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The Impact of Balanced Counseling on Contraceptive Method Choice and Determinants of Long Acting and Reversible Contraceptive Continuation in Nepal

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Abstract

Introduction Long-acting reversible contraceptives (LARCs) reduce rates of unintended pregnancies and repeat abortion. Uptake and continuation rates of LARCs are very low in Nepal, despite free provision from most health facilities. We sought to establish the effectiveness of a new approach to LARC promotion in Nepal. Methods We examined change in contraceptive method mix in Nepal using service data resulting from introduction of a balanced counseling (BC) approach to family planning (FP). All staff located at nine randomly selected FP sites were trained and began applying BC in April and May 2014. Women who accepted LARCs from a participating facility were re-contacted at 1, 3, 6 and 12 months. We estimated the LARC continuation rate and assessed determinants of continuation using descriptive analysis, Kaplan–Meier survival curves and univariate and multivariate Cox proportional hazard analysis. Results A total of 5744 women received BC between April and July 2014. 1580 women (27.5 %) took up LARCs, raising its contribution to contraceptive method mix at [organization] to 40 %, significantly higher than the 15 % recorded in 2013. 913 women were followed-up, and the LARC continuation rate at 12 months was 82 %. Women’s reported satisfaction with LARC [AHR 0.23; 95 % CI 0.14–0.39, p = 0.000] was the single strongest determinant of LARC continuation after adjusting for all background characteristics. Discussion The findings suggest BC is an effective approach for increasing LARC uptake in Nepal. The rate of LARC continuation and its determinants are important inputs to strategies for improved delivery of FP services.

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References

  1. Backman, T., Huhtala, S., Luoto, R., Tuominen, J., Rauramo, I., & Koskenvuo, M. (2002). Advance information improves user satisfaction with the levonorgestrel intrauterine system. Obstetric Gynecology, 99, 608–613.

    Google Scholar 

  2. Barkat, E. K., & Barkat, S. (2012). Unmet contraceptive need and family planning programmatic challenges in South Asia. http://site.icomp.org.my/Clients/icomp/2-barkat.pdf.

  3. Bel, S., Dahal, K., Thomas, D., Jha, C., Suvedi, H. N., & Prasai, S. (2012). Voices from the community: Access to health services a rapid participatory ethnographic evaluation and research (Rapid PEER) study. Kathmandu: Government of Nepal, Ministry of Health and Population.

    Google Scholar 

  4. Bhatta, N. P., Neupane, B. R., & Dhakal, L. (2010). Approaches and interventions to increase voluntary intrauterine contraceptive devices (IUCD) utilization. Contributions to Nepalese Studies, 0376-7574. http://www.thefreelibrary.com/_/print/PrintArticle.aspx?id=260060567.

  5. Blumenthal, P. D., Voedisch, A., & Gemzell-Danielsson, K. (2011). Strategies to prevent unintended pregnancy: Increasing use of long acting reversible contraception. Human Reproduction Update, 17(1), 121–137.

    Article  CAS  PubMed  Google Scholar 

  6. Chakraborty, N. M., Murphy, C., Paudel, M., & Sharma, S. (2015). Knowledge and perceptions of the intrauterine device among family planning providers in Nepal: A cross-sectional analysis by cadre and sector. BMC Health Service Research, 15, 39. doi:10.1186/s12913-015-0701-y.

    Article  Google Scholar 

  7. Department of Health Services. (2012). Annual report 2010/2011. Kathmandu: Government of Nepal, Ministry of Health and Population, DOHS.

    Google Scholar 

  8. Family Health Division (FHD), Ministry of Health and Population (Nepal). (2011). Guidelines to strengthen family planning services at district level, 2011. Kathmandu: Ministry of Health and Population, Department of Health Services.

    Google Scholar 

  9. Ferreira, A. L. C. G., Boa-Viagem, M. M., & Souza, A. I. (2015). Contraceptive continuation, pregnancy and abortion rate two years after post abortion counselling. Open Journal of Obstetrics and Gynecology, 5, 135–141.

    Article  CAS  Google Scholar 

  10. Hubacher, D., Cardenas, C., Harnendez, D., Cortes, M., & Janowitz, B. (1999). The costs and benefits of IUD follow-up visits in the Mexican Social Security Institute. International Family Planning Perspectives, 25(1), 21–26.

    Article  Google Scholar 

  11. Kalmuss, D., Davidson, A. R., Cushman, L. F., Heartwell, S., & Rulin, M. (1996). Determinants of early implant discontinuation among low-income women. Family Planning Perspectives, 28, 256–260.

    Article  CAS  PubMed  Google Scholar 

  12. Kidsley, S., & Bista, B. B. (2003). IUD research: a study to look at the potential for promoting intrauterine device in Nepal. Opportunities and choices. London: University of Southampton.

    Google Scholar 

  13. Krause, C. M., Jones, C. S., Joyce, S., Kuhn, M. E. J., Curtin, K., Murphy, L. P., et al. (2006). The impact of a multidisciplinary integrated approach on improving the health and quality of care for individual dealing with multiple chronic conditions. American Journal of Orthopsychiatry, 76(1), 109–114.

    Article  PubMed  Google Scholar 

  14. Leon, F., Brambila, C., de la Cruz, M., Bratt, J., Gutiérrez, G., Dávila, V., et al. (2005). Effects of IGSS’ job aids-assisted balanced counseling algorithms on quality of care and client outcomes. FRONTIERS, Final Report. Washington, DC: Population Council.

  15. Leon, F., Vernon, F., Martin, A., & Bruce, L. (2008). The balanced counseling strategy: A toolkit for family planning service providers. Washington, DC: Population Council.

    Google Scholar 

  16. Marie Stopes International (MSI). (2015). Helping Marie Stopes International to increase CYPs via more effective and successful insight led marketing. Nepal: Interim qualitative Report.

    Google Scholar 

  17. Mavranezouli, I. (2008). The cost-effectiveness of long-acting reversible contraceptive methods in the UK: Analysis based on a decision-analytic model developed for a National Institute for Health and Clinical Excellence (NICE) clinical practice guideline. Human Reproduction, 23(6), 1338–1345.

    Article  PubMed  Google Scholar 

  18. Ministry of Health (Nepal), New ERA, ORC Macro. (2007). Nepal demographic and health survey 2006. Kathmandu, Nepal and ORC Macro, Calverton, MD: Family Health Division, Ministry of Health, His Majesty’s Government, Kathmandu, Nepal; New ERA.

  19. Ministry of Health (Nepal), New ERA, ORC Macro. (2012). Nepal demographic and health survey 2011. Kathmandu, Nepal and ORC Macro, Calverton, MD: Family Health Division, Ministry of Health, His Majesty’s Government, Kathmandu, Nepal; New ERA.

  20. New Era & Engender Health. (2003). Contraceptive use and discontinuation patterns in Nepal: Norplant, IUCD, Pill, and Injectables. Nepal Family Health Programme. https://www.engenderhealth.org/files/pubs/family-planning/nepal_report_on_contraceptive_use.pdf.

  21. Puri, M., Henderson, J. T., Harper, C. C., Blum, M., & Joshi, D. (2015). Contraceptive discontinuation and pregnancy post abortion in Nepal: A longitudinal cohort study. Contraception, 91, 301–307.

    Article  PubMed  Google Scholar 

  22. Shrestha, D. R., Shrestha, A., & Ghimire, J. (2012). Emerging challenges in family planning programme in Nepal. Journal of Nepal Health Research Council, 10(21), 108–112.

    CAS  PubMed  Google Scholar 

  23. Thapa, S., & Neupane, S. (2013). Risk factors for repeat abortion in Nepal. International Journal of Gynecology Obstetrics, 120(1), 32–36.

    Article  PubMed  Google Scholar 

  24. Thapa, S., Paudel, I. S., Bhattarai, S., Joshi, R., & Thapa, K. (2015). Factors affecting IUCD discontinuation in Nepal: A nested case-control study. Asia Pacific Journal of Public Health, 27(2), 1280–1287.

    Article  Google Scholar 

  25. Winner, B., Peipert, J. F., Zhao, Q., Buckel, C., Madden, T., Allsworth, J., & Secura, G. (2012). Effectiveness of long-acting reversible contraception. New England Journal of Medicine, 366, 1998–2007. doi:10.1056/NEJMoa1110855.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We gratefully acknowledge the contributions of our RAs, who collected socio-demographic information, and call center counselors, who were responsible for phone follow-up. We would like to thank our MSC counsellors, department of operations and medical development team. Many thanks to Katy Footman and Kate Reiss who reviewed draft of this manuscript, and gave valuable advice that strengthened the quality of the manuscript.

Lastly and most importantly, we would like to thank all 1302 women participants who volunteered to participant in the study.

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Authors and Affiliations

  1. Marie Stopes International, 1 Conway Street, Fitzroy Square, London, W1T 6LP, UK

    Sabitri Sapkota

  2. Sunaulo Parivar Nepal, GPO Box 11254, Kathmandu, Nepal

    Ruchita Rajbhandary & Shilpa Lohani

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  1. Sabitri Sapkota
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  2. Ruchita Rajbhandary
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  3. Shilpa Lohani
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Correspondence to Sabitri Sapkota.

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Sapkota, S., Rajbhandary, R. & Lohani, S. The Impact of Balanced Counseling on Contraceptive Method Choice and Determinants of Long Acting and Reversible Contraceptive Continuation in Nepal. Matern Child Health J 21, 1713–1723 (2017). https://doi.org/10.1007/s10995-016-1920-5

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