Provision of postpartum long-acting reversible contraception: A quality improvement intervention with pre- and postintervention evaluation.

Abstract

Background. Unintended pregnancies remain an important health challenge in South Africa (SA) and worldwide. Improving access to
contraception and long-acting reversible contraception in particular, may reduce the number of unintended pregnancies.
Objective. To determine the impact of a training and supportive mentoring programme on postpartum uptake of long-acting reversible
contraceptive (LARC) methods.
Methods. A quality-of-care improvement intervention with pre- and post-intervention evaluation of LARC uptake was conducted
at a midwife-led, on-site obstetric unit in the Eastern Cape, SA. Midwives were trained in contraceptive counselling and postpartum
etonorgestrel implant insertion. The researcher provided counselling and postpartum intrauterine device (IUD) insertion services.
Results. In the 10 weeks prior to the intervention, neither the IUD nor the implant were provided in the unit. In the 10 weeks after the
intervention, uptake of the IUD was n=27/289 (9.3%) and the implant n=21/289 (7.3%). Use of no contraception or condoms increased
from n=22/273 (8.1%) to n=41/289 (14.2%) (p<0.02). The increase was accounted for by a change in staff in the last 4 weeks of the
intervention period (n=33/105 (31.4%) v. n=8/184 (4.4%) during the first 6 weeks; p<0.00).
Conclusion. Competing responsibilities of maternity staff may limit the contraceptive options offered to postpartum women. A
programme of training and supportive supervision resulted in a substantial increase in levels of LARC uptake. Strategies are needed to
institutionalise comprehensive postpartum contraceptive provision nationally.