Increasing access to postpartum contraception by linking family planning and infant vaccination services

通过将计划生育和婴儿疫苗接种服务联系起来，增加获得产后避孕的机会

• 批准号: 10593498
• 负责人: Sarah Averbach
• 金额: $ 22.54万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-15 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10593498
• 关键词: Address; Agreement; Behavior; Belief; Birth; Caring; Child; Childhood; Clinic; Communities; Contraceptive Agents; Contraceptive Usage; Contraceptive methods; Counseling; Country; Couples; Data; Decision Making; Development; Dose; Effectiveness; Effectiveness of Interventions; Eligibility Determination; Evidence based intervention; Family; Family Planning; Family Planning Center; Family Planning Programs; Frequencies; Gender; Gender Role; Grant; Health; Husband; Hybrids; Immunization Programs; Improve Access; India; Individual; Inequality; Inequity; Infant; Intervention; Interview; Intrauterine Devices; Link; Measures; Methods; Modeling; Nurses; Participant; Patient Self-Report; Perception; Persons; Postpartum Period; Postpartum Women; Pregnancy; Proctor framework; Provider; Public Health; Qualitative Research; Quality of Care; Randomized; Randomized, Controlled Trials; Recommendation; Reporting; Resources; Rural; Schedule; Services; Structure; Surveys; Target Populations; Vaccination; Vaccines; Visit; Woman; Work; acceptability and feasibility; arm; behavior influence; community center; contraceptive effectiveness; design; effectiveness evaluation; effectiveness outcome; expectation; follow-up; gender equity; implementation evaluation; implementation outcomes; improved; infant morbidity/mortality; innovation; male; maternal morbidity; maternal risk; nutrition; outreach; pilot test; pilot trial; postpartum contraception; prevent; programs; reproductive; rural setting; social expectations; standard of care; unintended pregnancy; uptake; young woman

Project Summary/Abstract: Family planning (FP), including provision of contraception, is care that supports individuals to achieve their desired number, timing, and spacing of children. Expanding access to postpartum FP can prevent maternal and infant morbidity and mortality by decreasing unintended pregnancy and short inter-pregnancy intervals. India is the country with the largest number of women with an unmet need for contraception, and rural postpartum women are among those with the highest unmet need. Community-based infant vaccination programs in rural India are an ideal setting to provide postpartum FP care because they are well-attended, and the infant vaccine schedule provides multiple opportunities to offer FP care including outreach and follow-up to postpartum women and couples. Our prior work in the region shows that gender-transformative programs – i.e., those that address restrictive gender norms (social expectations of people’s behavior based on their perceived gender) – are associated with increased contraceptive use and agency in contraceptive decision-making. Our central hypothesis is that linking community-based, gender-transformative FP care with existing public infant vaccination programs will reach more rural postpartum women and couples and improve uptake of postpartum contraception. The objective of this study is to pilot test PIVoT (Postpartum Integration of Vaccines and contraception through gender-Transformative programming), delivered by a nurse as a 30-minute counseling session plus contraception provision if desired (including intrauterine devices) at three infant vaccine visits that occur over an 8-week period in rural India. Our qualitative research from the region demonstrate that this model of care is feasible and acceptable to both our target population and providers. Using a hybrid-effectiveness design, the Proctor Implementation Outcomes Framework, and a mixed-methods approach, including a two-arm cluster randomized controlled trial, this study aims to assess the effect of the PIVoT intervention on: 1. Implementation outcomes -- intervention feasibility, acceptability, appropriateness, uptake, and fidelity and 2. Preliminary effectiveness -- contraceptive use, quality of care, and contraceptive decision-making agency. Villages (N=12) in rural India will be randomized to deliver the PIVoT intervention or the standard of care (referral to public health centers for FP counseling and provision of contraception) to postpartum women at infant vaccination visits. Implementation outcomes will be assessed via surveys from PIVoT participants (N=294), in- depth interviews with a subset of women participants, their husbands, and PIVoT providers (N=40), and PIVoT session observations. Our preliminary effectiveness evaluation will involve baseline and 6-month follow-up surveys with trial participants assessing contraceptive use and agency in contraceptive decision-making and their perceptions of quality of care. This study has the potential to guide implementation of an innovative gender- transformative FP intervention which increases access to contraception for postpartum women with unmet need.

项目摘要/摘要： 计划生育（FP），包括提供避孕药，是支持个人实现自己的 所需的数字，时间和儿童间距。扩大对产后FP的访问可以防止矩阵和 婴儿的发病率和死亡率通过减少意外怀孕和短期怀孕间隔。印度是 这个女性数量最多的国家未满足避孕的需求，而产后则是艰难的妇女 是最高需求的人之一。印度农村地区基于社区的婴儿疫苗计划是 一个理想的环境，是提供产后FP护理的理想环境，因为它们有很多，并且婴儿疫苗时间表 提供多个机会提供FP护理的机会，包括外展和对产后妇女的随访以及 夫妻。我们在该地区的先前工作表明，性别转化计划 - 即 限制性别规范（基于人们认为性别对行为的社会期望） - 是 与避孕决策的避孕药使用和代理机构的增加有关。我们的中心 假设是将基于社区的性别转换FP护理与现有公共婴儿疫苗联系起来 计划将吸引更多粗糙的产后妇女和夫妻，并改善产后违规的吸收。 这项研究的目的是试点测试枢轴（疫苗的产后整合和违反 通过性别转换编程），由护士作为30分钟的咨询会议和 如果需要（包括宫内设备），则在三个婴儿疫苗就诊（包括宫内设备） 印度农村地区为期8周。我们来自该地区的定性研究表明，这种护理模式是 对于我们的目标人群和提供者来说都是可行的。 使用混合效应设计，Proctor实施结果框架和混合方法 方法，包括两臂群集随机对照试验，本研究旨在评估 枢纽干预： 1。实施结果 - 干预可行性，可接受性，适当性，吸收和保真度 2。初步有效性 - 避孕药，护理质量和避孕决策机构。 印度农村地区的村庄（n = 12）将被随机分配以提供枢轴干预或护理标准（推荐 向公共卫生中心进行FP咨询和提供避孕的避孕） 疫苗访问。实施结果将通过枢轴参与者的调查（n = 294）进行评估， 与女性参与者，丈夫和枢轴提供商（n = 40）和Pivot的一部分的深度访谈 会话观察。我们的初步有效性评估将涉及基线和6个月的随访 与审判参与者进行调查，以评估避孕药的避孕决策和代理机构 他们对护理质量的看法。这项研究有可能指导实施创新的性别 变革性的FP干预增加了未满足需要的产后妇女获得避孕的机会。