Aim The aim of this systematic review was to synthesise the evidence on the comparative effectiveness of different counselling strategies for modern contraception on contraceptive behaviour and satisfaction, and to examine their advantages and disadvantages. Methods Six electronic databases (Medline, Embase, Global Health, Popline, CINAHL Plus, and Cochrane Library) were searched to identify publications comparing two or more contraceptive counselling strategies and reporting quantitative results on contraceptive use, uptake, continuation or switching, or client satisfaction. Studies of women or couples from any country, published in English since 1990 were considered. Results A total of 63 publications corresponding to 61 studies met the inclusion criteria. There was substantial heterogeneity in study settings, interventions and outcome measures. Interventions targeting women initiating a method (including structured counselling on side effects) tended to show positive effects on contraceptive continuation. In contrast, the majority of studies of provider training and decision-making tools for method choice did not find evidence of an effect. Additional antenatal or postpartum counselling sessions were associated with increased postpartum contraceptive use, regardless of their timing in pregnancy or postpartum. Dedicated pre-abortion contraceptive counselling was associated with increased use only when accompanied by broader contraceptive method provision. Male partner or couples counselling was effective at increasing contraceptive use in two of five studies targeting non-users, women initiating implants or seeking abortion. High-quality evidence is lacking for the majority of intervention types. Conclusions The evidence base and quality of studies are limited, and further research is needed to determine the effectiveness of many counselling interventions in different settings.

https://srh.bmj.com/content/familyplanning/46/4/254.full.pdf

A systematic review of the effectiveness of counselling strategies for modern contraceptive methods: what works and what doesn't?

Postpartum IUD insertion programs are new to Africa and few have been carefully evaluated. Also, data on the clinical outcomes of postpartum IUD insertions using the Copper T 380A IUD are sparse. Therefore, we conducted a study to evaluate introductory postpartum IUD programs using the Copper T 380A IUD in Kenya and Mali. Postpartum IUD acceptors in Kenya (n=224) and Mali (n=110) were interviewed at baseline and at 1, 3, and 6 months after delivery. We compared expulsion, medical removal, and discontinuation rates by insertion characteristics in each country. Six-month cumulative expulsion rates were lower for immediate insertions (those within 10 minutes of placental delivery) than for late insertions (generally between 10 minutes and 72 hours after placental delivery) in both Kenya (0.01 vs 0.05) and Mali (0.15 vs 0.27). Medical removals occurred in 1% and 7% of Kenyan and Malian acceptors, respectively, while pelvic infections were rare in both countries (≤2%). Differences in 6-month cumulative discontinuation rates between immediate and late insertions were not significant in either Kenya (0.05 vs 0.07) or in Mali (0.24 vs 0.32). This study suggests that postpartum IUD insertions can be performed safely with acceptable expulsion rates in African settings. Previous studies of other IUDs showed that expulsion rates are lower for immediate insertions compared with late postpartum insertions. This study suggests that these findings can be extended to the Copper T 380A IUD.

Clinical Outcomes of Two Early Postpartum IUD Insertion Programs in Africa.

Abstract Most vaginally inserted methods have limited availability and use despite offering characteristics that align with many women's stated preferences (e.g., nonhormonal and/or on demand). The objective of this review was to identify enablers and barriers to women's adoption and continuation of vaginally inserted contraceptive methods in low‐ and middle‐income countries (LMICs). We searched three databases (PubMed, Embase, and Web of Science) and 18 websites using keywords related to five vaginally inserted contraceptive methods (diaphragm, vaginal ring, female condom, copper intrauterine device [IUD], hormonal IUD) and terms associated with their adoption and continuation. Searches were limited to resources published between January 2010 and September 2020. Studies eligible for inclusion in our review presented results on women's use and perspectives on the enablers and barriers to adoption and continuation of the vaginally inserted contraceptive methods of interest in LMICs. Relevant studies among women's partners were also included, but not those of providers or other stakeholders. Data were coded, analyzed, and disaggregated according to a framework grounded in family planning (FP) literature and behavioral theories common to FP research and program implementation. Our initial search yielded 13,848 results, with 182 studies ultimately included in the analysis. Across methods, we found common enablers for method adoption, including quality contraceptive counseling as well as alignment between a woman's preferences and a method's duration of use and side effect profile. Common barriers included a lack of familiarity with the methods and product cost. Notably, vaginal insertion was not a major barrier to adoption in the literature reviewed. Vaginally inserted methods of contraception have the potential to fill a gap in method offerings and expand choice. Programmatic actions should address key barriers and enable voluntary use.

Barriers and Enablers Influencing Women's Adoption and Continuation of Vaginally Inserted Contraceptive Methods: A Literature Review

KEPERCAYAAN TERHADAP EFEKTIVITAS ALAT KONTRASEPSI
DALAM RAHIM (AKDR) BERDASARKAN KONSELING BIDAN
PADA AKSEPTOR KB DI BPM JEANNE SUBIYAH CIMANGGIS -
DEPOK TAHUN 2019
 
 
Desi Rusmiati1, Nur Aini2
Program Studi S1 Kesehatan Masyarakat
Sekolah Tinggi Ilmu Kesehatan Mitra RIA Husada
Email : info@mrh.ac.id
ABSTRAK
Cakupan penggunaan AKDR secara nasional masih sangat rendah dibandingkan dengan penggunaan KB suntik maupun pil. Jawa Barat hanya mencapai 12,7% jauh di bawah cakupan KB suntik. Penelitian ini bertujuan untuk mengetahui kepercayaan terhadap efektivitas AKDR berdasarkan konseling bidan pada aksetor KB di BPM Jeanne Subiyah Depok.. Metode penelitian kuantitatif menunggunakan desain non eksperimen dengan pendekatan cross sectional Populasinya adalah seluruh Akseptor KB dalam kurun waktu lima tahun terakhir.
Sampel sebanyak 88 responden yang dikumpulkan secara purposive sampling. Pengumpulan data menggunakan instrumen berupa kuesioner. Data dianalisis menggunakan uji Chi square. Hasil sebnayak 31,8% responden kurang percaya terhadap efektivitas AKDR. Dan sebanyak 28,4% mengatakan konseling yang diberikan kurang memadai Hasil analisis hubungan diketahui pada kelompok responden yang menyatakan konseling bidan kurang baik ada 56% yang kurang percaya terhadap efektivitas AKDR. Pada kelompok responden yang menyatakan suami kurang perduli ada 45,7% yang kurang percaya terhadap efektivitas AKDR. Variabel konseling bidan memiliki nilai OR 3,5 kesimpulan penelitan tiga dari 10 akseptor KB tidak memiliki kepercayaan yang baik terhadap efektivitas AKDR dalam mencegah kehamilanPeran Bidan dalam memberikan konseling KB memiliki peran yang signifikan dalam membangung kepercayaan akseptor KB terhadap efektivitas AKDR Dukungan suami memiliki peran yang signifikan dalam memperkuat kepercayaan akseptor KB terhadap efektivitas AKDR.
  Kata kunci: IUD, konseling keluarga berencana, kepercayaan, dukungan.

/pdf/kepercayaan-terhadap-efektivitas-alat-kontrasepsi-dalam-23lee33g6l.pdf

Kepercayaan terhadap efektivitas alat kontrasepsi dalam rahim (akdr) berdasarkan konseling bidan pada akseptor kb di bpm jeanne subiyah cimanggis - depok tahun 2019

Background and objective Unplanned pregnancies are very common in the postpartum period, and they often lead to negative outcomes such as abortion, low-birth-weight neonates, early delivery, postpartum bleeding, and fetal mortality. In the first 12 months after delivery, closely spaced and unintentional pregnancies can be prevented with postpartum contraception. The postpartum intrauterine contraceptive device (PPIUCD) is a method of family planning that may be used during the first few weeks after giving birth, and it is highly successful, reliable, affordable, non-hormonal, immediately reversible, long-acting, and does not interfere with lactation. Urban and educated women are largely aware of IUCD and its benefits, but the proportion of these women who use them is still small. In light of this, this study aimed to assess if providing focused antenatal counseling led to a greater postpartum IUCD acceptance rate when compared to routine counseling. Method We conducted a randomized controlled trial in the Department of Obstetrics and Gynaecology of a tertiary care center from January 2021 to December 2022. Based on the inclusion and exclusion criteria, 220 women were enrolled and were classified into two groups. Group A comprised 110 women (the focused counseling group) who received focused postpartum family planning (PPFP) counseling, and Group B consisted of the control group involving 110 women who received routine counseling. Results In both groups, the women who inserted IUCD were mostly gravida 2. Additionally, willingness to use IUCD was shown by 68% of women in the focused counseling group and 58% of women in the routine counseling group, and PPIUCD was accepted by 22% of women in the focused counseling group and 9% of women in the routine counseling group. Post-placental insertion was carried out in 18 (75%) cases in the focused counseling group and seven (70%) cases in the routine counseling group. Extended postpartum insertion (insertion within one year of delivery) was carried out in six (25%) cases in the focused counseling group and three (30%) cases in the routine counseling group. The most common reasons for the refusal were a preference for tubal ligation (TL) and a fear of side effects. When the patients were enquired about their contraceptive use over the past year on telephone conversations after one year of delivery, it was observed that 21.81% inserted PPIUCD, 30% used injectable depot-medroxyprogesterone acetate (DMPA), 13.63% had undergone TL, 11.81% used barrier contraception, while 22.72% did not use any contraception in the focussed counseling group. In the routine counseling group, 16.36% of women inserted PPIUCD, 20% used injectable DMPA, 12.72% underwent TL, 18.18% used barrier contraception, and 32.72% did not use any contraception. Conclusion Although PPIUCD is a long-acting reversible contraceptive that is safe and reliable, only a few women choose it as a method of birth control. This may be due to ignorance, misconceptions, and worries/fears about potential difficulties/adverse effects associated with IUCD insertion. The IUCD stigma mostly results from misconceptions about the fear of complications. Hence, we recommend that proper IUCD counseling be provided during antenatal care visits to dispel misunderstandings and concerns regarding potential complications associated with PPIUCD insertion.

/pdf/the-acceptance-of-postpartum-intrauterine-contraceptive-3515oo2i.pdf

The Acceptance of Postpartum Intrauterine Contraceptive Devices Among Women Who Receive Focused Family Planning Counseling in the Antenatal Period Compared to Those Who Receive Routine Counseling: A Randomized Controlled Trial

OBJECTIVE: To determine the effect of two levels of counselling on the provision of Intrauterine Contraceptive Device (IUCD) at six weeks post-partum of the post-placental intrauterine device. SETTING: Embu Provincial General Hospital Kenya. SUBJECTS: One hundred and thirty seven pregnant women at the gestation of 36 weeks to term who attended Antenatal clinic and were followed until delivery and at six weeks post-partum. DESIGN: A randomised "open-label" clinical trial. RESULTS: One hundred and twenty seven study participants were enrolled and randomised to intensive (64 women) or routine FP counselling (63 women). Seventy eight per cent of women in the intensive FP counselled group and 66% in the routine FP counselled group accepted to have the post-placental IUCD inserted. There was no significant difference in uptake in the two-randomisation arms (p-value 0.232). Complications included expulsion (3.7%) allergic reaction (1.8%) pelvic infection (1.8%) and abdominal pain (1.8%).The post-placental IUCD is a favourable method with continuation rates (91%) client (88%) and reported partner (77%) satisfaction were notably high at six weeks. The most critical barrier to uptake was lack of trained medical personnel to insert the post-placental IUCD which occurred in (60%) clients who had consented. CONCLUSION: The post-placental IUCD is an acceptable method among women irrespective of level of counselling. Intensive counselling did not significantly increase acceptance and uptake rates of post-placental IUCD insertion in comparison to routine counselling.

/pdf/the-effect-of-two-levels-of-counselling-on-acceptance-uptake-2qv71oadmt.pdf

The effect of two levels of counselling on acceptance, uptake and early outcomes of post-placental intra-uterine contraceptive device.

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The effect of two levels of counselling on acceptance, uptake and early outcomes of post-placental intra-uterine contraceptive device.