Journal Article

Delivery of home-based postpartum contraception in rural Guatemalan women: a cluster-randomized trial protocol

Asturias, Edwin, Harrison, Margo S., Bolanos, Antonio, Jimenez-Zambrano, Andrea, Heinrichs, Gretchen, Bunge-Montes, Saskia, Sheeder, Jeanelle, Scarbro, Sharon, Juarez-Colunga, Elizabeth, Berman, Stephen, Rivera, Claudia

2019

Overview

Background Postpartum contraception is important to prevent unintended and closely spaced pregnancies following childbirth. Methods This study is a cluster-randomized trial of communities in rural Guatemala where women receive ante- and postnatal care through a community-based nursing program. When nurses visit women for their postpartum visit in the intervention clusters, instead of providing only routine care that includes postpartum contraceptive education and counseling, the nurses will also bring a range of barrier, short-acting, and long-acting contraceptives that will be offered and administered in the home setting, after routine clinical care is provided. Discussion A barrier to postpartum contraception is access to medications and devices. Our study removes some access barriers (distance, time, cost) by providing contraception in the home. We also trained community nurses to place implants, which are a type of long-acting reversible contraceptive method that was previously only available in the closest town which is about an hour away by vehicular travel. Therefore, our study examines how home-based delivery of routinely available contraceptives and the less routinely available implant may be associated with increased uptake of postpartum contraception within 3 months of childbirth. The potential implications of this study include that nurses may be able to be trained to safely provide contraceptives, including placing implants, in the home setting, and provision of home-based contraception may be an effective way of delivering an evidence-based intervention for preventing unintended and closely spaced pregnancies in the postpartum period. Trial registration Clinicaltrials.gov, NCT04005391 . Retrospectively registered on 1 July 2019.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adolescent / Adult / Biomedicine / Birth control / Cluster-randomized trial / Community Health Services / Community programming / Consent / Contraception / Contraceptives / Counseling / Delivery of Health Care / Family planning / Family Planning Services / Female / Guatemala / Health education / Health Sciences / Home Health Nursing / House Calls / Humans / Implant / Intervention / Long-acting reversible contraceptives / Medicine / Medicine & Public Health / Methods / Nurses / Nursing / Nursing research / Oral contraceptives / Patient care / Postnatal Care / Postpartum contraception / Pregnancy / Qualitative research / Quality improvement / Randomized Controlled Trials as Topic / Reproductive Health / Rural Health Services / Statistics for Life Sciences / Study Protocol / Time Factors / Transplants & implants / Treatment Outcome / Women's Health / Womens health / Young Adult