aimed to integrate menstrual regulation, postabortion care and family planning services across six Directorate General of Health Services and Directorate General of Family Planning facilities by training providers on woman-centered abortion care and adding family planning services at sites offering postabortion care.
Methods
A pre-post evaluation was conducted in the six large intervention facilities. Structured client exit interviews were administered to all uterine evacuation clients presenting in the 2-week data collection period for each facility at baseline (n = 105; December 2011–January 2012) and endline (n = 107; February–March 2013). Primary outcomes included service integration indicators such as provision of menstrual regulation, postabortion care and family planning services in both facility types, and quality of care indicators such as provision of pain management, provider communication and women’s satisfaction with the services received. Outcomes were compared between baseline and endline for Directorate General of Family Planning and Directorate General of Health Services facilities, and chi-square tests and t-tests were used to test for differences between baseline and endline.
Results
At the end of the project there was an increase in menstrual regulation service provision in Directorate General of Health Services facilities, from none at baseline to 44.1% of uterine evacuation services at endline (p < 0.001). The proportion of women accepting a postabortion contraceptive method increased from 14.3% at baseline to 69.2% at endline in Directorate General of Health Services facilities (p = 0.006). Provider communication and women’s rating of the care they received increased significantly in both Directorate General of Health Services and Directorate General of Family Planning facilities.
Conclusions
Integration of menstrual regulation, postabortion care and family planning services is feasible in Bangladesh over a relatively short period of time. The intervention’s focus on woman-centered abortion care also improved quality of care. This model can be scaled up through the public health system to ensure women’s access to safe uterine evacuation services across all facility types in Bangladesh.
Keywords
Menstrual regulation Postabortion care Family planning Service integration Bangladesh health system
Reiss K, Andersen K, Barnard S, Ngo TD, Biswas K, Smith C, Carpenter J, Church K, Nuremowla S, Pearson E.
Using automated voice messages linked to telephone counselling to increase post-menstrual regulation contraceptive uptake and continuation in Bangladesh: study protocol for a randomised controlled trial. International Journal of Gynecology & Obstetrics. 2017;17 (769).
Publisher's VersionAbstract
Background
Adoption of modern contraceptive methods after menstrual regulation (MR) is thought to reduce subsequent unwanted pregnancy and abortion. Long-acting reversible contraceptives (LARCs) are highly effective at reducing unintended pregnancy, but uptake in Bangladesh is low. Providing information on the most effective methods of contraception increases uptake of more effective methods. This protocol describes a randomised controlled trial of an intervention delivered by mobile phone designed to support post-MR contraceptive use in Bangladesh.
Methods
This is a multi-site single blind individual randomised controlled trial. At least 960 women undergoing MR procedures at selected facilities will be recruited after their procedure by female research assistants. Women will be randomised into the control or intervention group with a 1:1 ratio.
All participants will receive usual clinic care, including contraceptive counselling and the telephone number of a non-toll-free call centre which provides counselling on MR and contraception. During the 4 months after their MR procedure, intervention participants will be sent 11 recorded interactive voice messages to their mobile phone about contraception with a focus on their chosen method and LARCs. Each message allows the participant to connect directly to the call centre. The intervention is free to the user. The control group will receive no messages delivered by mobile phone. All participants will be asked to complete an in-person questionnaire at recruitment and follow-up questionnaires by telephone at 2 weeks, 4 months and 12 months after their MR. The primary outcome for the trial will be self-reported LARC use 4 months post-MR. Secondary outcomes include LARC use at 2 weeks and 12 months post-MR, use of any effective modern contraceptive method at 2 weeks, 4 months and 12 months post-MR, and contraceptive discontinuation, contraceptive method switching, pregnancy, subsequent MR and experience of violence during the 12 month study period.
Discussion
Mobile phones offer a low-cost mechanism for providing individualised support to women with contraception outside of the clinic setting. This study will provide information on the effects of such an intervention among MR clients in Bangladesh.
Trial registration
Trial registered with clinicaltrials.gov Registration number: NCT02579785 Date of registration: 16th October 2015.
Keywords
mHealth Mobile phone Post-menstrual regulation Abortion Contraception Family planning Bangladesh Randomised controlled trial Protocol
Karra M, Subramanian SV, Fink G.
Height in healthy children in low- and middle-income countries: an assessment. The American Journal of Clinical Nutrition. 2017;105 (1).
Publisher's VersionAbstract
BACKGROUND:
Despite rapid economic development and reductions in child mortality worldwide, continued high rates of early childhood stunting have put the global applicability of international child-height standards into question.
OBJECTIVES:
We used population-based survey data to identify children growing up in healthy environments in low- and middle-income countries and compared the height distribution of these children to the height distribution of the reference sample established by the WHO.
DESIGN:
Height data were extracted from 169 Demographic and Health Surveys (DHSs) that were collected across 63 countries between 1990 and 2014. Children were classified as having grown up in ideal environments if they 1) had access to safe water and sanitation; 2) lived in households with finished floors, a television, and a car; 3) were born to highly educated mothers; 4) were single births; and 5) were delivered in hospitals. We compared the heights of children in ideal environments with those in the WHO reference sample.
RESULTS:
A total of 878,249 height records were extracted, and 1006 children (0.1%) were classified as having been raised in an ideal home environment. The mean height-for-age z score (HAZ) in this sample was not statistically different from zero (95% CI: -0.039, 0.125). The HAZ SD for the sample was estimated to be 1.3, and 5.3% of children in the sample were classified as being stunted (HAZ <-2). Similar means, SDs, and stunting rates were found when less restrictive definitions of ideal environments were used.
CONCLUSION:
The large current gaps in children's heights relative to those of the reference sample likely are not due to innate or genetic differences between children but, rather, reflect children's continued exposure to poverty, a lack of maternal education, and a lack of access to safe water and sanitation across populations.
Karra M, Canning D, Shah IH, Foster S, Senanayake H, Rathnasiri UDP, Pathiraja RP.
Location and content of counselling and acceptance of postpartum IUD in Sri Lanka. Reproductive Health. 2017;14 (42).
Publisher's VersionAbstract
BACKGROUND:
The immediate postpartum IUD (PPIUD) is a long-acting, reversible method of contraception that can be used safely and effectively following a birth. To appropriately facilitate the immediate postpartum insertion of IUDs, women must be informed of the method's availability and must be counselled on its benefits and risks prior to entering the delivery room. We examine the relationship between the location and quality of antenatal counselling and women's acceptance of immediate postpartum IUD (PPIUD) in four hospitals in Sri Lanka.
METHODS:
Data were collected between January 2015 and May 2015. Modified Poisson regressions with robust standard errors are used to assess the relationships between place of counselling, indicators of counselling quality, and PPIUD uptake following delivery.
RESULTS:
We find that women who were counselled in hospital antenatal clinics and admission wards were much more likely to have a PPIUD inserted than women who were counselled in field clinics or during home visits. Hospital-based counselling had higher quality indicators for providing information on PPIUD, and women were more likely to receive PPIUD information leaflets in hospital locations than in lower-tiered clinics or during home visits. Women who were counselled at hospital locations also reported a higher level of satisfaction with the counselling that they received. Receipt of hospital-based counselling was also linked to higher PPIUD uptake, in spite of the fact that women were more likely to be given information about the risks and alternatives to PPIUD in hospitals. The information about the risks of and alternatives to PPIUD, whether provided in hospital or in non-hospital settings, tended to lower the likelihood of acceptance to have a PPIUD insertion. Counselling in hospital admission wards was focused on women who had not been counselled at field clinics.
CONCLUSIONS:
The study findings call for efforts that improve the training of midwives who provide PPIUD counselling at field clinics and during the home visits. We also recommend that routine PPIUD counselling be conducted in hospitals, even if women have already been counselled elsewhere.
KEYWORDS:
Counselling; Postpartum IUD (PPIUD); Postpartum family planning; Quality of care; SRI Lanka